Hospital Natchitoches, LA

Natchitoches Regional Medical Center

Listed in its price file as “Natchitoches Parish Hospital Service District”.

Natchitoches Regional Medical Center in Natchitoches, LA publishes cash prices for 369 common procedures listed here, from its own machine-readable price file updated Mar 18, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Louisiana median for 226 of 367 procedures and below it for 133. By typical cash price it ranks #36 of 63 Louisiana hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.

501 Keyser Ave, Natchitoches, LA 71457 Collected Sep 23, 2026 Source price file Check a bill from this hospital (318) 214-4200

Acute care hospital Government-owned hospital Emergency department CMS star rating 4 of 5 CCN 190007 · CMS hospital register NPI 1689676835

Financial assistance

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

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

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Louisiana	Off list
Abdominal CT scan without and with contrast CPT 74170 CT ABDOMEN W/WO CONTRAST	$878.00	$2,195.00	$98.92–$1,756.00	11% below	60%
Abdominal CT scan without and with contrast inpatient CPT 74170 CT ABDOMEN W/WO CONTRAST	$878.00	$2,195.00	$98.92–$1,756.00	—	60%
Abdominal X-ray, 2 views CPT 74019 ABDOMEN XRAY 2 VIEWS	$51.60	$129.00	$11.30–$245.18	70% below	60%
Abdominal X-ray, 2 views CPT 74019 ABDOMEN	$145.20	$363.00	$11.30–$290.40	17% below	60%
Abdominal X-ray, 2 views CPT 74019 LECH ABDOMEN	$215.60	$539.00	$11.30–$431.20	24% above	60%
Abdominal X-ray, 2 views inpatient CPT 74019 ABDOMEN XRAY 2 VIEWS	$51.60	$129.00	$11.30–$245.18	—	60%
Abdominal X-ray, 2 views inpatient CPT 74019 ABDOMEN	$145.20	$363.00	$11.30–$290.40	—	60%
Abdominal X-ray, 2 views inpatient CPT 74019 LECH ABDOMEN	$215.60	$539.00	$11.30–$431.20	—	60%
Ankle X-ray, complete, 3 or more views one side CPT 73610 ANKLE 3+ VIEW RIGHT	$111.60	$279.00	—	2% below	60%
Ankle X-ray, complete, 3 or more views one side CPT 73610 ANKLE 3+ VIEW LEFT	$111.60	$279.00	—	2% below	60%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 ANKLE 3+ VIEW RIGHT	$111.60	$279.00	—	—	60%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 ANKLE 3+ VIEW LEFT	$111.60	$279.00	—	—	60%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 UPR/L XTREMITY ART 2 LEVELS	$144.80	$362.00	$107.91–$331.00	12% below	60%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 EXT ART/VENOUS LIMITED - WCC	$272.00	$680.00	$125.48–$544.00	65% above	60%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 UPR/L XTREMITY ART 2 LEVELS	$144.80	$362.00	$107.91–$331.00	—	60%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 EXT ART/VENOUS LIMITED - WCC	$272.00	$680.00	$125.48–$544.00	—	60%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT; U EXTR WO CONTRAST LEFT	$599.60	$1,499.00	—	5% below	60%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT; U EXTR WO CONTRAST RIGHT	$599.60	$1,499.00	—	5% below	60%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT; U EXTR WO CONTRAST LEFT	$599.60	$1,499.00	—	—	60%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT; U EXTR WO CONTRAST RIGHT	$599.60	$1,499.00	—	—	60%
Barium swallow (esophagus X-ray with contrast) CPT 74220 ESOPHAGUS	$215.60	$539.00	$29.97–$431.20	1% above	60%
Barium swallow (esophagus X-ray with contrast) CPT 74220 LECH ESOPHAGUS	$320.00	$800.00	$29.97–$640.00	50% above	60%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 ESOPHAGUS	$215.60	$539.00	$29.97–$431.20	—	60%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 LECH ESOPHAGUS	$320.00	$800.00	$29.97–$640.00	—	60%
Bone scan, whole body (nuclear medicine) CPT 78306 WHOLE BODY BONE SCAN	$644.80	$1,612.00	$81.81–$1,289.60	17% above	60%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 WHOLE BODY BONE SCAN	$644.80	$1,612.00	$81.81–$1,289.60	—	60%
Breast ultrasound, complete, one breast CPT 76641 ULTRASOUND BREAST COMPLETE	$120.40	$301.00	$31.75–$245.18	28% below	60%
Breast ultrasound, complete, one breast inpatient CPT 76641 ULTRASOUND BREAST COMPLETE	$120.40	$301.00	$31.75–$245.18	—	60%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CT ANGIO ABD & PELV W/O&W/DYEM	$379.60	$949.00	$144.93–$1,172.51	58% below	60%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CT ANGIO ABD & PELV W/O&W/DYEM	$379.60	$949.00	$144.93–$1,172.51	—	60%
CT angiography (CTA) of the head CPT 70496 CTA HEAD	$781.60	$1,954.00	$109.21–$1,563.20	18% above	60%
CT angiography (CTA) of the head inpatient CPT 70496 CTA HEAD	$781.60	$1,954.00	$109.21–$1,563.20	—	60%
CT angiography (CTA) of the neck CPT 70498 CTA NECK	$781.60	$1,954.00	$109.21–$1,563.20	18% above	60%
CT angiography (CTA) of the neck inpatient CPT 70498 CTA NECK	$781.60	$1,954.00	$109.21–$1,563.20	—	60%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA CHEST	$947.60	$2,369.00	$117.04–$1,895.20	17% above	60%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA CHEST	$947.60	$2,369.00	$117.04–$1,895.20	—	60%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CT ANGIO HRT W/3D IMAGE	$899.20	$2,248.00	$142.50–$1,798.40	91% above	60%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 CT ANGIO HRT W/3D IMAGE	$899.20	$2,248.00	$142.50–$1,798.40	—	60%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT HRT W/O DYE W/CA TEST	$899.20	$2,248.00	$31.45–$1,798.40	996% above	60%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT HRT W/O DYE W/CA TEST	$899.20	$2,248.00	$31.45–$1,798.40	—	60%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD & PELVIS W/O CONTRAST	$1,247.60	$3,119.00	$58.61–$2,495.20	13% above	60%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 LECH CT ABD & PELVIS W/O CONTR	$1,852.80	$4,632.00	$58.61–$3,705.60	68% above	60%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD & PELVIS W/O CONTRAST	$1,247.60	$3,119.00	$58.61–$2,495.20	—	60%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 LECH CT ABD & PELVIS W/O CONTR	$1,852.80	$4,632.00	$58.61–$3,705.60	—	60%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD & PELVIS W/CONTRAST M	$1,425.20	$3,563.00	$95.71–$2,850.40	29% above	60%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 LECH CT ABD & PELVIS W/CONTRAS	$2,116.40	$5,291.00	$95.71–$4,232.80	92% above	60%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD & PELVIS W/CONTRAST M	$1,425.20	$3,563.00	$95.71–$2,850.40	—	60%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 LECH CT ABD & PELVIS W/CONTRAS	$2,116.40	$5,291.00	$95.71–$4,232.80	—	60%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD&PELVIS WW/O CON 1+REGIO	$1,602.40	$4,006.00	$107.35–$3,204.80	13% above	60%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD&PELVIS WW/O CO 1+REGIOM	$1,602.40	$4,006.00	$107.35–$3,204.80	13% above	60%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 LECH CT ABD&PELVIS WW/O CON 1+	$2,380.00	$5,950.00	$107.35–$4,760.00	67% above	60%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD&PELVIS WW/O CON 1+REGIO	$1,602.40	$4,006.00	$107.35–$3,204.80	—	60%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD&PELVIS WW/O CO 1+REGIOM	$1,602.40	$4,006.00	$107.35–$3,204.80	—	60%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 LECH CT ABD&PELVIS WW/O CON 1+	$2,380.00	$5,950.00	$107.35–$4,760.00	—	60%
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W/CONTRAST	$798.00	$1,995.00	$85.53–$1,596.00	4% below	60%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN W/CONTRAST	$798.00	$1,995.00	$85.53–$1,596.00	—	60%
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/O CONTRAST	$706.00	$1,765.00	$63.58–$1,412.00	5% below	60%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN W/O CONTRAST	$706.00	$1,765.00	$63.58–$1,412.00	—	60%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIAL,SIN. W/O CONT	$568.00	$1,420.00	$62.37–$1,136.00	9% below	60%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILLOFACIAL,SIN. W/O CONT	$568.00	$1,420.00	$62.37–$1,136.00	—	60%
CT scan of the head or brain, no contrast dye CPT 70450 CT BRAIN/HEAD W/O CONTRAST	$604.80	$1,512.00	$57.62–$1,209.60	8% below	60%
CT scan of the head or brain, no contrast dye CPT 70450 CODE PURPLE	$604.80	$1,512.00	$57.62–$1,209.60	8% below	60%
CT scan of the head or brain, no contrast dye CPT 70450 LECH CT BRAIN/HEAD W/O CONTRAS	$898.00	$2,245.00	$57.62–$1,796.00	37% above	60%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT BRAIN/HEAD W/O CONTRAST	$604.80	$1,512.00	$57.62–$1,209.60	—	60%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CODE PURPLE	$604.80	$1,512.00	$57.62–$1,209.60	—	60%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 LECH CT BRAIN/HEAD W/O CONTRAS	$898.00	$2,245.00	$57.62–$1,796.00	—	60%
CT scan of the head with contrast CPT 70460 CT BRAIN/HEAD W/CONTRAST	$694.40	$1,736.00	$73.32–$1,388.80	3% below	60%
CT scan of the head with contrast inpatient CPT 70460 CT BRAIN/HEAD W/CONTRAST	$694.40	$1,736.00	$73.32–$1,388.80	—	60%
CT scan of the head without and with contrast CPT 70470 CT BRAIN/HEAD W/WO CONTRAST	$768.00	$1,920.00	$88.86–$1,536.00	14% below	60%
CT scan of the head without and with contrast inpatient CPT 70470 CT BRAIN/HEAD W/WO CONTRAST	$768.00	$1,920.00	$88.86–$1,536.00	—	60%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMBAR SPINE W/O CONTRAST	$748.80	$1,872.00	$65.25–$1,497.60	at median	60%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 LECH CT LUMBAR SPINE W/O CONTR	$1,111.60	$2,779.00	$65.25–$2,223.20	48% above	60%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT LUMBAR SPINE W/O CONTRAST	$748.80	$1,872.00	$65.25–$1,497.60	—	60%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 LECH CT LUMBAR SPINE W/O CONTR	$1,111.60	$2,779.00	$65.25–$2,223.20	—	60%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT CERVICAL SPINE W/O CONTRAST	$511.60	$1,279.00	$65.25–$1,023.20	27% below	60%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 LECH CT CERVICAL SPINE W/O CON	$833.20	$2,083.00	$65.25–$1,666.40	18% above	60%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT CERVICAL SPINE W/O CONTRAST	$511.60	$1,279.00	$65.25–$1,023.20	—	60%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 LECH CT CERVICAL SPINE W/O CON	$833.20	$2,083.00	$65.25–$1,666.40	—	60%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/CONT	$733.60	$1,834.00	$84.00–$1,467.20	8% below	60%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/CONT	$733.60	$1,834.00	$84.00–$1,467.20	—	60%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 CAROTID DOPPLER ULTRASOUND BI	$334.00	$835.00	$235.30–$668.00	—	60%
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 CAROTID DUPLEX COMPLETE	$334.00	$835.00	$235.30–$668.00	28% below	60%
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 LECH CAROTID DOPPLER ULTRASOUN	$496.00	$1,240.00	$235.30–$992.00	6% above	60%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 CAROTID DOPPLER ULTRASOUND BI	$334.00	$835.00	$235.30–$668.00	—	60%
Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 CAROTID DUPLEX COMPLETE	$334.00	$835.00	$235.30–$668.00	—	60%
Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 LECH CAROTID DOPPLER ULTRASOUN	$496.00	$1,240.00	$235.30–$992.00	—	60%
Chest CT scan without and with contrast CPT 71270 CT CHEST W/WO CONTRAST	$875.60	$2,189.00	$98.79–$1,751.20	15% below	60%
Chest CT scan without and with contrast inpatient CPT 71270 CT CHEST W/WO CONTRAST	$875.60	$2,189.00	$98.79–$1,751.20	—	60%
Chest X-ray, 2 views CPT 71046 CHEST 2 VIEWS	$92.00	$230.00	$10.39–$184.00	27% below	60%
Chest X-ray, 2 views CPT 71046 CHEST XRAY 2 VIEW	$113.60	$284.00	$10.39–$227.20	10% below	60%
Chest X-ray, 2 views CPT 71046 LECH CHEST 2 VIEWS	$135.20	$338.00	$10.39–$270.40	7% above	60%
Chest X-ray, 2 views inpatient CPT 71046 CHEST 2 VIEWS	$92.00	$230.00	$10.39–$184.00	—	60%
Chest X-ray, 2 views inpatient CPT 71046 CHEST XRAY 2 VIEW	$113.60	$284.00	$10.39–$227.20	—	60%
Chest X-ray, 2 views inpatient CPT 71046 LECH CHEST 2 VIEWS	$135.20	$338.00	$10.39–$270.40	—	60%
Chest X-ray, single view CPT 71045 CHEST SINGLE VIEW	$92.00	$230.00	$7.94–$184.00	11% below	60%
Chest X-ray, single view CPT 71045 CHEST XRAY 1 VIEW	$113.60	$284.00	$7.94–$227.20	10% above	60%
Chest X-ray, single view CPT 71045 LECH CHEST SINGLE VIEW	$116.80	$292.00	$7.94–$233.60	13% above	60%
Chest X-ray, single view inpatient CPT 71045 CHEST SINGLE VIEW	$92.00	$230.00	$7.94–$184.00	—	60%
Chest X-ray, single view inpatient CPT 71045 CHEST XRAY 1 VIEW	$113.60	$284.00	$7.94–$227.20	—	60%
Chest X-ray, single view inpatient CPT 71045 LECH CHEST SINGLE VIEW	$116.80	$292.00	$7.94–$233.60	—	60%
Collarbone (clavicle) X-ray, complete CPT 73000 CLAVICLE COMPLETE	$113.60	$284.00	$10.01–$227.20	at median	60%
Collarbone (clavicle) X-ray, complete one side CPT 73000 CLAVICLE,LEFT	$114.40	$286.00	—	at median	60%
Collarbone (clavicle) X-ray, complete one side CPT 73000 CLAVICLE,RIGHT	$114.40	$286.00	—	at median	60%
Collarbone (clavicle) X-ray, complete one side CPT 73000 LECH CLAVICLE,LEFT	$169.60	$424.00	—	49% above	60%
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 CLAVICLE COMPLETE	$113.60	$284.00	$10.01–$227.20	—	60%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 CLAVICLE,RIGHT	$114.40	$286.00	—	—	60%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 CLAVICLE,LEFT	$114.40	$286.00	—	—	60%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 LECH CLAVICLE,LEFT	$169.60	$424.00	—	—	60%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US EXAM ABDO BACK WALL,COMP	$182.00	$455.00	$33.46–$364.00	34% below	60%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 LECH US EXAM ABDO BACK WALL,CO	$270.00	$675.00	$33.46–$540.00	1% below	60%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US EXAM ABDO BACK WALL,COMP	$182.00	$455.00	$33.46–$364.00	—	60%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 LECH US EXAM ABDO BACK WALL,CO	$270.00	$675.00	$33.46–$540.00	—	60%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DEXA,AXIAL SKELETON	$201.20	$503.00	$24.61–$402.40	39% above	60%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DEXA,AXIAL SKELETON	$201.20	$503.00	$24.61–$402.40	—	60%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 DXA BONE DENSITY (PERIPHERAL)	$72.80	$182.00	$10.16–$182.03	8% below	60%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 DXA BONE DENSITY (PERIPHERAL)	$72.80	$182.00	$10.16–$182.03	—	60%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 OB US DETAILED SNGL FETUS	$259.60	$649.00	$70.24–$519.20	2% below	60%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 OB US DETAILED SNGL FETUS	$259.60	$649.00	$70.24–$519.20	—	60%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST W/O CONTRAST	$769.60	$1,924.00	$65.25–$1,539.20	15% above	60%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 LECH CT CHEST W/O CONTRAST	$1,143.20	$2,858.00	$65.25–$2,286.40	70% above	60%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST W/O CONTRAST	$769.60	$1,924.00	$65.25–$1,539.20	—	60%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 LECH CT CHEST W/O CONTRAST	$1,143.20	$2,858.00	$65.25–$2,286.40	—	60%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST W/CONTRAST	$841.60	$2,104.00	$84.84–$1,683.20	at median	60%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 LECH CT CHEST W/CONTRAST	$1,250.00	$3,125.00	$84.84–$2,500.00	49% above	60%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT CHEST W/CONTRAST	$841.60	$2,104.00	$84.84–$1,683.20	—	60%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 LECH CT CHEST W/CONTRAST	$1,250.00	$3,125.00	$84.84–$2,500.00	—	60%
