Goshen Hospital
Goshen Hospital in Goshen, IN publishes cash prices for 454 common procedures listed here, from its own machine-readable price file updated Aug 14, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Indiana median for 296 of 439 procedures and below it for 138. By typical cash price it ranks #56 of 84 Indiana hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.
200 High Park Ave, , Goshen, IN 46526 Collected Oct 25, 2026 Source price file Check a bill from this hospital (574) 364-1000
Acute care hospital Nonprofit hospital Emergency department CMS star rating 3 of 5 CCN 150026 · CMS hospital register NPI 1740268846
Financial assistance
Nonprofit hospital: it must offer free or discounted care to patients who qualify. How to apply
Goshen 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.
Scans and imaging
| Procedure | Cash price | List price | Insurers pay | vs Indiana | Off list |
|---|---|---|---|---|---|
| Abdominal CT scan without and with contrast CPT 74170 Ct abdomen w/o & w/dye | $1,892.80 | $2,704.00 | $426.48–$1,001.00 | 40% above | 30% |
| Abdominal CT scan without and with contrast CPT 74170 Ct abd w/wo cont | $1,892.80 | $2,704.00 | $426.48–$1,001.00 | 40% above | 30% |
| Abdominal CT scan without and with contrast inpatient CPT 74170 Ct abdomen w/o & w/dye | $1,892.80 | $2,704.00 | $426.48–$1,001.00 | — | 30% |
| Abdominal CT scan without and with contrast inpatient CPT 74170 Ct abd w/wo cont | $1,892.80 | $2,704.00 | $426.48–$1,001.00 | — | 30% |
| Abdominal X-ray, 2 views CPT 74019 X-ray exam abdomen 2 views | $326.20 | $466.00 | $103.79–$347.73 | 21% above | 30% |
| Abdominal X-ray, 2 views CPT 74019 Abd flat & erect | $326.20 | $466.00 | $103.79–$347.73 | 21% above | 30% |
| Abdominal X-ray, 2 views inpatient CPT 74019 X-ray exam abdomen 2 views | $326.20 | $466.00 | $103.79–$347.73 | — | 30% |
| Abdominal X-ray, 2 views inpatient CPT 74019 Abd flat & erect | $326.20 | $466.00 | $103.79–$347.73 | — | 30% |
| Ankle X-ray, complete, 3 or more views CPT 73610 X-ray exam of ankle | $331.80 | $474.00 | $86.39–$287.92 | 69% above | 30% |
| Ankle X-ray, complete, 3 or more views one side CPT 73610 Ankle comp min 3v lt | $221.20 | $316.00 | $77.10–$221.00 | 13% above | 30% |
| Ankle X-ray, complete, 3 or more views one side CPT 73610 Ankle comp min 3v rt | $221.20 | $316.00 | $77.10–$221.00 | 13% above | 30% |
| Ankle X-ray, complete, 3 or more views inpatient CPT 73610 X-ray exam of ankle | $331.80 | $474.00 | $86.39–$287.92 | — | 30% |
| Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 Ankle comp min 3v rt | $221.20 | $316.00 | $77.10–$221.00 | — | 30% |
| Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 Ankle comp min 3v lt | $221.20 | $316.00 | $77.10–$221.00 | — | 30% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 Us nips lea bilat 1-2 lev lmtd | $532.00 | $760.00 | $132.08–$601.92 | — | 30% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 Upr/l xtremity art 2 levels | $532.00 | $760.00 | $132.08–$601.92 | 45% above | 30% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient both sides CPT 93922 Us nips lea bilat 1-2 lev lmtd | $532.00 | $760.00 | $132.08–$601.92 | — | 30% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 Upr/l xtremity art 2 levels | $532.00 | $760.00 | $132.08–$601.92 | — | 30% |
| Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 Ct upper extremity w/o dye | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | 54% above | 30% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 Ct up ext lt w/o cont | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | 54% above | 30% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 Ct up ext rt w/o cont | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | 54% above | 30% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 Ct upper extremity w/o dye | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | — | 30% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 Ct up ext lt w/o cont | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | — | 30% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 Ct up ext rt w/o cont | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | — | 30% |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 X-ray xm esophagus 1cntrst | $399.70 | $571.00 | $174.13–$582.13 | 14% below | 30% |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 Esophagus sngl contrast study | $399.70 | $571.00 | $174.13–$582.13 | 14% below | 30% |
| Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 X-ray xm esophagus 1cntrst | $399.70 | $571.00 | $174.13–$582.13 | — | 30% |
| Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 Esophagus sngl contrast study | $399.70 | $571.00 | $174.13–$582.13 | — | 30% |
| Bone scan, whole body (nuclear medicine) CPT 78306 Nm bone/jnt imaging whole body | $1,653.40 | $2,362.00 | $396.87–$1,870.70 | 5% above | 30% |
| Bone scan, whole body (nuclear medicine) CPT 78306 Bone imaging whole body | $1,653.40 | $2,362.00 | $396.87–$1,870.70 | 5% above | 30% |
| Bone scan, whole body (nuclear medicine) inpatient CPT 78306 Nm bone/jnt imaging whole body | $1,653.40 | $2,362.00 | $396.87–$1,870.70 | — | 30% |
| Bone scan, whole body (nuclear medicine) inpatient CPT 78306 Bone imaging whole body | $1,653.40 | $2,362.00 | $396.87–$1,870.70 | — | 30% |
| Breast ultrasound, limited (one breast or one area) CPT 76642 Ultrasound breast limited | $469.00 | $670.00 | $86.39–$373.00 | 44% above | 30% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 Us breast diagnostic lmt rt | $312.20 | $446.00 | $86.39–$373.00 | 4% below | 30% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 Us breast diagnostic lmt lt | $312.20 | $446.00 | $86.39–$373.00 | 4% below | 30% |
| Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 Ultrasound breast limited | $469.00 | $670.00 | $86.39–$373.00 | — | 30% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 Us breast diagnostic lmt rt | $312.20 | $446.00 | $86.39–$373.00 | — | 30% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 Us breast diagnostic lmt lt | $312.20 | $446.00 | $86.39–$373.00 | — | 30% |
| CT angiography (CTA) of the abdomen and pelvis CPT 74174 Ct angio abd&pelv w/o&w/dye | $1,892.80 | $2,704.00 | $346.34–$1,167.82 | at median | 30% |
| CT angiography (CTA) of the abdomen and pelvis CPT 74174 Ct angio abd/pelvis | $1,892.80 | $2,704.00 | $346.34–$1,167.82 | at median | 30% |
| CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 Ct angio abd/pelvis | $1,892.80 | $2,704.00 | $346.34–$1,167.82 | — | 30% |
| CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 Ct angio abd&pelv w/o&w/dye | $1,892.80 | $2,704.00 | $346.34–$1,167.82 | — | 30% |
| CT angiography (CTA) of the head CPT 70496 Ct angio head | $1,892.80 | $2,704.00 | $426.48–$1,001.00 | 49% above | 30% |
| CT angiography (CTA) of the head CPT 70496 Ct angiography head | $1,892.80 | $2,704.00 | $426.48–$1,001.00 | 49% above | 30% |
| CT angiography (CTA) of the head inpatient CPT 70496 Ct angiography head | $1,892.80 | $2,704.00 | $426.48–$1,001.00 | — | 30% |
| CT angiography (CTA) of the head inpatient CPT 70496 Ct angio head | $1,892.80 | $2,704.00 | $426.48–$1,001.00 | — | 30% |
| CT angiography (CTA) of the neck CPT 70498 Ct angio neck | $1,892.80 | $2,704.00 | $426.48–$1,001.00 | 56% above | 30% |
| CT angiography (CTA) of the neck CPT 70498 Ct angiography neck | $1,892.80 | $2,704.00 | $426.48–$1,001.00 | 56% above | 30% |
| CT angiography (CTA) of the neck inpatient CPT 70498 Ct angio neck | $1,892.80 | $2,704.00 | $426.48–$1,001.00 | — | 30% |
| CT angiography (CTA) of the neck inpatient CPT 70498 Ct angiography neck | $1,892.80 | $2,704.00 | $426.48–$1,001.00 | — | 30% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 Ct angio chest | $1,892.80 | $2,704.00 | $426.48–$1,001.00 | 49% above | 30% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 Ct angiography chest | $1,892.80 | $2,704.00 | $426.48–$1,001.00 | 49% above | 30% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 Ct angio chest | $1,892.80 | $2,704.00 | $426.48–$1,001.00 | — | 30% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 Ct angiography chest | $1,892.80 | $2,704.00 | $426.48–$1,001.00 | — | 30% |
| CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 Ct angio hrt w/3d image | $1,892.80 | $2,704.00 | $346.34–$1,167.82 | 126% above | 30% |
| CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 Ct angio cardiac | $1,892.80 | $2,704.00 | $346.34–$1,167.82 | 126% above | 30% |
| CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 Ct angio cardiac | $1,892.80 | $2,704.00 | $346.34–$1,167.82 | — | 30% |
| CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 Ct angio hrt w/3d image | $1,892.80 | $2,704.00 | $346.34–$1,167.82 | — | 30% |
| CT of the heart without contrast dye to measure coronary calcium CPT 75571 Ct hrt w/o dye w/ca test | $93.75 | $133.93 | $86.39–$1,001.00 | 50% below | 30% |
| CT of the heart without contrast dye to measure coronary calcium CPT 75571 Ct calcium score cardiac | $93.75 | $133.93 | $86.39–$1,001.00 | 50% below | 30% |
| CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 Ct hrt w/o dye w/ca test | $93.75 | $133.93 | $86.39–$1,001.00 | — | 30% |
| CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 Ct calcium score cardiac | $93.75 | $133.93 | $86.39–$1,001.00 | — | 30% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 Ct abd & pelvis w/o contrast | $2,303.00 | $3,290.00 | $219.67–$1,001.00 | 92% above | 30% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 Ct abd/pelvis for renal stone | $2,303.00 | $3,290.00 | $219.67–$1,001.00 | 92% above | 30% |
| CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 Ct abd & pelvis w/o contrast | $2,303.00 | $3,290.00 | $219.67–$1,001.00 | — | 30% |
| CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 Ct abd/pelvis for renal stone | $2,303.00 | $3,290.00 | $219.67–$1,001.00 | — | 30% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 Ct abd & pelv w/contrast | $2,797.20 | $3,996.00 | $426.48–$1,167.82 | 62% above | 30% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 Ct abd/pelvis w cont | $2,797.20 | $3,996.00 | $426.48–$1,167.82 | 62% above | 30% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 Ct abd/pelvis w cont | $2,797.20 | $3,996.00 | $426.48–$1,167.82 | — | 30% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 Ct abd & pelv w/contrast | $2,797.20 | $3,996.00 | $426.48–$1,167.82 | — | 30% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 Ct abd/pelvis w/wo cont | $3,290.00 | $4,700.00 | $426.48–$1,167.82 | 92% above | 30% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 Ct abd & pelv 1/> regns | $3,290.00 | $4,700.00 | $426.48–$1,167.82 | 92% above | 30% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 Ct abd/pelvis w/wo cont | $3,290.00 | $4,700.00 | $426.48–$1,167.82 | — | 30% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 Ct abd & pelv 1/> regns | $3,290.00 | $4,700.00 | $426.48–$1,167.82 | — | 30% |
| CT scan of the abdomen with contrast CPT 74160 Ct abd w cont | $1,565.90 | $2,237.00 | $426.48–$1,001.00 | 47% above | 30% |
| CT scan of the abdomen with contrast CPT 74160 Ct abdomen w/dye | $1,565.90 | $2,237.00 | $426.48–$1,001.00 | 47% above | 30% |
| CT scan of the abdomen with contrast inpatient CPT 74160 Ct abdomen w/dye | $1,565.90 | $2,237.00 | $426.48–$1,001.00 | — | 30% |
| CT scan of the abdomen with contrast inpatient CPT 74160 Ct abd w cont | $1,565.90 | $2,237.00 | $426.48–$1,001.00 | — | 30% |
| CT scan of the abdomen without contrast CPT 74150 Ct abdomen w/o dye | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | 47% above | 30% |
| CT scan of the abdomen without contrast CPT 74150 Ct abd w/o cont | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | 47% above | 30% |
| CT scan of the abdomen without contrast inpatient CPT 74150 Ct abd w/o cont | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | — | 30% |
| CT scan of the abdomen without contrast inpatient CPT 74150 Ct abdomen w/o dye | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | — | 30% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 Ct maxillofacial w/o dye | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | 49% above | 30% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 Ct maxillofacial w/o cont | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | 49% above | 30% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 Ct maxillofacial w/o cont | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | — | 30% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 Ct maxillofacial w/o dye | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | — | 30% |
| CT scan of the head or brain, no contrast dye CPT 70450 Ct head/brain w/o dye | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | 62% above | 30% |
| CT scan of the head or brain, no contrast dye CPT 70450 Ct head w/o cont | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | 62% above | 30% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 Ct head w/o cont | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | — | 30% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 Ct head/brain w/o dye | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | — | 30% |
| CT scan of the head with contrast CPT 70460 Ct head w cont | $1,565.90 | $2,237.00 | $426.48–$1,001.00 | 83% above | 30% |
| CT scan of the head with contrast CPT 70460 Ct head/brain w/dye | $1,565.90 | $2,237.00 | $426.48–$1,001.00 | 83% above | 30% |
| CT scan of the head with contrast inpatient CPT 70460 Ct head/brain w/dye | $1,565.90 | $2,237.00 | $426.48–$1,001.00 | — | 30% |
| CT scan of the head with contrast inpatient CPT 70460 Ct head w cont | $1,565.90 | $2,237.00 | $426.48–$1,001.00 | — | 30% |
| CT scan of the head without and with contrast CPT 70470 Ct head/brain w/o & w/dye | $1,892.80 | $2,704.00 | $426.48–$1,001.00 | 82% above | 30% |
| CT scan of the head without and with contrast CPT 70470 Ct head w/wo cont | $1,892.80 | $2,704.00 | $426.48–$1,001.00 | 82% above | 30% |
| CT scan of the head without and with contrast inpatient CPT 70470 Ct head w/wo cont | $1,892.80 | $2,704.00 | $426.48–$1,001.00 | — | 30% |
| CT scan of the head without and with contrast inpatient CPT 70470 Ct head/brain w/o & w/dye | $1,892.80 | $2,704.00 | $426.48–$1,001.00 | — | 30% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 Ct lumbar spine w/o dye | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | 40% above | 30% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 Ct spine lumbar w/o cont | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | 40% above | 30% |
| CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 Ct lumbar spine w/o dye | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | — | 30% |
| CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 Ct spine lumbar w/o cont | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | — | 30% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 Ct spine cervical w/o cont | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | 49% above | 30% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 Ct neck spine w/o dye | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | 49% above | 30% |
| CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 Ct neck spine w/o dye | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | — | 30% |
| CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 Ct spine cervical w/o cont | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | — | 30% |
| CT scan of the pelvis, with contrast dye CPT 72193 Ct pelvis w cont | $1,565.90 | $2,237.00 | $426.48–$1,001.00 | 70% above | 30% |
| CT scan of the pelvis, with contrast dye CPT 72193 Ct pelvis w/dye | $1,565.90 | $2,237.00 | $426.48–$1,001.00 | 70% above | 30% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 Ct pelvis w/dye | $1,565.90 | $2,237.00 | $426.48–$1,001.00 | — | 30% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 Ct pelvis w cont | $1,565.90 | $2,237.00 | $426.48–$1,001.00 | — | 30% |
| Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 Extracranial bilat study | $1,079.40 | $1,542.00 | $236.87–$790.42 | — | 30% |
| Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 Us dup extracrn arter comp bil | $1,079.40 | $1,542.00 | $236.87–$790.42 | 13% above | 30% |
| Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 Extracranial bilat study | $1,079.40 | $1,542.00 | $236.87–$790.42 | — | 30% |
| Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 Us dup extracrn arter comp bil | $1,079.40 | $1,542.00 | $236.87–$790.42 | — | 30% |
| Chest CT scan without and with contrast CPT 71270 Ct chest w/wo cont | $1,892.80 | $2,704.00 | $426.48–$1,001.00 | 74% above | 30% |
| Chest CT scan without and with contrast CPT 71270 Ct thorax w/o & w/dye | $1,892.80 | $2,704.00 | $426.48–$1,001.00 | 74% above | 30% |
| Chest CT scan without and with contrast inpatient CPT 71270 Ct thorax w/o & w/dye | $1,892.80 | $2,704.00 | $426.48–$1,001.00 | — | 30% |
| Chest CT scan without and with contrast inpatient CPT 71270 Ct chest w/wo cont | $1,892.80 | $2,704.00 | $426.48–$1,001.00 | — | 30% |
| Chest X-ray, 2 views CPT 71046 X-ray exam chest 2 views | $256.20 | $366.00 | $221.00–$1,181.49 | 24% above | 30% |
| Chest X-ray, 2 views CPT 71046 Chest pa & lateral | $256.20 | $366.00 | $221.00–$1,181.49 | 24% above | 30% |
| Chest X-ray, 2 views inpatient CPT 71046 X-ray exam chest 2 views | $256.20 | $366.00 | $221.00–$1,181.49 | — | 30% |
| Chest X-ray, 2 views inpatient CPT 71046 Chest pa & lateral | $256.20 | $366.00 | $221.00–$1,181.49 | — | 30% |
| Chest X-ray, single view CPT 71045 X-ray exam chest 1 view | $214.20 | $306.00 | $221.00–$1,181.49 | 32% above | 30% |
| Chest X-ray, single view CPT 71045 Chest single 1v trauma port | $214.20 | $306.00 | $221.00–$1,181.49 | 32% above | 30% |
| Chest X-ray, single view inpatient CPT 71045 Chest single 1v trauma port | $214.20 | $306.00 | $221.00–$1,181.49 | — | 30% |
| Chest X-ray, single view inpatient CPT 71045 X-ray exam chest 1 view | $214.20 | $306.00 | $221.00–$1,181.49 | — | 30% |
| Collarbone (clavicle) X-ray, complete CPT 73000 X-ray exam of collar bone | $291.90 | $417.00 | $86.39–$287.92 | 52% above | 30% |
| Collarbone (clavicle) X-ray, complete one side CPT 73000 Clavicle comp lt | $194.60 | $278.00 | $67.83–$221.00 | 1% above | 30% |
| Collarbone (clavicle) X-ray, complete one side CPT 73000 Clavicle comp rt | $194.60 | $278.00 | $67.83–$221.00 | 1% above | 30% |
| Collarbone (clavicle) X-ray, complete inpatient CPT 73000 X-ray exam of collar bone | $291.90 | $417.00 | $86.39–$287.92 | — | 30% |
| Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 Clavicle comp rt | $194.60 | $278.00 | $67.83–$221.00 | — | 30% |
| Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 Clavicle comp lt | $194.60 | $278.00 | $67.83–$221.00 | — | 30% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 Us exam abdo back wall comp | $699.30 | $999.00 | $292.06–$420.80 | 40% above | 30% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 Us abdomen retroperitoneum com | $699.30 | $999.00 | $292.06–$420.80 | 40% above | 30% |
| Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 Us abdomen retroperitoneum com | $699.30 | $999.00 | $292.06–$420.80 | — | 30% |
| Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 Us exam abdo back wall comp | $699.30 | $999.00 | $292.06–$420.80 | — | 30% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 Dxa bone density axial | $338.10 | $483.00 | $103.79–$347.73 | 17% above | 30% |
| DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 Dxa bone density axial | $338.10 | $483.00 | $103.79–$347.73 | — | 30% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 Ct thorax w/o dye | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | 49% above | 30% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 Ct chest w/o cont | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | 49% above | 30% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 Ct thorax w/o dye | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | — | 30% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 Ct chest w/o cont | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | — | 30% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 Ct chest w cont | $1,565.90 | $2,237.00 | $426.48–$1,001.00 | 67% above | 30% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 Ct thorax w/dye | $1,565.90 | $2,237.00 | $426.48–$1,001.00 | 67% above | 30% |
| Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 Ct chest w cont | $1,565.90 | $2,237.00 | $426.48–$1,001.00 | — | 30% |
| Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 Ct thorax w/dye | $1,565.90 | $2,237.00 | $426.48–$1,001.00 | — | 30% |
| Diagnostic mammogram, both breasts both sides CPT 77066 Dx mammo incl cad bi | $385.00 | $550.00 | $134.20–$250.00 | — | 30% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 Dx mammo incl cad bi | $385.00 | $550.00 | $134.20–$250.00 | — | 30% |
| Diagnostic mammogram, one breast CPT 77065 Dx mammo incl cad uni | $334.60 | $478.00 | $112.63–$250.00 | 50% above | 30% |
| Diagnostic mammogram, one breast one side CPT 77065 Diag mammo right tomosynthesis | $334.60 | $478.00 | $116.63–$250.00 | 50% above | 30% |
| Diagnostic mammogram, one breast one side CPT 77065 Diag mammo left tomosynthesis | $334.60 | $478.00 | $116.63–$250.00 | 50% above | 30% |
| Diagnostic mammogram, one breast inpatient CPT 77065 Dx mammo incl cad uni | $334.60 | $478.00 | $112.63–$250.00 | — | 30% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 Diag mammo left tomosynthesis | $334.60 | $478.00 | $116.63–$250.00 | — | 30% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 Diag mammo right tomosynthesis | $334.60 | $478.00 | $116.63–$250.00 | — | 30% |
| Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 Us dup low ext art/bpg comp bi | $1,319.50 | $1,885.00 | $236.87–$1,492.92 | — | 30% |
| Duplex ultrasound of the leg arteries, both legs CPT 93925 Lower extremity study | $1,319.50 | $1,885.00 | $236.87–$1,492.92 | 41% above | 30% |
| Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 Us dup low ext art/bpg comp bi | $1,319.50 | $1,885.00 | $236.87–$1,492.92 | — | 30% |
| Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 Lower extremity study | $1,319.50 | $1,885.00 | $236.87–$1,492.92 | — | 30% |
| Duplex ultrasound of the leg veins, both legs CPT 93970 Extremity study | $1,250.20 | $1,786.00 | $236.87–$790.42 | 4% below | 30% |
| Duplex ultrasound of the leg veins, both legs CPT 93970 Us dup ext veins insuf/dvt bil | $1,250.20 | $1,786.00 | $236.87–$790.42 | 4% below | 30% |
| Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 Us dup ext veins insuf/dvt bil | $1,250.20 | $1,786.00 | $236.87–$790.42 | — | 30% |
| Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 Extremity study | $1,250.20 | $1,786.00 | $236.87–$790.42 | — | 30% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Tte w/doppler complete | $2,332.40 | $3,332.00 | $542.45–$2,638.94 | 41% above | 30% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Us echo tte w/doppler complete | $2,332.40 | $3,332.00 | $542.45–$2,638.94 | 41% above | 30% |
| Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 Tte w/doppler complete | $2,332.40 | $3,332.00 | $542.45–$2,638.94 | — | 30% |
| Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 Us echo tte w/doppler complete | $2,332.40 | $3,332.00 | $542.45–$2,638.94 | — | 30% |
| Elbow X-ray, 2 views CPT 73070 X-ray exam of elbow | $290.50 | $415.00 | $86.39–$328.68 | 75% above | 30% |
| Elbow X-ray, 2 views one side CPT 73070 Elbow 2v rt | $193.20 | $276.00 | $67.34–$218.59 | 17% above | 30% |
| Elbow X-ray, 2 views one side CPT 73070 Elbow 2v lt | $193.20 | $276.00 | $67.34–$218.59 | 17% above | 30% |
| Elbow X-ray, 2 views inpatient CPT 73070 X-ray exam of elbow | $290.50 | $415.00 | $86.39–$328.68 | — | 30% |
| Elbow X-ray, 2 views inpatient one side CPT 73070 Elbow 2v lt | $193.20 | $276.00 | $67.34–$218.59 | — | 30% |
| Elbow X-ray, 2 views inpatient one side CPT 73070 Elbow 2v rt | $193.20 | $276.00 | $67.34–$218.59 | — | 30% |
| Elbow X-ray, complete, 3 or more views CPT 73080 X-ray exam of elbow | $385.00 | $550.00 | $86.39–$287.92 | 51% above | 30% |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 Elbow comp min 3v lt | $256.20 | $366.00 | $86.39–$221.00 | at median | 30% |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 Elbow comp min 3v rt | $256.20 | $366.00 | $86.39–$221.00 | at median | 30% |
| Elbow X-ray, complete, 3 or more views inpatient CPT 73080 X-ray exam of elbow | $385.00 | $550.00 | $86.39–$287.92 | — | 30% |
| Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 Elbow comp min 3v lt | $256.20 | $366.00 | $86.39–$221.00 | — | 30% |
| Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 Elbow comp min 3v rt | $256.20 | $366.00 | $86.39–$221.00 | — | 30% |
| Eye socket (orbit) CT scan without contrast CPT 70480 Ct iac w/o contrast | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | 45% above | 30% |
| Eye socket (orbit) CT scan without contrast CPT 70480 Ct orbit/ear/fossa w/o dye | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | 45% above | 30% |
| Eye socket (orbit) CT scan without contrast inpatient CPT 70480 Ct iac w/o contrast | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | — | 30% |
| Eye socket (orbit) CT scan without contrast inpatient CPT 70480 Ct orbit/ear/fossa w/o dye | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | — | 30% |
| Facial bones X-ray, complete, 3 or more views CPT 70150 X-ray exam of facial bones | $329.70 | $471.00 | $103.79–$347.73 | 21% above | 30% |
| Facial bones X-ray, complete, 3 or more views CPT 70150 Facial bones zygoms min 3 v | $329.70 | $471.00 | $103.79–$347.73 | 21% above | 30% |
| Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 X-ray exam of facial bones | $329.70 | $471.00 | $103.79–$347.73 | — | 30% |
| Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 Facial bones zygoms min 3 v | $329.70 | $471.00 | $103.79–$347.73 | — | 30% |
| Forearm X-ray (radius and ulna), 2 views CPT 73090 X-ray exam of forearm | $343.70 | $491.00 | $86.39–$287.92 | 86% above | 30% |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 Forearm 2v rt | $228.90 | $327.00 | $79.79–$221.00 | 24% above | 30% |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 Forearm 2v lt | $228.90 | $327.00 | $79.79–$221.00 | 24% above | 30% |
| Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 X-ray exam of forearm | $343.70 | $491.00 | $86.39–$287.92 | — | 30% |
| Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 Forearm 2v lt | $228.90 | $327.00 | $79.79–$221.00 | — | 30% |
| Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 Forearm 2v rt | $228.90 | $327.00 | $79.79–$221.00 | — | 30% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 Nm hepatobili duct sys imag | $1,691.90 | $2,417.00 | $396.87–$1,914.26 | 29% above | 30% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 Hepatobiliary system imaging | $1,691.90 | $2,417.00 | $396.87–$1,914.26 | 29% above | 30% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 Nm hepatobili duct sys imag | $1,691.90 | $2,417.00 | $396.87–$1,914.26 | — | 30% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 Hepatobiliary system imaging | $1,691.90 | $2,417.00 | $396.87–$1,914.26 | — | 30% |
| Hand X-ray, 2 views CPT 73120 X-ray exam of hand | $357.00 | $510.00 | $103.79–$403.92 | 108% above | 30% |
| Hand X-ray, 2 views one side CPT 73120 Hand 2v lt | $238.00 | $340.00 | $82.96–$269.28 | 39% above | 30% |
| Hand X-ray, 2 views one side CPT 73120 Hand 2v rt | $238.00 | $340.00 | $82.96–$269.28 | 39% above | 30% |
| Hand X-ray, 2 views inpatient CPT 73120 X-ray exam of hand | $357.00 | $510.00 | $103.79–$403.92 | — | 30% |
| Hand X-ray, 2 views inpatient one side CPT 73120 Hand 2v lt | $238.00 | $340.00 | $82.96–$269.28 | — | 30% |
| Hand X-ray, 2 views inpatient one side CPT 73120 Hand 2v rt | $238.00 | $340.00 | $82.96–$269.28 | — | 30% |
| Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 X-ray exam of heel | $290.50 | $415.00 | $86.39–$287.92 | 36% above | 30% |
| Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 Calcaneous min 2v lt | $193.20 | $276.00 | $67.34–$221.00 | 10% below | 30% |
| Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 Calcaneous min 2v rt | $193.20 | $276.00 | $67.34–$221.00 | 10% below | 30% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 X-ray exam of heel | $290.50 | $415.00 | $86.39–$287.92 | — | 30% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 Calcaneous min 2v lt | $193.20 | $276.00 | $67.34–$221.00 | — | 30% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 Calcaneous min 2v rt | $193.20 | $276.00 | $67.34–$221.00 | — | 30% |
| Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 Sleep study unatt&resp efft | $583.10 | $833.00 | $214.36–$659.74 | 42% above | 30% |
| Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 Sleep study unatt&resp efft | $583.10 | $833.00 | $214.36–$659.74 | — | 30% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 Polysom 6/>yrs cpap 4/> parm | $4,113.20 | $5,876.00 | $852.51–$4,653.79 | 27% above | 30% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 Polysom 6/>yrs cpap 4/> parm | $4,113.20 | $5,876.00 | $852.51–$4,653.79 | — | 30% |
| Knee X-ray, 3 views CPT 73562 X-ray exam of knee 3 | $507.50 | $725.00 | $86.39–$287.92 | 121% above | 30% |
| Knee X-ray, 3 views one side CPT 73562 Knee 3v rt | $338.10 | $483.00 | $86.39–$221.00 | 48% above | 30% |
| Knee X-ray, 3 views one side CPT 73562 Knee 3v lt | $338.10 | $483.00 | $86.39–$221.00 | 48% above | 30% |
| Knee X-ray, 3 views inpatient CPT 73562 X-ray exam of knee 3 | $507.50 | $725.00 | $86.39–$287.92 | — | 30% |
| Knee X-ray, 3 views inpatient one side CPT 73562 Knee 3v lt | $338.10 | $483.00 | $86.39–$221.00 | — | 30% |
| Knee X-ray, 3 views inpatient one side CPT 73562 Knee 3v rt | $338.10 | $483.00 | $86.39–$221.00 | — | 30% |
| Knee X-ray, complete, 4 or more views CPT 73564 X-ray exam knee 4 or more | $583.10 | $833.00 | $103.79–$659.74 | 123% above | 30% |
| Knee X-ray, complete, 4 or more views one side CPT 73564 Knee comp min 4v rt | $388.50 | $555.00 | $103.79–$439.56 | 49% above | 30% |
| Knee X-ray, complete, 4 or more views one side CPT 73564 Knee comp min 4v lt | $388.50 | $555.00 | $103.79–$439.56 | 49% above | 30% |
| Knee X-ray, complete, 4 or more views inpatient CPT 73564 X-ray exam knee 4 or more | $583.10 | $833.00 | $103.79–$659.74 | — | 30% |
| Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 Knee comp min 4v rt | $388.50 | $555.00 | $103.79–$439.56 | — | 30% |
| Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 Knee comp min 4v lt | $388.50 | $555.00 | $103.79–$439.56 | — | 30% |
| Leg CT scan without contrast (hip to foot, any part) CPT 73700 Ct lower extremity w/o dye | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | 58% above | 30% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Ct low ext lt w/o cont | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | 58% above | 30% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Ct low ext rt w/o cont | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | 58% above | 30% |
| Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 Ct lower extremity w/o dye | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | — | 30% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 Ct low ext rt w/o cont | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | — | 30% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 Ct low ext lt w/o cont | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | — | 30% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Echo exam of abdomen | $766.50 | $1,095.00 | $292.06–$420.80 | 68% above | 30% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Us abd limited | $766.50 | $1,095.00 | $292.06–$420.80 | 68% above | 30% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 Echo exam of abdomen | $766.50 | $1,095.00 | $292.06–$420.80 | — | 30% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 Us abd limited | $766.50 | $1,095.00 | $292.06–$420.80 | — | 30% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 Us lmtd jt/nonvasc xtr strux | $440.30 | $629.00 | $103.79–$373.00 | 46% above | 30% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 Us ext non vascular lmt rt | $440.30 | $629.00 | $103.79–$373.00 | 46% above | 30% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 Unilateral axillary ultrasound | $440.30 | $629.00 | $103.79–$373.00 | 46% above | 30% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 Us ext non vascular lmt lt | $440.30 | $629.00 | $103.79–$373.00 | 46% above | 30% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 Us lmtd jt/nonvasc xtr strux | $440.30 | $629.00 | $103.79–$373.00 | — | 30% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 Unilateral axillary ultrasound | $440.30 | $629.00 | $103.79–$373.00 | — | 30% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 Us ext non vascular lmt rt | $440.30 | $629.00 | $103.79–$373.00 | — | 30% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 Us ext non vascular lmt lt | $440.30 | $629.00 | $103.79–$373.00 | — | 30% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 Ct lung screen | $140.00 | $200.00 | $103.79–$1,001.00 | 26% below | 30% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 Ct thorax lung cancer scr c- | $140.00 | $200.00 | $103.79–$1,001.00 | 26% below | 30% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 Ct lung screen | $140.00 | $200.00 | $103.79–$1,001.00 | — | 30% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 Ct thorax lung cancer scr c- | $140.00 | $200.00 | $103.79–$1,001.00 | — | 30% |
| Lower leg X-ray (tibia and fibula), 2 views CPT 73590 X-ray exam of lower leg | $483.70 | $691.00 | $86.39–$287.92 | 144% above | 30% |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 Tibia&fibula 2v rt | $322.70 | $461.00 | $86.39–$221.00 | 62% above | 30% |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 Tibia & fibula 2v lt | $322.70 | $461.00 | $86.39–$221.00 | 62% above | 30% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 X-ray exam of lower leg | $483.70 | $691.00 | $86.39–$287.92 | — | 30% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 Tibia&fibula 2v rt | $322.70 | $461.00 | $86.39–$221.00 | — | 30% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 Tibia & fibula 2v lt | $322.70 | $461.00 | $86.39–$221.00 | — | 30% |
| MR angiography (MRA) of the head without contrast CPT 70544 Mr angiography head w/o dye | $518.70 | $741.00 | $522.63–$1,253.00 | 54% below | 30% |
| MR angiography (MRA) of the head without contrast CPT 70544 Mra head w/o cont | $518.70 | $741.00 | $522.63–$1,253.00 | 54% below | 30% |
| MR angiography (MRA) of the head without contrast inpatient CPT 70544 Mra head w/o cont | $518.70 | $741.00 | $522.63–$1,253.00 | — | 30% |
| MR angiography (MRA) of the head without contrast inpatient CPT 70544 Mr angiography head w/o dye | $518.70 | $741.00 | $522.63–$1,253.00 | — | 30% |
| MRI of both breasts, without and then with contrast dye both sides CPT 77049 Mri breast c-+ w/cad bi | $1,045.10 | $1,493.00 | $364.29–$1,253.00 | — | 30% |
| MRI of both breasts, without and then with contrast dye CPT 77049 Mri breast w/wo cont bil | $1,045.10 | $1,493.00 | $364.29–$1,253.00 | 154% above | 30% |
| MRI of both breasts, without and then with contrast dye inpatient both sides CPT 77049 Mri breast c-+ w/cad bi | $1,045.10 | $1,493.00 | $364.29–$1,253.00 | — | 30% |
| MRI of both breasts, without and then with contrast dye inpatient CPT 77049 Mri breast w/wo cont bil | $1,045.10 | $1,493.00 | $364.29–$1,253.00 | — | 30% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 Mri jnt of lwr extre w/o dye | $1,442.00 | $2,060.00 | $522.63–$1,253.00 | 40% above | 30% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 Mri low ext jt w/o cont rt | $961.10 | $1,373.00 | $335.01–$1,253.00 | 7% below | 30% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 Mri low ext jt w/o cont lt | $961.10 | $1,373.00 | $335.01–$1,253.00 | 7% below | 30% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 Mri jnt of lwr extre w/o dye | $1,442.00 | $2,060.00 | $522.63–$1,253.00 | — | 30% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 Mri low ext jt w/o cont lt | $961.10 | $1,373.00 | $335.01–$1,253.00 | — | 30% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 Mri low ext jt w/o cont rt | $961.10 | $1,373.00 | $335.01–$1,253.00 | — | 30% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 Mri joint lwr extr w/o&w/dye | $1,442.00 | $2,060.00 | $842.54–$1,253.00 | at median | 30% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Mri low ext jt w/wo cont lt | $961.10 | $1,373.00 | $335.01–$1,253.00 | 34% below | 30% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Mri low ext jt w/wo cont rt | $961.10 | $1,373.00 | $335.01–$1,253.00 | 34% below | 30% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 Mri joint lwr extr w/o&w/dye | $1,442.00 | $2,060.00 | $842.54–$1,253.00 | — | 30% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 Mri low ext jt w/wo cont lt | $961.10 | $1,373.00 | $335.01–$1,253.00 | — | 30% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 Mri low ext jt w/wo cont rt | $961.10 | $1,373.00 | $335.01–$1,253.00 | — | 30% |
| MRI of the abdomen without contrast CPT 74181 Mri abdomen w/o dye | $961.10 | $1,373.00 | $522.63–$1,253.00 | 10% below | 30% |
| MRI of the abdomen without contrast CPT 74181 Mri abdomen secretin wo cont | $961.10 | $1,373.00 | $522.63–$1,253.00 | 10% below | 30% |
| MRI of the abdomen without contrast inpatient CPT 74181 Mri abdomen w/o dye | $961.10 | $1,373.00 | $522.63–$1,253.00 | — | 30% |
| MRI of the abdomen without contrast inpatient CPT 74181 Mri abdomen secretin wo cont | $961.10 | $1,373.00 | $522.63–$1,253.00 | — | 30% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 Mri abdomen w/o & w/dye | $961.10 | $1,373.00 | $842.54–$1,213.91 | 39% below | 30% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 Mr enterography abd wo/w cont | $961.10 | $1,373.00 | $842.54–$1,213.91 | 39% below | 30% |
| MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 Mri abdomen w/o & w/dye | $961.10 | $1,373.00 | $842.54–$1,213.91 | — | 30% |
| MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 Mr enterography abd wo/w cont | $961.10 | $1,373.00 | $842.54–$1,213.91 | — | 30% |
| MRI of the brain, no contrast dye CPT 70551 Mr iac w/o contrast | $961.10 | $1,373.00 | $522.63–$1,253.00 | 5% below | 30% |
| MRI of the brain, no contrast dye CPT 70551 Mri brain stem w/o dye | $961.10 | $1,373.00 | $522.63–$1,253.00 | 5% below | 30% |
| MRI of the brain, no contrast dye inpatient CPT 70551 Mri brain stem w/o dye | $961.10 | $1,373.00 | $522.63–$1,253.00 | — | 30% |
| MRI of the brain, no contrast dye inpatient CPT 70551 Mr iac w/o contrast | $961.10 | $1,373.00 | $522.63–$1,253.00 | — | 30% |
| MRI of the brain, with and without contrast dye CPT 70553 Mr iac w/wo contrast | $961.10 | $1,373.00 | $842.54–$1,253.00 | 26% below | 30% |
| MRI of the brain, with and without contrast dye CPT 70553 Mri brain stem w/o & w/dye | $961.10 | $1,373.00 | $842.54–$1,253.00 | 26% below | 30% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 Mri brain stem w/o & w/dye | $961.10 | $1,373.00 | $842.54–$1,253.00 | — | 30% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 Mr iac w/wo contrast | $961.10 | $1,373.00 | $842.54–$1,253.00 | — | 30% |
| MRI of the lower back, no contrast dye CPT 72148 Mri spine lumbar w/o cont | $961.10 | $1,373.00 | $522.63–$1,253.00 | 5% below | 30% |
| MRI of the lower back, no contrast dye CPT 72148 Mri lumbar spine w/o dye | $961.10 | $1,373.00 | $522.63–$1,253.00 | 5% below | 30% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 Mri spine lumbar w/o cont | $961.10 | $1,373.00 | $522.63–$1,253.00 | — | 30% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 Mri lumbar spine w/o dye | $961.10 | $1,373.00 | $522.63–$1,253.00 | — | 30% |
| MRI of the lower back, without and then with contrast dye CPT 72158 Mri lumbar spine w/o & w/dye | $961.10 | $1,373.00 | $842.54–$1,253.00 | 34% below | 30% |
| MRI of the lower back, without and then with contrast dye CPT 72158 Mri spine lumbar w/wo cont | $961.10 | $1,373.00 | $842.54–$1,253.00 | 34% below | 30% |
| MRI of the lower back, without and then with contrast dye inpatient CPT 72158 Mri spine lumbar w/wo cont | $961.10 | $1,373.00 | $842.54–$1,253.00 | — | 30% |
| MRI of the lower back, without and then with contrast dye inpatient CPT 72158 Mri lumbar spine w/o & w/dye | $961.10 | $1,373.00 | $842.54–$1,253.00 | — | 30% |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 Mri chest spine w/o dye | $961.10 | $1,373.00 | $522.63–$1,253.00 | 4% below | 30% |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 Mri spine thoracic w/o cont | $961.10 | $1,373.00 | $522.63–$1,253.00 | 4% below | 30% |
| MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 Mri chest spine w/o dye | $961.10 | $1,373.00 | $522.63–$1,253.00 | — | 30% |
| MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 Mri spine thoracic w/o cont | $961.10 | $1,373.00 | $522.63–$1,253.00 | — | 30% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 Mri neck spine w/o & w/dye | $961.10 | $1,373.00 | $842.54–$1,253.00 | 34% below | 30% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 Mri spine cervical w/wo cont | $961.10 | $1,373.00 | $842.54–$1,253.00 | 34% below | 30% |
| MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 Mri neck spine w/o & w/dye | $961.10 | $1,373.00 | $842.54–$1,253.00 | — | 30% |
| MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 Mri spine cervical w/wo cont | $961.10 | $1,373.00 | $842.54–$1,253.00 | — | 30% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 Mri spine cervical w/o cont | $961.10 | $1,373.00 | $522.63–$1,253.00 | 8% below | 30% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 Mri neck spine w/o dye | $961.10 | $1,373.00 | $522.63–$1,253.00 | 8% below | 30% |
| MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 Mri neck spine w/o dye | $961.10 | $1,373.00 | $522.63–$1,253.00 | — | 30% |
| MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 Mri spine cervical w/o cont | $961.10 | $1,373.00 | $522.63–$1,253.00 | — | 30% |
| MRI of the pelvis without and with contrast CPT 72197 Mr enterography pel wo/w cont | $961.10 | $1,373.00 | $842.54–$1,253.00 | 34% below | 30% |
| MRI of the pelvis without and with contrast CPT 72197 Mri pelvis w/o & w/dye | $961.10 | $1,373.00 | $842.54–$1,253.00 | 34% below | 30% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 Mr enterography pel wo/w cont | $961.10 | $1,373.00 | $842.54–$1,253.00 | — | 30% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 Mri pelvis w/o & w/dye | $961.10 | $1,373.00 | $842.54–$1,253.00 | — | 30% |
| MRI of the pelvis, no contrast dye CPT 72195 Mri pelvis w/o dye | $961.10 | $1,373.00 | $522.63–$1,253.00 | 9% below | 30% |
| MRI of the pelvis, no contrast dye CPT 72195 Mri pelvis w/o cont | $961.10 | $1,373.00 | $522.63–$1,253.00 | 9% below | 30% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 Mri pelvis w/o dye | $961.10 | $1,373.00 | $522.63–$1,253.00 | — | 30% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 Mri pelvis w/o cont | $961.10 | $1,373.00 | $522.63–$1,253.00 | — | 30% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 Mri joint upr extrem w/o dye | $1,442.00 | $2,060.00 | $522.63–$1,253.00 | 35% above | 30% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mri up ext jt w/o cont rt | $961.10 | $1,373.00 | $335.01–$1,253.00 | 10% below | 30% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mri up ext jt w/o cont lt | $961.10 | $1,373.00 | $335.01–$1,253.00 | 10% below | 30% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 Mri joint upr extrem w/o dye | $1,442.00 | $2,060.00 | $522.63–$1,253.00 | — | 30% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 Mri up ext jt w/o cont rt | $961.10 | $1,373.00 | $335.01–$1,253.00 | — | 30% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 Mri up ext jt w/o cont lt | $961.10 | $1,373.00 | $335.01–$1,253.00 | — | 30% |
| Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 X-ray exam neck spine 4/5vws | $422.80 | $604.00 | $103.79–$347.73 | 21% above | 30% |
| Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 Spine cervical 4 or 5v | $422.80 | $604.00 | $103.79–$347.73 | 21% above | 30% |
| Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 Spine cervical 4 or 5v | $422.80 | $604.00 | $103.79–$347.73 | — | 30% |
| Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 X-ray exam neck spine 4/5vws | $422.80 | $604.00 | $103.79–$347.73 | — | 30% |
| Neck soft tissue CT scan with contrast CPT 70491 Ct soft tissue neck w/dye | $1,565.90 | $2,237.00 | $426.48–$1,001.00 | 60% above | 30% |
| Neck soft tissue CT scan with contrast CPT 70491 Ct soft tissue neck w cont | $1,565.90 | $2,237.00 | $426.48–$1,001.00 | 60% above | 30% |
| Neck soft tissue CT scan with contrast inpatient CPT 70491 Ct soft tissue neck w cont | $1,565.90 | $2,237.00 | $426.48–$1,001.00 | — | 30% |
| Neck soft tissue CT scan with contrast inpatient CPT 70491 Ct soft tissue neck w/dye | $1,565.90 | $2,237.00 | $426.48–$1,001.00 | — | 30% |
| Neck soft tissue CT scan without contrast CPT 70490 Ct soft tissue neck w/o dye | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | 49% above | 30% |
| Neck soft tissue CT scan without contrast CPT 70490 Ct soft tissue neck w/o cont | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | 49% above | 30% |
| Neck soft tissue CT scan without contrast inpatient CPT 70490 Ct soft tissue neck w/o dye | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | — | 30% |
| Neck soft tissue CT scan without contrast inpatient CPT 70490 Ct soft tissue neck w/o cont | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | — | 30% |
| Neck soft tissue X-ray CPT 70360 Soft tissue neck pa & lat | $202.30 | $289.00 | $86.39–$287.92 | 17% above | 30% |
| Neck soft tissue X-ray CPT 70360 X-ray exam of neck | $202.30 | $289.00 | $86.39–$287.92 | 17% above | 30% |
| Neck soft tissue X-ray inpatient CPT 70360 Soft tissue neck pa & lat | $202.30 | $289.00 | $86.39–$287.92 | — | 30% |
| Neck soft tissue X-ray inpatient CPT 70360 X-ray exam of neck | $202.30 | $289.00 | $86.39–$287.92 | — | 30% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Nm myocard perf img spect ml | $4,244.80 | $6,064.00 | $1,285.26–$4,802.69 | 10% above | 30% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Ht muscle image spect mult | $4,244.80 | $6,064.00 | $1,285.26–$4,802.69 | 10% above | 30% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 Ht muscle image spect mult | $4,244.80 | $6,064.00 | $1,285.26–$4,802.69 | — | 30% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 Nm myocard perf img spect ml | $4,244.80 | $6,064.00 | $1,285.26–$4,802.69 | — | 30% |
| PET/CT scan from the base of the skull to mid-thigh CPT 78815 Pet image w/ct skull-thigh | $5,086.90 | $7,267.00 | $1,419.58–$5,755.46 | 25% above | 30% |
| PET/CT scan from the base of the skull to mid-thigh CPT 78815 Pet skull mid thigh dotatate | $5,086.90 | $7,267.00 | $1,419.58–$5,755.46 | 25% above | 30% |
| PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 Pet image w/ct skull-thigh | $5,086.90 | $7,267.00 | $1,419.58–$5,755.46 | — | 30% |
| PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 Pet skull mid thigh dotatate | $5,086.90 | $7,267.00 | $1,419.58–$5,755.46 | — | 30% |
| Pelvic CT scan without contrast CPT 72192 Ct pelvis w/o dye | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | 49% above | 30% |
| Pelvic CT scan without contrast CPT 72192 Ct pelvis w/o cont | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | 49% above | 30% |
| Pelvic CT scan without contrast inpatient CPT 72192 Ct pelvis w/o dye | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | — | 30% |
| Pelvic CT scan without contrast inpatient CPT 72192 Ct pelvis w/o cont | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | — | 30% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 Us exam pelvic limited | $255.50 | $365.00 | $292.06–$420.80 | 28% below | 30% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 Us pelvis limited or followup | $255.50 | $365.00 | $292.06–$420.80 | 28% below | 30% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 Us pelvis limited or followup | $255.50 | $365.00 | $292.06–$420.80 | — | 30% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 Us exam pelvic limited | $255.50 | $365.00 | $292.06–$420.80 | — | 30% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 Us pelvis (nonob) complete | $658.70 | $941.00 | $292.06–$420.80 | 42% above | 30% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 Us exam pelvic complete | $658.70 | $941.00 | $292.06–$420.80 | 42% above | 30% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 Us exam pelvic complete | $658.70 | $941.00 | $292.06–$420.80 | — | 30% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 Us pelvis (nonob) complete | $658.70 | $941.00 | $292.06–$420.80 | — | 30% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 Us preg uter>1st tri single | $611.10 | $873.00 | $103.79–$691.42 | 10% above | 30% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 Ob us >= 14 wks sngl fetus | $611.10 | $873.00 | $103.79–$691.42 | 10% above | 30% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 Us preg uter>1st tri single | $611.10 | $873.00 | $103.79–$691.42 | — | 30% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 Ob us >= 14 wks sngl fetus | $611.10 | $873.00 | $103.79–$691.42 | — | 30% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 Us preg uter 1st tri single | $611.10 | $873.00 | $103.79–$691.42 | 19% above | 30% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 Ob us < 14 wks single fetus | $611.10 | $873.00 | $103.79–$691.42 | 19% above | 30% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 Us preg uter 1st tri single | $611.10 | $873.00 | $103.79–$691.42 | — | 30% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 Ob us < 14 wks single fetus | $611.10 | $873.00 | $103.79–$691.42 | — | 30% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Ob us limited fetus(s) | $423.50 | $605.00 | $103.79–$479.16 | 11% above | 30% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Us preg limited | $423.50 | $605.00 | $103.79–$479.16 | 11% above | 30% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 Ob us limited fetus(s) | $423.50 | $605.00 | $103.79–$479.16 | — | 30% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 Us preg limited | $423.50 | $605.00 | $103.79–$479.16 | — | 30% |
| Rib X-ray, one side, 2 views CPT 71100 X-ray exam ribs uni 2 views | $237.30 | $339.00 | $86.39–$287.92 | 16% above | 30% |
| Rib X-ray, one side, 2 views one side CPT 71100 Ribs uni 2v lt | $237.30 | $339.00 | $82.72–$268.49 | 16% above | 30% |
| Rib X-ray, one side, 2 views one side CPT 71100 Ribs uni 2v rt | $237.30 | $339.00 | $82.72–$268.49 | 16% above | 30% |
| Rib X-ray, one side, 2 views inpatient CPT 71100 X-ray exam ribs uni 2 views | $237.30 | $339.00 | $86.39–$287.92 | — | 30% |
| Rib X-ray, one side, 2 views inpatient one side CPT 71100 Ribs uni 2v rt | $237.30 | $339.00 | $82.72–$268.49 | — | 30% |
| Rib X-ray, one side, 2 views inpatient one side CPT 71100 Ribs uni 2v lt | $237.30 | $339.00 | $82.72–$268.49 | — | 30% |
| Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 X-ray exam unilat ribs/chest | $399.70 | $571.00 | $103.79–$347.73 | 64% above | 30% |
| Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 Ribs uni min 3v lt & chest pa | $399.70 | $571.00 | $103.79–$221.00 | 64% above | 30% |
| Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 Ribs uni min 3v rt & chest pa | $399.70 | $571.00 | $103.79–$221.00 | 64% above | 30% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 Ribs uni min 3v rt & chest pa | $399.70 | $571.00 | $103.79–$221.00 | — | 30% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 X-ray exam unilat ribs/chest | $399.70 | $571.00 | $103.79–$347.73 | — | 30% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 Ribs uni min 3v lt & chest pa | $399.70 | $571.00 | $103.79–$221.00 | — | 30% |
| Screening mammogram, both breasts both sides CPT 77067 Scr mammo bi incl cad | $275.10 | $393.00 | $95.89–$250.00 | — | 30% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 Scr mammo bi incl cad | $275.10 | $393.00 | $95.89–$250.00 | — | 30% |
| Shoulder X-ray, complete, 2 or more views CPT 73030 X-ray exam of shoulder | $367.50 | $525.00 | $86.39–$287.92 | 76% above | 30% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 Shoulder comp min 2v lt | $245.00 | $350.00 | $85.40–$221.00 | 17% above | 30% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 Shoulder comp min 2v rt | $245.00 | $350.00 | $85.40–$221.00 | 17% above | 30% |
| Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 X-ray exam of shoulder | $367.50 | $525.00 | $86.39–$287.92 | — | 30% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 Shoulder comp min 2v rt | $245.00 | $350.00 | $85.40–$221.00 | — | 30% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 Shoulder comp min 2v lt | $245.00 | $350.00 | $85.40–$221.00 | — | 30% |
| Sinus X-ray, complete, 3 or more views CPT 70220 Sinuses paranasal min 3v | $256.20 | $366.00 | $86.39–$287.92 | 10% below | 30% |
| Sinus X-ray, complete, 3 or more views CPT 70220 X-ray exam of sinuses | $256.20 | $366.00 | $86.39–$287.92 | 10% below | 30% |
| Sinus X-ray, complete, 3 or more views inpatient CPT 70220 X-ray exam of sinuses | $256.20 | $366.00 | $86.39–$287.92 | — | 30% |
| Sinus X-ray, complete, 3 or more views inpatient CPT 70220 Sinuses paranasal min 3v | $256.20 | $366.00 | $86.39–$287.92 | — | 30% |
| Skull X-ray, fewer than 4 views CPT 70250 Skull ap & lat | $238.00 | $340.00 | $103.79–$347.73 | 2% above | 30% |
| Skull X-ray, fewer than 4 views CPT 70250 X-ray exam of skull | $238.00 | $340.00 | $103.79–$347.73 | 2% above | 30% |
| Skull X-ray, fewer than 4 views inpatient CPT 70250 X-ray exam of skull | $238.00 | $340.00 | $103.79–$347.73 | — | 30% |
| Skull X-ray, fewer than 4 views inpatient CPT 70250 Skull ap & lat | $238.00 | $340.00 | $103.79–$347.73 | — | 30% |
| Sleep study in a lab (polysomnography) CPT 95810 Polysom 6/> yrs 4/> param | $3,655.40 | $5,222.00 | $852.51–$4,135.82 | 38% above | 30% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 Polysom 6/> yrs 4/> param | $3,655.40 | $5,222.00 | $852.51–$4,135.82 | — | 30% |
| Stress echocardiogram, complete, including the stress test and supervision CPT 93351 Us echo dobutamine s/i | $2,627.80 | $3,754.00 | $542.45–$2,973.17 | 46% above | 30% |
| Stress echocardiogram, complete, including the stress test and supervision CPT 93351 Stress tte complete | $2,627.80 | $3,754.00 | $542.45–$2,973.17 | 46% above | 30% |
| Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 Stress tte complete | $2,627.80 | $3,754.00 | $542.45–$2,973.17 | — | 30% |
| Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 Us echo dobutamine s/i | $2,627.80 | $3,754.00 | $542.45–$2,973.17 | — | 30% |
| Swallow study (modified barium swallow, video X-ray) CPT 74230 X-ray xm swlng funcj c+ | $399.70 | $571.00 | $174.13–$582.13 | 10% above | 30% |
| Swallow study (modified barium swallow, video X-ray) CPT 74230 Barium swallow with video | $399.70 | $571.00 | $174.13–$582.13 | 10% above | 30% |
| Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 X-ray xm swlng funcj c+ | $399.70 | $571.00 | $174.13–$582.13 | — | 30% |
| Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 Barium swallow with video | $399.70 | $571.00 | $174.13–$582.13 | — | 30% |
| Thigh bone (femur) X-ray, 2 or more views CPT 73552 X-ray exam of femur 2/> | $343.70 | $491.00 | $86.39–$287.92 | 71% above | 30% |
| Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 Femur 2v rt | $228.90 | $327.00 | $79.79–$221.00 | 14% above | 30% |
| Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 Femur 2v lt | $228.90 | $327.00 | $79.79–$221.00 | 14% above | 30% |
| Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 X-ray exam of femur 2/> | $343.70 | $491.00 | $86.39–$287.92 | — | 30% |
| Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 Femur 2v lt | $228.90 | $327.00 | $79.79–$221.00 | — | 30% |
| Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 Femur 2v rt | $228.90 | $327.00 | $79.79–$221.00 | — | 30% |
| Thoracic spine (mid back) CT scan without contrast CPT 72128 Ct spine thoracic w/o cont | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | 46% above | 30% |
| Thoracic spine (mid back) CT scan without contrast CPT 72128 Ct chest spine w/o dye | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | 46% above | 30% |
| Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 Ct chest spine w/o dye | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | — | 30% |
| Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 Ct spine thoracic w/o cont | $1,238.30 | $1,769.00 | $219.67–$1,001.00 | — | 30% |
| Toe X-ray, 2 or more views CPT 73660 X-ray exam of toe(s) | $290.50 | $415.00 | $86.39–$287.92 | 89% above | 30% |
| Toe X-ray, 2 or more views one side CPT 73660 Toe(s) min 2v lt | $193.20 | $276.00 | $67.34–$221.00 | 26% above | 30% |
| Toe X-ray, 2 or more views one side CPT 73660 Toe(s) min 2v rt | $193.20 | $276.00 | $67.34–$221.00 | 26% above | 30% |
| Toe X-ray, 2 or more views inpatient CPT 73660 X-ray exam of toe(s) | $290.50 | $415.00 | $86.39–$287.92 | — | 30% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 Toe(s) min 2v rt | $193.20 | $276.00 | $67.34–$221.00 | — | 30% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 Toe(s) min 2v lt | $193.20 | $276.00 | $67.34–$221.00 | — | 30% |
| Transvaginal pelvic ultrasound CPT 76830 Us pelvis (nonob) transvaginal | $551.60 | $788.00 | $103.79–$373.00 | 36% above | 30% |
| Transvaginal pelvic ultrasound CPT 76830 Transvaginal us non-ob | $551.60 | $788.00 | $103.79–$373.00 | 36% above | 30% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 Us pelvis (nonob) transvaginal | $551.60 | $788.00 | $103.79–$373.00 | — | 30% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 Transvaginal us non-ob | $551.60 | $788.00 | $103.79–$373.00 | — | 30% |
| Transvaginal ultrasound during pregnancy CPT 76817 Transvaginal us obstetric | $423.50 | $605.00 | $103.79–$479.16 | 15% above | 30% |
| Transvaginal ultrasound during pregnancy CPT 76817 Us preg transvaginal | $423.50 | $605.00 | $103.79–$479.16 | 15% above | 30% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 Transvaginal us obstetric | $423.50 | $605.00 | $103.79–$479.16 | — | 30% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 Us preg transvaginal | $423.50 | $605.00 | $103.79–$479.16 | — | 30% |