Diagnostic mammogram, both breasts CPT 77066 3-D MAMMOGRAM DIAGNOSTIC BIL	$213.20	$533.00	$48.89–$533.00	45% above	60%
Diagnostic mammogram, both breasts CPT 77066 MAMMOGRAM DIAGNOSTIC BIL	$249.20	$623.00	$48.89–$623.00	69% above	60%
Diagnostic mammogram, both breasts CPT 77066 MAMMOGRAM DIAGNOSTIC BIL M	$249.20	$623.00	$48.89–$623.00	69% above	60%
Diagnostic mammogram, both breasts inpatient CPT 77066 3-D MAMMOGRAM DIAGNOSTIC BIL	$213.20	$533.00	$48.89–$533.00	—	60%
Diagnostic mammogram, both breasts inpatient CPT 77066 MAMMOGRAM DIAGNOSTIC BIL M	$249.20	$623.00	$48.89–$623.00	—	60%
Diagnostic mammogram, both breasts inpatient CPT 77066 MAMMOGRAM DIAGNOSTIC BIL	$249.20	$623.00	$48.89–$623.00	—	60%
Diagnostic mammogram, one breast one side CPT 77065 MAMMOGRAM-UNILATERAL RT/DIAG	$160.00	$400.00	—	31% above	60%
Diagnostic mammogram, one breast one side CPT 77065 MAMMOGRAM-UNILATERAL LT/DIAG	$160.00	$400.00	—	31% above	60%
Diagnostic mammogram, one breast one side CPT 77065 3-D MAMMO-UNILATERAL LT/DIAG	$213.20	$533.00	—	75% above	60%
Diagnostic mammogram, one breast one side CPT 77065 3-D MAMMO-UNILATERAL RT/DIAG	$213.20	$533.00	—	75% above	60%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MAMMOGRAM-UNILATERAL LT/DIAG	$160.00	$400.00	—	—	60%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MAMMOGRAM-UNILATERAL RT/DIAG	$160.00	$400.00	—	—	60%
Diagnostic mammogram, one breast inpatient one side CPT 77065 3-D MAMMO-UNILATERAL RT/DIAG	$213.20	$533.00	—	—	60%
Diagnostic mammogram, one breast inpatient one side CPT 77065 3-D MAMMO-UNILATERAL LT/DIAG	$213.20	$533.00	—	—	60%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 ART DPLX BILATERAL LOWER EXT	$352.80	$882.00	$235.30–$890.02	—	60%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 LECH ART DPLX BILATERAL LOW EX	$523.60	$1,309.00	$235.30–$1,047.20	—	60%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 ART DPLX BILATERAL LOWER EXT	$352.80	$882.00	$235.30–$890.02	—	60%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 LECH ART DPLX BILATERAL LOW EX	$523.60	$1,309.00	$235.30–$1,047.20	—	60%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 VENOUS DOPPLER BILATERAL UPPER	$399.60	$999.00	$235.30–$799.20	—	60%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 VENOUS DOPPLER BILATERAL LOWER	$423.20	$1,058.00	$235.30–$846.40	—	60%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 LECH VENOUS DOPPLER BILAT LOWE	$628.00	$1,570.00	$235.30–$1,256.00	—	60%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 VENOUS DOPPLER BILATERAL UPPER	$399.60	$999.00	$235.30–$799.20	—	60%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 VENOUS DOPPLER BILATERAL LOWER	$423.20	$1,058.00	$235.30–$846.40	—	60%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 LECH VENOUS DOPPLER BILAT LOWE	$628.00	$1,570.00	$235.30–$1,256.00	—	60%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHO COMPLETE	$671.20	$1,678.00	$500.21–$1,342.40	7% below	60%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHO COMPLETE	$671.20	$1,678.00	$500.21–$1,342.40	—	60%
Elbow X-ray, 2 views CPT 73070 ELBOW XRAY 2 VIEWS	$113.60	$284.00	$9.01–$227.20	at median	60%
Elbow X-ray, 2 views one side CPT 73070 ELBOW, 2 VIEWS LEFT	$122.80	$307.00	—	8% above	60%
Elbow X-ray, 2 views one side CPT 73070 ELBOW, 2 VIEWS RIGHT	$122.80	$307.00	—	8% above	60%
Elbow X-ray, 2 views one side CPT 73070 LECH ELBOW, 2 VIEWS RIGHT	$182.40	$456.00	—	60% above	60%
Elbow X-ray, 2 views inpatient CPT 73070 ELBOW XRAY 2 VIEWS	$113.60	$284.00	$9.01–$227.20	—	60%
Elbow X-ray, 2 views inpatient one side CPT 73070 ELBOW, 2 VIEWS RIGHT	$122.80	$307.00	—	—	60%
Elbow X-ray, 2 views inpatient one side CPT 73070 ELBOW, 2 VIEWS LEFT	$122.80	$307.00	—	—	60%
Elbow X-ray, 2 views inpatient one side CPT 73070 LECH ELBOW, 2 VIEWS RIGHT	$182.40	$456.00	—	—	60%
Elbow X-ray, complete, 3 or more views CPT 73080 ELBOW XRAY 3+ VIEWS	$113.60	$284.00	$10.12–$227.20	13% below	60%
Elbow X-ray, complete, 3 or more views one side CPT 73080 ELBOW 3+ VIEW LEFT	$131.60	$329.00	—	at median	60%
Elbow X-ray, complete, 3 or more views one side CPT 73080 ELBOW 3+ VIEW RIGHT	$141.60	$354.00	—	8% above	60%
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 ELBOW XRAY 3+ VIEWS	$113.60	$284.00	$10.12–$227.20	—	60%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 ELBOW 3+ VIEW LEFT	$131.60	$329.00	—	—	60%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 ELBOW 3+ VIEW RIGHT	$141.60	$354.00	—	—	60%
Eye socket (orbit) CT scan without contrast CPT 70480 CT ORBITS,SELLA,I/O EAR W/O CO	$568.00	$1,420.00	$64.32–$1,136.00	6% below	60%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT ORBITS,SELLA,I/O EAR W/O CO	$568.00	$1,420.00	$64.32–$1,136.00	—	60%
Facial bones X-ray, complete, 3 or more views CPT 70150 ZYGOMATIC ARCHES	$147.20	$368.00	$14.53–$294.40	at median	60%
Facial bones X-ray, complete, 3 or more views CPT 70150 FACIAL BONES	$147.20	$368.00	$14.53–$294.40	at median	60%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 FACIAL BONES	$147.20	$368.00	$14.53–$294.40	—	60%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 ZYGOMATIC ARCHES	$147.20	$368.00	$14.53–$294.40	—	60%
Forearm X-ray (radius and ulna), 2 views CPT 73090 FOREARM XRAY 2 VIEWS	$113.60	$284.00	$9.01–$227.20	1% above	60%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 FOREARM,2 VIEWS RIGHT	$122.80	$307.00	—	9% above	60%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 FOREARM,2 VIEWS LEFT	$122.80	$307.00	—	9% above	60%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 LECH FOREARM,2 VIEWS RIGHT	$182.40	$456.00	—	62% above	60%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 FOREARM XRAY 2 VIEWS	$113.60	$284.00	$9.01–$227.20	—	60%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 FOREARM,2 VIEWS RIGHT	$122.80	$307.00	—	—	60%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 FOREARM,2 VIEWS LEFT	$122.80	$307.00	—	—	60%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 LECH FOREARM,2 VIEWS RIGHT	$182.40	$456.00	—	—	60%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HEPATOBILIARY SYSTEM IMAGING	$514.80	$1,287.00	$89.84–$1,029.60	9% below	60%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HEPATOBILIARY SYSTEM IMAGING	$514.80	$1,287.00	$89.84–$1,029.60	—	60%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 HEEL XRAY 2+ VIEWS	$113.60	$284.00	$8.81–$227.20	4% above	60%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 HEEL,LEFT	$95.60	$239.00	—	12% below	60%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 HEEL,RIGHT	$95.60	$239.00	$8.81–$191.20	12% below	60%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 HEEL,RIGHT	$95.60	$239.00	$8.81–$191.20	12% below	60%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 HEEL XRAY 2+ VIEWS	$113.60	$284.00	$8.81–$227.20	—	60%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 HEEL,RIGHT	$95.60	$239.00	$8.81–$191.20	—	60%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 HEEL,LEFT	$95.60	$239.00	—	—	60%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 HEEL,RIGHT	$95.60	$239.00	$8.81–$191.20	—	60%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 HOME SLEEP TEST TYPE III	$246.00	$615.00	—	13% above	60%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 HOME SLEEP TEST TYPE III	$246.00	$615.00	—	—	60%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 CPAP TITRATION POLY	$2,365.20	$5,913.00	$990.38–$4,730.40	71% above	60%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 CPAP TITRATION POLY	$2,365.20	$5,913.00	$990.38–$4,730.40	—	60%
Knee X-ray, 3 views CPT 73562 KNEE XRAY 3 VIEWS	$113.60	$284.00	$12.53–$227.20	16% below	60%
Knee X-ray, 3 views one side CPT 73562 KNEE,RIGHT,3 VIEW	$134.00	$335.00	—	1% below	60%
Knee X-ray, 3 views one side CPT 73562 KNEE,LEFT,3 VIEW	$134.00	$335.00	—	1% below	60%
Knee X-ray, 3 views one side CPT 73562 LECH KNEE,LEFT,3 VIEW	$198.80	$497.00	—	47% above	60%
Knee X-ray, 3 views inpatient CPT 73562 KNEE XRAY 3 VIEWS	$113.60	$284.00	$12.53–$227.20	—	60%
Knee X-ray, 3 views inpatient one side CPT 73562 KNEE,LEFT,3 VIEW	$134.00	$335.00	—	—	60%
Knee X-ray, 3 views inpatient one side CPT 73562 KNEE,RIGHT,3 VIEW	$134.00	$335.00	—	—	60%
Knee X-ray, 3 views inpatient one side CPT 73562 LECH KNEE,LEFT,3 VIEW	$198.80	$497.00	—	—	60%
Knee X-ray, complete, 4 or more views CPT 73564 X-RAY EXAM KNEE 4 OR MORE	$124.00	$310.00	$14.48–$248.00	15% below	60%
Knee X-ray, complete, 4 or more views one side CPT 73564 KNEE;COMPLT 4/MORE VIEW-LT	$164.40	$411.00	—	13% above	60%
Knee X-ray, complete, 4 or more views one side CPT 73564 KNEE;COMPLT 4/MORE VIEW-RT	$164.40	$411.00	—	13% above	60%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 X-RAY EXAM KNEE 4 OR MORE	$124.00	$310.00	$14.48–$248.00	—	60%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 KNEE;COMPLT 4/MORE VIEW-RT	$164.40	$411.00	—	—	60%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 KNEE;COMPLT 4/MORE VIEW-LT	$164.40	$411.00	—	—	60%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT EXT LWR W/O CONT LT	$599.60	$1,499.00	—	at median	60%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT EXT LWR W/O CONT RT	$599.60	$1,499.00	—	at median	60%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 LECH CT EXT LWR W/O CONT RT	$890.80	$2,227.00	—	49% above	60%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 LECH CT EXT LWR W/O CONT LT	$890.80	$2,227.00	—	49% above	60%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT EXT LWR W/O CONT RT	$599.60	$1,499.00	—	—	60%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT EXT LWR W/O CONT LT	$599.60	$1,499.00	—	—	60%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 LECH CT EXT LWR W/O CONT LT	$890.80	$2,227.00	—	—	60%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 LECH CT EXT LWR W/O CONT RT	$890.80	$2,227.00	—	—	60%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 SPLEEN ULTRASOUND	$165.20	$413.00	$26.86–$330.40	34% below	60%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMINAL LIMITED	$214.00	$535.00	$26.86–$428.00	14% below	60%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 SPLEEN ULTRASOUND	$165.20	$413.00	$26.86–$330.40	—	60%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMINAL LIMITED	$214.00	$535.00	$26.86–$428.00	—	60%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US LTD NONVAS STRUX JT SP OR S	$96.40	$241.00	$19.93–$245.18	45% below	60%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US LTD NONVAS STRUX JT SP OR S	$96.40	$241.00	$19.93–$245.18	—	60%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 LOW DOSE CT SCAN FOR LUNG CANC	$169.20	$423.00	$43.72–$918.00	14% above	60%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 LOW DOSE CT SCAN FOR LUNG CANC	$169.20	$423.00	$43.72–$918.00	—	60%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 LOWER LEG XRAY 2 VIEWS	$113.60	$284.00	$9.71–$227.20	1% below	60%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 ANKLE XRAY 3 + VIEWS	$113.60	$284.00	$9.71–$227.20	1% below	60%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 LEG,LOWER,RIGHT	$111.60	$279.00	—	3% below	60%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 LEG,LOWER,LEFT	$111.60	$279.00	—	3% below	60%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 LECH LEG,LOWER,RIGHT	$165.60	$414.00	—	44% above	60%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 ANKLE XRAY 3 + VIEWS	$113.60	$284.00	$9.71–$227.20	—	60%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 LOWER LEG XRAY 2 VIEWS	$113.60	$284.00	$9.71–$227.20	—	60%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 LEG,LOWER,LEFT	$111.60	$279.00	—	—	60%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 LEG,LOWER,RIGHT	$111.60	$279.00	—	—	60%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 LECH LEG,LOWER,RIGHT	$165.60	$414.00	—	—	60%
MR angiography (MRA) of the head without contrast CPT 70544 MR ANGIO HEAD W/O CONTRAST	$1,268.00	$3,170.00	$134.34–$2,536.00	51% above	60%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 MR ANGIO HEAD W/O CONTRAST	$1,268.00	$3,170.00	$134.34–$2,536.00	—	60%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 EXT LWR JOINT W/O CONTRAST LT	$1,528.00	$3,820.00	—	76% above	60%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 EXT LWR JOINT W/O CONTRAST RT	$1,528.00	$3,820.00	—	76% above	60%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 EXT LWR JOINT W/O CONTRAST LT	$1,528.00	$3,820.00	—	—	60%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 EXT LWR JOINT W/O CONTRAST RT	$1,528.00	$3,820.00	—	—	60%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 EXT LWR JOINT W/WO CONTRAST LT	$1,735.60	$4,339.00	—	40% above	60%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 EXT LWR JOINT W/WO CONTRAST RT	$1,735.60	$4,339.00	—	40% above	60%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 EXT LWR JOINT W/WO CONTRAST RT	$1,735.60	$4,339.00	—	—	60%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 EXT LWR JOINT W/WO CONTRAST LT	$1,735.60	$4,339.00	—	—	60%
MRI of the abdomen without contrast CPT 74181 ABDOMEN W/O CONTRAST	$1,451.60	$3,629.00	$107.49–$2,903.20	62% above	60%
MRI of the abdomen without contrast CPT 74181 MRCP	$1,451.60	$3,629.00	$107.49–$2,903.20	62% above	60%
MRI of the abdomen without contrast inpatient CPT 74181 MRCP	$1,451.60	$3,629.00	$107.49–$2,903.20	—	60%
MRI of the abdomen without contrast inpatient CPT 74181 ABDOMEN W/O CONTRAST	$1,451.60	$3,629.00	$107.49–$2,903.20	—	60%
MRI of the abdomen, without and then with contrast dye CPT 74183 ABDOMEN W/WO CONTRAST	$1,885.20	$4,713.00	$201.58–$3,770.40	51% above	60%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 ABDOMEN W/WO CONTRAST	$1,885.20	$4,713.00	$201.58–$3,770.40	—	60%
MRI of the brain, no contrast dye CPT 70551 BRAIN W/O CONTRAST	$1,555.60	$3,889.00	$105.94–$3,111.20	58% above	60%
MRI of the brain, no contrast dye inpatient CPT 70551 BRAIN W/O CONTRAST	$1,555.60	$3,889.00	$105.94–$3,111.20	—	60%
MRI of the brain, with and without contrast dye CPT 70553 BRAIN W/WO CONTRAST	$2,147.60	$5,369.00	$203.83–$4,295.20	64% above	60%
MRI of the brain, with and without contrast dye inpatient CPT 70553 BRAIN W/WO CONTRAST	$2,147.60	$5,369.00	$203.83–$4,295.20	—	60%
MRI of the lower back, no contrast dye CPT 72148 LUMBAR W/O CONTRAST	$1,646.40	$4,116.00	$115.60–$3,292.80	59% above	60%
MRI of the lower back, no contrast dye inpatient CPT 72148 LUMBAR W/O CONTRAST	$1,646.40	$4,116.00	$115.60–$3,292.80	—	60%
MRI of the lower back, without and then with contrast dye CPT 72158 LUMBAR W/WO CONTRAST	$2,167.20	$5,418.00	$203.83–$4,334.40	59% above	60%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 LUMBAR W/WO CONTRAST	$2,167.20	$5,418.00	$203.83–$4,334.40	—	60%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 THORACIC W/O CONTRAST	$1,347.20	$3,368.00	$117.16–$2,694.40	55% above	60%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 THORACIC W/O CONTRAST	$1,347.20	$3,368.00	$117.16–$2,694.40	—	60%
MRI of the neck (cervical spine) without and with contrast CPT 72156 CERVICAL W/WO CONTRAST	$2,351.60	$5,879.00	$207.57–$4,703.20	75% above	60%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 CERVICAL W/WO CONTRAST	$2,351.60	$5,879.00	$207.57–$4,703.20	—	60%
MRI of the neck (cervical spine), no contrast dye CPT 72141 CERVICAL W/O CONTRAST	$1,713.60	$4,284.00	$107.49–$3,427.20	83% above	60%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 CERVICAL W/O CONTRAST	$1,713.60	$4,284.00	$107.49–$3,427.20	—	60%