| Ultrasound of the abdomen, complete CPT 76700 Us exam abdom complete | $926.80 | $1,324.00 | $292.06–$420.80 | 77% above | 30% |
| Ultrasound of the abdomen, complete CPT 76700 Us abdomen complete | $926.80 | $1,324.00 | $292.06–$420.80 | 77% above | 30% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 Us exam abdom complete | $926.80 | $1,324.00 | $292.06–$420.80 | — | 30% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 Us abdomen complete | $926.80 | $1,324.00 | $292.06–$420.80 | — | 30% |
| Ultrasound of the scrotum and testicles CPT 76870 Us exam scrotum | $742.70 | $1,061.00 | $103.79–$373.00 | 75% above | 30% |
| Ultrasound of the scrotum and testicles CPT 76870 Us scrotum | $742.70 | $1,061.00 | $103.79–$373.00 | 75% above | 30% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 Us exam scrotum | $742.70 | $1,061.00 | $103.79–$373.00 | — | 30% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 Us scrotum | $742.70 | $1,061.00 | $103.79–$373.00 | — | 30% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Us exam of head and neck | $658.00 | $940.00 | $103.79–$373.00 | 54% above | 30% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Us head/neck | $658.00 | $940.00 | $103.79–$373.00 | 54% above | 30% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 Us head/neck | $658.00 | $940.00 | $103.79–$373.00 | — | 30% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 Us exam of head and neck | $658.00 | $940.00 | $103.79–$373.00 | — | 30% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 X-ray xm upr gi trc 1cntrst | $399.70 | $571.00 | $174.13–$582.13 | 24% below | 30% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 Ugi series | $399.70 | $571.00 | $174.13–$582.13 | 24% below | 30% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 X-ray xm upr gi trc 1cntrst | $399.70 | $571.00 | $174.13–$582.13 | — | 30% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 Ugi series | $399.70 | $571.00 | $174.13–$582.13 | — | 30% |
| Upper arm X-ray (humerus), 2 views CPT 73060 X-ray exam of humerus | $331.80 | $474.00 | $86.39–$287.92 | 73% above | 30% |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 Humerus min 2v rt | $221.20 | $316.00 | $77.10–$221.00 | 15% above | 30% |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 Humerus min 2v lt | $221.20 | $316.00 | $77.10–$221.00 | 15% above | 30% |
| Upper arm X-ray (humerus), 2 views inpatient CPT 73060 X-ray exam of humerus | $331.80 | $474.00 | $86.39–$287.92 | — | 30% |
| Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 Humerus min 2v rt | $221.20 | $316.00 | $77.10–$221.00 | — | 30% |
| Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 Humerus min 2v lt | $221.20 | $316.00 | $77.10–$221.00 | — | 30% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 Extremity study | $799.40 | $1,142.00 | $103.79–$373.00 | 26% above | 30% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 Us dup ext veins insuf/dvt lmt | $799.40 | $1,142.00 | $103.79–$373.00 | 26% above | 30% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 Extremity study | $799.40 | $1,142.00 | $103.79–$373.00 | — | 30% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 Us dup ext veins insuf/dvt lmt | $799.40 | $1,142.00 | $103.79–$373.00 | — | 30% |
| Wrist X-ray, 2 views CPT 73100 X-ray exam of wrist | $304.50 | $435.00 | $86.39–$344.52 | 95% above | 30% |
| Wrist X-ray, 2 views one side CPT 73100 Wrist 2v lt | $203.00 | $290.00 | $70.76–$229.68 | 30% above | 30% |
| Wrist X-ray, 2 views one side CPT 73100 Wrist 2v rt | $203.00 | $290.00 | $70.76–$229.68 | 30% above | 30% |
| Wrist X-ray, 2 views inpatient CPT 73100 X-ray exam of wrist | $304.50 | $435.00 | $86.39–$344.52 | — | 30% |
| Wrist X-ray, 2 views inpatient one side CPT 73100 Wrist 2v rt | $203.00 | $290.00 | $70.76–$229.68 | — | 30% |
| Wrist X-ray, 2 views inpatient one side CPT 73100 Wrist 2v lt | $203.00 | $290.00 | $70.76–$229.68 | — | 30% |
| Wrist X-ray, complete, 3 or more views CPT 73110 X-ray exam of wrist | $385.00 | $550.00 | $86.39–$287.92 | 51% above | 30% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 Wrist comp min 3v rt | $256.20 | $366.00 | $86.39–$221.00 | 1% above | 30% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 Wrist comp min 3v lt | $256.20 | $366.00 | $86.39–$221.00 | 1% above | 30% |
| Wrist X-ray, complete, 3 or more views inpatient CPT 73110 X-ray exam of wrist | $385.00 | $550.00 | $86.39–$287.92 | — | 30% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 Wrist comp min 3v lt | $256.20 | $366.00 | $86.39–$221.00 | — | 30% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 Wrist comp min 3v rt | $256.20 | $366.00 | $86.39–$221.00 | — | 30% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 X-ray exam hip uni 2-3 views | $385.00 | $550.00 | $86.39–$287.92 | 45% above | 30% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 Pelvis/hips child 2v | $385.00 | $550.00 | $86.39–$287.92 | 45% above | 30% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 Hip during or proc rt | $807.80 | $1,154.00 | $86.39–$281.58 | 205% above | 30% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 Hip during or proc lt | $807.80 | $1,154.00 | $86.39–$281.58 | 205% above | 30% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 X-ray exam hip uni 2-3 views | $385.00 | $550.00 | $86.39–$287.92 | — | 30% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 Pelvis/hips child 2v | $385.00 | $550.00 | $86.39–$287.92 | — | 30% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 Hip during or proc rt | $807.80 | $1,154.00 | $86.39–$281.58 | — | 30% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 Hip during or proc lt | $807.80 | $1,154.00 | $86.39–$281.58 | — | 30% |
| X-ray of the abdomen, 1 view CPT 74018 X-ray exam abdomen 1 view | $203.00 | $290.00 | $86.39–$287.92 | 6% below | 30% |
| X-ray of the abdomen, 1 view CPT 74018 Abd ap | $203.00 | $290.00 | $86.39–$287.92 | 6% below | 30% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 Abd ap | $203.00 | $290.00 | $86.39–$287.92 | — | 30% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 X-ray exam abdomen 1 view | $203.00 | $290.00 | $86.39–$287.92 | — | 30% |
| X-ray of the ankle, 2 views CPT 73600 X-ray exam of ankle | $290.50 | $415.00 | $86.39–$328.68 | 82% above | 30% |
| X-ray of the ankle, 2 views one side CPT 73600 Ankle 2v rt | $193.20 | $276.00 | $67.34–$218.59 | 21% above | 30% |
| X-ray of the ankle, 2 views one side CPT 73600 Ankle 2v lt | $193.20 | $276.00 | $67.34–$218.59 | 21% above | 30% |
| X-ray of the ankle, 2 views inpatient CPT 73600 X-ray exam of ankle | $290.50 | $415.00 | $86.39–$328.68 | — | 30% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 Ankle 2v lt | $193.20 | $276.00 | $67.34–$218.59 | — | 30% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 Ankle 2v rt | $193.20 | $276.00 | $67.34–$218.59 | — | 30% |
| X-ray of the finger(s), 2 or more views CPT 73140 X-ray exam of finger(s) | $290.50 | $415.00 | $86.39–$287.92 | 82% above | 30% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 Finger(s) min 2v rt | $193.20 | $276.00 | $67.34–$221.00 | 21% above | 30% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 Finger(s) min 2v lt | $193.20 | $276.00 | $67.34–$221.00 | 21% above | 30% |
| X-ray of the finger(s), 2 or more views inpatient CPT 73140 X-ray exam of finger(s) | $290.50 | $415.00 | $86.39–$287.92 | — | 30% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 Finger(s) min 2v lt | $193.20 | $276.00 | $67.34–$221.00 | — | 30% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 Finger(s) min 2v rt | $193.20 | $276.00 | $67.34–$221.00 | — | 30% |
| X-ray of the foot, 2 views CPT 73620 X-ray exam of foot | $290.50 | $415.00 | $86.39–$328.68 | 77% above | 30% |
| X-ray of the foot, 2 views one side CPT 73620 Foot 2v lt | $193.20 | $276.00 | $67.34–$218.59 | 18% above | 30% |
| X-ray of the foot, 2 views one side CPT 73620 Foot 2v rt | $193.20 | $276.00 | $67.34–$218.59 | 18% above | 30% |
| X-ray of the foot, 2 views inpatient CPT 73620 X-ray exam of foot | $290.50 | $415.00 | $86.39–$328.68 | — | 30% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 Foot 2v lt | $193.20 | $276.00 | $67.34–$218.59 | — | 30% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 Foot 2v rt | $193.20 | $276.00 | $67.34–$218.59 | — | 30% |
| X-ray of the foot, complete, 3 or more views CPT 73630 X-ray exam of foot | $343.70 | $491.00 | $86.39–$287.92 | 71% above | 30% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 Foot comp min 3v lt | $228.90 | $327.00 | $79.79–$221.00 | 14% above | 30% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 Foot comp min 3v rt | $228.90 | $327.00 | $79.79–$221.00 | 14% above | 30% |
| X-ray of the foot, complete, 3 or more views inpatient CPT 73630 X-ray exam of foot | $343.70 | $491.00 | $86.39–$287.92 | — | 30% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 Foot comp min 3v rt | $228.90 | $327.00 | $79.79–$221.00 | — | 30% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 Foot comp min 3v lt | $228.90 | $327.00 | $79.79–$221.00 | — | 30% |
| X-ray of the hand, 3 or more views CPT 73130 X-ray exam of hand | $355.60 | $508.00 | $86.39–$287.92 | 76% above | 30% |
| X-ray of the hand, 3 or more views one side CPT 73130 Hand min 3v rt | $237.30 | $339.00 | $82.72–$221.00 | 18% above | 30% |
| X-ray of the hand, 3 or more views one side CPT 73130 Hand min 3v lt | $237.30 | $339.00 | $82.72–$221.00 | 18% above | 30% |
| X-ray of the hand, 3 or more views inpatient CPT 73130 X-ray exam of hand | $355.60 | $508.00 | $86.39–$287.92 | — | 30% |
| X-ray of the hand, 3 or more views inpatient one side CPT 73130 Hand min 3v rt | $237.30 | $339.00 | $82.72–$221.00 | — | 30% |
| X-ray of the hand, 3 or more views inpatient one side CPT 73130 Hand min 3v lt | $237.30 | $339.00 | $82.72–$221.00 | — | 30% |
| X-ray of the knee, 1 or 2 views CPT 73560 X-ray exam of knee 1 or 2 | $432.60 | $618.00 | $86.39–$489.46 | 107% above | 30% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 Knee 1-2v rt | $288.40 | $412.00 | $86.39–$326.30 | 38% above | 30% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 Knee standing ap lt | $288.40 | $412.00 | $86.39–$326.30 | 38% above | 30% |
| X-ray of the knee, 1 or 2 views inpatient CPT 73560 X-ray exam of knee 1 or 2 | $432.60 | $618.00 | $86.39–$489.46 | — | 30% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 Knee 1-2v rt | $288.40 | $412.00 | $86.39–$326.30 | — | 30% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 Knee standing ap lt | $288.40 | $412.00 | $86.39–$326.30 | — | 30% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 Spine lumbar 2-3v | $288.40 | $412.00 | $103.79–$347.73 | 15% above | 30% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 X-ray exam l-s spine 2/3 vws | $288.40 | $412.00 | $103.79–$347.73 | 15% above | 30% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 X-ray exam l-s spine 2/3 vws | $288.40 | $412.00 | $103.79–$347.73 | — | 30% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 Spine lumbar 2-3v | $288.40 | $412.00 | $103.79–$347.73 | — | 30% |
| X-ray of the lower back, 4 or more views CPT 72110 X-ray exam l-2 spine 4/>vws | $477.40 | $682.00 | $103.79–$347.73 | 38% above | 30% |
| X-ray of the lower back, 4 or more views CPT 72110 Spine lumbar min 4v | $477.40 | $682.00 | $103.79–$347.73 | 38% above | 30% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 Spine lumbar min 4v | $477.40 | $682.00 | $103.79–$347.73 | — | 30% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 X-ray exam l-2 spine 4/>vws | $477.40 | $682.00 | $103.79–$347.73 | — | 30% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 Spine thoracic 2v | $238.00 | $340.00 | $103.79–$347.73 | 2% above | 30% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 X-ray exam thorac spine 2vws | $238.00 | $340.00 | $103.79–$347.73 | 2% above | 30% |
| X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 Spine thoracic 2v | $238.00 | $340.00 | $103.79–$347.73 | — | 30% |
| X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 X-ray exam thorac spine 2vws | $238.00 | $340.00 | $103.79–$347.73 | — | 30% |
| X-ray of the nasal bones, 3 or more views CPT 70160 Nasal bones comp | $203.00 | $290.00 | $86.39–$287.92 | at median | 30% |
| X-ray of the nasal bones, 3 or more views CPT 70160 X-ray exam of nasal bones | $203.00 | $290.00 | $86.39–$287.92 | at median | 30% |
| X-ray of the nasal bones, 3 or more views inpatient CPT 70160 Nasal bones comp | $203.00 | $290.00 | $86.39–$287.92 | — | 30% |
| X-ray of the nasal bones, 3 or more views inpatient CPT 70160 X-ray exam of nasal bones | $203.00 | $290.00 | $86.39–$287.92 | — | 30% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 Spine cervical 2 or 3v | $288.40 | $412.00 | $86.39–$287.92 | 15% above | 30% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 X-ray exam neck spine 2-3 vw | $288.40 | $412.00 | $86.39–$287.92 | 15% above | 30% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 X-ray exam neck spine 2-3 vw | $288.40 | $412.00 | $86.39–$287.92 | — | 30% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 Spine cervical 2 or 3v | $288.40 | $412.00 | $86.39–$287.92 | — | 30% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 X-ray exam of pelvis | $245.00 | $350.00 | $103.79–$347.73 | 25% above | 30% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 Pelvis 1-2v | $245.00 | $350.00 | $103.79–$347.73 | 25% above | 30% |
| X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 Pelvis 1-2v | $245.00 | $350.00 | $103.79–$347.73 | — | 30% |
| X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 X-ray exam of pelvis | $245.00 | $350.00 | $103.79–$347.73 | — | 30% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 X-ray exam sacrum tailbone | $306.60 | $438.00 | $86.39–$287.92 | 40% above | 30% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 Sacrum & coccyx | $306.60 | $438.00 | $86.39–$287.92 | 40% above | 30% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 X-ray exam sacrum tailbone | $306.60 | $438.00 | $86.39–$287.92 | — | 30% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 Sacrum & coccyx | $306.60 | $438.00 | $86.39–$287.92 | — | 30% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Indiana | Off list |
|---|---|---|---|---|---|
| ACTH blood test CPT 82024 Assay of acth | $74.20 | $106.00 | $38.62–$132.45 | 70% below | 30% |
| ACTH blood test inpatient CPT 82024 Assay of acth | $74.20 | $106.00 | $38.62–$132.45 | — | 30% |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 Alanine amino (alt) (sgpt) | $9.80 | $14.00 | $5.30–$18.18 | 64% below | 30% |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 Alanine amino (alt)(sgpt) | $9.80 | $14.00 | $5.30–$18.18 | 64% below | 30% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 Alanine amino (alt) (sgpt) | $9.80 | $14.00 | $5.30–$18.18 | — | 30% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 Alanine amino (alt)(sgpt) | $9.80 | $14.00 | $5.30–$18.18 | — | 30% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 Transferase (ast)(sgot) | $9.80 | $14.00 | $5.18–$17.75 | 66% below | 30% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 Transferase (ast) (sgot) | $9.80 | $14.00 | $5.18–$17.75 | 66% below | 30% |
| AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 Transferase (ast) (sgot) | $9.80 | $14.00 | $5.18–$17.75 | — | 30% |
| AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 Transferase (ast)(sgot) | $9.80 | $14.00 | $5.18–$17.75 | — | 30% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Acute hepatitis panel | $91.70 | $131.00 | $47.63–$163.35 | 71% below | 30% |
| Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 Acute hepatitis panel | $91.70 | $131.00 | $47.63–$163.35 | — | 30% |
| Albumin blood test CPT 82040 Ms panel csf | $11.20 | $16.00 | $4.95–$16.98 | 51% below | 30% |
| Albumin blood test CPT 82040 Assay of serum albumin | $11.20 | $16.00 | $4.95–$16.98 | 51% below | 30% |
| Albumin blood test inpatient CPT 82040 Ms panel csf | $11.20 | $16.00 | $4.95–$16.98 | — | 30% |
| Albumin blood test inpatient CPT 82040 Assay of serum albumin | $11.20 | $16.00 | $4.95–$16.98 | — | 30% |
| Aldosterone blood test CPT 82088 Assay of aldosterone | $144.90 | $207.00 | $40.75–$139.75 | 30% below | 30% |
| Aldosterone blood test CPT 82088 Aldosterone 24 hr urine | $144.90 | $207.00 | $40.75–$139.75 | 30% below | 30% |
| Aldosterone blood test inpatient CPT 82088 Assay of aldosterone | $144.90 | $207.00 | $40.75–$139.75 | — | 30% |
| Aldosterone blood test inpatient CPT 82088 Aldosterone 24 hr urine | $144.90 | $207.00 | $40.75–$139.75 | — | 30% |
| Alkaline phosphatase (ALP) blood test CPT 84075 Assay alkaline phosphatas | $9.80 | $14.00 | $5.18–$17.75 | 69% below | 30% |
| Alkaline phosphatase (ALP) blood test CPT 84075 Assay alkaline phosphatase | $9.80 | $14.00 | $5.18–$17.75 | 69% below | 30% |
| Alkaline phosphatase (ALP) blood test inpatient CPT 84075 Assay alkaline phosphatase | $9.80 | $14.00 | $5.18–$17.75 | — | 30% |
| Alkaline phosphatase (ALP) blood test inpatient CPT 84075 Assay alkaline phosphatas | $9.80 | $14.00 | $5.18–$17.75 | — | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen cereal panel | $104.30 | $149.00 | $5.22–$17.90 | 443% above | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allg spec ige crude xtrc ea | $104.30 | $149.00 | $5.22–$17.90 | 443% above | 30% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen cereal panel | $104.30 | $149.00 | $5.22–$17.90 | — | 30% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allg spec ige crude xtrc ea | $104.30 | $149.00 | $5.22–$17.90 | — | 30% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 Prental risk quad - cpt 82105 | $51.80 | $74.00 | $16.77–$57.53 | 49% below | 30% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 Alpha-fetoprotein serum | $51.80 | $74.00 | $16.77–$57.53 | 49% below | 30% |
| Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 Alpha-fetoprotein serum | $51.80 | $74.00 | $16.77–$57.53 | — | 30% |
| Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 Prental risk quad - cpt 82105 | $51.80 | $74.00 | $16.77–$57.53 | — | 30% |
| Ammonia blood test CPT 82140 Assay of ammonia | $27.30 | $39.00 | $14.57–$49.98 | 77% below | 30% |
| Ammonia blood test inpatient CPT 82140 Assay of ammonia | $27.30 | $39.00 | $14.57–$49.98 | — | 30% |
| Amylase blood test CPT 82150 Amylase isoenzymes | $15.40 | $22.00 | $6.48–$22.23 | 70% below | 30% |
| Amylase blood test CPT 82150 Assay of amylase | $15.40 | $22.00 | $6.48–$22.23 | 70% below | 30% |
| Amylase blood test inpatient CPT 82150 Assay of amylase | $15.40 | $22.00 | $6.48–$22.23 | — | 30% |
| Amylase blood test inpatient CPT 82150 Amylase isoenzymes | $15.40 | $22.00 | $6.48–$22.23 | — | 30% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Ccp antibody | $98.70 | $141.00 | $12.95–$44.40 | 87% above | 30% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Rheumatoid arthritis panel | $98.70 | $141.00 | $12.95–$44.40 | 87% above | 30% |
| Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 Ccp antibody | $98.70 | $141.00 | $12.95–$44.40 | — | 30% |
| Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 Rheumatoid arthritis panel | $98.70 | $141.00 | $12.95–$44.40 | — | 30% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 Antinuclear antibodies | $59.50 | $85.00 | $12.09–$41.45 | 1% below | 30% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 Ana screenifawith reflex to | $59.50 | $85.00 | $12.09–$41.45 | 1% below | 30% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Antinuclear antibodies | $59.50 | $85.00 | $12.09–$41.45 | — | 30% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Ana screenifawith reflex to | $59.50 | $85.00 | $12.09–$41.45 | — | 30% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 Assay of natriuretic peptide | $148.40 | $212.00 | $39.26–$116.40 | 13% below | 30% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 B-type natriuretic acid | $148.40 | $212.00 | $39.26–$116.40 | 13% below | 30% |
| BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 Assay of natriuretic peptide | $148.40 | $212.00 | $39.26–$116.40 | — | 30% |
| BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 B-type natriuretic acid | $148.40 | $212.00 | $39.26–$116.40 | — | 30% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Nasopharyngeal culture | $126.00 | $180.00 | $8.62–$29.55 | 35% above | 30% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture othr specimn aerobic | $126.00 | $180.00 | $8.62–$29.55 | 35% above | 30% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Nasopharyngeal culture | $126.00 | $180.00 | $8.62–$29.55 | — | 30% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture othr specimn aerobic | $126.00 | $180.00 | $8.62–$29.55 | — | 30% |
| Basic metabolic panel (blood test) CPT 80048 Metabolic panel total ca | $16.80 | $24.00 | $8.46–$29.00 | 79% below | 30% |
| Basic metabolic panel (blood test) CPT 80048 Ebmp | $16.80 | $24.00 | $8.46–$29.00 | 79% below | 30% |
| Basic metabolic panel (blood test) inpatient CPT 80048 Metabolic panel total ca | $16.80 | $24.00 | $8.46–$29.00 | — | 30% |
| Basic metabolic panel (blood test) inpatient CPT 80048 Ebmp | $16.80 | $24.00 | $8.46–$29.00 | — | 30% |
| Bilirubin blood test, total CPT 82247 Bilirubin body fluid | $175.70 | $251.00 | $5.02–$17.20 | 407% above | 30% |
| Bilirubin blood test, total CPT 82247 Bilirubin total | $175.70 | $251.00 | $5.02–$17.20 | 407% above | 30% |
| Bilirubin blood test, total inpatient CPT 82247 Bilirubin body fluid | $175.70 | $251.00 | $5.02–$17.20 | — | 30% |
| Bilirubin blood test, total inpatient CPT 82247 Bilirubin total | $175.70 | $251.00 | $5.02–$17.20 | — | 30% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 Tissue exam by pathologist | $255.50 | $365.00 | $51.73–$174.72 | 1% below | 30% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 Tissue exam by pathologist | $255.50 | $365.00 | $51.73–$174.72 | — | 30% |
| Blood culture for bacteria CPT 87040 Blood culture for bacteria | $19.60 | $28.00 | $10.32–$35.40 | 85% below | 30% |
| Blood culture for bacteria CPT 87040 Blood culture for bacteri | $19.60 | $28.00 | $10.32–$35.40 | 85% below | 30% |
| Blood culture for bacteria inpatient CPT 87040 Blood culture for bacteri | $19.60 | $28.00 | $10.32–$35.40 | — | 30% |
| Blood culture for bacteria inpatient CPT 87040 Blood culture for bacteria | $19.60 | $28.00 | $10.32–$35.40 | — | 30% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 Routine venipuncture | $18.90 | $27.00 | $7.50–$9.09 | 14% above | 30% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 Retreat venipuncture | $18.90 | $27.00 | $7.50–$9.09 | 14% above | 30% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 Venipuncture | $18.90 | $27.00 | $7.50–$9.09 | 14% above | 30% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Venipuncture | $18.90 | $27.00 | $7.50–$9.09 | — | 30% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Routine venipuncture | $18.90 | $27.00 | $7.50–$9.09 | — | 30% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Retreat venipuncture | $18.90 | $27.00 | $7.50–$9.09 | — | 30% |
| Blood glucose (sugar) test CPT 82947 Gtt 2 hr ob - cpt 82947 | $44.80 | $64.00 | $3.82–$13.48 | 68% above | 30% |
| Blood glucose (sugar) test CPT 82947 Assay glucose blood quant | $44.80 | $64.00 | $3.82–$13.48 | 68% above | 30% |
| Blood glucose (sugar) test inpatient CPT 82947 Assay glucose blood quant | $44.80 | $64.00 | $3.82–$13.48 | — | 30% |
| Blood glucose (sugar) test inpatient CPT 82947 Gtt 2 hr ob - cpt 82947 | $44.80 | $64.00 | $3.82–$13.48 | — | 30% |
| Blood lead test CPT 83655 Urine heavy met rand-cpt 83655 | $51.80 | $74.00 | $12.11–$41.53 | 27% below | 30% |
| Blood lead test CPT 83655 Assay of lead | $51.80 | $74.00 | $12.11–$41.53 | 27% below | 30% |
| Blood lead test inpatient CPT 83655 Assay of lead | $51.80 | $74.00 | $12.11–$41.53 | — | 30% |
| Blood lead test inpatient CPT 83655 Urine heavy met rand-cpt 83655 | $51.80 | $74.00 | $12.11–$41.53 | — | 30% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Chorionic gonadotropin assay | $15.40 | $22.00 | $7.52–$25.80 | 79% below | 30% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Chorionic gonadotropn tet | $15.40 | $22.00 | $7.52–$25.80 | 79% below | 30% |
| Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 Chorionic gonadotropin assay | $15.40 | $22.00 | $7.52–$25.80 | — | 30% |
| Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 Chorionic gonadotropn tet | $15.40 | $22.00 | $7.52–$25.80 | — | 30% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Blood typing abo | $220.50 | $315.00 | $10.25–$421.50 | 349% above | 30% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Blood typing serologic abo | $220.50 | $315.00 | $10.25–$421.50 | 349% above | 30% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Blood typing abo | $220.50 | $315.00 | $10.25–$421.50 | — | 30% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Blood typing serologic abo | $220.50 | $315.00 | $10.25–$421.50 | — | 30% |
| Blood urea nitrogen (BUN) test CPT 84520 Assay of urea nitrogen | $7.70 | $11.00 | $3.95–$13.55 | 67% below | 30% |
| Blood urea nitrogen (BUN) test CPT 84520 Assay oif urea nitrogen | $7.70 | $11.00 | $3.95–$13.55 | 67% below | 30% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 Assay oif urea nitrogen | $7.70 | $11.00 | $3.95–$13.55 | — | 30% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 Assay of urea nitrogen | $7.70 | $11.00 | $3.95–$13.55 | — | 30% |
| C-peptide blood test CPT 84681 Assay of c-peptide | $40.60 | $58.00 | $20.81–$71.38 | 70% below | 30% |
| C-peptide blood test inpatient CPT 84681 Assay of c-peptide | $40.60 | $58.00 | $20.81–$71.38 | — | 30% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-reactive protein | $31.50 | $45.00 | $5.18–$17.75 | 54% below | 30% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 G crp | $31.50 | $45.00 | $5.18–$17.75 | 54% below | 30% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-reactive protein | $31.50 | $45.00 | $5.18–$17.75 | — | 30% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 G crp | $31.50 | $45.00 | $5.18–$17.75 | — | 30% |
| C. difficile toxin gene test (stool PCR) CPT 87493 C diff amplified probe | $167.30 | $239.00 | $37.27–$120.35 | 26% above | 30% |
| C. difficile toxin gene test (stool PCR) CPT 87493 C diff pcr | $167.30 | $239.00 | $37.27–$120.35 | 26% above | 30% |
| C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C diff amplified probe | $167.30 | $239.00 | $37.27–$120.35 | — | 30% |
| C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C diff pcr | $167.30 | $239.00 | $37.27–$120.35 | — | 30% |
| CA 19-9 blood test (tumor marker) CPT 86301 Body fluid ca 19-9 | $88.90 | $127.00 | $20.81–$71.38 | 39% below | 30% |
| CA 19-9 blood test (tumor marker) CPT 86301 Immunoassay tumor ca 19-9 | $88.90 | $127.00 | $20.81–$71.38 | 39% below | 30% |
| CA 19-9 blood test (tumor marker) inpatient CPT 86301 Body fluid ca 19-9 | $88.90 | $127.00 | $20.81–$71.38 | — | 30% |
| CA 19-9 blood test (tumor marker) inpatient CPT 86301 Immunoassay tumor ca 19-9 | $88.90 | $127.00 | $20.81–$71.38 | — | 30% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 Immunoassay tumor antigen | $40.60 | $58.00 | $20.81–$71.38 | 75% below | 30% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 Immunoassay tumor ca 125 | $40.60 | $58.00 | $20.81–$71.38 | 75% below | 30% |
| CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 Immunoassay tumor antigen | $40.60 | $58.00 | $20.81–$71.38 | — | 30% |
| CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 Immunoassay tumor ca 125 | $40.60 | $58.00 | $20.81–$71.38 | — | 30% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Sars-cov-2 covid-19 amp prb | $200.20 | $286.00 | $49.86–$226.51 | 89% above | 30% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 Sars-cov-2 covid-19 amp prb | $200.20 | $286.00 | $49.86–$226.51 | — | 30% |
| Calcium blood test, total CPT 82310 Assay of calcium | $9.80 | $14.00 | $5.16–$17.70 | 63% below | 30% |
| Calcium blood test, total inpatient CPT 82310 Assay of calcium | $9.80 | $14.00 | $5.16–$17.70 | — | 30% |
| Carcinoembryonic antigen (CEA) test CPT 82378 Carcinoembryonic antigen | $35.70 | $51.00 | $18.96–$65.03 | 70% below | 30% |
| Carcinoembryonic antigen (CEA) test CPT 82378 Body fluid cea | $35.70 | $51.00 | $18.96–$65.03 | 70% below | 30% |
| Carcinoembryonic antigen (CEA) test inpatient CPT 82378 Body fluid cea | $35.70 | $51.00 | $18.96–$65.03 | — | 30% |
| Carcinoembryonic antigen (CEA) test inpatient CPT 82378 Carcinoembryonic antigen | $35.70 | $51.00 | $18.96–$65.03 | — | 30% |
| Chickenpox (varicella) immunity blood test CPT 86787 Varicella-zoster antibody | $24.50 | $35.00 | $12.88–$44.18 | 75% below | 30% |
| Chickenpox (varicella) immunity blood test inpatient CPT 86787 Varicella-zoster antibody | $24.50 | $35.00 | $12.88–$44.18 | — | 30% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chylmd trach dna amp probe | $97.30 | $139.00 | $35.09–$120.35 | at median | 30% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Vaginal vaginitis panel-87491 | $97.30 | $139.00 | $35.09–$120.35 | at median | 30% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Vaginal vaginitis panel-87491 | $97.30 | $139.00 | $35.09–$120.35 | — | 30% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chylmd trach dna amp probe | $97.30 | $139.00 | $35.09–$120.35 | — | 30% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Gfgh - lipid | $89.60 | $128.00 | $13.01–$45.93 | 15% below | 30% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid panel | $89.60 | $128.00 | $13.01–$45.93 | 15% below | 30% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid panel | $89.60 | $128.00 | $13.01–$45.93 | — | 30% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Gfgh - lipid | $89.60 | $128.00 | $13.01–$45.93 | — | 30% |
| Complete blood count (CBC) with differential CPT 85025 Ghgh - cbc | $50.40 | $72.00 | $7.77–$26.65 | 22% above | 30% |
| Complete blood count (CBC) with differential CPT 85025 Complete cbc w/auto diff wbc | $50.40 | $72.00 | $7.77–$26.65 | 22% above | 30% |
| Complete blood count (CBC) with differential inpatient CPT 85025 Ghgh - cbc | $50.40 | $72.00 | $7.77–$26.65 | — | 30% |
| Complete blood count (CBC) with differential inpatient CPT 85025 Complete cbc w/auto diff wbc | $50.40 | $72.00 | $7.77–$26.65 | — | 30% |
| Complete blood count (CBC), no differential CPT 85027 Automated hemogram | $11.90 | $17.00 | $6.47–$22.18 | 60% below | 30% |
| Complete blood count (CBC), no differential CPT 85027 Complete cbc automated | $11.90 | $17.00 | $6.47–$22.18 | 60% below | 30% |
| Complete blood count (CBC), no differential inpatient CPT 85027 Automated hemogram | $11.90 | $17.00 | $6.47–$22.18 | — | 30% |
| Complete blood count (CBC), no differential inpatient CPT 85027 Complete cbc automated | $11.90 | $17.00 | $6.47–$22.18 | — | 30% |
| Comprehensive metabolic panel (blood test) CPT 80053 Gfgh - cmp | $170.10 | $243.00 | $10.56–$36.23 | 92% above | 30% |
| Comprehensive metabolic panel (blood test) CPT 80053 Comprehen metabolic panel | $170.10 | $243.00 | $10.56–$36.23 | 92% above | 30% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 Comprehen metabolic panel | $170.10 | $243.00 | $10.56–$36.23 | — | 30% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 Gfgh - cmp | $170.10 | $243.00 | $10.56–$36.23 | — | 30% |
| Cortisol blood test, total CPT 82533 Acth stimulation 2 specimens | $172.20 | $246.00 | $16.30–$55.90 | 82% above | 30% |
| Cortisol blood test, total CPT 82533 Total cortisol | $172.20 | $246.00 | $16.30–$55.90 | 82% above | 30% |
| Cortisol blood test, total inpatient CPT 82533 Total cortisol | $172.20 | $246.00 | $16.30–$55.90 | — | 30% |
| Cortisol blood test, total inpatient CPT 82533 Acth stimulation 2 specimens | $172.20 | $246.00 | $16.30–$55.90 | — | 30% |
| Creatine kinase (CK) blood test, total CPT 82550 Assay of ck (cpk) | $11.90 | $17.00 | $6.51–$22.33 | 69% below | 30% |
| Creatine kinase (CK) blood test, total inpatient CPT 82550 Assay of ck (cpk) | $11.90 | $17.00 | $6.51–$22.33 | — | 30% |
| Creatinine blood test CPT 82565 Assay of creatinine | $9.80 | $14.00 | $5.12–$17.58 | 66% below | 30% |
| Creatinine blood test inpatient CPT 82565 Assay of creatinine | $9.80 | $14.00 | $5.12–$17.58 | — | 30% |
| Cytomegalovirus (CMV) antibody test CPT 86644 Donor cytomegalovirus ab | $312.20 | $446.00 | $14.39–$49.35 | 292% above | 30% |
| Cytomegalovirus (CMV) antibody test CPT 86644 Cmv antibody | $312.20 | $446.00 | $14.39–$49.35 | 292% above | 30% |
| Cytomegalovirus (CMV) antibody test inpatient CPT 86644 Donor cytomegalovirus ab | $312.20 | $446.00 | $14.39–$49.35 | — | 30% |
| Cytomegalovirus (CMV) antibody test inpatient CPT 86644 Cmv antibody | $312.20 | $446.00 | $14.39–$49.35 | — | 30% |
| D-dimer blood test (blood clot marker) CPT 85379 Fibrin degradation quant | $18.90 | $27.00 | $10.18–$34.90 | 85% below | 30% |
| D-dimer blood test (blood clot marker) CPT 85379 Fibrin degradation | $18.90 | $27.00 | $10.18–$34.90 | 85% below | 30% |
| D-dimer blood test (blood clot marker) inpatient CPT 85379 Fibrin degradation quant | $18.90 | $27.00 | $10.18–$34.90 | — | 30% |
| D-dimer blood test (blood clot marker) inpatient CPT 85379 Fibrin degradation | $18.90 | $27.00 | $10.18–$34.90 | — | 30% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 Dehydroepiandrosterone | $43.40 | $62.00 | $22.23–$76.25 | 70% below | 30% |
| DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 Dehydroepiandrosterone | $43.40 | $62.00 | $22.23–$76.25 | — | 30% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug monitoring panel 1 w/conf | $184.10 | $263.00 | $62.14–$199.53 | 61% above | 30% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug test prsmv chem anlyzr | $184.10 | $263.00 | $62.14–$199.53 | 61% above | 30% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug test prsmv chem anlyzr | $184.10 | $263.00 | $62.14–$199.53 | — | 30% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug monitoring panel 1 w/conf | $184.10 | $263.00 | $62.14–$199.53 | — | 30% |
| Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 Electrolyte panel | $14.70 | $21.00 | $7.01–$24.05 | 77% below | 30% |
| Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 Electrolyte panel | $14.70 | $21.00 | $7.01–$24.05 | — | 30% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 Ebv iga ab | $76.30 | $109.00 | $18.14–$62.23 | 6% below | 30% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 Epstein-barr capsid vca | $76.30 | $109.00 | $18.14–$62.23 | 6% below | 30% |
| Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 Epstein-barr capsid vca | $76.30 | $109.00 | $18.14–$62.23 | — | 30% |
| Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 Ebv iga ab | $76.30 | $109.00 | $18.14–$62.23 | — | 30% |
| Estradiol blood test CPT 82670 Estradiol free | $197.40 | $282.00 | $27.94–$95.80 | 54% above | 30% |
| Estradiol blood test CPT 82670 Assay of estradiol | $197.40 | $282.00 | $27.94–$95.80 | 54% above | 30% |
| Estradiol blood test inpatient CPT 82670 Assay of estradiol | $197.40 | $282.00 | $27.94–$95.80 | — | 30% |
| Estradiol blood test inpatient CPT 82670 Estradiol free | $197.40 | $282.00 | $27.94–$95.80 | — | 30% |
| FSH (follicle-stimulating hormone) test CPT 83001 Fsh and lh pediatrics | $44.80 | $64.00 | $18.58–$63.73 | 65% below | 30% |
| FSH (follicle-stimulating hormone) test CPT 83001 Assay of gonadotropin (fsh) | $44.80 | $64.00 | $18.58–$63.73 | 65% below | 30% |
| FSH (follicle-stimulating hormone) test inpatient CPT 83001 Assay of gonadotropin (fsh) | $44.80 | $64.00 | $18.58–$63.73 | — | 30% |
| FSH (follicle-stimulating hormone) test inpatient CPT 83001 Fsh and lh pediatrics | $44.80 | $64.00 | $18.58–$63.73 | — | 30% |
| Fecal calprotectin (stool inflammation test) CPT 83993 Calprotectin | $37.80 | $54.00 | $19.63–$67.33 | 79% below | 30% |
| Fecal calprotectin (stool inflammation test) CPT 83993 Assay for calprotectin fecal | $37.80 | $54.00 | $19.63–$67.33 | 79% below | 30% |
| Fecal calprotectin (stool inflammation test) inpatient CPT 83993 Calprotectin | $37.80 | $54.00 | $19.63–$67.33 | — | 30% |
| Fecal calprotectin (stool inflammation test) inpatient CPT 83993 Assay for calprotectin fecal | $37.80 | $54.00 | $19.63–$67.33 | — | 30% |
| Ferritin blood test (iron stores) CPT 82728 Assay of ferritin | $51.80 | $74.00 | $13.63–$46.75 | 35% below | 30% |
| Ferritin blood test (iron stores) CPT 82728 Thalessemia comp - cpt 82728 | $51.80 | $74.00 | $13.63–$46.75 | 35% below | 30% |
| Ferritin blood test (iron stores) inpatient CPT 82728 Assay of ferritin | $51.80 | $74.00 | $13.63–$46.75 | — | 30% |
| Ferritin blood test (iron stores) inpatient CPT 82728 Thalessemia comp - cpt 82728 | $51.80 | $74.00 | $13.63–$46.75 | — | 30% |
| Fibrinogen blood test CPT 85384 Fibrinogen activity | $18.90 | $27.00 | $9.72–$29.13 | 68% below | 30% |
| Fibrinogen blood test CPT 85384 Fibrinogen activity clauss | $18.90 | $27.00 | $9.72–$29.13 | 68% below | 30% |
| Fibrinogen blood test inpatient CPT 85384 Fibrinogen activity clauss | $18.90 | $27.00 | $9.72–$29.13 | — | 30% |
| Fibrinogen blood test inpatient CPT 85384 Fibrinogen activity | $18.90 | $27.00 | $9.72–$29.13 | — | 30% |
| Folate (folic acid) blood test CPT 82746 Vitamin b12 cobalamin | $30.80 | $44.00 | $14.70–$50.43 | 60% below | 30% |
| Folate (folic acid) blood test CPT 82746 Assay of folic acid serum | $30.80 | $44.00 | $14.70–$50.43 | 60% below | 30% |
| Folate (folic acid) blood test inpatient CPT 82746 Assay of folic acid serum | $30.80 | $44.00 | $14.70–$50.43 | — | 30% |
| Folate (folic acid) blood test inpatient CPT 82746 Vitamin b12 cobalamin | $30.80 | $44.00 | $14.70–$50.43 | — | 30% |
| Free T3 thyroid hormone test CPT 84481 T3 free tracer dialysis | $39.20 | $56.00 | $16.94–$58.10 | 70% below | 30% |
| Free T3 thyroid hormone test CPT 84481 Free assay (ft-3) | $39.20 | $56.00 | $16.94–$58.10 | 70% below | 30% |
| Free T3 thyroid hormone test inpatient CPT 84481 Free assay (ft-3) | $39.20 | $56.00 | $16.94–$58.10 | — | 30% |
| Free T3 thyroid hormone test inpatient CPT 84481 T3 free tracer dialysis | $39.20 | $56.00 | $16.94–$58.10 | — | 30% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 Assay of free thyroxine | $18.20 | $26.00 | $9.02–$30.93 | 78% below | 30% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 Free t4 | $18.20 | $26.00 | $9.02–$30.93 | 78% below | 30% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 Assay of free thyroxine | $18.20 | $26.00 | $9.02–$30.93 | — | 30% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 Free t4 | $18.20 | $26.00 | $9.02–$30.93 | — | 30% |
| Free testosterone test CPT 84402 Assay of free testosterone | $147.00 | $210.00 | $25.47–$87.35 | 76% above | 30% |
| Free testosterone test CPT 84402 Testosterone; free | $147.00 | $210.00 | $25.47–$87.35 | 76% above | 30% |
| Free testosterone test inpatient CPT 84402 Testosterone; free | $147.00 | $210.00 | $25.47–$87.35 | — | 30% |
| Free testosterone test inpatient CPT 84402 Assay of free testosterone | $147.00 | $210.00 | $25.47–$87.35 | — | 30% |
| Gamma-glutamyl transferase (GGT) blood test CPT 82977 Assay of ggt | $14.70 | $21.00 | $7.20–$24.70 | 55% below | 30% |
| Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 Assay of ggt | $14.70 | $21.00 | $7.20–$24.70 | — | 30% |
| General health panel: metabolic panel, blood count and TSH in one order CPT 80050 General health panel | $448.00 | $640.00 | $117.53–$156.16 | 46% above | 30% |
| General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 General health panel | $448.00 | $640.00 | $117.53–$156.16 | — | 30% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Gtt 2 hr ob - cpt 82950 | $46.20 | $66.00 | $4.62–$16.28 | 13% above | 30% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose test | $46.20 | $66.00 | $4.62–$16.28 | 13% above | 30% |
| Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Gtt 2 hr ob - cpt 82950 | $46.20 | $66.00 | $4.62–$16.28 | — | 30% |
| Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Glucose test | $46.20 | $66.00 | $4.62–$16.28 | — | 30% |
| Glucose tolerance test, 3 samples CPT 82951 Glucose tolerance test (gtt) | $24.50 | $35.00 | $12.51–$44.15 | 67% below | 30% |
| Glucose tolerance test, 3 samples CPT 82951 Tolerance test 3 sp-cpt 82951 | $24.50 | $35.00 | $12.51–$44.15 | 67% below | 30% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 Tolerance test 3 sp-cpt 82951 | $24.50 | $35.00 | $12.51–$44.15 | — | 30% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 Glucose tolerance test (gtt) | $24.50 | $35.00 | $12.51–$44.15 | — | 30% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 N.gonorrhoeae dna amp prob | $97.30 | $139.00 | $35.09–$120.35 | at median | 30% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Vaginal vaginitis panel-87591 | $97.30 | $139.00 | $35.09–$120.35 | at median | 30% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Vaginal vaginitis panel-87591 | $97.30 | $139.00 | $35.09–$120.35 | — | 30% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 N.gonorrhoeae dna amp prob | $97.30 | $139.00 | $35.09–$120.35 | — | 30% |
| H. pylori stool antigen test CPT 87338 Helicobacter pylori antigen | $26.60 | $38.00 | $14.38–$49.33 | 80% below | 30% |
| H. pylori stool antigen test CPT 87338 Hpylori stool ia | $26.60 | $38.00 | $14.38–$49.33 | 80% below | 30% |
| H. pylori stool antigen test inpatient CPT 87338 Helicobacter pylori antigen | $26.60 | $38.00 | $14.38–$49.33 | — | 30% |
| H. pylori stool antigen test inpatient CPT 87338 Hpylori stool ia | $26.60 | $38.00 | $14.38–$49.33 | — | 30% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 Hiv1-rna | $272.30 | $389.00 | $85.10–$291.83 | 23% below | 30% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 Hiv-1 quant&revrse trnscrpj | $272.30 | $389.00 | $85.10–$291.83 | 23% below | 30% |
| HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 Hiv-1 quant&revrse trnscrpj | $272.30 | $389.00 | $85.10–$291.83 | — | 30% |
| HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 Hiv1-rna | $272.30 | $389.00 | $85.10–$291.83 | — | 30% |
| HIV-1 and HIV-2 antibody test CPT 86703 Hiv-1/hiv-2 1 result antbdy | $96.60 | $138.00 | $13.71–$47.00 | 61% above | 30% |
| HIV-1 and HIV-2 antibody test CPT 86703 Donor hiv-1/2 plus | $96.60 | $138.00 | $13.71–$47.00 | 61% above | 30% |
| HIV-1 and HIV-2 antibody test inpatient CPT 86703 Hiv-1/hiv-2 1 result antbdy | $96.60 | $138.00 | $13.71–$47.00 | — | 30% |
| HIV-1 and HIV-2 antibody test inpatient CPT 86703 Donor hiv-1/2 plus | $96.60 | $138.00 | $13.71–$47.00 | — | 30% |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 Hpv high-risk types | $67.90 | $97.00 | $35.09–$120.35 | 35% below | 30% |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 Thinprep® imaging pap | $67.90 | $97.00 | $35.09–$120.35 | 35% below | 30% |
| HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 Hpv high-risk types | $67.90 | $97.00 | $35.09–$120.35 | — | 30% |
| HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 Thinprep® imaging pap | $67.90 | $97.00 | $35.09–$120.35 | — | 30% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Gfgh - a1c | $58.10 | $83.00 | $9.71–$33.30 | 11% below | 30% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Glycosylated hemoglobin test | $58.10 | $83.00 | $9.71–$33.30 | 11% below | 30% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Gfgh - a1c | $58.10 | $83.00 | $9.71–$33.30 | — | 30% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Glycosylated hemoglobin test | $58.10 | $83.00 | $9.71–$33.30 | — | 30% |
| Hemoglobin blood test CPT 85018 Thalessemia comp - cpt 85018 | $5.60 | $8.00 | $2.37–$8.13 | 70% below | 30% |
| Hemoglobin blood test CPT 85018 Hemoglobin | $5.60 | $8.00 | $2.37–$8.13 | 70% below | 30% |
| Hemoglobin blood test inpatient CPT 85018 Thalessemia comp - cpt 85018 | $5.60 | $8.00 | $2.37–$8.13 | — | 30% |
| Hemoglobin blood test inpatient CPT 85018 Hemoglobin | $5.60 | $8.00 | $2.37–$8.13 | — | 30% |
| Hepatitis B core antibody test (total) CPT 86704 Hep b core atibdy igg/igm | $109.20 | $156.00 | $12.05–$41.33 | 63% above | 30% |
| Hepatitis B core antibody test (total) CPT 86704 Hep b core antibody total | $109.20 | $156.00 | $12.05–$41.33 | 63% above | 30% |
| Hepatitis B core antibody test (total) inpatient CPT 86704 Hep b core antibody total | $109.20 | $156.00 | $12.05–$41.33 | — | 30% |
| Hepatitis B core antibody test (total) inpatient CPT 86704 Hep b core atibdy igg/igm | $109.20 | $156.00 | $12.05–$41.33 | — | 30% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hep b surface antibody | $60.90 | $87.00 | $10.74–$36.83 | 7% below | 30% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis panel general | $60.90 | $87.00 | $10.74–$36.83 | 7% below | 30% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hep b surface antibody | $60.90 | $87.00 | $10.74–$36.83 | — | 30% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hepatitis panel general | $60.90 | $87.00 | $10.74–$36.83 | — | 30% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 Hepatitis b surface ag ia | $60.90 | $87.00 | $10.33–$35.43 | at median | 30% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 Hepatitis panel general | $60.90 | $87.00 | $10.33–$35.43 | at median | 30% |
| Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hepatitis b surface ag ia | $60.90 | $87.00 | $10.33–$35.43 | — | 30% |
| Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hepatitis panel general | $60.90 | $87.00 | $10.33–$35.43 | — | 30% |
| Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis c ab test | $84.70 | $121.00 | $14.27–$48.93 | 15% below | 30% |
| Hepatitis C antibody blood test (screening) CPT 86803 G hep c ab | $84.70 | $121.00 | $14.27–$48.93 | 15% below | 30% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 Hepatitis c ab test | $84.70 | $121.00 | $14.27–$48.93 | — | 30% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 G hep c ab | $84.70 | $121.00 | $14.27–$48.93 | — | 30% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 Hepatitis c revrs trnscrpj | $79.10 | $113.00 | $42.84–$146.90 | 65% below | 30% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 Hep c viral rna w/ref-cpt87522 | $79.10 | $113.00 | $42.84–$146.90 | 65% below | 30% |
| Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Hep c viral rna w/ref-cpt87522 | $79.10 | $113.00 | $42.84–$146.90 | — | 30% |
| Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Hepatitis c revrs trnscrpj | $79.10 | $113.00 | $42.84–$146.90 | — | 30% |
| Herpes blood test, HSV-1 antibody CPT 86695 Herpes simplex type 1 test | $88.90 | $127.00 | $13.19–$45.23 | 75% above | 30% |
| Herpes blood test, HSV-1 antibody CPT 86695 Herpes simplex virus 1 and 2 | $88.90 | $127.00 | $13.19–$45.23 | 75% above | 30% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 Herpes simplex type 1 test | $88.90 | $127.00 | $13.19–$45.23 | — | 30% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 Herpes simplex virus 1 and 2 | $88.90 | $127.00 | $13.19–$45.23 | — | 30% |
| Herpes blood test, HSV-2 antibody CPT 86696 Herpes simplex virus 1 and 2 | $88.90 | $127.00 | $19.35–$66.38 | 22% above | 30% |
| Herpes blood test, HSV-2 antibody CPT 86696 Herpes simplex type 2 test | $88.90 | $127.00 | $19.35–$66.38 | 22% above | 30% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 Herpes simplex type 2 test | $88.90 | $127.00 | $19.35–$66.38 | — | 30% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 Herpes simplex virus 1 and 2 | $88.90 | $127.00 | $19.35–$66.38 | — | 30% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 G crp high sensitivity | $31.50 | $45.00 | $12.95–$44.40 | 57% below | 30% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 C-reactive protein hs | $31.50 | $45.00 | $12.95–$44.40 | 57% below | 30% |
| High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-reactive protein hs | $31.50 | $45.00 | $12.95–$44.40 | — | 30% |
| High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 G crp high sensitivity | $31.50 | $45.00 | $12.95–$44.40 | — | 30% |
| Homocysteine blood test CPT 83090 Assay of homocystine | $35.00 | $50.00 | $17.92–$57.85 | 73% below | 30% |
| Homocysteine blood test CPT 83090 G homocysteine | $35.00 | $50.00 | $17.92–$57.85 | 73% below | 30% |
| Homocysteine blood test inpatient CPT 83090 Assay of homocystine | $35.00 | $50.00 | $17.92–$57.85 | — | 30% |
| Homocysteine blood test inpatient CPT 83090 G homocysteine | $35.00 | $50.00 | $17.92–$57.85 | — | 30% |
| Insulin blood test CPT 83525 Insulin response to glucose 3 | $65.10 | $93.00 | $11.43–$39.20 | 9% below | 30% |
| Insulin blood test CPT 83525 Assay of insulin | $65.10 | $93.00 | $11.43–$39.20 | 9% below | 30% |
| Insulin blood test inpatient CPT 83525 Insulin response to glucose 3 | $65.10 | $93.00 | $11.43–$39.20 | — | 30% |
| Insulin blood test inpatient CPT 83525 Assay of insulin | $65.10 | $93.00 | $11.43–$39.20 | — | 30% |
| Iron blood test (serum iron) CPT 83540 Assay of iron | $163.10 | $233.00 | $6.47–$22.20 | 240% above | 30% |
| Iron blood test (serum iron) CPT 83540 Ironliver tissue | $163.10 | $233.00 | $6.47–$22.20 | 240% above | 30% |
| Iron blood test (serum iron) inpatient CPT 83540 Ironliver tissue | $163.10 | $233.00 | $6.47–$22.20 | — | 30% |
| Iron blood test (serum iron) inpatient CPT 83540 Assay of iron | $163.10 | $233.00 | $6.47–$22.20 | — | 30% |
| Iron-binding capacity (TIBC) test CPT 83550 Iron binding test | $17.50 | $25.00 | $8.74–$29.98 | 60% below | 30% |
| Iron-binding capacity (TIBC) test inpatient CPT 83550 Iron binding test | $17.50 | $25.00 | $8.74–$29.98 | — | 30% |
| Kidney function blood test panel CPT 80069 Renal function panel | $17.50 | $25.00 | $8.68–$29.78 | 83% below | 30% |
| Kidney function blood test panel inpatient CPT 80069 Renal function panel | $17.50 | $25.00 | $8.68–$29.78 | — | 30% |
| LH (luteinizing hormone) test CPT 83002 Fsh and lh pediatrics | $44.80 | $64.00 | $18.52–$63.50 | 68% below | 30% |
| LH (luteinizing hormone) test CPT 83002 Assay of gonadotropin (lh) | $44.80 | $64.00 | $18.52–$63.50 | 68% below | 30% |
| LH (luteinizing hormone) test inpatient CPT 83002 Assay of gonadotropin (lh) | $44.80 | $64.00 | $18.52–$63.50 | — | 30% |
| LH (luteinizing hormone) test inpatient CPT 83002 Fsh and lh pediatrics | $44.80 | $64.00 | $18.52–$63.50 | — | 30% |
| Lactate (lactic acid) blood test CPT 83605 Assay of lactic acid | $26.60 | $38.00 | $11.57–$36.63 | 70% below | 30% |
| Lactate (lactic acid) blood test CPT 83605 D-lactate plasma | $26.60 | $38.00 | $11.57–$36.63 | 70% below | 30% |
| Lactate (lactic acid) blood test inpatient CPT 83605 D-lactate plasma | $26.60 | $38.00 | $11.57–$36.63 | — | 30% |
| Lactate (lactic acid) blood test inpatient CPT 83605 Assay of lactic acid | $26.60 | $38.00 | $11.57–$36.63 | — | 30% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 Lactate (ld) (ldh) enzyme | $44.10 | $63.00 | $6.04–$20.70 | 3% above | 30% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 Ldh peritoneal fluid | $44.10 | $63.00 | $6.04–$20.70 | 3% above | 30% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Lactate (ld) (ldh) enzyme | $44.10 | $63.00 | $6.04–$20.70 | — | 30% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Ldh peritoneal fluid | $44.10 | $63.00 | $6.04–$20.70 | — | 30% |
| Lipase blood test (pancreas enzyme) CPT 83690 Assay of lipase | $72.80 | $104.00 | $6.89–$23.63 | 18% below | 30% |
| Lipase blood test (pancreas enzyme) CPT 83690 Lipase jp drainage | $72.80 | $104.00 | $6.89–$23.63 | 18% below | 30% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 Assay of lipase | $72.80 | $104.00 | $6.89–$23.63 | — | 30% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase jp drainage | $72.80 | $104.00 | $6.89–$23.63 | — | 30% |
| Liver function blood test panel CPT 80076 Hepatic function panel | $16.10 | $23.00 | $8.17–$28.03 | 83% below | 30% |
| Liver function blood test panel inpatient CPT 80076 Hepatic function panel | $16.10 | $23.00 | $8.17–$28.03 | — | 30% |
| Lyme disease antibody test CPT 86618 Lyme disease antibody | $102.20 | $146.00 | $17.03–$58.40 | 17% below | 30% |
| Lyme disease antibody test CPT 86618 Lyme panel | $102.20 | $146.00 | $17.03–$58.40 | 17% below | 30% |
| Lyme disease antibody test inpatient CPT 86618 Lyme panel | $102.20 | $146.00 | $17.03–$58.40 | — | 30% |
| Lyme disease antibody test inpatient CPT 86618 Lyme disease antibody | $102.20 | $146.00 | $17.03–$58.40 | — | 30% |
| Magnesium blood test CPT 83735 Assay of magnesium | $72.80 | $104.00 | $6.70–$22.98 | 53% above | 30% |
| Magnesium blood test inpatient CPT 83735 Assay of magnesium | $72.80 | $104.00 | $6.70–$22.98 | — | 30% |
| Measles (rubeola) antibody test CPT 86765 Measles antibody igm | $24.50 | $35.00 | $12.88–$44.18 | 69% below | 30% |
| Measles (rubeola) antibody test CPT 86765 Rubeola antibody | $24.50 | $35.00 | $12.88–$44.18 | 69% below | 30% |
| Measles (rubeola) antibody test inpatient CPT 86765 Rubeola antibody | $24.50 | $35.00 | $12.88–$44.18 | — | 30% |
| Measles (rubeola) antibody test inpatient CPT 86765 Measles antibody igm | $24.50 | $35.00 | $12.88–$44.18 | — | 30% |
| Mono test (heterophile antibody, Monospot) CPT 86308 Heterophile antibody screen | $11.90 | $17.00 | $5.18–$17.75 | 85% below | 30% |
| Mono test (heterophile antibody, Monospot) CPT 86308 Heterophile antibodies | $11.90 | $17.00 | $5.18–$17.75 | 85% below | 30% |
| Mono test (heterophile antibody, Monospot) inpatient CPT 86308 Heterophile antibodies | $11.90 | $17.00 | $5.18–$17.75 | — | 30% |
| Mono test (heterophile antibody, Monospot) inpatient CPT 86308 Heterophile antibody screen | $11.90 | $17.00 | $5.18–$17.75 | — | 30% |
| Mumps immunity blood test CPT 86735 Mumps igm | $41.30 | $59.00 | $13.05–$44.75 | 46% below | 30% |
| Mumps immunity blood test CPT 86735 Mumps antibody | $41.30 | $59.00 | $13.05–$44.75 | 46% below | 30% |
| Mumps immunity blood test inpatient CPT 86735 Mumps igm | $41.30 | $59.00 | $13.05–$44.75 | — | 30% |
| Mumps immunity blood test inpatient CPT 86735 Mumps antibody | $41.30 | $59.00 | $13.05–$44.75 | — | 30% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 Psa free & total - cpt 84154 | $72.80 | $104.00 | $18.39–$63.08 | 5% above | 30% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 Assay of psa free | $72.80 | $104.00 | $18.39–$63.08 | 5% above | 30% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 Assay of psa free | $72.80 | $104.00 | $18.39–$63.08 | — | 30% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 Psa free & total - cpt 84154 | $72.80 | $104.00 | $18.39–$63.08 | — | 30% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Gfgh - psa | $91.00 | $130.00 | $18.39–$63.08 | 14% above | 30% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Assay of psa total | $91.00 | $130.00 | $18.39–$63.08 | 14% above | 30% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Assay of psa total | $91.00 | $130.00 | $18.39–$63.08 | — | 30% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Gfgh - psa | $91.00 | $130.00 | $18.39–$63.08 | — | 30% |
| Pap test (liquid-based, automated screening with review) CPT 88175 Cytopath c/v auto fluid redo | $51.10 | $73.00 | $26.61–$90.85 | 38% below | 30% |
| Pap test (liquid-based, automated screening with review) CPT 88175 Thinprep® imaging pap | $51.10 | $73.00 | $26.61–$90.85 | 38% below | 30% |
| Pap test (liquid-based, automated screening with review) inpatient CPT 88175 Thinprep® imaging pap | $51.10 | $73.00 | $26.61–$90.85 | — | 30% |
| Pap test (liquid-based, automated screening with review) inpatient CPT 88175 Cytopath c/v auto fluid redo | $51.10 | $73.00 | $26.61–$90.85 | — | 30% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 Cytopath c/v thin layer | $39.90 | $57.00 | $20.26–$69.48 | 43% below | 30% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 Thin prep pap | $39.90 | $57.00 | $20.26–$69.48 | 43% below | 30% |
| Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 Cytopath c/v thin layer | $39.90 | $57.00 | $20.26–$69.48 | — | 30% |
| Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 Thin prep pap | $39.90 | $57.00 | $20.26–$69.48 | — | 30% |
| Parathyroid hormone (PTH) blood test CPT 83970 Assay of parathormone | $163.80 | $234.00 | $41.28–$141.55 | 15% below | 30% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 Assay of parathormone | $163.80 | $234.00 | $41.28–$141.55 | — | 30% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Antiphospholipid syndrome | $150.50 | $215.00 | $6.01–$20.60 | 201% above | 30% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Thromboplastin time partial | $150.50 | $215.00 | $6.01–$20.60 | 201% above | 30% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Antiphospholipid syndrome | $150.50 | $215.00 | $6.01–$20.60 | — | 30% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Thromboplastin time partial | $150.50 | $215.00 | $6.01–$20.60 | — | 30% |
| Phosphorus (phosphate) blood test CPT 84100 Assay of phosphorus | $9.10 | $13.00 | $4.74–$16.25 | 68% below | 30% |
| Phosphorus (phosphate) blood test inpatient CPT 84100 Assay of phosphorus | $9.10 | $13.00 | $4.74–$16.25 | — | 30% |
| Potassium blood test CPT 84132 Assay of serum potassium | $9.10 | $13.00 | $4.76–$15.78 | 68% below | 30% |
| Potassium blood test inpatient CPT 84132 Assay of serum potassium | $9.10 | $13.00 | $4.76–$15.78 | — | 30% |
| Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 Fetal chrmoml aneuploidy | $1,712.90 | $2,447.00 | $737.57–$2,005.83 | 101% above | 30% |
| Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 Qnatal advanced panel | $1,712.90 | $2,447.00 | $737.57–$2,005.83 | 101% above | 30% |
| Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 Fetal chrmoml aneuploidy | $1,712.90 | $2,447.00 | $737.57–$2,005.83 | — | 30% |
| Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 Qnatal advanced panel | $1,712.90 | $2,447.00 | $737.57–$2,005.83 | — | 30% |
| Progesterone blood test CPT 84144 Progesterone lc/ms | $41.30 | $59.00 | $20.86–$71.55 | 70% below | 30% |
| Progesterone blood test CPT 84144 Assay of progesterone | $41.30 | $59.00 | $20.86–$71.55 | 70% below | 30% |
| Progesterone blood test inpatient CPT 84144 Assay of progesterone | $41.30 | $59.00 | $20.86–$71.55 | — | 30% |
| Progesterone blood test inpatient CPT 84144 Progesterone lc/ms | $41.30 | $59.00 | $20.86–$71.55 | — | 30% |