MRI of the pelvis without and with contrast CPT 72197 MRI PROSTATE	$400.00	$1,000.00	$201.58–$1,407.17	61% below	60%
MRI of the pelvis without and with contrast CPT 72197 PELVIS W/WO CONTRAST	$1,864.80	$4,662.00	$201.58–$3,729.60	82% above	60%
MRI of the pelvis without and with contrast CPT 72197 PROSTATE MRI W/O & W/DYE	$1,864.80	$4,662.00	$201.58–$3,729.60	82% above	60%
MRI of the pelvis without and with contrast CPT 72197 SACRUM/COCCYX WO/W CONTRAST	$1,864.80	$4,662.00	$201.58–$3,729.60	82% above	60%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PROSTATE	$400.00	$1,000.00	$201.58–$1,407.17	—	60%
MRI of the pelvis without and with contrast inpatient CPT 72197 PROSTATE MRI W/O & W/DYE	$1,864.80	$4,662.00	$201.58–$3,729.60	—	60%
MRI of the pelvis without and with contrast inpatient CPT 72197 SACRUM/COCCYX WO/W CONTRAST	$1,864.80	$4,662.00	$201.58–$3,729.60	—	60%
MRI of the pelvis without and with contrast inpatient CPT 72197 PELVIS W/WO CONTRAST	$1,864.80	$4,662.00	$201.58–$3,729.60	—	60%
MRI of the pelvis, no contrast dye CPT 72195 PELVIS W/O CONTRAST	$1,552.40	$3,881.00	$138.70–$3,104.80	91% above	60%
MRI of the pelvis, no contrast dye CPT 72195 SACRUM/COCCYX WO CONTRAST	$1,552.40	$3,881.00	$138.70–$3,104.80	91% above	60%
MRI of the pelvis, no contrast dye CPT 72195 PROSTATE MRI W/O DYE	$1,552.40	$3,881.00	$138.70–$3,104.80	91% above	60%
MRI of the pelvis, no contrast dye inpatient CPT 72195 PROSTATE MRI W/O DYE	$1,552.40	$3,881.00	$138.70–$3,104.80	—	60%
MRI of the pelvis, no contrast dye inpatient CPT 72195 PELVIS W/O CONTRAST	$1,552.40	$3,881.00	$138.70–$3,104.80	—	60%
MRI of the pelvis, no contrast dye inpatient CPT 72195 SACRUM/COCCYX WO CONTRAST	$1,552.40	$3,881.00	$138.70–$3,104.80	—	60%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 EXT UPP JOINT W/O CONTRAST LT	$1,566.80	$3,917.00	—	97% above	60%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 EXT UPP JOINT W/O CONTRAST RT	$1,646.40	$4,116.00	—	107% above	60%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 EXT UPP JOINT W/O CONTRAST LT	$1,566.80	$3,917.00	—	—	60%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 EXT UPP JOINT W/O CONTRAST RT	$1,646.40	$4,116.00	—	—	60%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 CERVICAL SPINE WITH OBL	$195.60	$489.00	$16.44–$391.20	3% below	60%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 CERVICAL SPINE WITH OBL	$195.60	$489.00	$16.44–$391.20	—	60%
Neck soft tissue CT scan with contrast CPT 70491 CT NECK SOFT TISSUE W/CONTRAST	$664.40	$1,661.00	$83.31–$1,328.80	3% below	60%
Neck soft tissue CT scan with contrast CPT 70491 LECH CT NECK SOFT TISSUE W/CON	$986.00	$2,465.00	$83.31–$1,972.00	44% above	60%
Neck soft tissue CT scan with contrast CPT 70491 CT NECK, CHEST, ABD/PEL W/CONT	$2,734.00	$6,835.00	$83.31–$5,468.00	301% above	60%
Neck soft tissue CT scan with contrast inpatient CPT 70491 CT NECK SOFT TISSUE W/CONTRAST	$664.40	$1,661.00	$83.31–$1,328.80	—	60%
Neck soft tissue CT scan with contrast inpatient CPT 70491 LECH CT NECK SOFT TISSUE W/CON	$986.00	$2,465.00	$83.31–$1,972.00	—	60%
Neck soft tissue CT scan with contrast inpatient CPT 70491 CT NECK, CHEST, ABD/PEL W/CONT	$2,734.00	$6,835.00	$83.31–$5,468.00	—	60%
Neck soft tissue CT scan without contrast CPT 70490 CT NECK SOFT TISSUE W/O CONTRA	$540.40	$1,351.00	$64.36–$1,080.80	19% below	60%
Neck soft tissue CT scan without contrast inpatient CPT 70490 CT NECK SOFT TISSUE W/O CONTRA	$540.40	$1,351.00	$64.36–$1,080.80	—	60%
Neck soft tissue X-ray CPT 70360 NECK SOFT TISSUE	$89.60	$224.00	$9.64–$182.03	21% below	60%
Neck soft tissue X-ray CPT 70360 Xray Neck Soft Tissue	$113.60	$284.00	$9.64–$227.20	at median	60%
Neck soft tissue X-ray inpatient CPT 70360 NECK SOFT TISSUE	$89.60	$224.00	$9.64–$182.03	—	60%
Neck soft tissue X-ray inpatient CPT 70360 Xray Neck Soft Tissue	$113.60	$284.00	$9.64–$227.20	—	60%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 CARD PERFUS,SPECT,MULTI	$1,460.40	$3,651.00	$131.87–$2,920.80	26% above	60%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 THAL/VIABILITY HEART SCAN	$1,591.60	$3,979.00	$131.87–$3,183.20	37% above	60%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 CARD PERFUS,SPECT,MULTI	$1,460.40	$3,651.00	$131.87–$2,920.80	—	60%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 THAL/VIABILITY HEART SCAN	$1,591.60	$3,979.00	$131.87–$3,183.20	—	60%
Pelvic CT scan without contrast CPT 72192 CT PELVIS W/O CONTRAST	$648.40	$1,621.00	$62.08–$1,296.80	1% below	60%
Pelvic CT scan without contrast inpatient CPT 72192 CT PELVIS W/O CONTRAST	$648.40	$1,621.00	$62.08–$1,296.80	—	60%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US EXAM PELVIC LIMITED	$46.80	$117.00	$20.04–$245.18	69% below	60%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 PELVIC SOFT TISSUE LTD	$109.60	$274.00	$20.04–$245.18	28% below	60%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US EXAM PELVIC LIMITED	$46.80	$117.00	$20.04–$245.18	—	60%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 PELVIC SOFT TISSUE LTD	$109.60	$274.00	$20.04–$245.18	—	60%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US EXAM URINARY BLADDER	$288.00	$720.00	$32.48–$576.00	5% above	60%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US EXAM,PELVIC,COMPLETE	$304.40	$761.00	$32.48–$608.80	11% above	60%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 LECH US EXAM URINARY BLADDER	$427.20	$1,068.00	$32.48–$854.40	55% above	60%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US EXAM URINARY BLADDER	$288.00	$720.00	$32.48–$576.00	—	60%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US EXAM,PELVIC,COMPLETE	$304.40	$761.00	$32.48–$608.80	—	60%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 LECH US EXAM URINARY BLADDER	$427.20	$1,068.00	$32.48–$854.40	—	60%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OB US GREATER THAN 14WK-TRIPLA	$276.40	$691.00	$41.98–$552.80	19% above	60%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OB US GREATER THAN 14WKS-TWINM	$276.40	$691.00	$41.98–$552.80	19% above	60%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OB US GREATER THAN 14WK TRIPLM	$276.40	$691.00	$41.98–$552.80	19% above	60%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OB US GREATER THAN 14WK-TWINSA	$276.40	$691.00	$41.98–$552.80	19% above	60%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OB US COMP GREATER THAN 14 WKS	$286.00	$715.00	$41.98–$572.00	23% above	60%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OB US GREATER THAN 14 WKSM	$293.20	$733.00	$41.98–$586.40	27% above	60%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 OB US GREATER THAN 14WKS-TWINM	$276.40	$691.00	$41.98–$552.80	—	60%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 OB US GREATER THAN 14WK-TWINSA	$276.40	$691.00	$41.98–$552.80	—	60%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 OB US GREATER THAN 14WK-TRIPLA	$276.40	$691.00	$41.98–$552.80	—	60%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 OB US GREATER THAN 14WK TRIPLM	$276.40	$691.00	$41.98–$552.80	—	60%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 OB US COMP GREATER THAN 14 WKS	$286.00	$715.00	$41.98–$572.00	—	60%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 OB US GREATER THAN 14 WKSM	$293.20	$733.00	$41.98–$586.40	—	60%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 OBUS LESS THAN 14 WKS-TWINSM	$276.40	$691.00	$36.49–$552.80	32% above	60%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 OBUS LESS THAN 14 WKS/TRIPLETM	$276.40	$691.00	$36.49–$552.80	32% above	60%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 OBUS LESS THAN 14 WKS-TWINSA	$276.40	$691.00	$36.49–$552.80	32% above	60%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 OBUS LESS THAN 14 WKS/TRIPLETA	$276.40	$691.00	$36.49–$552.80	32% above	60%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 OB US LESS THAN 14 WEEKS	$286.00	$715.00	$36.49–$572.00	37% above	60%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 OB US LESS THAN 14 WKSM	$293.20	$733.00	$36.49–$586.40	40% above	60%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 OBUS LESS THAN 14 WKS/TRIPLETA	$276.40	$691.00	$36.49–$552.80	—	60%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 OBUS LESS THAN 14 WKS-TWINSM	$276.40	$691.00	$36.49–$552.80	—	60%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 OBUS LESS THAN 14 WKS/TRIPLETM	$276.40	$691.00	$36.49–$552.80	—	60%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 OBUS LESS THAN 14 WKS-TWINSA	$276.40	$691.00	$36.49–$552.80	—	60%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 OB US LESS THAN 14 WEEKS	$286.00	$715.00	$36.49–$572.00	—	60%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 OB US LESS THAN 14 WKSM	$293.20	$733.00	$36.49–$586.40	—	60%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 OB US LIMITED FETUS	$46.80	$117.00	$25.15–$245.18	69% below	60%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 OB US LIMITED 1+ FETUS(S)	$125.60	$314.00	$25.15–$251.20	18% below	60%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 OB US LIMITED FETUS	$46.80	$117.00	$25.15–$245.18	—	60%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 OB US LIMITED 1+ FETUS(S)	$125.60	$314.00	$25.15–$251.20	—	60%
Rib X-ray, one side, 2 views one side CPT 71100 RIBS UNIL - 2 VIEWS	$104.40	$261.00	—	21% below	60%
Rib X-ray, one side, 2 views one side CPT 71100 RIBS UNIL - 2 VIEWS RIGHT	$104.40	$261.00	—	21% below	60%
Rib X-ray, one side, 2 views one side CPT 71100 RIBS 2 VIEWS XRAY UNILAT	$113.60	$284.00	$11.29–$227.20	14% below	60%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 RIBS UNIL - 2 VIEWS RIGHT	$104.40	$261.00	—	—	60%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 RIBS UNIL - 2 VIEWS	$104.40	$261.00	—	—	60%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 RIBS 2 VIEWS XRAY UNILAT	$113.60	$284.00	$11.29–$227.20	—	60%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 RIB UNILAT;W/PA CHEST RT	$204.80	$512.00	—	47% above	60%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 RIB UNILAT;W/PA CHEST LT	$204.80	$512.00	—	47% above	60%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 RIB UNILAT;W/PA CHEST LT	$204.80	$512.00	—	—	60%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 RIB UNILAT;W/PA CHEST RT	$204.80	$512.00	—	—	60%
Screening mammogram, both breasts CPT 77067 MAMMOGRAM SCREENING BIL	$186.00	$465.00	$39.37–$465.00	41% above	60%
Screening mammogram, both breasts CPT 77067 3-D MAMMOGRAM SCREENING BIL	$213.20	$533.00	$39.37–$533.00	62% above	60%
Screening mammogram, both breasts inpatient CPT 77067 MAMMOGRAM SCREENING BIL	$186.00	$465.00	$39.37–$465.00	—	60%
Screening mammogram, both breasts inpatient CPT 77067 3-D MAMMOGRAM SCREENING BIL	$213.20	$533.00	$39.37–$533.00	—	60%
Shoulder X-ray, complete, 2 or more views CPT 73030 SHOULDER XRAY 2+ VIEWS	$113.60	$284.00	$10.73–$227.20	11% below	60%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER,RIGHT	$122.80	$307.00	—	4% below	60%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER,LEFT	$122.80	$307.00	—	4% below	60%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XRAY SHOULDER 2 VIEW LEFT	$155.20	$388.00	—	22% above	60%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XRAY SHOULDER 2 VIEW RIGHT	$155.20	$388.00	—	22% above	60%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 LECH SHOULDER,LEFT	$182.40	$456.00	—	43% above	60%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 LECH SHOULDER,RIGHT	$182.40	$456.00	—	43% above	60%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 SHOULDER XRAY 2+ VIEWS	$113.60	$284.00	$10.73–$227.20	—	60%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 SHOULDER,RIGHT	$122.80	$307.00	—	—	60%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 SHOULDER,LEFT	$122.80	$307.00	—	—	60%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XRAY SHOULDER 2 VIEW LEFT	$155.20	$388.00	—	—	60%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XRAY SHOULDER 2 VIEW RIGHT	$155.20	$388.00	—	—	60%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 LECH SHOULDER,LEFT	$182.40	$456.00	—	—	60%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 LECH SHOULDER,RIGHT	$182.40	$456.00	—	—	60%
Sinus X-ray, complete, 3 or more views CPT 70220 Sinus Xray 3+ views	$113.60	$284.00	$11.59–$227.20	26% below	60%
Sinus X-ray, complete, 3 or more views CPT 70220 SINUSES	$147.20	$368.00	$11.59–$294.40	4% below	60%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 Sinus Xray 3+ views	$113.60	$284.00	$11.59–$227.20	—	60%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 SINUSES	$147.20	$368.00	$11.59–$294.40	—	60%
Skull X-ray, fewer than 4 views CPT 70250 AP & LAT SKULL	$108.40	$271.00	$11.03–$245.18	8% below	60%
Skull X-ray, fewer than 4 views inpatient CPT 70250 AP & LAT SKULL	$108.40	$271.00	$11.03–$245.18	—	60%
Sleep study in a lab (polysomnography) CPT 95810 POLYSOM 6/> YRS 4/> PARAM	$1,417.60	$3,544.00	$990.38–$2,835.20	6% above	60%
Sleep study in a lab (polysomnography) CPT 95810 POLYSOMNOGRAM	$2,089.60	$5,224.00	$990.38–$4,179.20	56% above	60%
Sleep study in a lab (polysomnography) inpatient CPT 95810 POLYSOM 6/> YRS 4/> PARAM	$1,417.60	$3,544.00	$990.38–$2,835.20	—	60%
Sleep study in a lab (polysomnography) inpatient CPT 95810 POLYSOMNOGRAM	$2,089.60	$5,224.00	$990.38–$4,179.20	—	60%
Swallow study (modified barium swallow, video X-ray) CPT 74230 MODIFIED BARIUM SWALLOW	$215.60	$539.00	$38.05–$431.20	10% below	60%
Swallow study (modified barium swallow, video X-ray) CPT 74230 LECH MODIFIED BARIUM SWALLOW	$320.00	$800.00	$38.05–$640.00	34% above	60%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 MODIFIED BARIUM SWALLOW	$215.60	$539.00	$38.05–$431.20	—	60%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 LECH MODIFIED BARIUM SWALLOW	$320.00	$800.00	$38.05–$640.00	—	60%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 FEMUR XRAY 2 + VIEWS	$113.60	$284.00	$10.93–$227.20	at median	60%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 FEMUR,2 VIEWS RIGHT	$119.20	$298.00	—	5% above	60%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 FEMUR,2 VIEWS LEFT	$126.80	$317.00	—	12% above	60%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 LECH FEMUR,2 VIEWS RIGHT	$176.80	$442.00	—	56% above	60%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 LECH FEMUR,2 VIEWS LEFT	$187.60	$469.00	—	65% above	60%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 FEMUR XRAY 2 + VIEWS	$113.60	$284.00	$10.93–$227.20	—	60%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 FEMUR,2 VIEWS RIGHT	$119.20	$298.00	—	—	60%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 FEMUR,2 VIEWS LEFT	$126.80	$317.00	—	—	60%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 LECH FEMUR,2 VIEWS RIGHT	$176.80	$442.00	—	—	60%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 LECH FEMUR,2 VIEWS LEFT	$187.60	$469.00	—	—	60%
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT THORACIC SPINE W/O CONTRAST	$689.20	$1,723.00	$65.25–$1,378.40	6% below	60%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT THORACIC SPINE W/O CONTRAST	$689.20	$1,723.00	$65.25–$1,378.40	—	60%
Toe X-ray, 2 or more views CPT 73660 TOE(S) XRAY 2 + VIEWS	$113.60	$284.00	$8.97–$227.20	6% above	60%
Toe X-ray, 2 or more views inpatient CPT 73660 TOE(S) XRAY 2 + VIEWS	$113.60	$284.00	$8.97–$227.20	—	60%
Transvaginal pelvic ultrasound CPT 76830 TRANSVAGINAL US NON OB	$237.20	$593.00	$36.68–$474.40	22% above	60%