| Prolactin blood test CPT 84146 Prolactin pituitary macroaden | $155.40 | $222.00 | $19.38–$66.45 | 54% above | 30% |
| Prolactin blood test CPT 84146 Assay of prolactin | $155.40 | $222.00 | $19.38–$66.45 | 54% above | 30% |
| Prolactin blood test inpatient CPT 84146 Assay of prolactin | $155.40 | $222.00 | $19.38–$66.45 | — | 30% |
| Prolactin blood test inpatient CPT 84146 Prolactin pituitary macroaden | $155.40 | $222.00 | $19.38–$66.45 | — | 30% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin time | $8.40 | $12.00 | $4.29–$13.48 | 68% below | 30% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin time | $8.40 | $12.00 | $4.29–$13.48 | — | 30% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 Drug screen com w/con-cpt80305 | $60.20 | $86.00 | $12.60–$37.40 | 40% below | 30% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 Drug test prsmv dir opt obs | $60.20 | $86.00 | $12.60–$37.40 | 40% below | 30% |
| Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 Drug test prsmv dir opt obs | $60.20 | $86.00 | $12.60–$37.40 | — | 30% |
| Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 Drug screen com w/con-cpt80305 | $60.20 | $86.00 | $12.60–$37.40 | — | 30% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 Streptococcus screen drt | $77.70 | $111.00 | $16.53–$41.10 | at median | 30% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 Strep a assay w/optic | $77.70 | $111.00 | $16.53–$41.10 | at median | 30% |
| Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 Strep a assay w/optic | $77.70 | $111.00 | $16.53–$41.10 | — | 30% |
| Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 Streptococcus screen drt | $77.70 | $111.00 | $16.53–$41.10 | — | 30% |
| Renin blood test CPT 84244 Assay of renin | $42.70 | $61.00 | $21.99–$75.43 | 62% below | 30% |
| Renin blood test inpatient CPT 84244 Assay of renin | $42.70 | $61.00 | $21.99–$75.43 | — | 30% |
| Rh blood typing CPT 86901 Blood typing rh (d) | $51.80 | $74.00 | $10.25–$128.35 | 34% above | 30% |
| Rh blood typing CPT 86901 Blood typing serologic rh(d) | $51.80 | $74.00 | $10.25–$128.35 | 34% above | 30% |
| Rh blood typing inpatient CPT 86901 Blood typing serologic rh(d) | $51.80 | $74.00 | $10.25–$128.35 | — | 30% |
| Rh blood typing inpatient CPT 86901 Blood typing rh (d) | $51.80 | $74.00 | $10.25–$128.35 | — | 30% |
| Rheumatoid factor (RF) test CPT 86431 Rheumatoid arthritis panel | $98.70 | $141.00 | $5.67–$19.45 | 102% above | 30% |
| Rheumatoid factor (RF) test CPT 86431 Rheumatoid factor quant | $98.70 | $141.00 | $5.67–$19.45 | 102% above | 30% |
| Rheumatoid factor (RF) test inpatient CPT 86431 Rheumatoid arthritis panel | $98.70 | $141.00 | $5.67–$19.45 | — | 30% |
| Rheumatoid factor (RF) test inpatient CPT 86431 Rheumatoid factor quant | $98.70 | $141.00 | $5.67–$19.45 | — | 30% |
| Rubella antibody test (immunity check) CPT 86762 Rubella antibody | $27.30 | $39.00 | $14.39–$49.35 | 59% below | 30% |
| Rubella antibody test (immunity check) inpatient CPT 86762 Rubella antibody | $27.30 | $39.00 | $14.39–$49.35 | — | 30% |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 Rbc sed rate automated | $6.30 | $9.00 | $2.70–$9.25 | 84% below | 30% |
| Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 Rbc sed rate automated | $6.30 | $9.00 | $2.70–$9.25 | — | 30% |
| Sodium blood test CPT 84295 Assay of serum sodium | $9.10 | $13.00 | $4.81–$16.50 | 75% below | 30% |
| Sodium blood test inpatient CPT 84295 Assay of serum sodium | $9.10 | $13.00 | $4.81–$16.50 | — | 30% |
| Stool ova and parasites exam CPT 87177 Ova and parasites with giardia | $53.90 | $77.00 | $8.90–$30.53 | 11% above | 30% |
| Stool ova and parasites exam CPT 87177 Ova and parasites smears | $53.90 | $77.00 | $8.90–$30.53 | 11% above | 30% |
| Stool ova and parasites exam inpatient CPT 87177 Ova and parasites with giardia | $53.90 | $77.00 | $8.90–$30.53 | — | 30% |
| Stool ova and parasites exam inpatient CPT 87177 Ova and parasites smears | $53.90 | $77.00 | $8.90–$30.53 | — | 30% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 Immunochem fecal occult blood | $99.40 | $142.00 | $4.26–$11.15 | 176% above | 30% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 Occult blood feces | $99.40 | $142.00 | $4.26–$11.15 | 176% above | 30% |
| Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Immunochem fecal occult blood | $99.40 | $142.00 | $4.26–$11.15 | — | 30% |
| Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Occult blood feces | $99.40 | $142.00 | $4.26–$11.15 | — | 30% |
| Stool test for hidden blood by immunoassay (FIT) CPT 82274 Assay test for blood fecal | $30.80 | $44.00 | $15.92–$54.55 | 41% below | 30% |
| Stool test for hidden blood by immunoassay (FIT) CPT 82274 Ifobt fecal occult blood | $30.80 | $44.00 | $15.92–$54.55 | 41% below | 30% |
| Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 Ifobt fecal occult blood | $30.80 | $44.00 | $15.92–$54.55 | — | 30% |
| Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 Assay test for blood fecal | $30.80 | $44.00 | $15.92–$54.55 | — | 30% |
| Syphilis antibody test (Treponema pallidum) CPT 86780 Treponema pallidum | $65.10 | $93.00 | $12.87–$45.40 | 4% below | 30% |
| Syphilis antibody test (Treponema pallidum) CPT 86780 Treponema pallidum antibody pa | $65.10 | $93.00 | $12.87–$45.40 | 4% below | 30% |
| Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 Treponema pallidum | $65.10 | $93.00 | $12.87–$45.40 | — | 30% |
| Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 Treponema pallidum antibody pa | $65.10 | $93.00 | $12.87–$45.40 | — | 30% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Treponema pallidum confm | $9.80 | $14.00 | $4.15–$14.65 | 76% below | 30% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Syphilis test non-trep qual | $9.80 | $14.00 | $4.15–$14.65 | 76% below | 30% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Syphilis test non-trep qual | $9.80 | $14.00 | $4.15–$14.65 | — | 30% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Treponema pallidum confm | $9.80 | $14.00 | $4.15–$14.65 | — | 30% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Quantiferon tb gold | $104.30 | $149.00 | $61.98–$212.55 | 30% below | 30% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Tb test cell immun measure | $104.30 | $149.00 | $61.98–$212.55 | 30% below | 30% |
| TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 Quantiferon tb gold | $104.30 | $149.00 | $61.98–$212.55 | — | 30% |
| TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 Tb test cell immun measure | $104.30 | $149.00 | $61.98–$212.55 | — | 30% |
| Testosterone blood test, total (not free testosterone) CPT 84403 Testos free tot bil-cpt 84403 | $79.80 | $114.00 | $25.81–$88.53 | 33% below | 30% |
| Testosterone blood test, total (not free testosterone) CPT 84403 Assay of total testosterone | $79.80 | $114.00 | $25.81–$88.53 | 33% below | 30% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Assay of total testosterone | $79.80 | $114.00 | $25.81–$88.53 | — | 30% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testos free tot bil-cpt 84403 | $79.80 | $114.00 | $25.81–$88.53 | — | 30% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroid perox & glob ab | $96.60 | $138.00 | $14.55–$49.90 | 4% above | 30% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 Microsomal antibody each | $96.60 | $138.00 | $14.55–$49.90 | 4% above | 30% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Thyroid perox & glob ab | $96.60 | $138.00 | $14.55–$49.90 | — | 30% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Microsomal antibody each | $96.60 | $138.00 | $14.55–$49.90 | — | 30% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Gfgh - tsh | $93.80 | $134.00 | $16.80–$57.63 | 15% above | 30% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Assay thyroid stim hormone | $93.80 | $134.00 | $16.80–$57.63 | 15% above | 30% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Gfgh - tsh | $93.80 | $134.00 | $16.80–$57.63 | — | 30% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Assay thyroid stim hormone | $93.80 | $134.00 | $16.80–$57.63 | — | 30% |
| Total IgE blood test CPT 82785 Allergy-mold profile plus ige | $104.30 | $149.00 | $16.46–$56.45 | 39% above | 30% |
| Total IgE blood test CPT 82785 Assay of ige | $104.30 | $149.00 | $16.46–$56.45 | 39% above | 30% |
| Total IgE blood test inpatient CPT 82785 Allergy-mold profile plus ige | $104.30 | $149.00 | $16.46–$56.45 | — | 30% |
| Total IgE blood test inpatient CPT 82785 Assay of ige | $104.30 | $149.00 | $16.46–$56.45 | — | 30% |
| Total cholesterol blood test CPT 82465 Assay bld/serum cholesterol | $16.80 | $24.00 | $4.23–$14.93 | 45% below | 30% |
| Total cholesterol blood test CPT 82465 Cardio iq ascvd pnl-cpt 82465 | $16.80 | $24.00 | $4.23–$14.93 | 45% below | 30% |
| Total cholesterol blood test inpatient CPT 82465 Assay bld/serum cholesterol | $16.80 | $24.00 | $4.23–$14.93 | — | 30% |
| Total cholesterol blood test inpatient CPT 82465 Cardio iq ascvd pnl-cpt 82465 | $16.80 | $24.00 | $4.23–$14.93 | — | 30% |
| Total thyroxine (T4) blood test CPT 84436 Thyroid panel - cpt 84436 | $21.70 | $31.00 | $6.87–$23.55 | 54% below | 30% |
| Total thyroxine (T4) blood test CPT 84436 Assay of total thyroxine | $21.70 | $31.00 | $6.87–$23.55 | 54% below | 30% |
| Total thyroxine (T4) blood test inpatient CPT 84436 Assay of total thyroxine | $21.70 | $31.00 | $6.87–$23.55 | — | 30% |
| Total thyroxine (T4) blood test inpatient CPT 84436 Thyroid panel - cpt 84436 | $21.70 | $31.00 | $6.87–$23.55 | — | 30% |
| Total triiodothyronine (T3) blood test CPT 84480 T3 free tracer dialysis | $39.20 | $56.00 | $14.18–$48.63 | 68% below | 30% |
| Total triiodothyronine (T3) blood test CPT 84480 Assay triiodothyronine (t3) | $39.20 | $56.00 | $14.18–$48.63 | 68% below | 30% |
| Total triiodothyronine (T3) blood test inpatient CPT 84480 Assay triiodothyronine (t3) | $39.20 | $56.00 | $14.18–$48.63 | — | 30% |
| Total triiodothyronine (T3) blood test inpatient CPT 84480 T3 free tracer dialysis | $39.20 | $56.00 | $14.18–$48.63 | — | 30% |
| Transferrin blood test CPT 84466 Assay of transferrin | $24.50 | $35.00 | $12.76–$43.78 | 71% below | 30% |
| Transferrin blood test inpatient CPT 84466 Assay of transferrin | $24.50 | $35.00 | $12.76–$43.78 | — | 30% |
| Trichomonas test (NAAT) CPT 87661 Vaginal vaginitis panel-87661 | $97.30 | $139.00 | $35.09–$120.35 | 3% above | 30% |
| Trichomonas test (NAAT) CPT 87661 Trichomonas vaginalis amplif | $97.30 | $139.00 | $35.09–$120.35 | 3% above | 30% |
| Trichomonas test (NAAT) inpatient CPT 87661 Trichomonas vaginalis amplif | $97.30 | $139.00 | $35.09–$120.35 | — | 30% |
| Trichomonas test (NAAT) inpatient CPT 87661 Vaginal vaginitis panel-87661 | $97.30 | $139.00 | $35.09–$120.35 | — | 30% |
| Triglycerides blood test CPT 84478 Trig peritoneal fluid | $22.40 | $32.00 | $5.58–$19.70 | 37% below | 30% |
| Triglycerides blood test CPT 84478 Assay of triglycerides | $22.40 | $32.00 | $5.58–$19.70 | 37% below | 30% |
| Triglycerides blood test inpatient CPT 84478 Assay of triglycerides | $22.40 | $32.00 | $5.58–$19.70 | — | 30% |
| Triglycerides blood test inpatient CPT 84478 Trig peritoneal fluid | $22.40 | $32.00 | $5.58–$19.70 | — | 30% |
| Troponin test, quantitative CPT 84484 High sensitivity troponin | $63.70 | $91.00 | $12.47–$33.75 | 47% below | 30% |
| Troponin test, quantitative CPT 84484 Assay of troponin quant | $63.70 | $91.00 | $12.47–$33.75 | 47% below | 30% |
| Troponin test, quantitative inpatient CPT 84484 Assay of troponin quant | $63.70 | $91.00 | $12.47–$33.75 | — | 30% |
| Troponin test, quantitative inpatient CPT 84484 High sensitivity troponin | $63.70 | $91.00 | $12.47–$33.75 | — | 30% |
| Uric acid blood test CPT 84550 Assay of blood/uric acid | $8.40 | $12.00 | $4.52–$15.50 | 82% below | 30% |
| Uric acid blood test inpatient CPT 84550 Assay of blood/uric acid | $8.40 | $12.00 | $4.52–$15.50 | — | 30% |
| Urinalysis with microscope exam, automated CPT 81001 Q urinalysis | $4.99 | $7.13 | $3.17–$10.88 | 88% below | 30% |
| Urinalysis with microscope exam, automated CPT 81001 Urinalysis auto w/scope | $4.99 | $7.13 | $3.17–$10.88 | 88% below | 30% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 Urinalysis auto w/scope | $4.99 | $7.13 | $3.17–$10.88 | — | 30% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 Q urinalysis | $4.99 | $7.13 | $3.17–$10.88 | — | 30% |
| Urinalysis without microscope exam, automated CPT 81003 Glucose qualitative urine | $11.20 | $16.00 | $2.25–$7.70 | 54% below | 30% |
| Urinalysis without microscope exam, automated CPT 81003 Urinalysis auto w/o scope | $11.20 | $16.00 | $2.25–$7.70 | 54% below | 30% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis auto w/o scope | $11.20 | $16.00 | $2.25–$7.70 | — | 30% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Glucose qualitative urine | $11.20 | $16.00 | $2.25–$7.70 | — | 30% |
| Urinalysis without microscope exam, manual CPT 81002 Urine dipstick | $39.90 | $57.00 | $3.48–$8.75 | 156% above | 30% |
| Urinalysis without microscope exam, manual CPT 81002 Urinalysis nonauto w/o scope | $39.90 | $57.00 | $3.48–$8.75 | 156% above | 30% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Urinalysis nonauto w/o scope | $39.90 | $57.00 | $3.48–$8.75 | — | 30% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Urine dipstick | $39.90 | $57.00 | $3.48–$8.75 | — | 30% |
| Urine culture for bacteria, with colony count CPT 87086 Culture urine routine | $15.40 | $22.00 | $8.07–$27.68 | 65% below | 30% |
| Urine culture for bacteria, with colony count CPT 87086 Urine culture/colony count | $15.40 | $22.00 | $8.07–$27.68 | 65% below | 30% |
| Urine culture for bacteria, with colony count inpatient CPT 87086 Urine culture/colony count | $15.40 | $22.00 | $8.07–$27.68 | — | 30% |
| Urine culture for bacteria, with colony count inpatient CPT 87086 Culture urine routine | $15.40 | $22.00 | $8.07–$27.68 | — | 30% |
| Urine microalbumin (albumin) test CPT 82043 Microalbuminquantitative | $14.00 | $20.00 | $5.78–$19.83 | 60% below | 30% |
| Urine microalbumin (albumin) test CPT 82043 Ur albumin quantitative | $14.00 | $20.00 | $5.78–$19.83 | 60% below | 30% |
| Urine microalbumin (albumin) test inpatient CPT 82043 Ur albumin quantitative | $14.00 | $20.00 | $5.78–$19.83 | — | 30% |
| Urine microalbumin (albumin) test inpatient CPT 82043 Microalbuminquantitative | $14.00 | $20.00 | $5.78–$19.83 | — | 30% |
| Urine pregnancy test, read by color change CPT 81025 Bedside ucg | $66.50 | $95.00 | $8.61–$21.68 | 24% above | 30% |
| Urine pregnancy test, read by color change CPT 81025 Urine pregnancy test | $66.50 | $95.00 | $8.61–$21.68 | 24% above | 30% |
| Urine pregnancy test, read by color change inpatient CPT 81025 Bedside ucg | $66.50 | $95.00 | $8.61–$21.68 | — | 30% |
| Urine pregnancy test, read by color change inpatient CPT 81025 Urine pregnancy test | $66.50 | $95.00 | $8.61–$21.68 | — | 30% |
| Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin b-12 | $30.80 | $44.00 | $15.08–$51.70 | 58% below | 30% |
| Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin b12 cobalamin | $30.80 | $44.00 | $15.08–$51.70 | 58% below | 30% |
| Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Vitamin b-12 | $30.80 | $44.00 | $15.08–$51.70 | — | 30% |
| Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Vitamin b12 cobalamin | $30.80 | $44.00 | $15.08–$51.70 | — | 30% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin d125 | $144.90 | $207.00 | $29.60–$101.53 | 8% above | 30% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin d 25 hydroxy | $144.90 | $207.00 | $29.60–$101.53 | 8% above | 30% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin d125 | $144.90 | $207.00 | $29.60–$101.53 | — | 30% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin d 25 hydroxy | $144.90 | $207.00 | $29.60–$101.53 | — | 30% |
| Zinc blood test CPT 84630 Assay of zinc | $21.70 | $31.00 | $11.39–$39.05 | 74% below | 30% |
| Zinc blood test inpatient CPT 84630 Assay of zinc | $21.70 | $31.00 | $11.39–$39.05 | — | 30% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Bhcg male | $28.70 | $41.00 | $15.05–$51.63 | 64% below | 30% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Chorionic gonadotropin test | $28.70 | $41.00 | $15.05–$51.63 | 64% below | 30% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Bhcg male | $28.70 | $41.00 | $15.05–$51.63 | — | 30% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Chorionic gonadotropin test | $28.70 | $41.00 | $15.05–$51.63 | — | 30% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Indiana | Off list |
|---|---|---|---|---|---|
| Appendectomy for a ruptured appendix with abscess or peritonitis inpatient CPT 44960 Appendectomy | $43,733.80 | $62,476.86 | $15,244.35–$49,481.67 | — | 30% |
| Appendectomy, open surgery inpatient CPT 44950 Appendectomy | $43,733.80 | $62,476.86 | $6,426.86–$49,481.67 | — | 30% |
| Arthroscopic ACL reconstruction or repair of the knee CPT 29888 Knee arthroscopy/surgery | $28,647.70 | $40,925.28 | $7,203.58–$32,412.82 | 44% above | 30% |
| Arthroscopic ACL reconstruction or repair of the knee one side CPT 29888 Knee arthroscopy/surgery | $26,630.14 | $38,043.05 | $7,203.58–$30,130.10 | 34% above | 30% |
| Arthroscopic ACL reconstruction or repair of the knee one side CPT 29888 Knee arthroscopy/surgery | $32,096.16 | $45,851.66 | $7,203.58–$36,314.51 | 62% above | 30% |
| Arthroscopic ACL reconstruction or repair of the knee inpatient CPT 29888 Knee arthroscopy/surgery | $28,647.70 | $40,925.28 | $7,203.58–$32,412.82 | — | 30% |
| Arthroscopic ACL reconstruction or repair of the knee inpatient one side CPT 29888 Knee arthroscopy/surgery | $26,630.14 | $38,043.05 | $7,203.58–$30,130.10 | — | 30% |
| Arthroscopic ACL reconstruction or repair of the knee inpatient one side CPT 29888 Knee arthroscopy/surgery | $32,096.16 | $45,851.66 | $7,203.58–$36,314.51 | — | 30% |
| Arthroscopic rotator cuff repair of the shoulder CPT 29827 Arthroscop rotator cuff repr | $28,758.38 | $41,083.40 | $7,203.58–$32,538.05 | 70% above | 30% |
| Arthroscopic rotator cuff repair of the shoulder one side CPT 29827 Arthroscop rotator cuff repr | $28,644.08 | $40,920.11 | $7,203.58–$32,408.73 | 69% above | 30% |
| Arthroscopic rotator cuff repair of the shoulder one side CPT 29827 Arthroscop rotator cuff repr | $28,758.38 | $41,083.40 | $7,203.58–$32,538.05 | 70% above | 30% |
| Arthroscopic rotator cuff repair of the shoulder inpatient CPT 29827 Arthroscop rotator cuff repr | $28,758.38 | $41,083.40 | $7,203.58–$32,538.05 | — | 30% |
| Arthroscopic rotator cuff repair of the shoulder inpatient one side CPT 29827 Arthroscop rotator cuff repr | $28,644.08 | $40,920.11 | $7,203.58–$32,408.73 | — | 30% |
| Arthroscopic rotator cuff repair of the shoulder inpatient one side CPT 29827 Arthroscop rotator cuff repr | $28,758.38 | $41,083.40 | $7,203.58–$32,538.05 | — | 30% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 Bx breast 1st lesion strtctc | $5,853.14 | $8,361.63 | $1,639.62–$6,622.41 | 134% above | 30% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 Bx breast 1st lesion strtctc | $5,761.00 | $8,230.00 | $1,639.62–$6,518.16 | 130% above | 30% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 Bx breast 1st lesion strtctc | $5,967.69 | $8,525.27 | $1,639.62–$6,752.01 | 138% above | 30% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 Bx breast 1st lesion strtctc | $18,920.80 | $27,029.71 | $1,639.62–$21,407.53 | — | 30% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient one side CPT 19081 Bx breast 1st lesion strtctc | $5,761.00 | $8,230.00 | $1,639.62–$6,518.16 | — | 30% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient one side CPT 19081 Bx breast 1st lesion strtctc | $5,967.69 | $8,525.27 | $1,639.62–$6,752.01 | — | 30% |
| Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 Treatment of ankle fracture | $529.90 | $757.00 | $184.71–$599.54 | 35% above | 30% |
| Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 Treatment of ankle fracture | $529.90 | $757.00 | $184.71–$599.54 | — | 30% |
| Broken foot (metatarsal) treatment without surgery or setting CPT 28470 Treat metatarsal fracture | $529.90 | $757.00 | $184.71–$599.54 | 21% above | 30% |
| Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 Treat metatarsal fracture | $529.90 | $757.00 | $184.71–$599.54 | — | 30% |
| Bunion correction with a bone cut near the head of the first metatarsal inpatient CPT 28296 Correction hallux valgus | $71,564.49 | $102,234.99 | $3,248.27–$80,970.11 | — | 30% |
| Bunion correction with removal of part of the big toe joint inpatient CPT 28292 Correction hallux valgus | $71,564.49 | $102,234.99 | $3,248.27–$80,970.11 | — | 30% |
| Cardiac catheterization with coronary angiogram CPT 93458 Lhc w/lv & nat cor arteries | $14,387.10 | $20,553.00 | $3,218.42–$16,277.98 | 46% above | 30% |
| Cardiac catheterization with coronary angiogram CPT 93458 L hrt artery/ventricle angio | $14,387.10 | $20,553.00 | $3,218.42–$16,277.98 | 46% above | 30% |
| Cardiac catheterization with coronary angiogram inpatient CPT 93458 Lhc w/lv & nat cor arteries | $14,387.10 | $20,553.00 | $3,218.42–$16,277.98 | — | 30% |
| Cardiac catheterization with coronary angiogram inpatient CPT 93458 L hrt artery/ventricle angio | $14,387.10 | $20,553.00 | $3,218.42–$16,277.98 | — | 30% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion electiveexte | $3,728.90 | $5,327.00 | $656.15–$4,218.98 | 166% above | 30% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion electric ext | $3,728.90 | $5,327.00 | $656.15–$4,218.98 | 166% above | 30% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Cardioversion electric ext | $3,728.90 | $5,327.00 | $656.15–$4,218.98 | — | 30% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Cardioversion electiveexte | $3,728.90 | $5,327.00 | $656.15–$4,218.98 | — | 30% |
| Carpal tunnel release, open surgery CPT 64721 Carpal tunnel surgery | $13,835.83 | $19,765.47 | $1,938.56–$15,654.25 | 194% above | 30% |
| Carpal tunnel release, open surgery one side CPT 64721 Carpal tunnel surgery | $8,484.28 | $12,120.40 | $1,938.56–$9,599.36 | 80% above | 30% |
| Carpal tunnel release, open surgery one side CPT 64721 Carpal tunnel surgery | $8,829.56 | $12,613.65 | $1,938.56–$9,990.01 | 87% above | 30% |
| Carpal tunnel release, open surgery inpatient CPT 64721 Carpal tunnel surgery | $13,835.83 | $19,765.47 | $1,938.56–$15,654.25 | — | 30% |
| Carpal tunnel release, open surgery inpatient one side CPT 64721 Carpal tunnel surgery | $8,484.28 | $12,120.40 | $1,938.56–$9,599.36 | — | 30% |
| Carpal tunnel release, open surgery inpatient one side CPT 64721 Carpal tunnel surgery | $8,829.56 | $12,613.65 | $1,938.56–$9,990.01 | — | 30% |
| Catheter ablation for atrial fibrillation CPT 93656 Tx atrial fib pulm vein isol | $52,059.70 | $74,371.00 | $25,948.27–$80,220.62 | 87% above | 30% |
| Catheter ablation for atrial fibrillation CPT 93656 Ep comp w transsep pun/abla af | $52,059.70 | $74,371.00 | $25,948.27–$80,220.62 | 87% above | 30% |
| Catheter ablation for atrial fibrillation inpatient CPT 93656 Ep comp w transsep pun/abla af | $52,059.70 | $74,371.00 | $25,948.27–$80,220.62 | — | 30% |
| Catheter ablation for atrial fibrillation inpatient CPT 93656 Tx atrial fib pulm vein isol | $52,059.70 | $74,371.00 | $25,948.27–$80,220.62 | — | 30% |
| Cervical biopsy CPT 57500 Cervical biopsy | $2,398.20 | $3,426.00 | $914.37–$2,847.32 | 78% above | 30% |
| Cervical biopsy CPT 57500 Biopsy of cervix | $3,180.50 | $4,543.57 | $914.37–$3,598.51 | 136% above | 30% |
| Cervical biopsy inpatient CPT 57500 Cervical biopsy | $2,398.20 | $3,426.00 | $914.37–$2,847.32 | — | 30% |
| Cervical biopsy inpatient CPT 57500 Biopsy of cervix | $16,116.18 | $23,023.11 | $914.37–$18,234.30 | — | 30% |
| Cesarean delivery, including prenatal and postpartum care inpatient CPT 59510 Cesarean delivery | $14,451.16 | $20,644.52 | $5,037.26–$16,350.46 | — | 30% |
| Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 Circum 28 days or older | $7,131.26 | $10,187.52 | $2,075.22–$8,068.52 | 34% above | 30% |
| Circumcision by surgical excision, older than 28 days (children and adults) inpatient CPT 54161 Circum 28 days or older | $2,139.62 | $3,056.60 | $2,075.22–$6,698.63 | — | 30% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 Circumcision w/regionl block | $6,025.08 | $8,607.25 | $2,075.22–$6,816.94 | 746% above | 30% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 Circumcision w/regionl block | $2,139.62 | $3,056.60 | $2,075.22–$6,698.63 | — | 30% |
| Circumcision, surgical, older than a newborn inpatient CPT 54160 Circumcision neonate | $2,139.62 | $3,056.60 | $692.24–$2,420.83 | — | 30% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 Treat fracture radius/ulna | $7,646.22 | $10,923.17 | $244.88–$8,651.15 | 1655% above | 30% |
| Closed treatment of a wrist (distal radius) fracture, no resetting one side CPT 25600 Treat fracture radius/ulna | $7,646.22 | $10,923.17 | $244.88–$8,651.15 | 1655% above | 30% |
| Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 Treat fracture radius/ulna | $17,244.61 | $24,635.16 | $244.88–$19,511.05 | — | 30% |
| Closed treatment of a wrist (distal radius) fracture, no resetting inpatient one side CPT 25600 Treat fracture radius/ulna | $7,646.22 | $10,923.17 | $244.88–$8,651.15 | — | 30% |
| Colonoscopy with endoscopic ultrasound CPT 45391 Colonoscopy w/endoscope us | $7,113.86 | $10,162.65 | $1,187.96–$8,048.82 | 315% above | 30% |
| Colonoscopy with endoscopic ultrasound inpatient CPT 45391 Colonoscopy w/endoscope us | $34,573.80 | $49,391.14 | $1,187.96–$39,117.78 | — | 30% |
| Colonoscopy with polyp removal CPT 45385 Colonoscopy w/lesion removal | $5,761.37 | $8,230.53 | $1,187.96–$6,518.58 | 89% above | 30% |
| Colonoscopy with polyp removal inpatient CPT 45385 Colonoscopy w/lesion removal | $5,761.37 | $8,230.53 | $1,187.96–$6,518.58 | — | 30% |
| Colonoscopy with tissue sample CPT 45380 Colonoscopy and biopsy | $5,709.92 | $8,157.03 | $1,187.96–$6,460.37 | 93% above | 30% |
| Colonoscopy with tissue sample inpatient CPT 45380 Colonoscopy and biopsy | $32,649.69 | $46,642.41 | $1,187.96–$36,940.79 | — | 30% |
| Colonoscopy, diagnostic CPT 45378 Diagnostic colonoscopy | $5,011.23 | $7,158.90 | $923.21–$5,669.85 | 147% above | 30% |
| Colonoscopy, diagnostic inpatient CPT 45378 Diagnostic colonoscopy | $34,573.80 | $49,391.14 | $923.21–$39,117.78 | — | 30% |
| Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 Colpscpy w/bxec curt; vagcvx | $237.30 | $339.00 | $268.49–$994.70 | 90% below | 30% |
| Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 Bx/curett of cervix w/scope | $390.60 | $558.00 | $302.52–$994.70 | 83% below | 30% |
| Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 Colpscpy w/bxec curt; vagcvx | $237.30 | $339.00 | $268.49–$994.70 | — | 30% |
| Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 Bx/curett of cervix w/scope | $390.60 | $558.00 | $302.52–$994.70 | — | 30% |
| Coronary stent placement, one artery CPT 92928 Prq card stent w/angio 1 vsl | $25,649.40 | $36,642.00 | $11,460.45–$37,083.66 | 64% above | 30% |
| Coronary stent placement, one artery inpatient CPT 92928 Prq card stent w/angio 1 vsl | $25,649.40 | $36,642.00 | $11,460.45–$37,083.66 | — | 30% |
| Cystoscopy with ureteral stent placement CPT 52332 Cystoscopy and treatment | $9,416.20 | $13,451.71 | $3,282.22–$10,653.75 | 35% above | 30% |
| Cystoscopy with ureteral stent placement one side CPT 52332 Cystoscopy and treatment | $10,198.74 | $14,569.63 | $3,499.41–$11,539.15 | 47% above | 30% |
| Cystoscopy with ureteral stent placement one side CPT 52332 Cystoscopy and treatment | $10,586.00 | $15,122.86 | $3,499.41–$11,977.31 | 52% above | 30% |
| Cystoscopy with ureteral stent placement inpatient CPT 52332 Cystoscopy and treatment | $25,188.52 | $35,983.60 | $3,499.41–$28,499.01 | — | 30% |
| Cystoscopy with ureteral stent placement inpatient one side CPT 52332 Cystoscopy and treatment | $10,198.74 | $14,569.63 | $3,499.41–$11,539.15 | — | 30% |
| Cystoscopy with ureteral stent placement inpatient one side CPT 52332 Cystoscopy and treatment | $10,586.00 | $15,122.86 | $3,499.41–$11,977.31 | — | 30% |
| Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 Cystoscopy | $6,846.76 | $9,781.08 | $692.24–$7,746.62 | 151% above | 30% |
| Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 Cystoscopy | $34,095.18 | $48,707.40 | $692.24–$38,576.26 | — | 30% |
| D&C (dilation and curettage), not related to pregnancy CPT 58120 Dilation and curettage | $13,075.83 | $18,679.75 | $3,213.65–$14,794.36 | 25% above | 30% |
| D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 Dilation and curettage | $13,075.83 | $18,679.75 | $3,213.65–$14,794.36 | — | 30% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 Destruction 1st premalig les | $448.70 | $641.00 | $156.40–$507.67 | 140% above | 30% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 Destruction 1st premal les | $448.70 | $641.00 | $156.40–$507.67 | 140% above | 30% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 Destruct premalg lesion | $1,389.72 | $1,985.32 | $199.18–$1,572.37 | 645% above | 30% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 Destruction 1st premal les | $448.70 | $641.00 | $156.40–$507.67 | — | 30% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 Destruction 1st premalig les | $448.70 | $641.00 | $156.40–$507.67 | — | 30% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 Destruct premalg lesion | $1,389.72 | $1,985.32 | $199.18–$1,572.37 | — | 30% |
| Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 Create eardrum opening | $27,304.75 | $39,006.79 | $1,540.33–$30,893.38 | 346% above | 30% |
| Ear tube placement (tympanostomy) under general anesthesia, one ear one side CPT 69436 Create eardrum opening | $27,304.75 | $39,006.79 | $1,540.33–$30,893.38 | 346% above | 30% |
| Ear tube placement (tympanostomy) under general anesthesia, one ear inpatient CPT 69436 Create eardrum opening | $27,304.75 | $39,006.79 | $1,540.33–$30,893.38 | — | 30% |
| Ear tube placement (tympanostomy) under general anesthesia, one ear inpatient one side CPT 69436 Create eardrum opening | $27,304.75 | $39,006.79 | $1,540.33–$30,893.38 | — | 30% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 Remove impacted ear wax uni | $126.70 | $181.00 | $58.56–$194.24 | 28% below | 30% |
| Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 Remove impacted ear wax uni | $126.70 | $181.00 | $58.56–$194.24 | — | 30% |
| Earwax removal with instruments, one ear CPT 69210 Remove impacted ear wax uni | $5,439.20 | $7,770.29 | $58.56–$6,154.07 | 3302% above | 30% |
| Earwax removal with instruments, one ear inpatient CPT 69210 Remove impacted ear wax uni | $5,439.20 | $7,770.29 | $58.56–$6,154.07 | — | 30% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 Endometrial bx; w/o dilation | $454.30 | $649.00 | $200.70–$657.83 | 59% above | 30% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 Biopsy of uterus lining | $1,211.92 | $1,731.31 | $200.70–$1,371.20 | 323% above | 30% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 Endometrial bx; w/o dilation | $454.30 | $649.00 | $200.70–$657.83 | — | 30% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 Biopsy of uterus lining | $1,211.92 | $1,731.31 | $200.70–$1,371.20 | — | 30% |
| Endoscopic sinus surgery: full ethmoid sinus opening CPT 31255 Nsl/sins ndsc w/tot ethmdct | $25,523.11 | $36,461.59 | $7,006.27–$28,877.58 | 54% above | 30% |
| Endoscopic sinus surgery: full ethmoid sinus opening inpatient CPT 31255 Nsl/sins ndsc w/tot ethmdct | $25,523.11 | $36,461.59 | $7,006.27–$28,877.58 | — | 30% |
| Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue CPT 31267 Endoscopy maxillary sinus | $25,523.11 | $36,461.59 | $7,006.27–$28,877.58 | 171% above | 30% |
| Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue inpatient CPT 31267 Endoscopy maxillary sinus | $25,523.11 | $36,461.59 | $7,006.27–$28,877.58 | — | 30% |
| First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 Rpr aa hrn 1st 3-10 rdc | $21,194.38 | $30,277.68 | $6,426.86–$23,979.92 | 13% above | 30% |
| First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm inpatient CPT 49593 Rpr aa hrn 1st 3-10 rdc | $21,194.38 | $30,277.68 | $6,426.86–$23,979.92 | — | 30% |
| First repair of a front abdominal hernia larger than 10 cm CPT 49595 Rpr aa hrn 1st > 10 rdc | $30,065.28 | $42,950.40 | $6,426.86–$34,016.72 | 2% below | 30% |
| First repair of a front abdominal hernia larger than 10 cm one side CPT 49595 Rpr aa hrn 1st > 10 rdc | $30,265.78 | $43,236.83 | $6,426.86–$34,243.57 | 2% below | 30% |
| First repair of a front abdominal hernia larger than 10 cm inpatient CPT 49595 Rpr aa hrn 1st > 10 rdc | $30,065.28 | $42,950.40 | $6,426.86–$34,016.72 | — | 30% |
| First repair of a front abdominal hernia larger than 10 cm inpatient one side CPT 49595 Rpr aa hrn 1st > 10 rdc | $30,265.78 | $43,236.83 | $6,426.86–$34,243.57 | — | 30% |
| First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 Rpr aa hrn 1st < 3 cm rdc | $14,577.13 | $20,824.47 | $3,554.43–$16,492.98 | 63% above | 30% |
| First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm one side CPT 49591 Rpr aa hrn 1st < 3 cm rdc | $23,923.20 | $34,176.00 | $3,554.43–$27,067.39 | 167% above | 30% |
| First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm inpatient CPT 49591 Rpr aa hrn 1st < 3 cm rdc | $14,577.13 | $20,824.47 | $3,554.43–$16,492.98 | — | 30% |
| First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm inpatient one side CPT 49591 Rpr aa hrn 1st < 3 cm rdc | $23,923.20 | $34,176.00 | $3,554.43–$27,067.39 | — | 30% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 Diagnostic sigmoidoscopy | $12,556.75 | $17,938.21 | $923.21–$14,207.06 | 505% above | 30% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 Diagnostic sigmoidoscopy | $34,573.80 | $49,391.14 | $923.21–$39,117.78 | — | 30% |
| Gallbladder removal, laparoscopic CPT 47562 Laparoscopic cholecystectomy | $19,683.36 | $28,119.09 | $6,001.68–$22,270.32 | 20% above | 30% |
| Gallbladder removal, laparoscopic inpatient CPT 47562 Laparoscopic cholecystectomy | $38,733.81 | $55,334.02 | $6,001.68–$43,824.54 | — | 30% |
| Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 Laparo cholecystectomy/graph | $21,071.32 | $30,101.89 | $6,001.68–$23,840.70 | 24% above | 30% |
| Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery inpatient CPT 47563 Laparo cholecystectomy/graph | $29,361.49 | $41,944.99 | $6,001.68–$33,220.43 | — | 30% |
| Gallbladder removal, open surgery through a larger incision inpatient CPT 47600 Removal of gallbladder | $34,862.48 | $49,803.54 | $12,152.06–$39,444.40 | — | 30% |
| Hammertoe correction surgery CPT 28285 Repair of hammertoe | $8,804.67 | $12,578.10 | $3,069.06–$9,961.86 | 29% below | 30% |
| Hammertoe correction surgery inpatient CPT 28285 Repair of hammertoe | $8,804.67 | $12,578.10 | $3,069.06–$9,961.86 | — | 30% |
| Hemorrhoid banding (rubber band ligation) CPT 46221 Ligation of hemorrhoid(s) | $7,771.24 | $11,101.77 | $923.21–$8,792.60 | 253% above | 30% |
| Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 Ligation of hemorrhoid(s) | $7,771.24 | $11,101.77 | $923.21–$8,792.60 | — | 30% |
| Hemorrhoidectomy (internal and external), one area CPT 46255 Remove int/ext hem 1 group | $8,414.01 | $12,020.02 | $2,755.53–$9,519.86 | 48% above | 30% |
| Hemorrhoidectomy (internal and external), one area inpatient CPT 46255 Remove int/ext hem 1 group | $23,956.21 | $34,223.16 | $2,755.53–$27,104.74 | — | 30% |
| Hip replacement after an earlier hip surgery (conversion to total hip) CPT 27132 Total hip arthroplasty | $52,949.45 | $75,642.07 | $12,745.56–$59,908.52 | 12% above | 30% |
| Hip replacement after an earlier hip surgery (conversion to total hip) one side CPT 27132 Total hip arthroplasty | $52,949.45 | $75,642.07 | $12,745.56–$59,908.52 | 12% above | 30% |
| Hip replacement after an earlier hip surgery (conversion to total hip) inpatient CPT 27132 Total hip arthroplasty | $47,417.83 | $67,739.76 | $12,745.56–$53,649.89 | — | 30% |
| Hip replacement after an earlier hip surgery (conversion to total hip) inpatient one side CPT 27132 Total hip arthroplasty | $52,949.45 | $75,642.07 | $12,745.56–$59,908.52 | — | 30% |
| Hysterectomy through an abdominal incision (total) inpatient CPT 58150 Total hysterectomy | $34,135.23 | $48,764.61 | $11,898.56–$38,621.57 | — | 30% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 Us pelvis saline infusion cath | $423.50 | $605.00 | $147.62–$479.16 | 47% above | 30% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 Catheter for hysterography | $423.50 | $605.00 | $147.62–$479.16 | 47% above | 30% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 Catheter for hysterography | $423.50 | $605.00 | $147.62–$479.16 | — | 30% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 Us pelvis saline infusion cath | $423.50 | $605.00 | $147.62–$479.16 | — | 30% |
| Hysteroscopy with endometrial ablation CPT 58563 Hysteroscopy ablation | $13,040.26 | $18,628.94 | $4,966.16–$16,142.19 | 57% above | 30% |
| Hysteroscopy with endometrial ablation inpatient CPT 58563 Hysteroscopy ablation | $13,040.26 | $18,628.94 | $4,966.16–$16,142.19 | — | 30% |
| Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 Hysteroscopy biopsy | $12,831.18 | $18,330.25 | $3,213.65–$14,517.56 | 84% above | 30% |
| Hysteroscopy with uterine lining sampling and/or polyp removal inpatient CPT 58558 Hysteroscopy biopsy | $12,831.18 | $18,330.25 | $3,213.65–$14,517.56 | — | 30% |
| IUD insertion (the device itself billed separately) CPT 58300 Insert intrauterine device | $15,782.38 | $22,546.26 | $5,501.29–$17,856.64 | 182% above | 30% |
| IUD insertion (the device itself billed separately) one side CPT 58300 Insert intrauterine device | $19,093.59 | $27,276.55 | $6,655.48–$21,603.03 | 241% above | 30% |
| IUD insertion (the device itself billed separately) inpatient CPT 58300 Insert intrauterine device | $15,782.38 | $22,546.26 | $5,501.29–$17,856.64 | — | 30% |
| IUD insertion (the device itself billed separately) inpatient one side CPT 58300 Insert intrauterine device | $19,093.59 | $27,276.55 | $6,655.48–$21,603.03 | — | 30% |
| Incision and drainage of a simple or single skin abscess CPT 10060 I & d abscess simple | $448.70 | $641.00 | $156.40–$507.67 | 3% below | 30% |
| Incision and drainage of a simple or single skin abscess CPT 10060 I & d of abscess; simple | $448.70 | $641.00 | $156.40–$507.67 | 3% below | 30% |
| Incision and drainage of a simple or single skin abscess CPT 10060 I&d abscess simple | $448.70 | $641.00 | $156.40–$507.67 | 3% below | 30% |
| Incision and drainage of a simple or single skin abscess CPT 10060 Drainage of skin abscess | $3,490.23 | $4,986.04 | $199.18–$3,948.94 | 656% above | 30% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&d abscess simple | $448.70 | $641.00 | $156.40–$507.67 | — | 30% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I & d abscess simple | $448.70 | $641.00 | $156.40–$507.67 | — | 30% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I & d of abscess; simple | $448.70 | $641.00 | $156.40–$507.67 | — | 30% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 Drainage of skin abscess | $21,091.22 | $30,130.32 | $199.18–$23,863.21 | — | 30% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 Prp i/hern init reduc >5 yr | $9,129.68 | $13,042.40 | $3,182.35–$10,329.58 | 4% above | 30% |
| Inguinal (groin) hernia repair, age 5 or older one side CPT 49505 Prp i/hern init reduc >5 yr | $9,112.14 | $13,017.34 | $3,176.23–$10,309.73 | 4% above | 30% |
| Inguinal (groin) hernia repair, age 5 or older one side CPT 49505 Prp i/hern init reduc >5 yr | $9,647.85 | $13,782.64 | $3,362.96–$10,915.85 | 10% above | 30% |
| Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 Prp i/hern init reduc >5 yr | $28,627.05 | $40,895.79 | $3,554.43–$32,389.47 | — | 30% |
| Inguinal (groin) hernia repair, age 5 or older inpatient one side CPT 49505 Prp i/hern init reduc >5 yr | $9,112.14 | $13,017.34 | $3,176.23–$10,309.73 | — | 30% |
| Inguinal (groin) hernia repair, age 5 or older inpatient one side CPT 49505 Prp i/hern init reduc >5 yr | $9,647.85 | $13,782.64 | $3,362.96–$10,915.85 | — | 30% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Inj tendon sheath/ligament | $4,829.90 | $6,899.85 | $304.73–$5,464.68 | 803% above | 30% |
| Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 Inj tendon sheath/ligament | $23,227.90 | $33,182.72 | $304.73–$26,280.71 | — | 30% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Drain/inj joint/bursa w/o us | $1,813.11 | $2,590.16 | $304.73–$2,051.41 | 339% above | 30% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 Drain/inj joint/bursa w/o us | $2,652.80 | $3,789.71 | $304.73–$3,001.45 | 542% above | 30% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 Drain/inj joint/bursa w/o us | $2,810.40 | $4,014.85 | $304.73–$3,179.76 | 581% above | 30% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Drain/inj joint/bursa w/o us | $23,227.90 | $33,182.72 | $304.73–$26,280.71 | — | 30% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 Drain/inj joint/bursa w/o us | $2,652.80 | $3,789.71 | $304.73–$3,001.45 | — | 30% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 Drain/inj joint/bursa w/o us | $2,810.40 | $4,014.85 | $304.73–$3,179.76 | — | 30% |
| Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 Insert drug implant device | $6,786.56 | $9,695.09 | $132.08–$7,678.51 | 261% above | 30% |
| Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 Insert drug implant device | $6,786.56 | $9,695.09 | $132.08–$7,678.51 | — | 30% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Drain/inj joint/bursa w/o us | $5,973.56 | $8,533.66 | $304.73–$6,758.66 | 1297% above | 30% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 Drain/inj joint/bursa w/o us | $3,884.27 | $5,548.95 | $304.73–$4,394.77 | 809% above | 30% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 Drain/inj joint/bursa w/o us | $5,973.56 | $8,533.66 | $304.73–$6,758.66 | 1297% above | 30% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Drain/inj joint/bursa w/o us | $23,227.90 | $33,182.72 | $304.73–$26,280.71 | — | 30% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 Drain/inj joint/bursa w/o us | $3,884.27 | $5,548.95 | $304.73–$4,394.77 | — | 30% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 Drain/inj joint/bursa w/o us | $5,973.56 | $8,533.66 | $304.73–$6,758.66 | — | 30% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 Drain/inj joint/bursa w/o us | $5,770.97 | $8,244.24 | $304.73–$6,529.44 | 1865% above | 30% |
| Joint injection or drainage, small joint (fingers, toes) one side CPT 20600 Drain/inj joint/bursa w/o us | $5,325.22 | $7,607.46 | $304.73–$6,025.11 | 1713% above | 30% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 Drain/inj joint/bursa w/o us | $23,227.90 | $33,182.72 | $304.73–$26,280.71 | — | 30% |
| Joint injection or drainage, small joint (fingers, toes) inpatient one side CPT 20600 Drain/inj joint/bursa w/o us | $5,325.22 | $7,607.46 | $304.73–$6,025.11 | — | 30% |
| Knee arthroscopy with meniscus repair (one side of the knee) CPT 29882 Knee arthroscopy/surgery | $10,968.55 | $15,669.35 | $3,248.27–$12,410.13 | 17% below | 30% |
| Knee arthroscopy with meniscus repair (one side of the knee) one side CPT 29882 Knee arthroscopy/surgery | $10,968.55 | $15,669.35 | $3,248.27–$12,410.13 | 17% below | 30% |
| Knee arthroscopy with meniscus repair (one side of the knee) one side CPT 29882 Knee arthroscopy/surgery | $42,441.57 | $60,630.81 | $3,248.27–$48,019.60 | 220% above | 30% |
| Knee arthroscopy with meniscus repair (one side of the knee) inpatient CPT 29882 Knee arthroscopy/surgery | $10,968.55 | $15,669.35 | $3,248.27–$12,410.13 | — | 30% |
| Knee arthroscopy with meniscus repair (one side of the knee) inpatient one side CPT 29882 Knee arthroscopy/surgery | $10,968.55 | $15,669.35 | $3,248.27–$12,410.13 | — | 30% |
| Knee arthroscopy with meniscus repair (one side of the knee) inpatient one side CPT 29882 Knee arthroscopy/surgery | $42,441.57 | $60,630.81 | $3,248.27–$48,019.60 | — | 30% |
| Knee arthroscopy with meniscus trim CPT 29881 Knee arthroscopy/surgery | $26,798.74 | $38,283.91 | $3,248.27–$30,320.86 | 228% above | 30% |
| Knee arthroscopy with meniscus trim one side CPT 29881 Knee arthroscopy/surgery | $19,162.77 | $27,375.39 | $3,248.27–$21,681.31 | 134% above | 30% |
| Knee arthroscopy with meniscus trim one side CPT 29881 Knee arthroscopy/surgery | $19,496.82 | $27,852.60 | $3,248.27–$22,059.26 | 138% above | 30% |
| Knee arthroscopy with meniscus trim inpatient CPT 29881 Knee arthroscopy/surgery | $36,935.33 | $52,764.75 | $3,248.27–$41,789.68 | — | 30% |
| Knee arthroscopy with meniscus trim inpatient one side CPT 29881 Knee arthroscopy/surgery | $19,162.77 | $27,375.39 | $3,248.27–$21,681.31 | — | 30% |
| Knee arthroscopy with meniscus trim inpatient one side CPT 29881 Knee arthroscopy/surgery | $19,496.82 | $27,852.60 | $3,248.27–$22,059.26 | — | 30% |
| Knee arthroscopy with removal of both torn meniscus parts CPT 29880 Knee arthroscopy/surgery | $11,379.05 | $16,255.79 | $3,248.27–$12,874.59 | 43% above | 30% |
| Knee arthroscopy with removal of both torn meniscus parts one side CPT 29880 Knee arthroscopy/surgery | $10,512.93 | $15,018.47 | $3,248.27–$11,894.63 | 32% above | 30% |
| Knee arthroscopy with removal of both torn meniscus parts one side CPT 29880 Knee arthroscopy/surgery | $11,379.05 | $16,255.79 | $3,248.27–$12,874.59 | 43% above | 30% |
| Knee arthroscopy with removal of both torn meniscus parts inpatient CPT 29880 Knee arthroscopy/surgery | $36,935.33 | $52,764.75 | $3,248.27–$41,789.68 | — | 30% |
| Knee arthroscopy with removal of both torn meniscus parts inpatient one side CPT 29880 Knee arthroscopy/surgery | $10,512.93 | $15,018.47 | $3,248.27–$11,894.63 | — | 30% |
| Knee arthroscopy with removal of both torn meniscus parts inpatient one side CPT 29880 Knee arthroscopy/surgery | $11,379.05 | $16,255.79 | $3,248.27–$12,874.59 | — | 30% |
| Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 Knee arthroscopy/surgery | $25,101.73 | $35,859.62 | $3,248.27–$28,400.82 | 127% above | 30% |
| Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) inpatient CPT 29877 Knee arthroscopy/surgery | $36,935.33 | $52,764.75 | $3,248.27–$41,789.68 | — | 30% |
| Laparoscopic Roux-en-Y gastric bypass, standard limb length CPT 43644 Lap gastric bypass/roux-en-y | $43,835.76 | $62,622.51 | $15,279.89–$49,597.03 | 9% above | 30% |
| Laparoscopic Roux-en-Y gastric bypass, standard limb length inpatient CPT 43644 Lap gastric bypass/roux-en-y | $32,900.86 | $47,001.23 | $11,468.30–$37,224.97 | — | 30% |
| Laparoscopic adjustable gastric band placement (Lap-Band) inpatient CPT 43770 Lap place gastr adj device | $29,617.90 | $42,311.29 | $10,323.95–$33,510.54 | — | 30% |
| Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 Laparoscopy appendectomy | $20,246.17 | $28,923.10 | $6,001.68–$22,907.10 | 42% above | 30% |
| Laparoscopic appendectomy (appendix removal through small cuts) inpatient CPT 44970 Laparoscopy appendectomy | $30,235.06 | $43,192.94 | $6,001.68–$34,208.81 | — | 30% |
| Laparoscopic fundoplication (anti-reflux surgery) CPT 43280 Laparoscopy fundoplasty | $37,154.34 | $53,077.63 | $10,552.73–$42,037.48 | 59% above | 30% |
| Laparoscopic fundoplication (anti-reflux surgery) inpatient CPT 43280 Laparoscopy fundoplasty | $49,675.80 | $70,965.43 | $10,552.73–$56,204.62 | — | 30% |
| Laparoscopic hysterectomy (uterus 250 g or less) CPT 58570 Tlh uterus 250 g or less | $25,935.51 | $37,050.73 | $10,552.73–$34,044.69 | 15% above | 30% |
| Laparoscopic hysterectomy (uterus 250 g or less) inpatient CPT 58570 Tlh uterus 250 g or less | $36,212.04 | $51,731.48 | $10,552.73–$40,971.33 | — | 30% |
| Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries CPT 58571 Tlh w/t/o 250 g or less | $29,936.85 | $42,766.93 | $10,552.73–$34,044.69 | 31% above | 30% |
| Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries inpatient CPT 58571 Tlh w/t/o 250 g or less | $34,386.79 | $49,123.98 | $10,552.73–$38,906.19 | — | 30% |
| Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 Lap ing hernia repair init | $24,004.67 | $34,292.39 | $6,001.68–$27,159.57 | 42% above | 30% |
| Laparoscopic inguinal (groin) hernia repair, first repair on that side one side CPT 49650 Lap ing hernia repair init | $23,444.76 | $33,492.51 | $6,001.68–$26,526.07 | 39% above | 30% |
| Laparoscopic inguinal (groin) hernia repair, first repair on that side one side CPT 49650 Lap ing hernia repair init | $23,949.53 | $34,213.61 | $6,001.68–$27,097.18 | 42% above | 30% |
| Laparoscopic inguinal (groin) hernia repair, first repair on that side inpatient CPT 49650 Lap ing hernia repair init | $42,538.31 | $60,769.02 | $6,001.68–$48,129.06 | — | 30% |
| Laparoscopic inguinal (groin) hernia repair, first repair on that side inpatient one side CPT 49650 Lap ing hernia repair init | $23,444.76 | $33,492.51 | $6,001.68–$26,526.07 | — | 30% |
| Laparoscopic inguinal (groin) hernia repair, first repair on that side inpatient one side CPT 49650 Lap ing hernia repair init | $23,949.53 | $34,213.61 | $6,001.68–$27,097.18 | — | 30% |
| Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 Lap ing hernia repair recur | $20,786.35 | $29,694.79 | $6,001.68–$23,518.27 | 30% above | 30% |
| Laparoscopic inguinal (groin) hernia repair, recurrent hernia one side CPT 49651 Lap ing hernia repair recur | $18,328.40 | $26,183.43 | $6,001.68–$20,737.28 | 15% above | 30% |
| Laparoscopic inguinal (groin) hernia repair, recurrent hernia one side CPT 49651 Lap ing hernia repair recur | $22,752.74 | $32,503.92 | $6,001.68–$25,743.10 | 42% above | 30% |
| Laparoscopic inguinal (groin) hernia repair, recurrent hernia inpatient CPT 49651 Lap ing hernia repair recur | $42,538.31 | $60,769.02 | $6,001.68–$48,129.06 | — | 30% |
| Laparoscopic inguinal (groin) hernia repair, recurrent hernia inpatient one side CPT 49651 Lap ing hernia repair recur | $18,328.40 | $26,183.43 | $6,001.68–$20,737.28 | — | 30% |
| Laparoscopic inguinal (groin) hernia repair, recurrent hernia inpatient one side CPT 49651 Lap ing hernia repair recur | $22,752.74 | $32,503.92 | $6,001.68–$25,743.10 | — | 30% |
| Laparoscopic removal of an adjustable gastric band and its port CPT 43774 Lap rmvl gastr adj all parts | $29,580.08 | $42,257.25 | $3,827.51–$33,467.74 | at median | 30% |
| Laparoscopic removal of an adjustable gastric band and its port inpatient CPT 43774 Lap rmvl gastr adj all parts | $29,617.90 | $42,311.29 | $3,827.51–$33,510.54 | — | 30% |
| Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 Laparoscopy remove adnexa | $14,624.39 | $20,891.98 | $6,001.68–$19,078.36 | 10% below | 30% |
| Laparoscopic removal of fallopian tubes and/or ovaries one side CPT 58661 Laparoscopy remove adnexa | $16,109.27 | $23,013.24 | $5,615.23–$18,226.49 | 1% below | 30% |
| Laparoscopic removal of fallopian tubes and/or ovaries one side CPT 58661 Laparoscopy remove adnexa | $20,980.11 | $29,971.58 | $6,001.68–$23,737.49 | 29% above | 30% |
| Laparoscopic removal of fallopian tubes and/or ovaries inpatient CPT 58661 Laparoscopy remove adnexa | $31,466.40 | $44,952.00 | $6,001.68–$35,601.98 | — | 30% |
| Laparoscopic removal of fallopian tubes and/or ovaries inpatient one side CPT 58661 Laparoscopy remove adnexa | $16,109.27 | $23,013.24 | $5,615.23–$18,226.49 | — | 30% |
| Laparoscopic removal of fallopian tubes and/or ovaries inpatient one side CPT 58661 Laparoscopy remove adnexa | $20,980.11 | $29,971.58 | $6,001.68–$23,737.49 | — | 30% |
| Laparoscopic sleeve gastrectomy for weight loss CPT 43775 Lap sleeve gastrectomy | $39,388.78 | $56,269.69 | $13,729.80–$44,565.59 | 29% above | 30% |
| Laparoscopic sleeve gastrectomy for weight loss inpatient CPT 43775 Lap sleeve gastrectomy | $30,537.63 | $43,625.18 | $10,644.54–$34,551.14 | — | 30% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Int rep sc/ax/trk/ext 2.5 or l | $901.60 | $1,288.00 | $314.27–$1,020.10 | 25% above | 30% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Intmd rpr s/a/t/ext 2.5 cm/< | $6,573.97 | $9,391.39 | $403.57–$7,437.98 | 814% above | 30% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 Int rep sc/ax/trk/ext 2.5 or l | $901.60 | $1,288.00 | $314.27–$1,020.10 | — | 30% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 Intmd rpr s/a/t/ext 2.5 cm/< | $6,573.97 | $9,391.39 | $403.57–$7,437.98 | — | 30% |
| Left heart catheterization, diagnostic one side CPT 93452 Left heart cath w lv inj | $9,552.90 | $13,647.00 | $3,218.42–$10,808.42 | 23% above | 30% |
| Left heart catheterization, diagnostic one side CPT 93452 Left hrt cath w/ventrclgrphy | $9,552.90 | $13,647.00 | $3,218.42–$10,808.42 | 23% above | 30% |
| Left heart catheterization, diagnostic inpatient one side CPT 93452 Left hrt cath w/ventrclgrphy | $9,552.90 | $13,647.00 | $3,218.42–$10,808.42 | — | 30% |
| Left heart catheterization, diagnostic inpatient one side CPT 93452 Left heart cath w lv inj | $9,552.90 | $13,647.00 | $3,218.42–$10,808.42 | — | 30% |
| Lower-back epidural injection, with imaging guidance CPT 62323 Njx interlaminar lmbr/sac | $2,377.77 | $3,396.81 | $700.76–$2,690.27 | 85% above | 30% |
| Lower-back epidural injection, with imaging guidance one side CPT 62323 Njx interlaminar lmbr/sac | $2,538.00 | $3,625.71 | $700.76–$2,871.56 | 97% above | 30% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 Njx interlaminar lmbr/sac | $2,377.77 | $3,396.81 | $700.76–$2,690.27 | — | 30% |
| Lower-back epidural injection, with imaging guidance inpatient one side CPT 62323 Njx interlaminar lmbr/sac | $2,538.00 | $3,625.71 | $700.76–$2,871.56 | — | 30% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Inj foramen epidural l/s | $5,619.66 | $8,028.08 | $878.06–$6,358.24 | 244% above | 30% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 Inj foramen epidural l/s | $5,619.66 | $8,028.08 | $878.06–$6,358.24 | — | 30% |
| Lumpectomy (partial mastectomy) CPT 19301 Partial masectomy | $8,052.80 | $11,504.00 | $2,806.98–$9,111.17 | 3% above | 30% |
| Lumpectomy (partial mastectomy) CPT 19301 Partial mastectomy | $11,279.63 | $16,113.75 | $3,887.03–$12,762.09 | 44% above | 30% |
| Lumpectomy (partial mastectomy) one side CPT 19301 Partial mastectomy | $11,266.93 | $16,095.62 | $3,887.03–$12,747.73 | 44% above | 30% |
| Lumpectomy (partial mastectomy) one side CPT 19301 Partial mastectomy | $11,279.63 | $16,113.75 | $3,887.03–$12,762.09 | 44% above | 30% |
| Lumpectomy (partial mastectomy) inpatient CPT 19301 Partial masectomy | $8,052.80 | $11,504.00 | $2,806.98–$9,111.17 | — | 30% |
| Lumpectomy (partial mastectomy) inpatient CPT 19301 Partial mastectomy | $32,412.58 | $46,303.69 | $3,887.03–$36,672.52 | — | 30% |
| Lumpectomy (partial mastectomy) inpatient one side CPT 19301 Partial mastectomy | $11,266.93 | $16,095.62 | $3,887.03–$12,747.73 | — | 30% |
| Lumpectomy (partial mastectomy) inpatient one side CPT 19301 Partial mastectomy | $11,279.63 | $16,113.75 | $3,887.03–$12,762.09 | — | 30% |
| Mastectomy (total removal of the breast) CPT 19303 Mast simple complete | $26,726.15 | $38,180.22 | $6,592.00–$30,238.73 | 52% above | 30% |
| Mastectomy (total removal of the breast) one side CPT 19303 Mast simple complete | $24,916.65 | $35,595.21 | $6,592.00–$28,191.41 | 42% above | 30% |
| Mastectomy (total removal of the breast) one side CPT 19303 Mast simple complete | $26,726.15 | $38,180.22 | $6,592.00–$30,238.73 | 52% above | 30% |
| Mastectomy (total removal of the breast) inpatient CPT 19303 Mast simple complete | $26,726.15 | $38,180.22 | $6,592.00–$30,238.73 | — | 30% |
| Mastectomy (total removal of the breast) inpatient one side CPT 19303 Mast simple complete | $24,916.65 | $35,595.21 | $6,592.00–$28,191.41 | — | 30% |
| Mastectomy (total removal of the breast) inpatient one side CPT 19303 Mast simple complete | $26,726.15 | $38,180.22 | $6,592.00–$30,238.73 | — | 30% |
| Miscarriage treatment with D&C, first trimester CPT 59820 Care of miscarriage | $9,130.81 | $13,044.02 | $3,213.65–$10,397.06 | 111% above | 30% |
| Miscarriage treatment with D&C, first trimester inpatient CPT 59820 Care of miscarriage | $22,198.08 | $31,711.54 | $3,213.65–$25,115.54 | — | 30% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 Ex ben arm/leg/trnk .5cm or < | $1,428.00 | $2,040.00 | $497.76–$1,615.68 | 36% below | 30% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 Exc tr-ext b9+marg 0.5 cm< | $16,204.83 | $23,149.76 | $703.00–$18,334.61 | 621% above | 30% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 Ex ben arm/leg/trnk .5cm or < | $1,428.00 | $2,040.00 | $497.76–$1,615.68 | — | 30% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 Exc tr-ext b9+marg 0.5 cm< | $22,997.19 | $32,853.13 | $703.00–$26,019.68 | — | 30% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 Ex ben faceearsmum.5cmor< | $1,421.70 | $2,031.00 | $495.56–$1,608.55 | 93% above | 30% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 Exc face-mm b9+marg 0.5 cm/< | $3,931.61 | $5,616.59 | $703.00–$4,448.34 | 433% above | 30% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 Ex ben faceearsmum.5cmor< | $1,421.70 | $2,031.00 | $495.56–$1,608.55 | — | 30% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 Exc face-mm b9+marg 0.5 cm/< | $3,931.61 | $5,616.59 | $703.00–$4,448.34 | — | 30% |
| Nail removal (partial or complete), one nail CPT 11730 Avulsion nailsimple1 plate | $448.70 | $641.00 | $156.40–$507.67 | 13% above | 30% |
| Nail removal (partial or complete), one nail CPT 11730 Removal of nail plate | $7,915.44 | $11,307.77 | $199.18–$8,955.75 | 1899% above | 30% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 Avulsion nailsimple1 plate | $448.70 | $641.00 | $156.40–$507.67 | — | 30% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 Removal of nail plate | $7,915.44 | $11,307.77 | $199.18–$8,955.75 | — | 30% |
| Open Roux-en-Y gastric bypass through an abdominal incision CPT 43846 Gastric bypass for obesity | $46,086.55 | $65,837.93 | $16,064.45–$52,143.64 | — | 30% |
| Open Roux-en-Y gastric bypass through an abdominal incision inpatient CPT 43846 Gastric bypass for obesity | $46,086.55 | $65,837.93 | $16,064.45–$52,143.64 | — | 30% |
| Pacemaker implant (dual chamber) CPT 33208 Insrt heart pm atrial & vent | $36,489.48 | $52,127.83 | $10,376.18–$41,285.24 | 202% above | 30% |
| Pacemaker implant (dual chamber) inpatient CPT 33208 Insrt heart pm atrial & vent | $55,224.70 | $78,892.43 | $10,376.18–$62,482.80 | — | 30% |