Transvaginal pelvic ultrasound inpatient CPT 76830 TRANSVAGINAL US NON OB	$237.20	$593.00	$36.68–$474.40	—	60%
Transvaginal ultrasound during pregnancy CPT 76817 TRANSVAGINAL US OBSTETRIC	$46.80	$117.00	$28.77–$245.18	72% below	60%
Transvaginal ultrasound during pregnancy CPT 76817 TRANSVAGINAL OB US	$125.60	$314.00	$28.77–$251.20	26% below	60%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 TRANSVAGINAL US OBSTETRIC	$46.80	$117.00	$28.77–$245.18	—	60%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 TRANSVAGINAL OB US	$125.60	$314.00	$28.77–$251.20	—	60%
Ultrasound of the abdomen, complete CPT 76700 US EXAM,ABDOM,COMPLETE	$397.20	$993.00	$35.96–$794.40	34% above	60%
Ultrasound of the abdomen, complete CPT 76700 LECH US EXAM,ABDOM,COMPLETE	$589.60	$1,474.00	$35.96–$1,179.20	98% above	60%
Ultrasound of the abdomen, complete inpatient CPT 76700 US EXAM,ABDOM,COMPLETE	$397.20	$993.00	$35.96–$794.40	—	60%
Ultrasound of the abdomen, complete inpatient CPT 76700 LECH US EXAM,ABDOM,COMPLETE	$589.60	$1,474.00	$35.96–$1,179.20	—	60%
Ultrasound of the scrotum and testicles CPT 76870 TESTICULAR ULTRASOUND	$256.00	$640.00	$30.82–$512.00	21% above	60%
Ultrasound of the scrotum and testicles inpatient CPT 76870 TESTICULAR ULTRASOUND	$256.00	$640.00	$30.82–$512.00	—	60%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US EXAM HEAD & NECK/SOFT TISSU	$252.00	$630.00	$33.80–$504.00	at median	60%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US EXAM OF THYROID	$267.20	$668.00	$33.80–$534.40	6% above	60%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US EXAM HEAD & NECK/SOFT TISSU	$252.00	$630.00	$33.80–$504.00	—	60%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US EXAM OF THYROID	$267.20	$668.00	$33.80–$534.40	—	60%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 GASTROGRAFIN GI	$172.00	$430.00	$37.83–$401.74	30% below	60%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 UPPER GI	$204.80	$512.00	$37.83–$409.60	16% below	60%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 UGI W SM BOWEL	$339.60	$849.00	$37.83–$679.20	39% above	60%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 UPPER GI W/SM BOWEL	$400.80	$1,002.00	$37.83–$801.60	64% above	60%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 GASTROGRAFIN GI	$172.00	$430.00	$37.83–$401.74	—	60%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 UPPER GI	$204.80	$512.00	$37.83–$409.60	—	60%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 UGI W SM BOWEL	$339.60	$849.00	$37.83–$679.20	—	60%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 UPPER GI W/SM BOWEL	$400.80	$1,002.00	$37.83–$801.60	—	60%
Upper arm X-ray (humerus), 2 views CPT 73060 HUMERUS XRAY 2 + VIEWS	$113.60	$284.00	$9.81–$227.20	at median	60%
Upper arm X-ray (humerus), 2 views one side CPT 73060 HUMERUS,RIGHT	$114.40	$286.00	—	1% above	60%
Upper arm X-ray (humerus), 2 views one side CPT 73060 HUMERUS,MIN 2 VIEWS	$122.80	$307.00	—	8% above	60%
Upper arm X-ray (humerus), 2 views one side CPT 73060 LECH HUMERUS,MIN 2 VIEWS	$182.40	$456.00	—	60% above	60%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 HUMERUS XRAY 2 + VIEWS	$113.60	$284.00	$9.81–$227.20	—	60%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 HUMERUS,RIGHT	$114.40	$286.00	—	—	60%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 HUMERUS,MIN 2 VIEWS	$122.80	$307.00	—	—	60%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 LECH HUMERUS,MIN 2 VIEWS	$182.40	$456.00	—	—	60%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 VENOUS DOPPLER LTD UPPER LEFT	$257.20	$643.00	—	2% above	60%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 VENOUS DOPPLER LTD UPPER RIGHT	$257.20	$643.00	—	2% above	60%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 VENOUS DOPPLER LTD LOWER RIGHT	$270.80	$677.00	—	8% above	60%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 VENOUS DOPPLER LTD LOWER LEFT	$270.80	$677.00	—	8% above	60%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 LECH VENOUS DOPPLER LT UP L	$381.60	$954.00	—	52% above	60%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 LECH VENOUS DOPPLER LTD LOW LT	$402.40	$1,006.00	—	60% above	60%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 LECH VENOUS DOPPLER LTD LOW RT	$402.40	$1,006.00	—	60% above	60%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 VENOUS DOPPLER LTD UPPER RIGHT	$257.20	$643.00	—	—	60%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 VENOUS DOPPLER LTD UPPER LEFT	$257.20	$643.00	—	—	60%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 VENOUS DOPPLER LTD LOWER LEFT	$270.80	$677.00	—	—	60%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 VENOUS DOPPLER LTD LOWER RIGHT	$270.80	$677.00	—	—	60%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 LECH VENOUS DOPPLER LT UP L	$381.60	$954.00	—	—	60%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 LECH VENOUS DOPPLER LTD LOW LT	$402.40	$1,006.00	—	—	60%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 LECH VENOUS DOPPLER LTD LOW RT	$402.40	$1,006.00	—	—	60%
Wrist X-ray, complete, 3 or more views CPT 73110 WRIST XRAY 3+ VIEWS	$113.60	$284.00	$12.62–$227.20	at median	60%
Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST,LEFT,MIN 3 VIEW	$108.00	$270.00	—	5% below	60%
Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST,RIGHT,MIN 3 VIEW	$108.00	$270.00	—	5% below	60%
Wrist X-ray, complete, 3 or more views one side CPT 73110 LECH WRIST,RIGHT,MIN 3 VIEW	$160.40	$401.00	—	41% above	60%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 WRIST XRAY 3+ VIEWS	$113.60	$284.00	$12.62–$227.20	—	60%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 WRIST,LEFT,MIN 3 VIEW	$108.00	$270.00	—	—	60%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 WRIST,RIGHT,MIN 3 VIEW	$108.00	$270.00	—	—	60%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 LECH WRIST,RIGHT,MIN 3 VIEW	$160.40	$401.00	—	—	60%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP,DURING OR PROC-RT	$124.40	$311.00	—	at median	60%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP,DURING OR PROC-LT	$124.40	$311.00	—	at median	60%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP,LEFT (2) VIEW	$134.00	$335.00	—	8% above	60%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP,RIGHT,(2) VIEW	$134.00	$335.00	—	8% above	60%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 LECH HIP,RIGHT,(2) VIEW	$198.80	$497.00	—	60% above	60%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 LECH HIP,LEFT (2) VIEW	$198.80	$497.00	—	60% above	60%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP,DURING OR PROC-LT	$124.40	$311.00	—	—	60%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP,DURING OR PROC-RT	$124.40	$311.00	—	—	60%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP,RIGHT,(2) VIEW	$134.00	$335.00	—	—	60%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP,LEFT (2) VIEW	$134.00	$335.00	—	—	60%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 LECH HIP,LEFT (2) VIEW	$198.80	$497.00	—	—	60%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 LECH HIP,RIGHT,(2) VIEW	$198.80	$497.00	—	—	60%
X-ray of the abdomen, 1 view CPT 74018 ABDOMEN XRAY 1 VIEW	$38.00	$95.00	$9.34–$182.03	69% below	60%
X-ray of the abdomen, 1 view CPT 74018 ABDOMEN,FOR SITZ MARKS	$94.00	$235.00	$9.34–$188.00	22% below	60%
X-ray of the abdomen, 1 view CPT 74018 ABD SGL AP VW	$100.00	$250.00	$9.34–$200.00	17% below	60%
X-ray of the abdomen, 1 view CPT 74018 LECH ABD SGL AP VW	$148.00	$370.00	$9.34–$296.00	22% above	60%
X-ray of the abdomen, 1 view inpatient CPT 74018 ABDOMEN XRAY 1 VIEW	$38.00	$95.00	$9.34–$182.03	—	60%
X-ray of the abdomen, 1 view inpatient CPT 74018 ABDOMEN,FOR SITZ MARKS	$94.00	$235.00	$9.34–$188.00	—	60%
X-ray of the abdomen, 1 view inpatient CPT 74018 ABD SGL AP VW	$100.00	$250.00	$9.34–$200.00	—	60%
X-ray of the abdomen, 1 view inpatient CPT 74018 LECH ABD SGL AP VW	$148.00	$370.00	$9.34–$296.00	—	60%
X-ray of the finger(s), 2 or more views CPT 73140 FINDER XRAY 2+ VIEWS	$113.60	$284.00	$11.67–$227.20	11% above	60%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 FINDER XRAY 2+ VIEWS	$113.60	$284.00	$11.67–$227.20	—	60%
X-ray of the foot, complete, 3 or more views CPT 73630 FOOT XRAY 3 + VIEWS	$113.60	$284.00	$10.52–$227.20	5% below	60%
X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT,LEFT	$111.60	$279.00	—	7% below	60%
X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT,RIGHT	$111.60	$279.00	—	7% below	60%
X-ray of the foot, complete, 3 or more views one side CPT 73630 LECH FOOT,LEFT	$165.60	$414.00	—	39% above	60%
X-ray of the foot, complete, 3 or more views one side CPT 73630 LECH FOOT,RIGHT	$165.60	$414.00	—	39% above	60%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 FOOT XRAY 3 + VIEWS	$113.60	$284.00	$10.52–$227.20	—	60%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 FOOT,RIGHT	$111.60	$279.00	—	—	60%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 FOOT,LEFT	$111.60	$279.00	—	—	60%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 LECH FOOT,RIGHT	$165.60	$414.00	—	—	60%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 LECH FOOT,LEFT	$165.60	$414.00	—	—	60%
X-ray of the hand, 3 or more views CPT 73130 HAND XRAY 3+ VIEWS	$113.60	$284.00	$11.42–$227.20	5% below	60%
X-ray of the hand, 3 or more views one side CPT 73130 HAND; MIN 3 VIEWS	$122.80	$307.00	—	3% above	60%
X-ray of the hand, 3 or more views one side CPT 73130 HAND;MIN 3 VIEWS	$122.80	$307.00	—	3% above	60%
X-ray of the hand, 3 or more views inpatient CPT 73130 HAND XRAY 3+ VIEWS	$113.60	$284.00	$11.42–$227.20	—	60%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 HAND;MIN 3 VIEWS	$122.80	$307.00	—	—	60%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 HAND; MIN 3 VIEWS	$122.80	$307.00	—	—	60%
X-ray of the knee, 1 or 2 views CPT 73560 KNEE XRAY 1/2 VIEWS	$113.60	$284.00	$10.51–$227.20	2% above	60%
X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE; AP & LAT LEFT	$119.20	$298.00	—	7% above	60%
X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE; AP & LAT RIGHT	$119.20	$298.00	—	7% above	60%
X-ray of the knee, 1 or 2 views one side CPT 73560 LECH KNEE; AP & LAT RIGHT	$176.80	$442.00	—	58% above	60%
X-ray of the knee, 1 or 2 views one side CPT 73560 LECH KNEE; AP & LAT LEFT	$176.80	$442.00	—	58% above	60%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 KNEE XRAY 1/2 VIEWS	$113.60	$284.00	$10.51–$227.20	—	60%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 KNEE; AP & LAT RIGHT	$119.20	$298.00	—	—	60%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 KNEE; AP & LAT LEFT	$119.20	$298.00	—	—	60%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 LECH KNEE; AP & LAT LEFT	$176.80	$442.00	—	—	60%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 LECH KNEE; AP & LAT RIGHT	$176.80	$442.00	—	—	60%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 LS SPINE -2/3 VWS	$141.60	$354.00	$12.28–$283.20	6% below	60%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 LECH LS SPINE -2/3 VWS	$209.60	$524.00	$12.28–$419.20	39% above	60%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 LS SPINE -2/3 VWS	$141.60	$354.00	$12.28–$283.20	—	60%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 LECH LS SPINE -2/3 VWS	$209.60	$524.00	$12.28–$419.20	—	60%
X-ray of the lower back, 4 or more views CPT 72110 LS SPINE, MIN 4 VWS	$181.60	$454.00	$15.93–$363.20	15% below	60%
X-ray of the lower back, 4 or more views CPT 72110 LECH LS SPINE, MIN 4 VWS	$269.60	$674.00	$15.93–$539.20	26% above	60%
X-ray of the lower back, 4 or more views inpatient CPT 72110 LS SPINE, MIN 4 VWS	$181.60	$454.00	$15.93–$363.20	—	60%
X-ray of the lower back, 4 or more views inpatient CPT 72110 LECH LS SPINE, MIN 4 VWS	$269.60	$674.00	$15.93–$539.20	—	60%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 THORACIC SPINE	$138.00	$345.00	$10.16–$276.00	8% below	60%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 THORACIC SPINE	$138.00	$345.00	$10.16–$276.00	—	60%
X-ray of the nasal bones, 3 or more views CPT 70160 NASAL BONES	$118.80	$297.00	$11.52–$237.60	6% above	60%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 NASAL BONES	$118.80	$297.00	$11.52–$237.60	—	60%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 CERVICAL SPINE NO OBL	$164.00	$410.00	$12.19–$328.00	14% above	60%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 CERVICAL SPINE NO OBL	$164.00	$410.00	$12.19–$328.00	—	60%
X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS 1-2 VIEWS XRAY	$51.60	$129.00	$8.63–$245.18	61% below	60%
X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS - AP (ONE VIEW)	$115.60	$289.00	$8.63–$245.18	12% below	60%
X-ray of the pelvis, 1 or 2 views CPT 72170 LECH PELVIS - AP (ONE VIEW)	$171.20	$428.00	$8.63–$342.40	31% above	60%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PELVIS 1-2 VIEWS XRAY	$51.60	$129.00	$8.63–$245.18	—	60%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PELVIS - AP (ONE VIEW)	$115.60	$289.00	$8.63–$245.18	—	60%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 LECH PELVIS - AP (ONE VIEW)	$171.20	$428.00	$8.63–$342.40	—	60%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 SACRO-COCCYGEAL	$134.00	$335.00	$10.02–$268.00	2% below	60%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 SACRO-COCCYGEAL	$134.00	$335.00	$10.02–$268.00	—	60%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Louisiana	Off list
ACTH blood test CPT 82024 ACTH	$110.00	$275.00	$34.76–$276.04	3% above	60%
ACTH blood test inpatient CPT 82024 ACTH	$110.00	$275.00	$34.76–$276.04	—	60%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 SGPT (ALT)	$33.20	$83.00	$4.77–$66.40	71% above	60%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 SGPT (ALT)	$33.20	$83.00	$4.77–$66.40	—	60%
AST (aspartate aminotransferase) enzyme test CPT 84450 SGOT (AST)	$33.20	$83.00	$4.66–$66.40	73% above	60%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 SGOT (AST)	$33.20	$83.00	$4.66–$66.40	—	60%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE HEPATITIS PANEL	$106.80	$267.00	$42.87–$400.98	9% below	60%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 ACUTE HEPATITIS PANEL	$106.80	$267.00	$42.87–$400.98	—	60%
Albumin blood test CPT 82040 ALBUMIN SERUM	$25.20	$63.00	$4.46–$50.40	74% above	60%
Albumin blood test inpatient CPT 82040 ALBUMIN SERUM	$25.20	$63.00	$4.46–$50.40	—	60%
Aldosterone blood test CPT 82088 ALDOSTERONE	$104.80	$262.00	$36.68–$290.92	10% above	60%
Aldosterone blood test inpatient CPT 82088 ALDOSTERONE	$104.80	$262.00	$36.68–$290.92	—	60%
Alkaline phosphatase (ALP) blood test CPT 84075 ALKA PHOSPHATASE	$29.20	$73.00	$4.66–$58.40	53% above	60%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 ALKA PHOSPHATASE	$29.20	$73.00	$4.66–$58.40	—	60%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN, QN/SEMI (RASH)	$24.40	$61.00	$4.70–$48.80	135% above	60%
Allergy blood test, specific IgE, per allergen CPT 86003 ALPHA-GAL COMPONENTS	$51.60	$129.00	$4.70–$103.20	397% above	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN, QN/SEMI (RASH)	$24.40	$61.00	$4.70–$48.80	—	60%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALPHA-GAL COMPONENTS	$51.60	$129.00	$4.70–$103.20	—	60%
Alpha-fetoprotein (AFP) blood test CPT 82105 AFP TUMOR MARKER	$37.20	$93.00	$15.09–$119.38	29% below	60%
Alpha-fetoprotein (AFP) blood test CPT 82105 AFP (MATERNAL)	$40.00	$100.00	$15.09–$119.38	24% below	60%