| Paracentesis with imaging guidance CPT 49083 Abd paracentesis w/imaging | $2,680.69 | $3,829.56 | $900.41–$3,033.01 | 94% above | 30% |
| Paracentesis with imaging guidance one side CPT 49083 Abd paracentesis w/imaging | $2,483.60 | $3,548.00 | $865.71–$2,810.02 | 79% above | 30% |
| Paracentesis with imaging guidance one side CPT 49083 Abd paracentesis w/imaging | $2,507.90 | $3,582.71 | $874.18–$2,837.51 | 81% above | 30% |
| Paracentesis with imaging guidance inpatient CPT 49083 Abd paracentesis w/imaging | $18,153.92 | $25,934.17 | $900.41–$20,539.86 | — | 30% |
| Paracentesis with imaging guidance inpatient one side CPT 49083 Abd paracentesis w/imaging | $2,483.60 | $3,548.00 | $865.71–$2,810.02 | — | 30% |
| Paracentesis with imaging guidance inpatient one side CPT 49083 Abd paracentesis w/imaging | $2,507.90 | $3,582.71 | $874.18–$2,837.51 | — | 30% |
| Partial knee replacement (one compartment) CPT 27446 Revision of knee joint | $27,121.78 | $38,745.40 | $9,453.88–$30,686.36 | 9% above | 30% |
| Partial knee replacement (one compartment) one side CPT 27446 Revision of knee joint | $27,121.78 | $38,745.40 | $9,453.88–$30,686.36 | 9% above | 30% |
| Partial knee replacement (one compartment) inpatient CPT 27446 Revision of knee joint | $27,121.78 | $38,745.40 | $9,453.88–$30,686.36 | — | 30% |
| Partial knee replacement (one compartment) inpatient one side CPT 27446 Revision of knee joint | $27,121.78 | $38,745.40 | $9,453.88–$30,686.36 | — | 30% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 Removal of nail bed | $1,199.10 | $1,713.00 | $403.57–$1,356.70 | 72% above | 30% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 Excision nail and nail matrix | $1,199.10 | $1,713.00 | $403.57–$1,356.70 | 72% above | 30% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 Excision nail&nail matrix | $1,199.10 | $1,713.00 | $403.57–$1,356.70 | 72% above | 30% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Excision nail&nail matrix | $1,199.10 | $1,713.00 | $403.57–$1,356.70 | — | 30% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Excision nail and nail matrix | $1,199.10 | $1,713.00 | $403.57–$1,356.70 | — | 30% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Removal of nail bed | $1,199.10 | $1,713.00 | $403.57–$1,356.70 | — | 30% |
| Prostate removal (prostatectomy), laparoscopic inpatient CPT 55866 Laparo radical prostatectomy | $50,166.75 | $71,666.78 | $10,552.73–$56,760.09 | — | 30% |
| Removal of a breast lump, open surgery CPT 19120 Exc cyst fibroadenoma breast | $7,621.60 | $10,888.00 | $2,656.67–$8,623.30 | 51% above | 30% |
| Removal of a breast lump, open surgery CPT 19120 Removal of breast lesion | $7,705.12 | $11,007.32 | $2,685.79–$8,717.80 | 53% above | 30% |
| Removal of a breast lump, open surgery one side CPT 19120 Removal of breast lesion | $6,980.30 | $9,971.85 | $2,433.13–$7,897.71 | 38% above | 30% |
| Removal of a breast lump, open surgery one side CPT 19120 Removal of breast lesion | $7,376.29 | $10,537.56 | $2,571.16–$8,345.75 | 46% above | 30% |
| Removal of a breast lump, open surgery inpatient CPT 19120 Exc cyst fibroadenoma breast | $7,621.60 | $10,888.00 | $2,656.67–$8,623.30 | — | 30% |
| Removal of a breast lump, open surgery inpatient CPT 19120 Removal of breast lesion | $32,412.58 | $46,303.69 | $3,887.03–$36,672.52 | — | 30% |
| Removal of a breast lump, open surgery inpatient one side CPT 19120 Removal of breast lesion | $6,980.30 | $9,971.85 | $2,433.13–$7,897.71 | — | 30% |
| Removal of a breast lump, open surgery inpatient one side CPT 19120 Removal of breast lesion | $7,376.29 | $10,537.56 | $2,571.16–$8,345.75 | — | 30% |
| Removal of a foreign object under the skin, simple CPT 10120 I & r of foreign body | $799.40 | $1,142.00 | $278.65–$904.46 | 30% above | 30% |
| Removal of a foreign object under the skin, simple CPT 10120 Remove foreign body | $9,361.45 | $13,373.50 | $403.57–$10,591.81 | 1421% above | 30% |
| Removal of a foreign object under the skin, simple one side CPT 10120 Remove foreign body | $6,486.12 | $9,265.89 | $403.57–$7,338.58 | 954% above | 30% |
| Removal of a foreign object under the skin, simple one side CPT 10120 Remove foreign body | $7,284.86 | $10,406.94 | $403.57–$8,242.30 | 1083% above | 30% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 I & r of foreign body | $799.40 | $1,142.00 | $278.65–$904.46 | — | 30% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 Remove foreign body | $43,701.34 | $62,430.49 | $403.57–$49,444.95 | — | 30% |
| Removal of a foreign object under the skin, simple inpatient one side CPT 10120 Remove foreign body | $6,486.12 | $9,265.89 | $403.57–$7,338.58 | — | 30% |
| Removal of a foreign object under the skin, simple inpatient one side CPT 10120 Remove foreign body | $7,284.86 | $10,406.94 | $403.57–$8,242.30 | — | 30% |
| Removal of one lobe of the thyroid (lobectomy) CPT 60220 Partial removal of thyroid | $17,074.45 | $24,392.07 | $6,001.68–$19,318.52 | 72% above | 30% |
| Removal of one lobe of the thyroid (lobectomy) one side CPT 60220 Partial removal of thyroid | $15,542.79 | $22,203.98 | $5,417.77–$17,585.55 | 57% above | 30% |
| Removal of one lobe of the thyroid (lobectomy) one side CPT 60220 Partial removal of thyroid | $17,118.31 | $24,454.73 | $5,966.95–$19,368.15 | 73% above | 30% |
| Removal of one lobe of the thyroid (lobectomy) inpatient CPT 60220 Partial removal of thyroid | $37,000.71 | $52,858.15 | $6,001.68–$41,863.65 | — | 30% |
| Removal of one lobe of the thyroid (lobectomy) inpatient one side CPT 60220 Partial removal of thyroid | $15,542.79 | $22,203.98 | $5,417.77–$17,585.55 | — | 30% |
| Removal of one lobe of the thyroid (lobectomy) inpatient one side CPT 60220 Partial removal of thyroid | $17,118.31 | $24,454.73 | $5,966.95–$19,368.15 | — | 30% |
| Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 Colon ca scrn not hi rsk ind | $4,560.45 | $6,514.93 | $923.21–$5,159.82 | 143% above | 30% |
| Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 Colon ca scrn not hi rsk ind | $4,560.45 | $6,514.93 | $923.21–$5,159.82 | — | 30% |
| Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 Colorectal scrn; hi risk ind | $4,459.26 | $6,370.37 | $923.21–$5,045.33 | 159% above | 30% |
| Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 Colorectal scrn; hi risk ind | $4,459.26 | $6,370.37 | $923.21–$5,045.33 | — | 30% |
| Septoplasty to straighten the nasal septum CPT 30520 Repair of nasal septum | $10,025.48 | $14,322.12 | $3,291.41–$11,343.12 | at median | 30% |
| Septoplasty to straighten the nasal septum inpatient CPT 30520 Repair of nasal septum | $10,025.48 | $14,322.12 | $3,291.41–$11,343.12 | — | 30% |
| Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 Fragmenting of kidney stone | $14,728.89 | $21,041.27 | $3,499.41–$16,664.69 | 18% above | 30% |
| Shock-wave lithotripsy to break up kidney stones (from outside the body) one side CPT 50590 Fragmenting of kidney stone | $15,044.80 | $21,492.57 | $3,499.41–$17,022.12 | 21% above | 30% |
| Shock-wave lithotripsy to break up kidney stones (from outside the body) one side CPT 50590 Fragmenting of kidney stone | $15,403.77 | $22,005.39 | $3,499.41–$17,428.27 | 23% above | 30% |
| Shock-wave lithotripsy to break up kidney stones (from outside the body) inpatient CPT 50590 Fragmenting of kidney stone | $14,728.89 | $21,041.27 | $3,499.41–$16,664.69 | — | 30% |
| Shock-wave lithotripsy to break up kidney stones (from outside the body) inpatient one side CPT 50590 Fragmenting of kidney stone | $15,044.80 | $21,492.57 | $3,499.41–$17,022.12 | — | 30% |
| Shock-wave lithotripsy to break up kidney stones (from outside the body) inpatient one side CPT 50590 Fragmenting of kidney stone | $15,403.77 | $22,005.39 | $3,499.41–$17,428.27 | — | 30% |
| Short arm splint (forearm and hand) CPT 29125 Apply forearm splint | $285.60 | $408.00 | $99.55–$323.14 | 57% above | 30% |
| Short arm splint (forearm and hand) CPT 29125 Appl short arm splint static | $285.60 | $408.00 | $99.55–$323.14 | 57% above | 30% |
| Short arm splint (forearm and hand) inpatient CPT 29125 Appl short arm splint static | $285.60 | $408.00 | $99.55–$323.14 | — | 30% |
| Short arm splint (forearm and hand) inpatient CPT 29125 Apply forearm splint | $13,970.28 | $19,957.54 | $132.08–$15,806.37 | — | 30% |
| Short leg splint (calf to foot) CPT 29515 Application short leg splint | $349.30 | $499.00 | $121.76–$395.21 | 45% above | 30% |
| Short leg splint (calf to foot) CPT 29515 Application lower leg splint | $349.30 | $499.00 | $121.76–$395.21 | 45% above | 30% |
| Short leg splint (calf to foot) inpatient CPT 29515 Application short leg splint | $349.30 | $499.00 | $121.76–$395.21 | — | 30% |
| Short leg splint (calf to foot) inpatient CPT 29515 Application lower leg splint | $349.30 | $499.00 | $121.76–$395.21 | — | 30% |
| Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 Shoulder arthroscopy/surgery | $28,642.80 | $40,918.28 | $3,248.27–$32,407.28 | 100% above | 30% |
| Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) one side CPT 29824 Shoulder arthroscopy/surgery | $20,945.07 | $29,921.53 | $3,248.27–$23,697.85 | 46% above | 30% |
| Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) one side CPT 29824 Shoulder arthroscopy/surgery | $28,642.80 | $40,918.28 | $3,248.27–$32,407.28 | 100% above | 30% |
| Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) inpatient CPT 29824 Shoulder arthroscopy/surgery | $28,642.80 | $40,918.28 | $3,248.27–$32,407.28 | — | 30% |
| Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) inpatient one side CPT 29824 Shoulder arthroscopy/surgery | $20,945.07 | $29,921.53 | $3,248.27–$23,697.85 | — | 30% |
| Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) inpatient one side CPT 29824 Shoulder arthroscopy/surgery | $28,642.80 | $40,918.28 | $3,248.27–$32,407.28 | — | 30% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 Shoulder arthroscopy/surgery | $28,642.80 | $40,918.28 | $9,984.06–$32,407.28 | 86% above | 30% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) one side CPT 29826 Shoulder arthroscopy/surgery | $25,136.00 | $35,908.57 | $8,761.69–$28,439.59 | 63% above | 30% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) one side CPT 29826 Shoulder arthroscopy/surgery | $28,642.80 | $40,918.28 | $9,984.06–$32,407.28 | 86% above | 30% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 Shoulder arthroscopy/surgery | $28,642.80 | $40,918.28 | $9,984.06–$32,407.28 | — | 30% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient one side CPT 29826 Shoulder arthroscopy/surgery | $25,136.00 | $35,908.57 | $8,761.69–$28,439.59 | — | 30% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient one side CPT 29826 Shoulder arthroscopy/surgery | $28,642.80 | $40,918.28 | $9,984.06–$32,407.28 | — | 30% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Rpr 2/n/ax/gen/trnk 2.5cm/< | $448.70 | $641.00 | $156.40–$507.67 | 2% above | 30% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Rpr s/n/ax/gen/trnk 2.5cm/< | $13,493.89 | $19,276.99 | $199.18–$15,267.38 | 2981% above | 30% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 Rpr 2/n/ax/gen/trnk 2.5cm/< | $448.70 | $641.00 | $156.40–$507.67 | — | 30% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 Rpr s/n/ax/gen/trnk 2.5cm/< | $19,602.77 | $28,003.96 | $199.18–$22,179.14 | — | 30% |
| Skin biopsy, punch, one lesion CPT 11104 Skin bx punch | $901.60 | $1,288.00 | $314.27–$1,020.10 | 100% above | 30% |
| Skin biopsy, punch, one lesion CPT 11104 Skin bx punch singl les | $901.60 | $1,288.00 | $314.27–$1,020.10 | 100% above | 30% |
| Skin biopsy, punch, one lesion CPT 11104 Skin bx; punch single lesion | $901.60 | $1,288.00 | $314.27–$1,020.10 | 100% above | 30% |
| Skin biopsy, punch, one lesion CPT 11104 Punch bx single lesion | $901.60 | $1,288.00 | $314.27–$1,020.10 | 100% above | 30% |
| Skin biopsy, punch, one lesion CPT 11104 Punch bx skin single lesion | $2,643.61 | $3,776.58 | $403.57–$2,991.05 | 486% above | 30% |
| Skin biopsy, punch, one lesion inpatient CPT 11104 Skin bx punch | $901.60 | $1,288.00 | $314.27–$1,020.10 | — | 30% |
| Skin biopsy, punch, one lesion inpatient CPT 11104 Skin bx; punch single lesion | $901.60 | $1,288.00 | $314.27–$1,020.10 | — | 30% |
| Skin biopsy, punch, one lesion inpatient CPT 11104 Skin bx punch singl les | $901.60 | $1,288.00 | $314.27–$1,020.10 | — | 30% |
| Skin biopsy, punch, one lesion inpatient CPT 11104 Punch bx single lesion | $901.60 | $1,288.00 | $314.27–$1,020.10 | — | 30% |
| Skin biopsy, punch, one lesion inpatient CPT 11104 Punch bx skin single lesion | $23,761.48 | $33,944.97 | $403.57–$26,884.42 | — | 30% |
| Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 Ex mal arm/leg/trnk .5cm or < | $1,587.60 | $2,268.00 | $553.39–$1,796.26 | 228% above | 30% |
| Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 Exc tr-ext mal+marg 0.5 cm/< | $2,660.70 | $3,801.00 | $703.00–$3,010.39 | 450% above | 30% |
| Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 Ex mal arm/leg/trnk .5cm or < | $1,587.60 | $2,268.00 | $553.39–$1,796.26 | — | 30% |
| Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 Exc tr-ext mal+marg 0.5 cm/< | $26,350.72 | $37,643.88 | $703.00–$29,813.95 | — | 30% |
| Skin tag removal, up to 15 tags CPT 11200 Removal skin tags up to 15 | $448.70 | $641.00 | $156.40–$507.67 | 59% above | 30% |
| Skin tag removal, up to 15 tags CPT 11200 Skin tag removal; up to 15 | $448.70 | $641.00 | $156.40–$507.67 | 59% above | 30% |
| Skin tag removal, up to 15 tags CPT 11200 Removal skin tagsup to 15 | $448.70 | $641.00 | $156.40–$507.67 | 59% above | 30% |
| Skin tag removal, up to 15 tags CPT 11200 Removal of skin tags <w/15 | $1,762.47 | $2,517.82 | $199.18–$1,994.11 | 523% above | 30% |
| Skin tag removal, up to 15 tags inpatient CPT 11200 Skin tag removal; up to 15 | $448.70 | $641.00 | $156.40–$507.67 | — | 30% |
| Skin tag removal, up to 15 tags inpatient CPT 11200 Removal skin tagsup to 15 | $448.70 | $641.00 | $156.40–$507.67 | — | 30% |
| Skin tag removal, up to 15 tags inpatient CPT 11200 Removal skin tags up to 15 | $448.70 | $641.00 | $156.40–$507.67 | — | 30% |
| Skin tag removal, up to 15 tags inpatient CPT 11200 Removal of skin tags <w/15 | $28,435.33 | $40,621.90 | $199.18–$32,172.54 | — | 30% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 Dx lmbr spi pnxr | $1,094.80 | $1,564.00 | $700.76–$2,264.54 | 7% above | 30% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 Dx lmbr spi pnxr | $33,679.49 | $48,113.56 | $700.76–$38,105.94 | — | 30% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Rpr s/n/ax/gen/trnk 2.6-7.5cm | $399.70 | $571.00 | $139.32–$452.23 | at median | 30% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Rpr s/n/ax/gen/trnk2.6-7.5cm | $9,583.64 | $13,690.91 | $199.18–$10,843.20 | 2302% above | 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 Rpr s/n/ax/gen/trnk 2.6-7.5cm | $399.70 | $571.00 | $139.32–$452.23 | — | 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 Rpr s/n/ax/gen/trnk2.6-7.5cm | $19,602.77 | $28,003.96 | $199.18–$22,179.14 | — | 30% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Rpr f/e/e/n/l/m 2.5 cm/< | $430.50 | $615.00 | $150.06–$487.08 | at median | 30% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 Rpr f/e/e/n/l/m 2.5 cm/< | $23,492.12 | $33,560.17 | $199.18–$26,579.65 | — | 30% |
| TURP (transurethral resection of the prostate) CPT 52601 Prostatectomy (turp) | $17,178.77 | $24,541.10 | $5,322.90–$19,436.55 | 7% above | 30% |
| TURP (transurethral resection of the prostate) inpatient CPT 52601 Prostatectomy (turp) | $30,755.72 | $43,936.74 | $5,322.90–$34,797.90 | — | 30% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 Tangential bx single lesion | $415.80 | $594.00 | $144.94–$581.45 | 2% above | 30% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 Skin bx tangntl single les | $415.80 | $594.00 | $144.94–$581.45 | 2% above | 30% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 Tangntl bx skin single les | $13,011.46 | $18,587.80 | $403.57–$14,721.54 | 3096% above | 30% |
| Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 Tangential bx single lesion | $415.80 | $594.00 | $144.94–$581.45 | — | 30% |
| Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 Skin bx tangntl single les | $415.80 | $594.00 | $144.94–$581.45 | — | 30% |
| Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 Tangntl bx skin single les | $23,761.48 | $33,944.97 | $403.57–$26,884.42 | — | 30% |
| Thoracentesis with imaging guidance CPT 32555 Thoracentesis | $1,395.10 | $1,993.00 | $486.29–$1,578.46 | 27% above | 30% |
| Thoracentesis with imaging guidance CPT 32555 Aspirate pleura w/ imaging | $5,335.14 | $7,621.63 | $622.75–$6,036.33 | 387% above | 30% |
| Thoracentesis with imaging guidance one side CPT 32555 Aspirate pleura w/ imaging | $2,443.41 | $3,490.58 | $622.75–$2,764.54 | 123% above | 30% |
| Thoracentesis with imaging guidance one side CPT 32555 Aspirate pleura w/ imaging | $2,990.31 | $4,271.87 | $622.75–$3,383.32 | 173% above | 30% |
| Thoracentesis with imaging guidance inpatient CPT 32555 Thoracentesis | $1,395.10 | $1,993.00 | $486.29–$1,578.46 | — | 30% |
| Thoracentesis with imaging guidance inpatient CPT 32555 Aspirate pleura w/ imaging | $29,317.46 | $41,882.08 | $622.75–$33,170.61 | — | 30% |
| Thoracentesis with imaging guidance inpatient one side CPT 32555 Aspirate pleura w/ imaging | $2,443.41 | $3,490.58 | $622.75–$2,764.54 | — | 30% |
| Thoracentesis with imaging guidance inpatient one side CPT 32555 Aspirate pleura w/ imaging | $2,990.31 | $4,271.87 | $622.75–$3,383.32 | — | 30% |
| Tonsil and adenoid removal, age 12 or older CPT 42821 Remove tonsils and adenoids | $15,095.40 | $21,564.86 | $3,291.41–$17,079.37 | 124% above | 30% |
| Tonsil and adenoid removal, age 12 or older inpatient CPT 42821 Remove tonsils and adenoids | $15,095.40 | $21,564.86 | $3,291.41–$17,079.37 | — | 30% |
| Tonsil and adenoid removal, child under 12 CPT 42820 Remove tonsils and adenoids | $13,538.83 | $19,341.18 | $4,719.25–$15,318.21 | 118% above | 30% |
| Tonsil and adenoid removal, child under 12 inpatient CPT 42820 Remove tonsils and adenoids | $13,538.83 | $19,341.18 | $4,719.25–$15,318.21 | — | 30% |
| Total hip replacement CPT 27130 Total hip arthroplasty | $41,847.58 | $59,782.25 | $12,745.56–$47,347.54 | 42% above | 30% |
| Total hip replacement one side CPT 27130 Total hip arthroplasty | $40,686.84 | $58,124.06 | $12,745.56–$46,034.26 | 38% above | 30% |
| Total hip replacement one side CPT 27130 Total hip arthroplasty | $41,847.58 | $59,782.25 | $12,745.56–$47,347.54 | 42% above | 30% |
| Total hip replacement inpatient CPT 27130 Total hip arthroplasty | $47,417.83 | $67,739.76 | $12,745.56–$53,649.89 | — | 30% |
| Total hip replacement inpatient one side CPT 27130 Total hip arthroplasty | $40,686.84 | $58,124.06 | $12,745.56–$46,034.26 | — | 30% |
| Total hip replacement inpatient one side CPT 27130 Total hip arthroplasty | $41,847.58 | $59,782.25 | $12,745.56–$47,347.54 | — | 30% |
| Total knee replacement CPT 27447 Total knee arthroplasty | $42,110.17 | $60,157.38 | $12,745.56–$47,644.64 | 59% above | 30% |
| Total knee replacement one side CPT 27447 Total knee arthroplasty | $41,054.74 | $58,649.63 | $12,745.56–$46,450.51 | 55% above | 30% |
| Total knee replacement one side CPT 27447 Total knee arthroplasty | $41,174.40 | $58,820.57 | $12,745.56–$46,585.89 | 55% above | 30% |
| Total knee replacement inpatient CPT 27447 Total knee arthroplasty | $49,271.87 | $70,388.39 | $12,745.56–$55,747.60 | — | 30% |
| Total knee replacement inpatient one side CPT 27447 Total knee arthroplasty | $41,054.74 | $58,649.63 | $12,745.56–$46,450.51 | — | 30% |
| Total knee replacement inpatient one side CPT 27447 Total knee arthroplasty | $41,174.40 | $58,820.57 | $12,745.56–$46,585.89 | — | 30% |
| Total shoulder replacement CPT 23472 Reconstruct shoulder joint | $46,543.59 | $66,490.84 | $16,223.76–$52,660.75 | 34% above | 30% |
| Total shoulder replacement one side CPT 23472 Reconstruct shoulder joint | $43,199.56 | $61,713.66 | $15,058.13–$48,877.22 | 24% above | 30% |
| Total shoulder replacement one side CPT 23472 Reconstruct shoulder joint | $46,543.59 | $66,490.84 | $16,223.76–$52,660.75 | 34% above | 30% |
| Total shoulder replacement inpatient CPT 23472 Reconstruct shoulder joint | $82,091.77 | $117,273.96 | $17,406.64–$92,880.98 | — | 30% |
| Total shoulder replacement inpatient one side CPT 23472 Reconstruct shoulder joint | $43,199.56 | $61,713.66 | $15,058.13–$48,877.22 | — | 30% |
| Total shoulder replacement inpatient one side CPT 23472 Reconstruct shoulder joint | $46,543.59 | $66,490.84 | $16,223.76–$52,660.75 | — | 30% |
| Total thyroid removal (thyroidectomy) CPT 60240 Removal of thyroid | $22,412.24 | $32,017.48 | $6,001.68–$25,357.84 | 51% above | 30% |
| Total thyroid removal (thyroidectomy) one side CPT 60240 Removal of thyroid | $17,695.79 | $25,279.70 | $6,001.68–$20,021.52 | 20% above | 30% |
| Total thyroid removal (thyroidectomy) one side CPT 60240 Removal of thyroid | $22,689.25 | $32,413.22 | $6,001.68–$25,671.27 | 53% above | 30% |
| Total thyroid removal (thyroidectomy) inpatient CPT 60240 Removal of thyroid | $28,595.10 | $40,850.14 | $6,001.68–$32,353.31 | — | 30% |
| Total thyroid removal (thyroidectomy) inpatient one side CPT 60240 Removal of thyroid | $17,695.79 | $25,279.70 | $6,001.68–$20,021.52 | — | 30% |
| Total thyroid removal (thyroidectomy) inpatient one side CPT 60240 Removal of thyroid | $22,689.25 | $32,413.22 | $6,001.68–$25,671.27 | — | 30% |
| Trigger finger release surgery CPT 26055 Incise finger tendon sheath | $7,992.26 | $11,417.52 | $1,596.33–$9,042.68 | 91% above | 30% |
| Trigger finger release surgery one side CPT 26055 Incise finger tendon sheath | $7,838.59 | $11,197.99 | $1,596.33–$8,868.81 | 87% above | 30% |
| Trigger finger release surgery one side CPT 26055 Incise finger tendon sheath | $9,466.72 | $13,523.89 | $1,596.33–$10,710.92 | 126% above | 30% |
| Trigger finger release surgery inpatient CPT 26055 Incise finger tendon sheath | $7,992.26 | $11,417.52 | $1,596.33–$9,042.68 | — | 30% |
| Trigger finger release surgery inpatient one side CPT 26055 Incise finger tendon sheath | $7,838.59 | $11,197.99 | $1,596.33–$8,868.81 | — | 30% |
| Trigger finger release surgery inpatient one side CPT 26055 Incise finger tendon sheath | $9,466.72 | $13,523.89 | $1,596.33–$10,710.92 | — | 30% |
| Trigger point injections, 1 or 2 muscles CPT 20552 Trigger point injection | $666.40 | $952.00 | $232.29–$753.98 | 17% above | 30% |
| Trigger point injections, 1 or 2 muscles CPT 20552 Trigger pt inj; 1 or 2 muscles | $666.40 | $952.00 | $232.29–$753.98 | 17% above | 30% |
| Trigger point injections, 1 or 2 muscles CPT 20552 Inj trigger point 1/2 muscl | $3,324.33 | $4,749.04 | $304.73–$3,761.24 | 486% above | 30% |
| Trigger point injections, 1 or 2 muscles one side CPT 20552 Inj trigger point 1/2 muscl | $3,324.33 | $4,749.04 | $304.73–$3,761.24 | 486% above | 30% |
| Trigger point injections, 1 or 2 muscles one side CPT 20552 Inj trigger point 1/2 muscl | $3,368.88 | $4,812.69 | $304.73–$3,811.65 | 494% above | 30% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Trigger point injection | $666.40 | $952.00 | $232.29–$753.98 | — | 30% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Trigger pt inj; 1 or 2 muscles | $666.40 | $952.00 | $232.29–$753.98 | — | 30% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Inj trigger point 1/2 muscl | $3,324.33 | $4,749.04 | $304.73–$3,761.24 | — | 30% |
| Trigger point injections, 1 or 2 muscles inpatient one side CPT 20552 Inj trigger point 1/2 muscl | $3,324.33 | $4,749.04 | $304.73–$3,761.24 | — | 30% |
| Trigger point injections, 1 or 2 muscles inpatient one side CPT 20552 Inj trigger point 1/2 muscl | $3,368.88 | $4,812.69 | $304.73–$3,811.65 | — | 30% |
| Tubal ligation, laparoscopic (tubes sealed by cautery) CPT 58670 Laparoscopy tubal cautery | $13,680.56 | $19,543.66 | $6,001.68–$19,078.36 | 2% below | 30% |
| Tubal ligation, laparoscopic (tubes sealed by cautery) inpatient CPT 58670 Laparoscopy tubal cautery | $13,680.56 | $19,543.66 | $6,001.68–$19,078.36 | — | 30% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 Bx breast 1st lesion us imag | $5,658.74 | $8,083.92 | $1,639.62–$6,402.46 | 144% above | 30% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 Bx breast 1st lesion us imag | $5,605.61 | $8,008.02 | $1,639.62–$6,342.35 | 141% above | 30% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 Bx breast 1st lesion us imag | $5,721.09 | $8,172.99 | $1,639.62–$6,473.01 | 146% above | 30% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 Bx breast 1st lesion us imag | $18,920.80 | $27,029.71 | $1,639.62–$21,407.53 | — | 30% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 Bx breast 1st lesion us imag | $5,605.61 | $8,008.02 | $1,639.62–$6,342.35 | — | 30% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 Bx breast 1st lesion us imag | $5,721.09 | $8,172.99 | $1,639.62–$6,473.01 | — | 30% |
| Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 Esoph egd dilation <30 mm | $5,854.21 | $8,363.16 | $1,904.99–$6,623.62 | 83% above | 30% |
| Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 Esoph egd dilation <30 mm | $30,507.41 | $43,582.02 | $1,904.99–$34,516.96 | — | 30% |
| Upper endoscopy (EGD) with biopsy CPT 43239 Egd biopsy single/multiple | $6,167.41 | $8,810.59 | $900.41–$6,977.99 | 104% above | 30% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 Egd biopsy single/multiple | $29,778.74 | $42,541.06 | $900.41–$33,692.52 | — | 30% |
| Upper endoscopy (EGD) with injection into the lining CPT 43236 Uppr gi scope w/submuc inj | $6,651.09 | $9,501.55 | $900.41–$7,525.23 | 73% above | 30% |
| Upper endoscopy (EGD) with injection into the lining inpatient CPT 43236 Uppr gi scope w/submuc inj | $29,598.89 | $42,284.13 | $900.41–$33,489.03 | — | 30% |
| Upper endoscopy (EGD) with polyp removal by snare CPT 43251 Egd remove lesion snare | $6,789.65 | $9,699.50 | $1,904.99–$7,682.00 | 73% above | 30% |
| Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 Egd remove lesion snare | $31,280.42 | $44,686.32 | $1,904.99–$35,391.57 | — | 30% |
| Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 Egd guide wire insertion | $5,811.09 | $8,301.55 | $900.41–$6,574.83 | 115% above | 30% |
| Upper endoscopy (EGD) with widening of the esophagus over a guide wire inpatient CPT 43248 Egd guide wire insertion | $29,633.42 | $42,333.46 | $900.41–$33,528.10 | — | 30% |
| Upper endoscopy (EGD), diagnostic CPT 43235 Egd diagnostic brush wash | $4,751.32 | $6,787.60 | $900.41–$5,375.78 | 100% above | 30% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 Egd diagnostic brush wash | $29,479.13 | $42,113.04 | $900.41–$33,353.53 | — | 30% |
| Upper endoscopy with drainage of a pseudocyst through the stomach wall CPT 43240 Egd w/transmural drain cyst | $20,553.25 | $29,361.79 | $6,026.86–$23,254.54 | 76% above | 30% |
| Upper endoscopy with drainage of a pseudocyst through the stomach wall inpatient CPT 43240 Egd w/transmural drain cyst | $29,617.90 | $42,311.29 | $6,026.86–$33,510.54 | — | 30% |
| Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 Cystouretero w/lithotripsy | $16,018.80 | $22,884.00 | $5,322.90–$18,124.13 | 62% above | 30% |
| Ureteroscopy with laser stone breaking (lithotripsy) one side CPT 52353 Cystouretero w/lithotripsy | $9,827.93 | $14,039.90 | $3,425.74–$11,119.60 | at median | 30% |
| Ureteroscopy with laser stone breaking (lithotripsy) one side CPT 52353 Cystouretero w/lithotripsy | $16,018.80 | $22,884.00 | $5,322.90–$18,124.13 | 62% above | 30% |
| Ureteroscopy with laser stone breaking (lithotripsy) inpatient CPT 52353 Cystouretero w/lithotripsy | $23,513.65 | $33,590.93 | $5,322.90–$26,604.02 | — | 30% |
| Ureteroscopy with laser stone breaking (lithotripsy) inpatient one side CPT 52353 Cystouretero w/lithotripsy | $9,827.93 | $14,039.90 | $3,425.74–$11,119.60 | — | 30% |
| Ureteroscopy with laser stone breaking (lithotripsy) inpatient one side CPT 52353 Cystouretero w/lithotripsy | $16,018.80 | $22,884.00 | $5,322.90–$18,124.13 | — | 30% |
| Ureteroscopy with laser stone breaking and stent placement CPT 52356 Cysto/uretero w/lithotripsy | $16,425.34 | $23,464.77 | $5,322.90–$18,584.10 | 3% above | 30% |
| Ureteroscopy with laser stone breaking and stent placement one side CPT 52356 Cysto/uretero w/lithotripsy | $16,080.80 | $22,972.57 | $5,322.90–$18,194.28 | 1% above | 30% |
| Ureteroscopy with laser stone breaking and stent placement one side CPT 52356 Cysto/uretero w/lithotripsy | $16,993.06 | $24,275.80 | $5,322.90–$19,226.43 | 6% above | 30% |
| Ureteroscopy with laser stone breaking and stent placement inpatient CPT 52356 Cysto/uretero w/lithotripsy | $25,083.18 | $35,833.11 | $5,322.90–$28,379.82 | — | 30% |
| Ureteroscopy with laser stone breaking and stent placement inpatient one side CPT 52356 Cysto/uretero w/lithotripsy | $16,080.80 | $22,972.57 | $5,322.90–$18,194.28 | — | 30% |
| Ureteroscopy with laser stone breaking and stent placement inpatient one side CPT 52356 Cysto/uretero w/lithotripsy | $16,993.06 | $24,275.80 | $5,322.90–$19,226.43 | — | 30% |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care inpatient CPT 59610 Vbac delivery | $11,237.46 | $16,053.51 | $3,917.06–$12,714.38 | — | 30% |