Alpha-fetoprotein (AFP) blood test CPT 82105 LECH AFP TUMOR MARKER	$54.40	$136.00	$15.09–$119.38	4% above	60%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 AFP TUMOR MARKER	$37.20	$93.00	$15.09–$119.38	—	60%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 AFP (MATERNAL)	$40.00	$100.00	$15.09–$119.38	—	60%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 LECH AFP TUMOR MARKER	$54.40	$136.00	$15.09–$119.38	—	60%
Ammonia blood test CPT 82140 AMMONIA	$59.60	$149.00	$13.11–$119.20	20% above	60%
Ammonia blood test CPT 82140 LECH AMMONIA	$88.80	$222.00	$13.11–$177.60	79% above	60%
Ammonia blood test inpatient CPT 82140 AMMONIA	$59.60	$149.00	$13.11–$119.20	—	60%
Ammonia blood test inpatient CPT 82140 LECH AMMONIA	$88.80	$222.00	$13.11–$177.60	—	60%
Amylase blood test CPT 82150 URINE AMYLASE	$40.40	$101.00	$5.83–$80.80	81% above	60%
Amylase blood test CPT 82150 AMYLASE BODY FLUID	$40.40	$101.00	$5.83–$80.80	81% above	60%
Amylase blood test CPT 82150 AMYLASE	$40.40	$101.00	$5.83–$80.80	81% above	60%
Amylase blood test CPT 82150 LECH AMYLASE	$59.20	$148.00	$5.83–$118.40	166% above	60%
Amylase blood test inpatient CPT 82150 AMYLASE BODY FLUID	$40.40	$101.00	$5.83–$80.80	—	60%
Amylase blood test inpatient CPT 82150 AMYLASE	$40.40	$101.00	$5.83–$80.80	—	60%
Amylase blood test inpatient CPT 82150 URINE AMYLASE	$40.40	$101.00	$5.83–$80.80	—	60%
Amylase blood test inpatient CPT 82150 LECH AMYLASE	$59.20	$148.00	$5.83–$118.40	—	60%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CYCLIC CITRULLINATED PEPTIDE	$47.60	$119.00	$11.66–$95.20	6% above	60%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CYCLIC CITRULLINATED PEPTIDE	$47.60	$119.00	$11.66–$95.20	—	60%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA	$62.80	$157.00	$10.88–$125.60	45% above	60%
Antinuclear antibody (ANA) blood test, screen CPT 86038 LECH ANA	$92.80	$232.00	$10.88–$185.60	115% above	60%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA	$62.80	$157.00	$10.88–$125.60	—	60%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 LECH ANA	$92.80	$232.00	$10.88–$185.60	—	60%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 BRAIN NATRIURETIC PEPTIDE	$71.60	$179.00	$35.33–$242.46	15% above	60%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 LECH BRAIN NATRIURETIC PEPTIDE	$105.60	$264.00	$35.33–$242.46	69% above	60%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 BRAIN NATRIURETIC PEPTIDE	$71.60	$179.00	$35.33–$242.46	—	60%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 LECH BRAIN NATRIURETIC PEPTIDE	$105.60	$264.00	$35.33–$242.46	—	60%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 N/P CULTURE	$40.80	$102.00	$7.76–$81.60	40% above	60%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 ROUTINE CULTURE	$47.20	$118.00	$7.76–$94.40	62% above	60%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE OTR SPECIMEN AEROBIC	$47.20	$118.00	$7.76–$94.40	62% above	60%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 LECH ROUTINE CULTURE	$69.60	$174.00	$7.76–$139.20	139% above	60%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 LEGIONELLA CULTURE	$76.40	$191.00	$7.76–$152.80	163% above	60%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 N/P CULTURE	$40.80	$102.00	$7.76–$81.60	—	60%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 ROUTINE CULTURE	$47.20	$118.00	$7.76–$94.40	—	60%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE OTR SPECIMEN AEROBIC	$47.20	$118.00	$7.76–$94.40	—	60%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 LECH ROUTINE CULTURE	$69.60	$174.00	$7.76–$139.20	—	60%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 LEGIONELLA CULTURE	$76.40	$191.00	$7.76–$152.80	—	60%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL	$92.00	$230.00	$7.61–$184.00	176% above	60%
Basic metabolic panel (blood test) CPT 80048 LECH BASIC METABOLIC PANEL	$136.40	$341.00	$7.61–$272.80	310% above	60%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL	$92.00	$230.00	$7.61–$184.00	—	60%
Basic metabolic panel (blood test) inpatient CPT 80048 LECH BASIC METABOLIC PANEL	$136.40	$341.00	$7.61–$272.80	—	60%
Bilirubin blood test, total CPT 82247 BILIRUBIN, TOTAL	$25.20	$63.00	$4.27–$50.40	53% above	60%
Bilirubin blood test, total CPT 82247 LECH BILIRUBIN, TOTAL	$37.20	$93.00	$4.27–$74.40	126% above	60%
Bilirubin blood test, total CPT 82247 BILLIRUBIN, TOTAL BODY FLUID	$73.60	$184.00	$4.27–$147.20	347% above	60%
Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN, TOTAL	$25.20	$63.00	$4.27–$50.40	—	60%
Bilirubin blood test, total inpatient CPT 82247 LECH BILIRUBIN, TOTAL	$37.20	$93.00	$4.27–$74.40	—	60%
Bilirubin blood test, total inpatient CPT 82247 BILLIRUBIN, TOTAL BODY FLUID	$73.60	$184.00	$4.27–$147.20	—	60%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 TISSUE EXAM BY PATH LEVEL 4	$112.40	$281.00	$26.06–$224.80	38% above	60%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 TISSUE EXAM BY PATH LEVEL 4	$112.40	$281.00	$26.06–$224.80	—	60%
Blood culture for bacteria CPT 87040 BLOOD CULTURE WITH ARD	$58.00	$145.00	$9.29–$116.00	34% above	60%
Blood culture for bacteria CPT 87040 LECH BLOOD CULTURE WITH ARD	$86.00	$215.00	$9.29–$172.00	99% above	60%
Blood culture for bacteria inpatient CPT 87040 BLOOD CULTURE WITH ARD	$58.00	$145.00	$9.29–$116.00	—	60%
Blood culture for bacteria inpatient CPT 87040 LECH BLOOD CULTURE WITH ARD	$86.00	$215.00	$9.29–$172.00	—	60%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 ROUTINE VENIPUNCTURE	$10.80	$27.00	$8.04–$21.60	31% above	60%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE	$10.80	$27.00	$2.70–$21.60	31% above	60%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 BLOOD COLLECTION FEE	$12.80	$32.00	$2.70–$25.60	55% above	60%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 SPECIMEN COLLECTION, BLOOD	$12.80	$32.00	$2.70–$25.60	55% above	60%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 LECH BLOOD COLLECTION FEE	$19.20	$48.00	$2.70–$38.40	132% above	60%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 ROUTINE VENIPUNCTURE	$10.80	$27.00	$8.04–$21.60	—	60%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE	$10.80	$27.00	$2.70–$21.60	—	60%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 BLOOD COLLECTION FEE	$12.80	$32.00	$2.70–$25.60	—	60%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 SPECIMEN COLLECTION, BLOOD	$12.80	$32.00	$2.70–$25.60	—	60%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 LECH BLOOD COLLECTION FEE	$19.20	$48.00	$2.70–$38.40	—	60%
Blood glucose (sugar) test CPT 82947 ASSAY GLUCOSE	$5.20	$13.00	$3.54–$27.96	63% below	60%
Blood glucose (sugar) test CPT 82947 GLUCOSE	$27.60	$69.00	$3.54–$55.20	97% above	60%
Blood glucose (sugar) test inpatient CPT 82947 ASSAY GLUCOSE	$5.20	$13.00	$3.54–$27.96	—	60%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE	$27.60	$69.00	$3.54–$55.20	—	60%
Blood lead test CPT 83655 LEAD LEVEL	$46.40	$116.00	$10.90–$92.80	65% above	60%
Blood lead test inpatient CPT 83655 LEAD LEVEL	$46.40	$116.00	$10.90–$92.80	—	60%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HCG, QUALITATIVE	$55.20	$138.00	$6.77–$110.40	76% above	60%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HCG, QUALITATIVE	$55.20	$138.00	$6.77–$110.40	—	60%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPING SEROLOGIC; ABO	$143.20	$358.00	$2.69–$286.40	213% above	60%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 LECH BLOOD TYPING SEROLOGIC; A	$197.20	$493.00	$2.69–$394.40	332% above	60%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 LECH BLOOD TYPING SEROLOGI ABO	$197.20	$493.00	$2.69–$394.40	332% above	60%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BLOOD TYPING SEROLOGIC; ABO	$143.20	$358.00	$2.69–$286.40	—	60%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 LECH BLOOD TYPING SEROLOGIC; A	$197.20	$493.00	$2.69–$394.40	—	60%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 LECH BLOOD TYPING SEROLOGI ABO	$197.20	$493.00	$2.69–$394.40	—	60%
Blood urea nitrogen (BUN) test CPT 84520 BUN	$27.20	$68.00	$3.56–$54.40	70% above	60%
Blood urea nitrogen (BUN) test inpatient CPT 84520 BUN	$27.20	$68.00	$3.56–$54.40	—	60%
C-peptide blood test CPT 84681 C-PEPTIDE	$76.00	$190.00	$18.73–$152.00	37% above	60%
C-peptide blood test inpatient CPT 84681 C-PEPTIDE	$76.00	$190.00	$18.73–$152.00	—	60%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 CRP - SF (PJ)	$40.00	$100.00	$4.66–$80.00	72% above	60%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN	$42.80	$107.00	$4.66–$85.60	84% above	60%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 LECH C-REACTIVE PROTEIN	$63.20	$158.00	$4.66–$126.40	172% above	60%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 CRP - SF (PJ)	$40.00	$100.00	$4.66–$80.00	—	60%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN	$42.80	$107.00	$4.66–$85.60	—	60%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 LECH C-REACTIVE PROTEIN	$63.20	$158.00	$4.66–$126.40	—	60%
C. difficile toxin gene test (stool PCR) CPT 87493 C. DIFFICILE DNA AMPLIFICATION	$68.80	$172.00	$33.54–$249.93	1% above	60%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C. DIFFICILE DNA AMPLIFICATION	$68.80	$172.00	$33.54–$249.93	—	60%
CA 19-9 blood test (tumor marker) CPT 86301 CA 19-9	$67.20	$168.00	$18.73–$149.20	38% above	60%
CA 19-9 blood test (tumor marker) CPT 86301 LECH CA 19-9	$99.60	$249.00	$18.73–$199.20	104% above	60%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA 19-9	$67.20	$168.00	$18.73–$149.20	—	60%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 LECH CA 19-9	$99.60	$249.00	$18.73–$199.20	—	60%
CA-125 blood test (ovarian cancer marker) CPT 86304 CA 125	$70.40	$176.00	$18.73–$149.20	35% above	60%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA 125	$70.40	$176.00	$18.73–$149.20	—	60%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-COV-2 COVID-19 AMP PRB	$107.60	$269.00	$43.61–$215.20	49% above	60%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-COV-2 COVID-19 AMP PRB	$107.60	$269.00	$43.61–$215.20	—	60%
Calcium blood test, total CPT 82310 CALCIUM (PTH)	$14.80	$37.00	$4.64–$37.29	21% below	60%
Calcium blood test, total CPT 82310 CALCIUM	$24.80	$62.00	$4.64–$49.60	32% above	60%
Calcium blood test, total CPT 82310 LECH CALCIUM	$36.80	$92.00	$4.64–$73.60	95% above	60%
Calcium blood test, total inpatient CPT 82310 CALCIUM (PTH)	$14.80	$37.00	$4.64–$37.29	—	60%
Calcium blood test, total inpatient CPT 82310 CALCIUM	$24.80	$62.00	$4.64–$49.60	—	60%
Calcium blood test, total inpatient CPT 82310 LECH CALCIUM	$36.80	$92.00	$4.64–$73.60	—	60%
Carcinoembryonic antigen (CEA) test CPT 82378 C E A	$59.20	$148.00	$17.06–$134.26	at median	60%
Carcinoembryonic antigen (CEA) test CPT 82378 LECH C E A	$87.60	$219.00	$17.06–$175.20	49% above	60%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 C E A	$59.20	$148.00	$17.06–$134.26	—	60%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 LECH C E A	$87.60	$219.00	$17.06–$175.20	—	60%
Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA ZOSTER AB IGG	$68.80	$172.00	$11.16–$137.60	83% above	60%
Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA ZOSTER AB IGM	$68.80	$172.00	$11.16–$137.60	83% above	60%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA ZOSTER AB IGG	$68.80	$172.00	$11.16–$137.60	—	60%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA ZOSTER AB IGM	$68.80	$172.00	$11.16–$137.60	—	60%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA DNA PROBE	$51.60	$129.00	$31.58–$249.93	12% below	60%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA TRACHOMATIS CONJ SWA	$58.00	$145.00	$31.58–$249.93	1% below	60%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA DNA PROBE	$51.60	$129.00	$31.58–$249.93	—	60%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA TRACHOMATIS CONJ SWA	$58.00	$145.00	$31.58–$249.93	—	60%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL	$80.00	$200.00	$11.88–$160.00	63% above	60%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LECH LIPID PANEL	$118.80	$297.00	$11.88–$237.60	142% above	60%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL	$80.00	$200.00	$11.88–$160.00	—	60%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LECH LIPID PANEL	$118.80	$297.00	$11.88–$237.60	—	60%
Complete blood count (CBC) with differential CPT 85025 CBC W/ AUTO DIFF	$73.20	$183.00	$6.99–$146.40	175% above	60%
Complete blood count (CBC) with differential CPT 85025 LECH CBC W/ AUTO DIFF	$108.00	$270.00	$6.99–$216.00	305% above	60%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC W/ AUTO DIFF	$73.20	$183.00	$6.99–$146.40	—	60%
Complete blood count (CBC) with differential inpatient CPT 85025 LECH CBC W/ AUTO DIFF	$108.00	$270.00	$6.99–$216.00	—	60%
Comprehensive metabolic panel (blood test) CPT 80053 COMP METABOLIC PANEL	$97.60	$244.00	$9.50–$195.20	32% above	60%
Comprehensive metabolic panel (blood test) CPT 80053 LECH COMP METABOLIC PANEL	$144.80	$362.00	$9.50–$289.60	95% above	60%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMP METABOLIC PANEL	$97.60	$244.00	$9.50–$195.20	—	60%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 LECH COMP METABOLIC PANEL	$144.80	$362.00	$9.50–$289.60	—	60%
Cortisol blood test, total CPT 82533 CORTISOL	$48.80	$122.00	$14.67–$115.62	27% above	60%
Cortisol blood test, total CPT 82533 CORTISOL, SALIVARY MIDNIGHT	$258.80	$647.00	$14.67–$517.60	576% above	60%
Cortisol blood test, total inpatient CPT 82533 CORTISOL	$48.80	$122.00	$14.67–$115.62	—	60%
Cortisol blood test, total inpatient CPT 82533 CORTISOL, SALIVARY MIDNIGHT	$258.80	$647.00	$14.67–$517.60	—	60%
Creatinine blood test CPT 82565 CREATININE;BLD	$28.40	$71.00	$4.61–$56.80	62% above	60%
Creatinine blood test inpatient CPT 82565 CREATININE;BLD	$28.40	$71.00	$4.61–$56.80	—	60%
Cytomegalovirus (CMV) antibody test CPT 86644 CMV ABS, IGG	$46.40	$116.00	$12.95–$102.59	25% above	60%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CMV ABS, IGG	$46.40	$116.00	$12.95–$102.59	—	60%
DHEA sulfate (DHEA-S) blood test CPT 82627 DEHYDROEPIANDROSTERONE-SU	$72.40	$181.00	$20.01–$158.52	26% above	60%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DEHYDROEPIANDROSTERONE-SU	$72.40	$181.00	$20.01–$158.52	—	60%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG SCREEN MULITIPLE CLASS	$231.20	$578.00	$55.93–$462.40	708% above	60%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRESUMPTIVE CHEM ANA	$243.60	$609.00	$55.93–$487.20	752% above	60%
Drug screen by lab instrument (any number of drug classes) CPT 80307 LECH DRUG SCREEN MULITIPLE CLA	$342.80	$857.00	$55.93–$685.60	1099% above	60%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG SCREEN MULITIPLE CLASS	$231.20	$578.00	$55.93–$462.40	—	60%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRESUMPTIVE CHEM ANA	$243.60	$609.00	$55.93–$487.20	—	60%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 LECH DRUG SCREEN MULITIPLE CLA	$342.80	$857.00	$55.93–$685.60	—	60%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 ELECTROLYTE PANEL	$63.60	$159.00	$6.31–$127.20	72% above	60%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 ELECTROLYTE PANEL	$63.60	$159.00	$6.31–$127.20	—	60%
Epstein-Barr virus (EBV) antibody test CPT 86665 EBV AB TO VIR CAPS AG IG	$55.20	$138.00	$16.33–$128.70	8% above	60%
Epstein-Barr virus (EBV) antibody test CPT 86665 EBV AB TO VIR. CAPS. AG, I	$55.20	$138.00	$16.33–$128.70	8% above	60%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EBV AB TO VIR. CAPS. AG, I	$55.20	$138.00	$16.33–$128.70	—	60%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EBV AB TO VIR CAPS AG IG	$55.20	$138.00	$16.33–$128.70	—	60%
FSH (follicle-stimulating hormone) test CPT 83001 FSH	$59.20	$148.00	$16.72–$132.41	5% above	60%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH	$59.20	$148.00	$16.72–$132.41	—	60%
Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN, FECAL	$240.00	$600.00	$17.67–$480.00	141% above	60%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CALPROTECTIN, FECAL	$240.00	$600.00	$17.67–$480.00	—	60%
Ferritin blood test (iron stores) CPT 82728 FERRITIN	$43.60	$109.00	$12.27–$96.97	5% below	60%
Ferritin blood test (iron stores) CPT 82728 LECH FERRITIN	$64.40	$161.00	$12.27–$128.80	40% above	60%
Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN	$43.60	$109.00	$12.27–$96.97	—	60%
Ferritin blood test (iron stores) inpatient CPT 82728 LECH FERRITIN	$64.40	$161.00	$12.27–$128.80	—	60%
Fibrinogen blood test CPT 85384 FIBRINOGEN LEV	$64.00	$160.00	$8.46–$128.00	112% above	60%
Fibrinogen blood test inpatient CPT 85384 FIBRINOGEN LEV	$64.00	$160.00	$8.46–$128.00	—	60%
Folate (folic acid) blood test CPT 82746 FOLATE LEVEL	$56.00	$140.00	$13.23–$112.00	42% above	60%
Folate (folic acid) blood test CPT 82746 LECH FOLATE LEVEL	$82.40	$206.00	$13.23–$164.80	109% above	60%
Folate (folic acid) blood test inpatient CPT 82746 FOLATE LEVEL	$56.00	$140.00	$13.23–$112.00	—	60%
Folate (folic acid) blood test inpatient CPT 82746 LECH FOLATE LEVEL	$82.40	$206.00	$13.23–$164.80	—	60%
Free T3 thyroid hormone test CPT 84481 T3 FREE	$115.60	$289.00	$14.40–$231.20	169% above	60%
Free T3 thyroid hormone test inpatient CPT 84481 T3 FREE	$115.60	$289.00	$14.40–$231.20	—	60%
Free T4 (free thyroxine) thyroid blood test CPT 84439 T4 FREE	$52.80	$132.00	$8.12–$105.60	52% above	60%
Free T4 (free thyroxine) thyroid blood test CPT 84439 LECH T4 FREE	$77.60	$194.00	$8.12–$155.20	123% above	60%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4 FREE	$52.80	$132.00	$8.12–$105.60	—	60%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 LECH T4 FREE	$77.60	$194.00	$8.12–$155.20	—	60%
Free testosterone test CPT 84402 TESTOSTERONE, FREE	$69.60	$174.00	$22.92–$180.92	14% above	60%
Free testosterone test inpatient CPT 84402 TESTOSTERONE, FREE	$69.60	$174.00	$22.92–$180.92	—	60%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 GAMMA GT	$26.80	$67.00	$6.48–$53.60	8% above	60%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 LECH GAMMA GT	$39.60	$99.00	$6.48–$79.20	59% above	60%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 GAMMA GT	$26.80	$67.00	$6.48–$53.60	—	60%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 LECH GAMMA GT	$39.60	$99.00	$6.48–$79.20	—	60%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 2 HR POST-PRANDIAL GLUCO	$27.20	$68.00	$4.28–$54.40	68% above	60%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 1 HR DMS	$34.80	$87.00	$4.28–$69.60	115% above	60%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 2 HR POST-PRANDIAL GLUCO	$27.20	$68.00	$4.28–$54.40	—	60%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 1 HR DMS	$34.80	$87.00	$4.28–$69.60	—	60%
Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE TEST (GTT)	$25.60	$64.00	$11.58–$91.36	43% below	60%
Glucose tolerance test, 3 samples CPT 82951 5 HR GTT (3 SPEC.)	$53.20	$133.00	$11.58–$106.40	19% above	60%
Glucose tolerance test, 3 samples CPT 82951 3 HR GTT	$53.20	$133.00	$11.58–$106.40	19% above	60%
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOLERANCE TEST (GTT)	$25.60	$64.00	$11.58–$91.36	—	60%
Glucose tolerance test, 3 samples inpatient CPT 82951 5 HR GTT (3 SPEC.)	$53.20	$133.00	$11.58–$106.40	—	60%
Glucose tolerance test, 3 samples inpatient CPT 82951 3 HR GTT	$53.20	$133.00	$11.58–$106.40	—	60%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GC DNA AMPLIFICATION	$51.60	$129.00	$31.58–$249.93	12% below	60%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 GC DNA AMPLIFICATION	$51.60	$129.00	$31.58–$249.93	—	60%
H. pylori antibody blood test CPT 86677 H. pylori ANTIBODY,IgA	$31.60	$79.00	$14.32–$102.59	31% below	60%
H. pylori antibody blood test inpatient CPT 86677 H. pylori ANTIBODY,IgA	$31.60	$79.00	$14.32–$102.59	—	60%
H. pylori stool antigen test CPT 87338 H. PYLORI ANTIGEN	$100.80	$252.00	$12.22–$201.60	64% above	60%
H. pylori stool antigen test inpatient CPT 87338 H. PYLORI ANTIGEN	$100.80	$252.00	$12.22–$201.60	—	60%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 RNA QUANT. BY PCR	$188.80	$472.00	$76.59–$606.10	10% above	60%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV-1 RNA QUANT. BY PCR	$188.80	$472.00	$76.59–$606.10	—	60%
HIV-1 and HIV-2 antibody test CPT 86703 HIV-1/HIV-2 ABS	$67.20	$168.00	$11.65–$134.40	127% above	60%
HIV-1 and HIV-2 antibody test CPT 86703 LECH HIV-1/HIV-2 ABS	$99.60	$249.00	$11.65–$199.20	237% above	60%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV-1/HIV-2 ABS	$67.20	$168.00	$11.65–$134.40	—	60%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 LECH HIV-1/HIV-2 ABS	$99.60	$249.00	$11.65–$199.20	—	60%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV 4TH GEN w/RFX	$164.40	$411.00	$21.67–$328.80	242% above	60%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV 4TH GEN w/RFX	$164.40	$411.00	$21.67–$328.80	—	60%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV HIGH RISK TYPES	$51.60	$129.00	$31.58–$249.93	3% below	60%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV HIGH RISK TYPES	$51.60	$129.00	$31.58–$249.93	—	60%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN A1C	$11.60	$29.00	$8.74–$69.01	65% below	60%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 GLYCOSYLATED HEMOGLOBIN TEST	$55.20	$138.00	$8.74–$110.40	68% above	60%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 LECH GLYCOSYLATED HEMOGLOBIN T	$81.20	$203.00	$8.74–$162.40	148% above	60%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HEMOGLOBIN A1C	$11.60	$29.00	$8.74–$69.01	—	60%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 GLYCOSYLATED HEMOGLOBIN TEST	$55.20	$138.00	$8.74–$110.40	—	60%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 LECH GLYCOSYLATED HEMOGLOBIN T	$81.20	$203.00	$8.74–$162.40	—	60%
Hemoglobin blood test CPT 85018 HEMOGLOBIN	$24.80	$62.00	$2.13–$49.60	138% above	60%
Hemoglobin blood test CPT 85018 LECH HEMOGLOBIN	$36.80	$92.00	$2.13–$73.60	254% above	60%
Hemoglobin blood test inpatient CPT 85018 HEMOGLOBIN	$24.80	$62.00	$2.13–$49.60	—	60%
Hemoglobin blood test inpatient CPT 85018 LECH HEMOGLOBIN	$36.80	$92.00	$2.13–$73.60	—	60%
Hepatitis B core antibody test (total) CPT 86704 HEP B CORE AB, IGG/IGM	$51.20	$128.00	$10.85–$102.40	77% above	60%
Hepatitis B core antibody test (total) inpatient CPT 86704 HEP B CORE AB, IGG/IGM	$51.20	$128.00	$10.85–$102.40	—	60%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURF. AB.	$51.20	$128.00	$9.67–$102.40	79% above	60%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B SURF. AB.	$51.20	$128.00	$9.67–$102.40	—	60%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEP. B SURF. ANTIGEN	$38.80	$97.00	$9.30–$77.60	6% above	60%
Hepatitis B surface antigen (HBsAg) test CPT 87340 LECH HEP. B SURF. ANTIGEN	$57.60	$144.00	$9.30–$115.20	57% above	60%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEP. B SURF. ANTIGEN	$38.80	$97.00	$9.30–$77.60	—	60%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 LECH HEP. B SURF. ANTIGEN	$57.60	$144.00	$9.30–$115.20	—	60%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C	$53.20	$133.00	$12.84–$106.40	14% above	60%
Hepatitis C antibody blood test (screening) CPT 86803 LECH HEPATITIS C	$78.40	$196.00	$12.84–$156.80	69% above	60%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C	$53.20	$133.00	$12.84–$106.40	—	60%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 LECH HEPATITIS C	$78.40	$196.00	$12.84–$156.80	—	60%
Hepatitis C viral load (HCV RNA) test CPT 87522 HEPATITIS C RNA, QUANT.	$190.40	$476.00	$38.56–$380.80	62% above	60%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEPATITIS C RNA, QUANT.	$190.40	$476.00	$38.56–$380.80	—	60%
Herpes blood test, HSV-1 antibody CPT 86695 TORCH ANTIBODY IgG	$25.20	$63.00	$11.87–$93.27	4% below	60%
Herpes blood test, HSV-1 antibody CPT 86695 HSV TYPE I, IGM	$40.40	$101.00	$11.87–$93.27	55% above	60%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 TORCH ANTIBODY IgG	$25.20	$63.00	$11.87–$93.27	—	60%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HSV TYPE I, IGM	$40.40	$101.00	$11.87–$93.27	—	60%
Herpes blood test, HSV-2 antibody CPT 86696 HSV TYPE II AB, IGG	$42.80	$107.00	$17.42–$138.02	3% below	60%
Herpes blood test, HSV-2 antibody CPT 86696 HSV TYPE 2 GLYCOPROTEIN G-S Ab	$42.80	$107.00	$17.42–$138.02	3% below	60%
Herpes blood test, HSV-2 antibody CPT 86696 HSV TYPE II, IGM	$42.80	$107.00	$17.42–$138.02	3% below	60%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HSV TYPE II AB, IGG	$42.80	$107.00	$17.42–$138.02	—	60%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HSV TYPE II, IGM	$42.80	$107.00	$17.42–$138.02	—	60%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HSV TYPE 2 GLYCOPROTEIN G-S Ab	$42.80	$107.00	$17.42–$138.02	—	60%
Homocysteine blood test CPT 83090 HOMOCYSTINE	$37.20	$93.00	$16.13–$119.38	35% below	60%
Homocysteine blood test inpatient CPT 83090 HOMOCYSTINE	$37.20	$93.00	$16.13–$119.38	—	60%
Insulin blood test CPT 83525 INSULIN #2	$19.20	$48.00	$10.29–$82.04	42% below	60%
Insulin blood test CPT 83525 INSULIN #1	$19.20	$48.00	$10.29–$82.04	42% below	60%
Insulin blood test CPT 83525 INSULIN #3	$19.20	$48.00	$10.29–$82.04	42% below	60%
Insulin blood test CPT 83525 INSULIN	$46.40	$116.00	$10.29–$92.80	41% above	60%
Insulin blood test inpatient CPT 83525 INSULIN #1	$19.20	$48.00	$10.29–$82.04	—	60%
Insulin blood test inpatient CPT 83525 INSULIN #3	$19.20	$48.00	$10.29–$82.04	—	60%
Insulin blood test inpatient CPT 83525 INSULIN #2	$19.20	$48.00	$10.29–$82.04	—	60%
Insulin blood test inpatient CPT 83525 INSULIN	$46.40	$116.00	$10.29–$92.80	—	60%
Iron blood test (serum iron) CPT 83540 IRON-SERUM	$34.80	$87.00	$5.50–$69.60	61% above	60%
Iron blood test (serum iron) CPT 83540 LECH IRON-SERUM	$50.80	$127.00	$5.50–$101.60	135% above	60%
Iron blood test (serum iron) inpatient CPT 83540 IRON-SERUM	$34.80	$87.00	$5.50–$69.60	—	60%
Iron blood test (serum iron) inpatient CPT 83540 LECH IRON-SERUM	$50.80	$127.00	$5.50–$101.60	—	60%
Iron-binding capacity (TIBC) test CPT 83550 TOTAL IRON BINDING CAPACI	$41.20	$103.00	$7.87–$82.40	28% above	60%
Iron-binding capacity (TIBC) test CPT 83550 LECH TOTAL IRON BINDING CAPACI	$61.20	$153.00	$7.87–$122.40	90% above	60%
Iron-binding capacity (TIBC) test inpatient CPT 83550 TOTAL IRON BINDING CAPACI	$41.20	$103.00	$7.87–$82.40	—	60%
Iron-binding capacity (TIBC) test inpatient CPT 83550 LECH TOTAL IRON BINDING CAPACI	$61.20	$153.00	$7.87–$122.40	—	60%
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL	$66.00	$165.00	$7.81–$132.00	21% above	60%
Kidney function blood test panel CPT 80069 LECH RENAL FUNCTION PANEL	$97.20	$243.00	$7.81–$194.40	78% above	60%
Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL	$66.00	$165.00	$7.81–$132.00	—	60%
Kidney function blood test panel inpatient CPT 80069 LECH RENAL FUNCTION PANEL	$97.20	$243.00	$7.81–$194.40	—	60%
LH (luteinizing hormone) test CPT 83002 LH	$62.00	$155.00	$16.67–$132.41	15% above	60%
LH (luteinizing hormone) test inpatient CPT 83002 LH	$62.00	$155.00	$16.67–$132.41	—	60%
Lactate (lactic acid) blood test CPT 83605 LACTIC ACID	$45.60	$114.00	$10.41–$91.20	63% above	60%
Lactate (lactic acid) blood test inpatient CPT 83605 LACTIC ACID	$45.60	$114.00	$10.41–$91.20	—	60%
Lactate dehydrogenase (LDH) blood test CPT 83615 LDH, TOTAL	$35.20	$88.00	$5.44–$70.40	69% above	60%
Lactate dehydrogenase (LDH) blood test CPT 83615 LACTATE - SF (NSA)	$40.00	$100.00	$5.44–$80.00	92% above	60%
Lactate dehydrogenase (LDH) blood test CPT 83615 LECH LDH, TOTAL	$51.60	$129.00	$5.44–$103.20	148% above	60%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH, TOTAL	$35.20	$88.00	$5.44–$70.40	—	60%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LACTATE - SF (NSA)	$40.00	$100.00	$5.44–$80.00	—	60%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LECH LDH, TOTAL	$51.60	$129.00	$5.44–$103.20	—	60%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE	$50.80	$127.00	$6.20–$101.60	103% above	60%
Lipase blood test (pancreas enzyme) CPT 83690 LECH LIPASE	$74.80	$187.00	$6.20–$149.60	199% above	60%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE	$50.80	$127.00	$6.20–$101.60	—	60%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LECH LIPASE	$74.80	$187.00	$6.20–$149.60	—	60%
Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL	$58.00	$145.00	$7.35–$116.00	13% above	60%
Liver function blood test panel CPT 80076 LECH HEPATIC FUNCTION PANEL	$86.00	$215.00	$7.35–$172.00	68% above	60%
Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL	$58.00	$145.00	$7.35–$116.00	—	60%
Liver function blood test panel inpatient CPT 80076 LECH HEPATIC FUNCTION PANEL	$86.00	$215.00	$7.35–$172.00	—	60%
Lyme disease antibody test CPT 86618 LYME DISEASE SCREEN	$80.80	$202.00	$15.33–$161.60	60% above	60%
Lyme disease antibody test inpatient CPT 86618 LYME DISEASE SCREEN	$80.80	$202.00	$15.33–$161.60	—	60%
Magnesium blood test CPT 83735 MAGNESIUM	$33.20	$83.00	$6.03–$66.40	50% above	60%
Magnesium blood test CPT 83735 LECH MAGNESIUM	$48.80	$122.00	$6.03–$97.60	121% above	60%
Magnesium blood test CPT 83735 MAGNESIUM, RBC	$123.60	$309.00	$6.03–$247.20	459% above	60%
Magnesium blood test inpatient CPT 83735 MAGNESIUM	$33.20	$83.00	$6.03–$66.40	—	60%
Magnesium blood test inpatient CPT 83735 LECH MAGNESIUM	$48.80	$122.00	$6.03–$97.60	—	60%
Magnesium blood test inpatient CPT 83735 MAGNESIUM, RBC	$123.60	$309.00	$6.03–$247.20	—	60%
Measles (rubeola) antibody test CPT 86765 RUBEOLA AB, IGM	$69.20	$173.00	$11.59–$138.40	124% above	60%
Measles (rubeola) antibody test CPT 86765 MEASLES (RUBEOLA), IgG	$69.20	$173.00	$11.59–$138.40	124% above	60%
Measles (rubeola) antibody test CPT 86765 MEASLES (RUBEOLA), IgM	$69.20	$173.00	$11.59–$138.40	124% above	60%
Measles (rubeola) antibody test CPT 86765 RUBEOLA AB, IGG	$69.20	$173.00	$11.59–$138.40	124% above	60%
Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA AB, IGG	$69.20	$173.00	$11.59–$138.40	—	60%
Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA AB, IGM	$69.20	$173.00	$11.59–$138.40	—	60%
Measles (rubeola) antibody test inpatient CPT 86765 MEASLES (RUBEOLA), IgM	$69.20	$173.00	$11.59–$138.40	—	60%
Measles (rubeola) antibody test inpatient CPT 86765 MEASLES (RUBEOLA), IgG	$69.20	$173.00	$11.59–$138.40	—	60%
Mono test (heterophile antibody, Monospot) CPT 86308 MONOTEST	$66.40	$166.00	$4.66–$132.80	188% above	60%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONOTEST	$66.40	$166.00	$4.66–$132.80	—	60%
Mumps immunity blood test CPT 86735 MUMPS AB (IGG)	$43.60	$109.00	$11.75–$93.27	44% above	60%
Mumps immunity blood test CPT 86735 MUMPS AB, IGM	$43.60	$109.00	$11.75–$93.27	44% above	60%
Mumps immunity blood test inpatient CPT 86735 MUMPS AB, IGM	$43.60	$109.00	$11.75–$93.27	—	60%
Mumps immunity blood test inpatient CPT 86735 MUMPS AB (IGG)	$43.60	$109.00	$11.75–$93.27	—	60%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA, FREE	$55.60	$139.00	$16.55–$130.55	14% above	60%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA, FREE	$55.60	$139.00	$16.55–$130.55	—	60%
PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATE SPECIFIC ANTIGEN	$76.80	$192.00	$16.55–$153.60	73% above	60%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROSTATE SPECIFIC ANTIGEN	$76.80	$192.00	$16.55–$153.60	—	60%