| Vaginal delivery, including prenatal and postpartum care inpatient CPT 59400 Obstetrical care | $11,238.92 | $16,055.60 | $3,917.57–$12,716.04 | — | 30% |
| Vasectomy, one or both sides, including follow-up semen testing CPT 55250 Removal of sperm duct(s) | $6,185.36 | $8,836.23 | $2,075.22–$6,998.29 | 26% above | 30% |
| Vasectomy, one or both sides, including follow-up semen testing inpatient CPT 55250 Removal of sperm duct(s) | $6,185.36 | $8,836.23 | $2,075.22–$6,998.29 | — | 30% |
| Vein ablation, radiofrequency, first vein CPT 36475 Endovenous rf 1st vein | $13,891.78 | $19,845.40 | $3,134.58–$15,717.56 | 123% above | 30% |
| Vein ablation, radiofrequency, first vein one side CPT 36475 Endovenous rf 1st vein | $11,590.53 | $16,557.90 | $3,134.58–$13,113.86 | 86% above | 30% |
| Vein ablation, radiofrequency, first vein one side CPT 36475 Endovenous rf 1st vein | $11,846.05 | $16,922.93 | $3,134.58–$13,402.96 | 90% above | 30% |
| Vein ablation, radiofrequency, first vein inpatient CPT 36475 Endovenous rf 1st vein | $53,805.57 | $76,865.10 | $3,134.58–$60,877.16 | — | 30% |
| Vein ablation, radiofrequency, first vein inpatient one side CPT 36475 Endovenous rf 1st vein | $11,590.53 | $16,557.90 | $3,134.58–$13,113.86 | — | 30% |
| Vein ablation, radiofrequency, first vein inpatient one side CPT 36475 Endovenous rf 1st vein | $11,846.05 | $16,922.93 | $3,134.58–$13,402.96 | — | 30% |
| Wart removal, up to 14 warts CPT 17110 Benign lesion non skin tag 14< | $400.40 | $572.00 | $139.57–$453.02 | 35% above | 30% |
| Wart removal, up to 14 warts CPT 17110 Destruct b9 lesion 1-14 | $599.39 | $856.27 | $199.18–$678.17 | 102% above | 30% |
| Wart removal, up to 14 warts inpatient CPT 17110 Benign lesion non skin tag 14< | $400.40 | $572.00 | $139.57–$453.02 | — | 30% |
| Wart removal, up to 14 warts inpatient CPT 17110 Destruct b9 lesion 1-14 | $2,251.87 | $3,216.95 | $199.18–$2,547.82 | — | 30% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Deb subcut tiss first 20cm | $901.60 | $1,288.00 | $314.27–$1,020.10 | 16% above | 30% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Debrid subq 1st 20 sq cm | $901.60 | $1,288.00 | $314.27–$1,020.10 | 16% above | 30% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Deb subq tissue 20 sq cm/< | $1,747.45 | $2,496.36 | $403.57–$1,977.12 | 125% above | 30% |
| Wound debridement, skin and tissue under it, first 20 sq cm one side CPT 11042 Deb subq tissue 20 sq cm/< | $6,270.29 | $8,957.56 | $403.57–$7,094.39 | 706% above | 30% |
| Wound debridement, skin and tissue under it, first 20 sq cm one side CPT 11042 Deb subq tissue 20 sq cm/< | $8,221.17 | $11,744.53 | $403.57–$9,301.67 | 957% above | 30% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 Debrid subq 1st 20 sq cm | $901.60 | $1,288.00 | $314.27–$1,020.10 | — | 30% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 Deb subcut tiss first 20cm | $901.60 | $1,288.00 | $314.27–$1,020.10 | — | 30% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 Deb subq tissue 20 sq cm/< | $28,249.55 | $40,356.50 | $403.57–$31,962.35 | — | 30% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient one side CPT 11042 Deb subq tissue 20 sq cm/< | $6,270.29 | $8,957.56 | $403.57–$7,094.39 | — | 30% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient one side CPT 11042 Deb subq tissue 20 sq cm/< | $8,221.17 | $11,744.53 | $403.57–$9,301.67 | — | 30% |
| Wrist fracture surgery (plate and screws), distal radius CPT 25607 Treat fx rad extra-articul | $19,315.11 | $27,593.02 | $6,732.70–$21,853.67 | 100% above | 30% |
| Wrist fracture surgery (plate and screws), distal radius one side CPT 25607 Treat fx rad extra-articul | $11,750.09 | $16,785.84 | $4,095.74–$13,294.39 | 22% above | 30% |
| Wrist fracture surgery (plate and screws), distal radius one side CPT 25607 Treat fx rad extra-articul | $19,315.11 | $27,593.02 | $6,732.70–$21,853.67 | 100% above | 30% |
| Wrist fracture surgery (plate and screws), distal radius inpatient CPT 25607 Treat fx rad extra-articul | $33,324.89 | $47,606.99 | $7,203.58–$37,704.74 | — | 30% |
| Wrist fracture surgery (plate and screws), distal radius inpatient one side CPT 25607 Treat fx rad extra-articul | $11,750.09 | $16,785.84 | $4,095.74–$13,294.39 | — | 30% |
| Wrist fracture surgery (plate and screws), distal radius inpatient one side CPT 25607 Treat fx rad extra-articul | $19,315.11 | $27,593.02 | $6,732.70–$21,853.67 | — | 30% |
Doctor visits and therapy
| Procedure | Cash price | List price | Insurers pay | vs Indiana | Off list |
|---|---|---|---|---|---|
| Blood transfusion (giving blood or blood components) CPT 36430 Blood transfusion service | $11,750.28 | $16,786.11 | $437.97–$13,294.60 | 1205% above | 30% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood transfusion service | $26,481.81 | $37,831.16 | $437.97–$29,962.28 | — | 30% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Aerosol 1st sub inpt/outpt/obv | $424.90 | $607.00 | $217.39–$665.09 | 277% above | 30% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Airway inhalation treatment | $424.90 | $607.00 | $217.39–$665.09 | 277% above | 30% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Aerosol 1st sub inpt/outpt/obv | $424.90 | $607.00 | $217.39–$665.09 | — | 30% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Airway inhalation treatment | $424.90 | $607.00 | $217.39–$665.09 | — | 30% |
| Chemotherapy IV infusion, first hour CPT 96413 Chem admin iv;infus up to 1hr | $676.20 | $966.00 | $327.91–$1,084.63 | at median | 30% |
| Chemotherapy IV infusion, first hour CPT 96413 Chemo iv infusion 1 hr | $676.20 | $966.00 | $327.91–$1,084.63 | at median | 30% |
| Chemotherapy IV infusion, first hour inpatient CPT 96413 Chemo iv infusion 1 hr | $676.20 | $966.00 | $327.91–$1,084.63 | — | 30% |
| Chemotherapy IV infusion, first hour inpatient CPT 96413 Chem admin iv;infus up to 1hr | $676.20 | $966.00 | $327.91–$1,084.63 | — | 30% |
| Critical care, first 30 to 74 minutes CPT 99291 Critical care 1st 30-74 min | $1,647.10 | $2,353.00 | $820.04–$2,755.33 | 22% below | 30% |
| Critical care, first 30 to 74 minutes CPT 99291 Critical care first hour | $1,647.10 | $2,353.00 | $820.04–$2,755.33 | 22% below | 30% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 Critical care first hour | $1,647.10 | $2,353.00 | $820.04–$2,755.33 | — | 30% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 Critical care 1st 30-74 min | $1,647.10 | $2,353.00 | $820.04–$2,755.33 | — | 30% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Ekg-resting | $233.10 | $333.00 | $58.56–$263.74 | 15% above | 30% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Electrocardiogram tracing | $233.10 | $333.00 | $58.56–$263.74 | 15% above | 30% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 Electrocardiogram tracing | $233.10 | $333.00 | $58.56–$263.74 | — | 30% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 Ekg-resting | $233.10 | $333.00 | $58.56–$263.74 | — | 30% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Emergency room level i | $194.60 | $278.00 | $83.71–$287.92 | 11% below | 30% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Emergency dept visit | $194.60 | $278.00 | $83.71–$287.92 | 11% below | 30% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 Emergency dept visit | $194.60 | $278.00 | $83.71–$287.92 | — | 30% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 Emergency room level i | $194.60 | $278.00 | $83.71–$287.92 | — | 30% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Emergency room level ii | $364.00 | $520.00 | $152.43–$517.84 | 13% below | 30% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Emergency dept visit | $364.00 | $520.00 | $152.43–$517.84 | 13% below | 30% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 Emergency dept visit | $364.00 | $520.00 | $152.43–$517.84 | — | 30% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 Emergency room level ii | $364.00 | $520.00 | $152.43–$517.84 | — | 30% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Emergency dept visit | $637.00 | $910.00 | $271.00–$905.43 | 18% below | 30% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Emergency room level iii | $637.00 | $910.00 | $271.00–$905.43 | 18% below | 30% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 Emergency room level iii | $637.00 | $910.00 | $271.00–$905.43 | — | 30% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 Emergency dept visit | $637.00 | $910.00 | $271.00–$905.43 | — | 30% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Emergency dept visit | $980.00 | $1,400.00 | $414.24–$1,392.43 | 17% below | 30% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Emergency room level iv | $980.00 | $1,400.00 | $414.24–$1,392.43 | 17% below | 30% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 Emergency room level iv | $980.00 | $1,400.00 | $414.24–$1,392.43 | — | 30% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 Emergency dept visit | $980.00 | $1,400.00 | $414.24–$1,392.43 | — | 30% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Emergency dept visit | $1,165.50 | $1,665.00 | $591.21–$2,004.84 | 33% below | 30% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Emergency room level v | $1,165.50 | $1,665.00 | $591.21–$2,004.84 | 33% below | 30% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 Emergency dept visit | $1,165.50 | $1,665.00 | $591.21–$2,004.84 | — | 30% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 Emergency room level v | $1,165.50 | $1,665.00 | $591.21–$2,004.84 | — | 30% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 Cardiac stress test | $900.90 | $1,287.00 | $214.36–$1,019.30 | 18% above | 30% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 Cardiovascular stress test | $900.90 | $1,287.00 | $214.36–$1,019.30 | 18% above | 30% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Cardiovascular stress test | $900.90 | $1,287.00 | $214.36–$1,019.30 | — | 30% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Cardiac stress test | $900.90 | $1,287.00 | $214.36–$1,019.30 | — | 30% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Hydration iv infusion init | $392.70 | $561.00 | $211.16–$688.96 | 7% above | 30% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 Hydration iv infusion init | $392.70 | $561.00 | $211.16–$688.96 | — | 30% |
| IV infusion of a medicine, first hour CPT 96365 Iv infusion tx/dx up to 1 hr | $400.40 | $572.00 | $211.16–$688.96 | 1% below | 30% |
| IV infusion of a medicine, first hour CPT 96365 Ther/proph/diag iv inf init | $400.40 | $572.00 | $211.16–$688.96 | 1% below | 30% |
| IV infusion of a medicine, first hour inpatient CPT 96365 Iv infusion tx/dx up to 1 hr | $400.40 | $572.00 | $211.16–$688.96 | — | 30% |
| IV infusion of a medicine, first hour inpatient CPT 96365 Ther/proph/diag iv inf init | $400.40 | $572.00 | $211.16–$688.96 | — | 30% |
| IV push of a medicine, first drug CPT 96374 Inj single or initial drug | $388.50 | $555.00 | $211.16–$688.96 | 83% above | 30% |
| IV push of a medicine, first drug CPT 96374 Ther/proph/diag inj iv push | $388.50 | $555.00 | $211.16–$688.96 | 83% above | 30% |
| IV push of a medicine, first drug inpatient CPT 96374 Inj single or initial drug | $388.50 | $555.00 | $211.16–$688.96 | — | 30% |
| IV push of a medicine, first drug inpatient CPT 96374 Ther/proph/diag inj iv push | $388.50 | $555.00 | $211.16–$688.96 | — | 30% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 Ther/proph/diag inj sc/im | $118.30 | $169.00 | $71.48–$232.73 | 12% above | 30% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 Injection sc/im | $118.30 | $169.00 | $71.48–$232.73 | 12% above | 30% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Injection sc/im | $118.30 | $169.00 | $71.48–$232.73 | — | 30% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Ther/proph/diag inj sc/im | $118.30 | $169.00 | $71.48–$232.73 | — | 30% |
| Mental health diagnostic evaluation (intake), without medical services CPT 90791 Psych diagnostic evaluation | $381.50 | $545.00 | $176.21–$525.39 | 52% above | 30% |
| Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 Psych diagnostic evaluation | $381.50 | $545.00 | $176.21–$525.39 | — | 30% |
| Neuromuscular re-education, 15 minutes CPT 97112 Neuromuscular reeducation | $112.70 | $161.00 | $30.53–$127.51 | 49% above | 30% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 Neuromuscular reeducation | $112.70 | $161.00 | $30.53–$127.51 | — | 30% |
| New patient office visit, about 30 minutes CPT 99203 Ob eval new pt level 3 | $245.00 | $350.00 | $85.40–$277.20 | 48% above | 30% |
| New patient office visit, about 30 minutes CPT 99203 Office/outpatient visit new | $245.00 | $350.00 | $85.40–$277.20 | 48% above | 30% |
| New patient office visit, about 30 minutes CPT 99203 Op visit new pt level 3 | $245.00 | $350.00 | $85.40–$277.20 | 48% above | 30% |
| New patient office visit, about 30 minutes inpatient CPT 99203 Op visit new pt level 3 | $245.00 | $350.00 | $85.40–$277.20 | — | 30% |
| New patient office visit, about 30 minutes inpatient CPT 99203 Office/outpatient visit new | $245.00 | $350.00 | $85.40–$277.20 | — | 30% |
| New patient office visit, about 30 minutes inpatient CPT 99203 Ob eval new pt level 3 | $245.00 | $350.00 | $85.40–$277.20 | — | 30% |
| New patient office visit, about 45 minutes CPT 99204 Office/outpatient visit new | $314.30 | $449.00 | $109.56–$355.61 | 66% above | 30% |
| New patient office visit, about 45 minutes CPT 99204 Ob eval new pt level 4 | $314.30 | $449.00 | $109.56–$355.61 | 66% above | 30% |
| New patient office visit, about 45 minutes CPT 99204 Op visit new pt level 4 | $314.30 | $449.00 | $109.56–$355.61 | 66% above | 30% |
| New patient office visit, about 45 minutes inpatient CPT 99204 Office/outpatient visit new | $314.30 | $449.00 | $109.56–$355.61 | — | 30% |
| New patient office visit, about 45 minutes inpatient CPT 99204 Ob eval new pt level 4 | $314.30 | $449.00 | $109.56–$355.61 | — | 30% |
| New patient office visit, about 45 minutes inpatient CPT 99204 Op visit new pt level 4 | $314.30 | $449.00 | $109.56–$355.61 | — | 30% |
| New patient office visit, about 60 minutes CPT 99205 Op visit new pt level 5 | $462.70 | $661.00 | $161.28–$523.51 | 82% above | 30% |
| New patient office visit, about 60 minutes CPT 99205 Ob eval new pt level 5 | $463.40 | $662.00 | $161.53–$524.30 | 83% above | 30% |
| New patient office visit, about 60 minutes CPT 99205 Office/outpatient visit new | $463.40 | $662.00 | $161.53–$524.30 | 83% above | 30% |
| New patient office visit, about 60 minutes inpatient CPT 99205 Op visit new pt level 5 | $462.70 | $661.00 | $161.28–$523.51 | — | 30% |
| New patient office visit, about 60 minutes inpatient CPT 99205 Office/outpatient visit new | $463.40 | $662.00 | $161.53–$524.30 | — | 30% |
| New patient office visit, about 60 minutes inpatient CPT 99205 Ob eval new pt level 5 | $463.40 | $662.00 | $161.53–$524.30 | — | 30% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 Ob eval new pt level 2 | $194.60 | $278.00 | $67.83–$220.18 | 39% above | 30% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 Op visit new pt level 2 | $194.60 | $278.00 | $67.83–$220.18 | 39% above | 30% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 Office/outpatient visit new | $194.60 | $278.00 | $67.83–$220.18 | 39% above | 30% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 Office/outpatient visit new | $194.60 | $278.00 | $67.83–$220.18 | — | 30% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 Ob eval new pt level 2 | $194.60 | $278.00 | $67.83–$220.18 | — | 30% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 Op visit new pt level 2 | $194.60 | $278.00 | $67.83–$220.18 | — | 30% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Medical nutrition indiv in | $35.00 | $50.00 | $12.20–$39.60 | 2% above | 30% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Mnt initial/intervention 15min | $35.00 | $50.00 | $12.20–$39.60 | 2% above | 30% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 Medical nutrition indiv in | $35.00 | $50.00 | $12.20–$39.60 | — | 30% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 Mnt initial/intervention 15min | $35.00 | $50.00 | $12.20–$39.60 | — | 30% |
| Occupational therapy evaluation, low complexity CPT 97165 Ot eval low complex 30 min | $252.00 | $360.00 | $87.84–$285.12 | 58% above | 30% |
| Occupational therapy evaluation, low complexity inpatient CPT 97165 Ot eval low complex 30 min | $252.00 | $360.00 | $87.84–$285.12 | — | 30% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 Pt eval high complex 45 min | $319.20 | $456.00 | $91.66–$361.15 | 36% above | 30% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 Pt eval high complex 45 min | $319.20 | $456.00 | $91.66–$361.15 | — | 30% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Pt eval low complex 20 min | $217.70 | $311.00 | $75.88–$246.31 | 52% above | 30% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 Pt eval low complex 20 min | $217.70 | $311.00 | $75.88–$246.31 | — | 30% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Pt eval mod complex 30 min | $268.10 | $383.00 | $91.66–$303.34 | 44% above | 30% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 Pt eval mod complex 30 min | $268.10 | $383.00 | $91.66–$303.34 | — | 30% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Manual therapy 1/> regions | $105.00 | $150.00 | $25.85–$118.80 | 23% above | 30% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 Manual therapy 1/> regions | $105.00 | $150.00 | $25.85–$118.80 | — | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic exercises | $108.50 | $155.00 | $27.10–$122.76 | 44% above | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic exercises | $108.50 | $155.00 | $27.10–$122.76 | — | 30% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 Behav chng smoking 3-10 min | $50.40 | $72.00 | $37.20–$97.41 | 68% above | 30% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 Tobacco use counsel 3-10 min | $50.40 | $72.00 | $37.20–$97.41 | 68% above | 30% |
| Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 Tobacco use counsel 3-10 min | $50.40 | $72.00 | $37.20–$97.41 | — | 30% |
| Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 Behav chng smoking 3-10 min | $50.40 | $72.00 | $37.20–$97.41 | — | 30% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 Op visit est pt level 5 | $314.30 | $449.00 | $109.56–$355.61 | 109% above | 30% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 Office/outpatient visit est | $314.30 | $449.00 | $109.56–$355.61 | 109% above | 30% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 Ob eval est pt level 5 | $314.30 | $449.00 | $109.56–$355.61 | 109% above | 30% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Office/outpatient visit est | $314.30 | $449.00 | $109.56–$355.61 | — | 30% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Ob eval est pt level 5 | $314.30 | $449.00 | $109.56–$355.61 | — | 30% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Op visit est pt level 5 | $314.30 | $449.00 | $109.56–$355.61 | — | 30% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 Ob eval est pt level 3 | $194.60 | $278.00 | $67.83–$220.18 | 121% above | 30% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 Op visit est pt level 3 | $194.60 | $278.00 | $67.83–$220.18 | 121% above | 30% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 Office/outpatient visit est | $194.60 | $278.00 | $67.83–$220.18 | 121% above | 30% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Office/outpatient visit est | $194.60 | $278.00 | $67.83–$220.18 | — | 30% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Op visit est pt level 3 | $194.60 | $278.00 | $67.83–$220.18 | — | 30% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Ob eval est pt level 3 | $194.60 | $278.00 | $67.83–$220.18 | — | 30% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Op visit est pt level 4 | $245.00 | $350.00 | $85.40–$277.20 | 121% above | 30% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Ob eval est pt level 4 | $245.00 | $350.00 | $85.40–$277.20 | 121% above | 30% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Office/outpatient visit est | $245.00 | $350.00 | $85.40–$277.20 | 121% above | 30% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Office/outpatient visit est | $245.00 | $350.00 | $85.40–$277.20 | — | 30% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Op visit est pt level 4 | $245.00 | $350.00 | $85.40–$277.20 | — | 30% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Ob eval est pt level 4 | $245.00 | $350.00 | $85.40–$277.20 | — | 30% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Office/outpatient visit est | $194.60 | $278.00 | $67.83–$220.18 | 277% above | 30% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Op visit est pt level 2 | $194.60 | $278.00 | $67.83–$220.18 | 277% above | 30% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Ob eval est pt level 2 | $194.60 | $278.00 | $67.83–$220.18 | 277% above | 30% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Office/outpatient visit est | $194.60 | $278.00 | $67.83–$220.18 | — | 30% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Op visit est pt level 2 | $194.60 | $278.00 | $67.83–$220.18 | — | 30% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Ob eval est pt level 2 | $194.60 | $278.00 | $67.83–$220.18 | — | 30% |
| Speech and language evaluation CPT 92523 Speech sound lang comprehen | $539.70 | $771.00 | $188.12–$610.63 | 164% above | 30% |
| Speech and language evaluation inpatient CPT 92523 Speech sound lang comprehen | $539.70 | $771.00 | $188.12–$610.63 | — | 30% |
| Speech therapy session, individual CPT 92507 Speech/hearing therapy | $345.80 | $494.00 | $71.54–$391.25 | 137% above | 30% |
| Speech therapy session, individual inpatient CPT 92507 Speech/hearing therapy | $345.80 | $494.00 | $71.54–$391.25 | — | 30% |
| Spirometry (breathing test) CPT 94010 Bedside spirometry | $335.30 | $479.00 | $214.36–$511.62 | 37% above | 30% |
| Spirometry (breathing test) CPT 94010 Breathing capacity test | $335.30 | $479.00 | $214.36–$511.62 | 37% above | 30% |
| Spirometry (breathing test) inpatient CPT 94010 Breathing capacity test | $335.30 | $479.00 | $214.36–$511.62 | — | 30% |
| Spirometry (breathing test) inpatient CPT 94010 Bedside spirometry | $335.30 | $479.00 | $214.36–$511.62 | — | 30% |
| Spirometry before and after a bronchodilator CPT 94060 Evaluation of wheezing | $621.60 | $888.00 | $370.45–$1,018.28 | 14% above | 30% |
| Spirometry before and after a bronchodilator CPT 94060 Disability spiro b & a | $621.60 | $888.00 | $370.45–$1,018.28 | 14% above | 30% |
| Spirometry before and after a bronchodilator inpatient CPT 94060 Evaluation of wheezing | $621.60 | $888.00 | $370.45–$1,018.28 | — | 30% |
| Spirometry before and after a bronchodilator inpatient CPT 94060 Disability spiro b & a | $621.60 | $888.00 | $370.45–$1,018.28 | — | 30% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 Therapeutic activities | $93.10 | $133.00 | $32.45–$105.34 | 23% above | 30% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Therapeutic activities | $93.10 | $133.00 | $32.45–$105.34 | — | 30% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Phlebotomy | $228.90 | $327.00 | $132.08–$421.50 | 9% above | 30% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Phlebotomy therapeutic | $228.90 | $327.00 | $132.08–$421.50 | 9% above | 30% |
| Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 Phlebotomy | $228.90 | $327.00 | $132.08–$421.50 | — | 30% |
| Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 Phlebotomy therapeutic | $228.90 | $327.00 | $132.08–$421.50 | — | 30% |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs Indiana | Off list |
|---|---|---|---|---|---|
| Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 Varicella vaccine (varivax) | $410.18 | $585.97 | $142.98–$464.09 | at median | 30% |
| Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 Varicella vaccine (varivax) | $410.18 | $585.97 | $142.98–$464.09 | — | 30% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 Fluarix syringe 2025-26 | $98.19 | $140.27 | $34.23–$111.09 | 152% above | 30% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 Fluarix syringe 2025-26 | $98.19 | $140.27 | $34.23–$111.09 | — | 30% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 Hepatitis b vaccine adult | $447.69 | $639.55 | $156.05–$506.52 | 154% above | 30% |
| Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 Hepatitis b vaccine adult | $447.69 | $639.55 | $156.05–$506.52 | — | 30% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 Hepatitis b pediatric5mcg | $180.90 | $258.43 | $63.06–$204.68 | 147% above | 30% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 Hepatitis b pediatric5mcg | $180.90 | $258.43 | $63.06–$204.68 | — | 30% |
| Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 Haemophophilus b conj. vaccine | $108.69 | $155.27 | $37.89–$122.97 | 123% above | 30% |
| Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 Haemophophilus b conj. vaccine | $108.69 | $155.27 | $37.89–$122.97 | — | 30% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Fluzone hd syringe 2025-26 | $405.69 | $579.55 | $141.41–$459.00 | 126% above | 30% |
| High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 Fluzone hd syringe 2025-26 | $405.69 | $579.55 | $141.41–$459.00 | — | 30% |
| MMR vaccine (measles, mumps and rubella), live CPT 90707 Measles-mumps-rubella vaccine | $571.84 | $816.91 | $199.33–$646.99 | 122% above | 30% |
| MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 Measles-mumps-rubella vaccine | $571.84 | $816.91 | $199.33–$646.99 | — | 30% |
| Meningococcal ACWY (MenACWY) vaccine CPT 90734 Meningococcal/menveo conj vac | $427.50 | $610.72 | $149.02–$483.69 | 22% above | 30% |
| Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 Meningococcal/menveo conj vac | $427.50 | $610.72 | $149.02–$483.69 | — | 30% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 Mening b vacc comp 0.5ml syr | $608.09 | $868.70 | $211.96–$688.01 | 57% above | 30% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 Mening b vacc comp 0.5ml syr | $608.09 | $868.70 | $211.96–$688.01 | — | 30% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 Pneumococcal 13-val conj vac | $598.81 | $855.44 | $208.73–$677.51 | 28% above | 30% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 Pneumococcal 13-val conj vac | $598.81 | $855.44 | $208.73–$677.51 | — | 30% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 Prevnar-20 syringe | $726.33 | $1,037.62 | $253.18–$821.80 | 16% above | 30% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 Prevnar-20 syringe | $726.33 | $1,037.62 | $253.18–$821.80 | — | 30% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Pnu imune 23 syringe | $300.41 | $429.16 | $104.72–$339.89 | 42% above | 30% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Ppsv23 vacc 2 yrs+ subq/im | $300.41 | $429.16 | $104.72–$339.89 | 42% above | 30% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 Pnu imune 23 syringe | $300.41 | $429.16 | $104.72–$339.89 | — | 30% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 Ppsv23 vacc 2 yrs+ subq/im | $300.41 | $429.16 | $104.72–$339.89 | — | 30% |
| Polio vaccine, inactivated (IPV) CPT 90713 Poliovirus vaccine 0.5ml/ipol | $276.91 | $395.59 | $96.52–$313.31 | 123% above | 30% |
| Polio vaccine, inactivated (IPV) inpatient CPT 90713 Poliovirus vaccine 0.5ml/ipol | $276.91 | $395.59 | $96.52–$313.31 | — | 30% |
| Rabies vaccine, one dose CPT 90675 Rabies vaccine inact 2.5iu/ml | $1,032.79 | $1,475.41 | $306.30–$1,168.52 | 29% above | 30% |
| Rabies vaccine, one dose inpatient CPT 90675 Rabies vaccine inact 2.5iu/ml | $1,032.79 | $1,475.41 | $306.30–$1,168.52 | — | 30% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 Tetanus diphtheri tubex | $228.76 | $326.80 | $79.74–$258.83 | 100% above | 30% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 Tetanus diphtheri tubex | $228.76 | $326.80 | $79.74–$258.83 | — | 30% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Diph/tet/ap | $303.09 | $432.99 | $105.65–$342.93 | 147% above | 30% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Diph/tet/ap | $303.09 | $432.99 | $105.65–$342.93 | — | 30% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Immunization admin | $118.30 | $169.00 | $71.48–$232.73 | 92% above | 30% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Admin immunization | $118.30 | $169.00 | $71.48–$232.73 | 92% above | 30% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Admin immunization | $118.30 | $169.00 | $71.48–$232.73 | — | 30% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Immunization admin | $118.30 | $169.00 | $71.48–$232.73 | — | 30% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Admin immunization ea addl | $46.90 | $67.00 | $16.35–$53.06 | 18% above | 30% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Immunization admin each add | $46.90 | $67.00 | $16.35–$53.06 | 18% above | 30% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Immunization admin each add | $46.90 | $67.00 | $16.35–$53.06 | — | 30% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Admin immunization ea addl | $46.90 | $67.00 | $16.35–$53.06 | — | 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.