Pap test (liquid-based, automated screening with review) CPT 88175 CYTOPATH C/V AUTO FLUID REDO	$54.00	$135.00	$22.62–$188.39	25% above	60%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 CYTOPATH C/V AUTO FLUID REDO	$54.00	$135.00	$22.62–$188.39	—	60%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 CYTOPATH C/V THIN LAYER	$105.20	$263.00	$17.22–$210.40	263% above	60%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 CYTOPATH C/V THIN LAYER	$105.20	$263.00	$17.22–$210.40	—	60%
Parathyroid hormone (PTH) blood test CPT 83970 PARATHYROID HORMONE	$132.80	$332.00	$37.15–$294.68	45% above	60%
Parathyroid hormone (PTH) blood test CPT 83970 LECH PARATHYROID HORMONE	$196.40	$491.00	$37.15–$392.80	115% above	60%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PARATHYROID HORMONE	$132.80	$332.00	$37.15–$294.68	—	60%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 LECH PARATHYROID HORMONE	$196.40	$491.00	$37.15–$392.80	—	60%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT	$38.00	$95.00	$5.41–$76.00	83% above	60%
Partial thromboplastin time (PTT) clotting test CPT 85730 LECH PTT	$56.00	$140.00	$5.41–$112.00	170% above	60%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT	$38.00	$95.00	$5.41–$76.00	—	60%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 LECH PTT	$56.00	$140.00	$5.41–$112.00	—	60%
Phosphorus (phosphate) blood test CPT 84100 PHOSPHOROUS	$25.20	$63.00	$4.27–$50.40	54% above	60%
Phosphorus (phosphate) blood test CPT 84100 LECH PHOSPHOROUS	$37.20	$93.00	$4.27–$74.40	128% above	60%
Phosphorus (phosphate) blood test inpatient CPT 84100 PHOSPHOROUS	$25.20	$63.00	$4.27–$50.40	—	60%
Phosphorus (phosphate) blood test inpatient CPT 84100 LECH PHOSPHOROUS	$37.20	$93.00	$4.27–$74.40	—	60%
Potassium blood test CPT 84132 POTASSIUM	$25.20	$63.00	$4.28–$50.40	49% above	60%
Potassium blood test inpatient CPT 84132 POTASSIUM	$25.20	$63.00	$4.28–$50.40	—	60%
Progesterone blood test CPT 84144 PROGESTERONE	$55.60	$139.00	$18.77–$149.20	at median	60%
Progesterone blood test inpatient CPT 84144 PROGESTERONE	$55.60	$139.00	$18.77–$149.20	—	60%
Prolactin blood test CPT 84146 PROLACTIN ASSAY	$76.80	$192.00	$17.44–$153.60	19% above	60%
Prolactin blood test inpatient CPT 84146 PROLACTIN ASSAY	$76.80	$192.00	$17.44–$153.60	—	60%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTIME	$33.60	$84.00	$3.86–$67.20	132% above	60%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME - D	$33.60	$84.00	$3.86–$67.20	132% above	60%
Prothrombin time (PT/INR) clotting test CPT 85610 LECH PROTIME	$49.20	$123.00	$3.86–$98.40	240% above	60%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTIME	$33.60	$84.00	$3.86–$67.20	—	60%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME - D	$33.60	$84.00	$3.86–$67.20	—	60%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 LECH PROTIME	$49.20	$123.00	$3.86–$98.40	—	60%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 DRUG TEST PRSMV DIR OPT OBS	$19.20	$48.00	$11.22–$78.33	17% below	60%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 DRUG TEST DIRECT OBS	$19.20	$48.00	$11.22–$78.33	17% below	60%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 DRUG TEST PRSMV DIR OPT OBS	$19.20	$48.00	$11.22–$78.33	—	60%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 DRUG TEST DIRECT OBS	$19.20	$48.00	$11.22–$78.33	—	60%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA IA W DO	$14.40	$36.00	$14.07–$85.80	36% below	60%
Rapid flu test (influenza antigen) CPT 87804 INFLU TESTING	$16.00	$40.00	$14.07–$85.80	29% below	60%
Rapid flu test (influenza antigen) CPT 87804 iaadiadoo influenza	$20.80	$52.00	$14.07–$85.80	8% below	60%
Rapid flu test (influenza antigen) CPT 87804 Influenza Assay	$21.60	$54.00	$14.07–$85.80	4% below	60%
Rapid flu test (influenza antigen) CPT 87804 INFLU VIRUS A AG	$36.00	$90.00	$14.07–$85.80	60% above	60%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA B ANTIGEN	$36.00	$90.00	$14.07–$85.80	60% above	60%
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA IA W DO	$14.40	$36.00	$14.07–$85.80	—	60%
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLU TESTING	$16.00	$40.00	$14.07–$85.80	—	60%
Rapid flu test (influenza antigen) inpatient CPT 87804 iaadiadoo influenza	$20.80	$52.00	$14.07–$85.80	—	60%
Rapid flu test (influenza antigen) inpatient CPT 87804 Influenza Assay	$21.60	$54.00	$14.07–$85.80	—	60%
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLU VIRUS A AG	$36.00	$90.00	$14.07–$85.80	—	60%
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA B ANTIGEN	$36.00	$90.00	$14.07–$85.80	—	60%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREP A ASSAY W/OPTIC	$14.40	$36.00	$14.05–$85.80	41% below	60%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREP A	$16.00	$40.00	$14.05–$85.80	35% below	60%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 QUICK STREP SCREEN	$33.60	$84.00	$14.05–$85.80	37% above	60%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 STREP A ASSAY W/OPTIC	$14.40	$36.00	$14.05–$85.80	—	60%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 STREP A	$16.00	$40.00	$14.05–$85.80	—	60%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 QUICK STREP SCREEN	$33.60	$84.00	$14.05–$85.80	—	60%
Renin blood test CPT 84244 RENIN	$59.20	$148.00	$19.79–$156.66	1% below	60%
Renin blood test inpatient CPT 84244 RENIN	$59.20	$148.00	$19.79–$156.66	—	60%
Rh blood typing CPT 86901 RH CHARGE ONLY (LBC)	$39.20	$98.00	$2.69–$78.40	85% above	60%
Rh blood typing CPT 86901 RH FACTOR	$45.20	$113.00	$2.69–$90.40	113% above	60%
Rh blood typing CPT 86901 LECH RH FACTOR	$57.60	$144.00	$2.69–$115.20	172% above	60%
Rh blood typing CPT 86901 LECH RH CHARGE ONLY (LBC)	$58.00	$145.00	$2.69–$116.00	173% above	60%
Rh blood typing inpatient CPT 86901 RH CHARGE ONLY (LBC)	$39.20	$98.00	$2.69–$78.40	—	60%
Rh blood typing inpatient CPT 86901 RH FACTOR	$45.20	$113.00	$2.69–$90.40	—	60%
Rh blood typing inpatient CPT 86901 LECH RH FACTOR	$57.60	$144.00	$2.69–$115.20	—	60%
Rh blood typing inpatient CPT 86901 LECH RH CHARGE ONLY (LBC)	$58.00	$145.00	$2.69–$116.00	—	60%
Rheumatoid factor (RF) test CPT 86431 RA TEST	$42.00	$105.00	$5.10–$84.00	81% above	60%
Rheumatoid factor (RF) test inpatient CPT 86431 RA TEST	$42.00	$105.00	$5.10–$84.00	—	60%
Rubella antibody test (immunity check) CPT 86762 RUBELLA AB, IGM	$61.20	$153.00	$12.95–$122.40	83% above	60%
Rubella antibody test (immunity check) CPT 86762 RUBELLA AB IGG	$61.20	$153.00	$12.95–$122.40	83% above	60%
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA AB IGG	$61.20	$153.00	$12.95–$122.40	—	60%
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA AB, IGM	$61.20	$153.00	$12.95–$122.40	—	60%
Sodium blood test CPT 84295 SODIUM	$25.20	$63.00	$4.33–$50.40	48% above	60%
Sodium blood test inpatient CPT 84295 SODIUM	$25.20	$63.00	$4.33–$50.40	—	60%
Stool ova and parasites exam CPT 87177 OCP (STOOL)	$30.80	$77.00	$8.01–$63.40	2% above	60%
Stool ova and parasites exam CPT 87177 LECH OCP (STOOL)	$45.60	$114.00	$8.01–$91.20	51% above	60%
Stool ova and parasites exam inpatient CPT 87177 OCP (STOOL)	$30.80	$77.00	$8.01–$63.40	—	60%
Stool ova and parasites exam inpatient CPT 87177 LECH OCP (STOOL)	$45.60	$114.00	$8.01–$91.20	—	60%
Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLOOD FECES	$10.00	$25.00	$3.72–$22.40	26% below	60%
Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLD, FECAL, SCREENING	$19.20	$48.00	$3.72–$38.40	42% above	60%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 OCCULT BLOOD FECES	$10.00	$25.00	$3.72–$22.40	—	60%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 OCCULT BLD, FECAL, SCREENING	$19.20	$48.00	$3.72–$38.40	—	60%
Syphilis antibody test (Treponema pallidum) CPT 86780 FLUORESCENT TREPONEMAL Ab, CSF	$26.80	$67.00	$11.92–$95.12	at median	60%
Syphilis antibody test (Treponema pallidum) CPT 86780 TREPONEMA PALLIDUM	$62.80	$157.00	$11.92–$125.60	134% above	60%
Syphilis antibody test (Treponema pallidum) CPT 86780 T pallidum IgG	$62.80	$157.00	$11.92–$125.60	134% above	60%
Syphilis antibody test (Treponema pallidum) CPT 86780 LECH TREPONEMA PALLIDUM	$92.80	$232.00	$11.92–$185.60	246% above	60%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 FLUORESCENT TREPONEMAL Ab, CSF	$26.80	$67.00	$11.92–$95.12	—	60%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 T pallidum IgG	$62.80	$157.00	$11.92–$125.60	—	60%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 TREPONEMA PALLIDUM	$62.80	$157.00	$11.92–$125.60	—	60%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 LECH TREPONEMA PALLIDUM	$92.80	$232.00	$11.92–$185.60	—	60%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR, QUALITATIVE TEST, SERUM	$7.60	$19.00	$3.84–$29.82	41% below	60%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 VDRL OR RPR	$43.60	$109.00	$3.84–$87.20	239% above	60%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR, QUALITATIVE TEST, SERUM	$7.60	$19.00	$3.84–$29.82	—	60%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 VDRL OR RPR	$43.60	$109.00	$3.84–$87.20	—	60%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QUANTIFERON TB GOLD IN TUBE	$250.40	$626.00	$55.78–$500.80	112% above	60%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 LECH QUANTIFERON TB GOLD IN TU	$371.60	$929.00	$55.78–$743.20	215% above	60%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 QUANTIFERON TB GOLD IN TUBE	$250.40	$626.00	$55.78–$500.80	—	60%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 LECH QUANTIFERON TB GOLD IN TU	$371.60	$929.00	$55.78–$743.20	—	60%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE	$94.80	$237.00	$23.23–$189.60	59% above	60%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE	$94.80	$237.00	$23.23–$189.60	—	60%
Thyroid peroxidase (TPO) antibody test CPT 86376 MICROSOMAL AB	$64.80	$162.00	$13.10–$129.60	73% above	60%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 MICROSOMAL AB	$64.80	$162.00	$13.10–$129.60	—	60%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH (THYR STIM HORM)	$52.80	$132.00	$15.12–$119.38	31% above	60%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 LECH TSH (THYR STIM HORM)	$77.60	$194.00	$15.12–$155.20	92% above	60%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH (THYR STIM HORM)	$52.80	$132.00	$15.12–$119.38	—	60%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 LECH TSH (THYR STIM HORM)	$77.60	$194.00	$15.12–$155.20	—	60%
Total IgE blood test CPT 82785 IMMUNOGLOBULIN E	$48.40	$121.00	$14.81–$117.47	26% above	60%
Total IgE blood test inpatient CPT 82785 IMMUNOGLOBULIN E	$48.40	$121.00	$14.81–$117.47	—	60%
Total cholesterol blood test CPT 82465 CHOLESTEROL	$25.20	$63.00	$3.92–$50.40	68% above	60%
Total cholesterol blood test inpatient CPT 82465 CHOLESTEROL	$25.20	$63.00	$3.92–$50.40	—	60%
Total thyroxine (T4) blood test CPT 84436 TOTAL THYROXINE (T4)	$32.40	$81.00	$5.84–$64.80	39% above	60%
Total thyroxine (T4) blood test CPT 84436 LECH TOTAL THYROXINE (T4)	$48.00	$120.00	$5.84–$96.00	105% above	60%
Total thyroxine (T4) blood test inpatient CPT 84436 TOTAL THYROXINE (T4)	$32.40	$81.00	$5.84–$64.80	—	60%
Total thyroxine (T4) blood test inpatient CPT 84436 LECH TOTAL THYROXINE (T4)	$48.00	$120.00	$5.84–$96.00	—	60%
Total triiodothyronine (T3) blood test CPT 84480 TRIIODOTHYRONINE T3; TOTAL	$55.20	$138.00	$12.05–$110.40	24% above	60%
Total triiodothyronine (T3) blood test CPT 84480 LECH TRIIODOTHYRONINE T3; TOTA	$81.20	$203.00	$12.05–$162.40	83% above	60%
Total triiodothyronine (T3) blood test inpatient CPT 84480 TRIIODOTHYRONINE T3; TOTAL	$55.20	$138.00	$12.05–$110.40	—	60%
Total triiodothyronine (T3) blood test inpatient CPT 84480 LECH TRIIODOTHYRONINE T3; TOTA	$81.20	$203.00	$12.05–$162.40	—	60%
Transferrin blood test CPT 84466 TRANSFERRIN	$38.40	$96.00	$11.48–$91.36	4% below	60%
Transferrin blood test inpatient CPT 84466 TRANSFERRIN	$38.40	$96.00	$11.48–$91.36	—	60%
Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS AMPLIF	$58.80	$147.00	$31.58–$249.93	13% above	60%
Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS VAGINALIS AMPLIF	$58.80	$147.00	$31.58–$249.93	—	60%
Triglycerides blood test CPT 84478 TRIGLYCERIDES	$38.40	$96.00	$5.17–$76.80	61% above	60%
Triglycerides blood test inpatient CPT 84478 TRIGLYCERIDES	$38.40	$96.00	$5.17–$76.80	—	60%
Troponin test, quantitative CPT 84484 TROPONIN	$60.40	$151.00	$10.76–$120.80	59% above	60%
Troponin test, quantitative CPT 84484 LECH TROPONIN	$89.20	$223.00	$10.76–$178.40	134% above	60%
Troponin test, quantitative inpatient CPT 84484 TROPONIN	$60.40	$151.00	$10.76–$120.80	—	60%
Troponin test, quantitative inpatient CPT 84484 LECH TROPONIN	$89.20	$223.00	$10.76–$178.40	—	60%
Uric acid blood test CPT 84550 URIC ACID	$28.00	$70.00	$4.07–$56.00	68% above	60%
Uric acid blood test CPT 84550 LECH URIC ACID	$41.20	$103.00	$4.07–$82.40	148% above	60%
Uric acid blood test inpatient CPT 84550 URIC ACID	$28.00	$70.00	$4.07–$56.00	—	60%
Uric acid blood test inpatient CPT 84550 LECH URIC ACID	$41.20	$103.00	$4.07–$82.40	—	60%
Urinalysis with microscope exam, automated CPT 81001 U/A AUTO W/SCOPE	$4.40	$11.00	$2.85–$22.40	81% below	60%
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS DIPSTICK W/MICRO	$28.40	$71.00	$2.85–$56.80	20% above	60%
Urinalysis with microscope exam, automated CPT 81001 LECH URINALYSIS DIPSTICK W/MIC	$42.40	$106.00	$2.85–$84.80	79% above	60%
Urinalysis with microscope exam, automated inpatient CPT 81001 U/A AUTO W/SCOPE	$4.40	$11.00	$2.85–$22.40	—	60%
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS DIPSTICK W/MICRO	$28.40	$71.00	$2.85–$56.80	—	60%
Urinalysis with microscope exam, automated inpatient CPT 81001 LECH URINALYSIS DIPSTICK W/MIC	$42.40	$106.00	$2.85–$84.80	—	60%
Urinalysis with microscope exam, manual CPT 81000 U/A NON AUTO W/SCOPE	$4.40	$11.00	$3.42–$22.40	40% below	60%
Urinalysis with microscope exam, manual inpatient CPT 81000 U/A NON AUTO W/SCOPE	$4.40	$11.00	$3.42–$22.40	—	60%
Urinalysis without microscope exam, automated CPT 81003 URINE DIP STICK W/O	$3.20	$8.00	$2.03–$16.79	63% below	60%
Urinalysis without microscope exam, automated CPT 81003 UA	$4.00	$10.00	$2.03–$16.79	54% below	60%
Urinalysis without microscope exam, automated CPT 81003 Urinalysis Auto	$4.40	$11.00	$2.03–$16.79	49% below	60%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS W/O MICRO	$6.00	$15.00	$2.03–$16.79	31% below	60%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS DIPSTICK	$14.00	$35.00	$2.03–$28.00	61% above	60%
Urinalysis without microscope exam, automated CPT 81003 LECH URINALYSIS DIPSTICK	$20.40	$51.00	$2.03–$40.80	135% above	60%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINE DIP STICK W/O	$3.20	$8.00	$2.03–$16.79	—	60%
Urinalysis without microscope exam, automated inpatient CPT 81003 UA	$4.00	$10.00	$2.03–$16.79	—	60%
Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis Auto	$4.40	$11.00	$2.03–$16.79	—	60%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS W/O MICRO	$6.00	$15.00	$2.03–$16.79	—	60%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS DIPSTICK	$14.00	$35.00	$2.03–$28.00	—	60%
Urinalysis without microscope exam, automated inpatient CPT 81003 LECH URINALYSIS DIPSTICK	$20.40	$51.00	$2.03–$40.80	—	60%
Urinalysis without microscope exam, manual CPT 81002 URINE DIPSTICK	$3.60	$9.00	$2.96–$18.64	48% below	60%
Urinalysis without microscope exam, manual CPT 81002 U/A NON AUTO W/O SCOPE	$4.40	$11.00	$2.96–$18.64	36% below	60%
Urinalysis without microscope exam, manual inpatient CPT 81002 URINE DIPSTICK	$3.60	$9.00	$2.96–$18.64	—	60%
Urinalysis without microscope exam, manual inpatient CPT 81002 U/A NON AUTO W/O SCOPE	$4.40	$11.00	$2.96–$18.64	—	60%
Urine culture for bacteria, with colony count CPT 87086 ORGANISM CC, URINE	$16.40	$41.00	$7.26–$57.83	55% below	60%
Urine culture for bacteria, with colony count CPT 87086 LECH ORGANISM CC, URINE	$24.00	$60.00	$7.26–$57.83	35% below	60%
Urine culture for bacteria, with colony count inpatient CPT 87086 ORGANISM CC, URINE	$16.40	$41.00	$7.26–$57.83	—	60%
Urine culture for bacteria, with colony count inpatient CPT 87086 LECH ORGANISM CC, URINE	$24.00	$60.00	$7.26–$57.83	—	60%
Urine microalbumin (albumin) test CPT 82043 ALBUMIN, TIMED URINE	$10.00	$25.00	$5.20–$41.05	49% below	60%
Urine microalbumin (albumin) test CPT 82043 MICROALBUMIN, URINE	$32.40	$81.00	$5.20–$64.80	66% above	60%
Urine microalbumin (albumin) test inpatient CPT 82043 ALBUMIN, TIMED URINE	$10.00	$25.00	$5.20–$41.05	—	60%
Urine microalbumin (albumin) test inpatient CPT 82043 MICROALBUMIN, URINE	$32.40	$81.00	$5.20–$64.80	—	60%
Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY	$8.80	$22.00	$7.32–$44.75	56% below	60%
Urine pregnancy test, read by color change CPT 81025 PREGNANCY, URINE	$25.60	$64.00	$7.32–$51.20	28% above	60%
Urine pregnancy test, read by color change inpatient CPT 81025 URINE PREGNANCY	$8.80	$22.00	$7.32–$44.75	—	60%
Urine pregnancy test, read by color change inpatient CPT 81025 PREGNANCY, URINE	$25.60	$64.00	$7.32–$51.20	—	60%
Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B 12	$60.40	$151.00	$13.57–$120.80	52% above	60%
Vitamin B12 (cobalamin) blood test CPT 82607 LECH VITAMIN B 12	$89.20	$223.00	$13.57–$178.40	124% above	60%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B 12	$60.40	$151.00	$13.57–$120.80	—	60%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 LECH VITAMIN B 12	$89.20	$223.00	$13.57–$178.40	—	60%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 CALCIFEDIOL (25-OH VIT. D-	$134.00	$335.00	$26.64–$268.00	74% above	60%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 LECH CALCIFEDIOL (25-OH VIT. D	$198.40	$496.00	$26.64–$396.80	158% above	60%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 CALCIFEDIOL (25-OH VIT. D-	$134.00	$335.00	$26.64–$268.00	—	60%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 LECH CALCIFEDIOL (25-OH VIT. D	$198.40	$496.00	$26.64–$396.80	—	60%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 LECH DIHYDROXYVITAMIN D 1,25	$54.40	$136.00	$34.65–$274.13	47% below	60%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 DIHYDROXYVITAMIN D 1,25	$144.00	$360.00	$34.65–$288.00	41% above	60%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 LECH DIHYDROXYVITAMIN D 1,25	$54.40	$136.00	$34.65–$274.13	—	60%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 DIHYDROXYVITAMIN D 1,25	$144.00	$360.00	$34.65–$288.00	—	60%
Zinc blood test CPT 84630 ZINC	$41.20	$103.00	$10.25–$82.40	22% above	60%
Zinc blood test inpatient CPT 84630 ZINC	$41.20	$103.00	$10.25–$82.40	—	60%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG, QUANTITATIVE	$81.20	$203.00	$13.55–$162.40	60% above	60%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCG, QUANTITATIVE	$81.20	$203.00	$13.55–$162.40	—	60%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Louisiana	Off list
Balloon dilation of the maxillary sinus opening, one side CPT 31295 NSL/SINS NDSC SURG MAX SINS	$6,534.40	$16,336.00	$535.50–$13,068.80	146% above	60%
Balloon dilation of the maxillary sinus opening, one side inpatient CPT 31295 NSL/SINS NDSC SURG MAX SINS	$6,534.40	$16,336.00	$535.50–$13,068.80	—	60%
Botox injections for chronic migraine CPT 64615 CHEMODENERV MUSC MIGRAINE	$293.60	$734.00	$218.80–$2,100.00	83% above	60%
Botox injections for chronic migraine inpatient CPT 64615 CHEMODENERV MUSC MIGRAINE	$293.60	$734.00	$218.80–$2,100.00	—	60%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 CLTX DSTL FIBULAR FX LAT MALLS	$231.60	$579.00	$233.51–$2,100.00	27% above	60%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 CLTX DSTL FIBULAR FX LAT MALLS	$231.60	$579.00	$233.51–$2,100.00	—	60%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 CL TX METATARSAL FX; WO MANIP	$231.60	$579.00	$172.59–$2,100.00	19% above	60%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 CL TX METATARSAL FX; WO MANIP	$231.60	$579.00	$172.59–$2,100.00	—	60%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION, ELECTIVE	$614.80	$1,537.00	$458.17–$1,229.60	6% above	60%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION, ELECTIVE	$614.80	$1,537.00	$458.17–$1,229.60	—	60%
Cervical biopsy CPT 57500 BIOPSY OF CERVIX	$760.40	$1,901.00	$349.65–$2,100.00	51% above	60%
Cervical biopsy inpatient CPT 57500 BIOPSY OF CERVIX	$760.40	$1,901.00	$349.65–$2,100.00	—	60%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION	$2,142.40	$5,356.00	$468.30–$4,410.57	81% above	60%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 CIRCUMCISION	$2,142.40	$5,356.00	$468.30–$4,410.57	—	60%
Circumcision, surgical, older than a newborn CPT 54160 CIRCUMCISION NEONATE <=28 DAYS	$645.60	$1,614.00	$468.30–$4,410.57	28% below	60%
Circumcision, surgical, older than a newborn inpatient CPT 54160 CIRCUMCISION NEONATE <=28 DAYS	$645.60	$1,614.00	$468.30–$4,410.57	—	60%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 CLTX DSTL RADIAL FX/EPIPHYSL S	$231.60	$579.00	$172.59–$2,100.00	7% below	60%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 CLTX DSTL RADIAL FX/EPIPHYSL S	$231.60	$579.00	$172.59–$2,100.00	—	60%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 BX/CURETT OF CERVIX W/SCOPE	$338.00	$845.00	$296.11–$2,600.00	32% above	60%
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 BX/CURETT OF CERVIX W/SCOPE	$338.00	$845.00	$296.11–$2,600.00	—	60%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOSCOPY	$626.00	$1,565.00	$349.65–$2,100.00	1% below	60%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOURETHROSCOPY	$645.60	$1,614.00	$349.65–$2,100.00	2% above	60%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 CYSTOSCOPY	$626.00	$1,565.00	$349.65–$2,100.00	—	60%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 CYSTOURETHROSCOPY	$645.60	$1,614.00	$349.65–$2,100.00	—	60%
Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 TYMPANOSTOMY GEN ANESTHESIA	$1,518.40	$3,796.00	$535.50–$3,585.62	3% above	60%
Ear tube placement (tympanostomy) under general anesthesia, one ear inpatient CPT 69436 TYMPANOSTOMY GEN ANESTHESIA	$1,518.40	$3,796.00	$535.50–$3,585.62	—	60%
Ear tube placement (tympanostomy) with local anesthesia, one ear one side CPT 69433 TYMPANOSTOMY LOCAL; UNILATERAL	$508.00	$1,270.00	$495.73–$3,200.00	2% above	60%
Ear tube placement (tympanostomy) with local anesthesia, one ear inpatient one side CPT 69433 TYMPANOSTOMY LOCAL; UNILATERAL	$508.00	$1,270.00	$495.73–$3,200.00	—	60%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVE IMPACTED EAR WAX UNIL	$63.20	$158.00	$47.09–$2,100.00	10% below	60%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 REMOVE IMPACTED EAR WAX UNIL	$63.20	$158.00	$47.09–$2,100.00	—	60%
Earwax removal with instruments, one ear CPT 69210 REMOVE IMPACTED EAR WAX UN	$62.80	$157.00	$46.80–$2,100.00	2% above	60%
Earwax removal with instruments, one ear CPT 69210 HBO - REMOVE IMPACTED EAR WAX	$66.00	$165.00	$49.18–$2,100.00	7% above	60%
Earwax removal with instruments, one ear one side CPT 69210 REM IMPACT CERUMEN INST UNILAT	$61.60	$154.00	$45.90–$2,100.00	at median	60%
Earwax removal with instruments, one ear inpatient CPT 69210 REMOVE IMPACTED EAR WAX UN	$62.80	$157.00	$46.80–$2,100.00	—	60%
Earwax removal with instruments, one ear inpatient CPT 69210 HBO - REMOVE IMPACTED EAR WAX	$66.00	$165.00	$49.18–$2,100.00	—	60%
Earwax removal with instruments, one ear inpatient one side CPT 69210 REM IMPACT CERUMEN INST UNILAT	$61.60	$154.00	$45.90–$2,100.00	—	60%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 BIOPSY OF UTERUS LINING	$204.00	$510.00	$152.03–$2,100.00	31% above	60%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 BIOPSY OF UTERUS LINING	$204.00	$510.00	$152.03–$2,100.00	—	60%
Endoscopic sinus surgery: full ethmoid sinus opening CPT 31255 NSL/SINS NDSC W/TOT ETHMDCT	$6,534.40	$16,336.00	$752.85–$13,068.80	15% below	60%
Endoscopic sinus surgery: full ethmoid sinus opening inpatient CPT 31255 NSL/SINS NDSC W/TOT ETHMDCT	$6,534.40	$16,336.00	$752.85–$13,068.80	—	60%
Endoscopic sinus surgery: opening the maxillary (cheek) sinus CPT 31256 NSL/SINS NDSC W/TOT ETHMDCT	$3,476.00	$8,690.00	$535.50–$6,952.00	6% above	60%
Endoscopic sinus surgery: opening the maxillary (cheek) sinus inpatient CPT 31256 NSL/SINS NDSC W/TOT ETHMDCT	$3,476.00	$8,690.00	$535.50–$6,952.00	—	60%
Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue CPT 31267 NASAL ENDO W MA; W REM TISS MS	$6,534.40	$16,336.00	$535.50–$13,068.80	3% below	60%
Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue inpatient CPT 31267 NASAL ENDO W MA; W REM TISS MS	$6,534.40	$16,336.00	$535.50–$13,068.80	—	60%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 INJ PARAVERT F JNT L/S 1 LEV	$1,091.60	$2,729.00	$813.51–$2,183.20	61% above	60%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 INJ PARAVERT F JNT L/S 1 LEV	$1,091.60	$2,729.00	$813.51–$2,183.20	—	60%
IUD insertion (the device itself billed separately) CPT 58300 INSERT INTRA DEV	$52.80	$132.00	$88.44–$2,100.00	68% below	60%
IUD insertion (the device itself billed separately) inpatient CPT 58300 INSERT INTRA DEV	$52.80	$132.00	$88.44–$2,100.00	—	60%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSC; SMPL OR SGL	$201.60	$504.00	$193.43–$2,100.00	at median	60%
Incision and drainage of a simple or single skin abscess CPT 10060 DRAINAGE OF SKIN ABSCESS	$202.00	$505.00	$193.43–$2,100.00	at median	60%
Incision and drainage of a simple or single skin abscess CPT 10060 I & D ABSCESS-SIMP/SING	$208.00	$520.00	$193.43–$2,100.00	3% above	60%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSC; SMPL OR SGL WCC	$240.00	$600.00	$193.43–$2,100.00	19% above	60%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D ABSC; SMPL OR SGL	$201.60	$504.00	$193.43–$2,100.00	—	60%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 DRAINAGE OF SKIN ABSCESS	$202.00	$505.00	$193.43–$2,100.00	—	60%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I & D ABSCESS-SIMP/SING	$208.00	$520.00	$193.43–$2,100.00	—	60%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D ABSC; SMPL OR SGL WCC	$240.00	$600.00	$193.43–$2,100.00	—	60%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ SGL TENDON SHTH OR LIGAME	$293.60	$734.00	$218.80–$2,100.00	35% above	60%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 inj tendon sheath	$312.00	$780.00	$232.51–$2,100.00	43% above	60%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJ SGL TENDON SHTH OR LIGAME	$293.60	$734.00	$218.80–$2,100.00	—	60%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 inj tendon sheath	$312.00	$780.00	$232.51–$2,100.00	—	60%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHROC/ASP/INJ MAJOR JOINT	$270.40	$676.00	$201.51–$2,100.00	5% above	60%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJ MAJOR JOINT/BURSA W	$293.60	$734.00	$218.80–$2,100.00	14% above	60%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 inj/aspirate major joint	$312.00	$780.00	$232.51–$2,100.00	21% above	60%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJ MJR JNT/BURSA W/OUS	$347.20	$868.00	$258.75–$2,100.00	34% above	60%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJ MAJOR JT/BURSA W/O U	$348.40	$871.00	$259.64–$2,100.00	35% above	60%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 Inj/Drain-Jt/shldr/knee/hip LT	$293.60	$734.00	—	14% above	60%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 DRAIN/MJR JT/BURSA W/O US RT M	$293.60	$734.00	—	14% above	60%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 DRAIN/MJR JNT/BURSA W/O US RT	$293.60	$734.00	—	14% above	60%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ARTHROC/ASP/INJ MAJOR JOINT	$270.40	$676.00	$201.51–$2,100.00	—	60%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRAIN/INJ MAJOR JOINT/BURSA W	$293.60	$734.00	$218.80–$2,100.00	—	60%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 inj/aspirate major joint	$312.00	$780.00	$232.51–$2,100.00	—	60%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRAIN/INJ MJR JNT/BURSA W/OUS	$347.20	$868.00	$258.75–$2,100.00	—	60%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRAIN/INJ MAJOR JT/BURSA W/O U	$348.40	$871.00	$259.64–$2,100.00	—	60%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 Inj/Drain-Jt/shldr/knee/hip LT	$293.60	$734.00	—	—	60%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 DRAIN/MJR JNT/BURSA W/O US RT	$293.60	$734.00	—	—	60%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 DRAIN/MJR JT/BURSA W/O US RT M	$293.60	$734.00	—	—	60%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 INSERT DRUG IMP DEV	$135.20	$338.00	$100.75–$2,100.00	56% above	60%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 INSERT DRUG IMP DEV	$135.20	$338.00	$100.75–$2,100.00	—	60%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHROCE/ASP/INJ INTERMED	$275.20	$688.00	$205.09–$2,100.00	11% above	60%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/INJ INTER JOINT/BURSA W/	$293.60	$734.00	$218.80–$2,100.00	18% above	60%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/INJ INTE JNT/BURSA W/OUS	$347.20	$868.00	$258.75–$2,100.00	40% above	60%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/IN INTER JOINT/BURSA W/O	$348.40	$871.00	$259.64–$2,100.00	40% above	60%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ARTHROCE/ASP/INJ INTERMED	$275.20	$688.00	$205.09–$2,100.00	—	60%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 DRAIN/INJ INTER JOINT/BURSA W/	$293.60	$734.00	$218.80–$2,100.00	—	60%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 DRAIN/INJ INTE JNT/BURSA W/OUS	$347.20	$868.00	$258.75–$2,100.00	—	60%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 DRAIN/IN INTER JOINT/BURSA W/O	$348.40	$871.00	$259.64–$2,100.00	—	60%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAIN/INJ SMALL JOINT/BURSA W/	$347.20	$868.00	$258.75–$2,100.00	34% above	60%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 DRAIN/INJ SMALL JOINT/BURSA W/	$347.20	$868.00	$258.75–$2,100.00	—	60%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 CL WND 2.5CM< SC,AX,TRK	$281.20	$703.00	$349.65–$2,100.00	13% below	60%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 REPAIR INTERMEDIATE S/A/T/E 2.	$388.40	$971.00	$349.65–$2,100.00	21% above	60%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 CL WND 2.5CM< SC,AX,TRK	$281.20	$703.00	$349.65–$2,100.00	—	60%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 REPAIR INTERMEDIATE S/A/T/E 2.	$388.40	$971.00	$349.65–$2,100.00	—	60%
Lower-back epidural injection, with imaging guidance CPT 62323 NJX INTERLAMINAR LMBR/SAC	$842.00	$2,105.00	$349.65–$2,100.00	19% above	60%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 NJX INTERLAMINAR LMBR/SAC	$842.00	$2,105.00	$349.65–$2,100.00	—	60%
Lower-back epidural injection, without imaging guidance CPT 62322 INJECT SPINE L/S (CD)	$842.00	$2,105.00	$349.65–$2,100.00	115% above	60%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 INJECT SPINE L/S (CD)	$842.00	$2,105.00	$349.65–$2,100.00	—	60%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJ FORAMEN EPIDURAL L/S	$1,091.60	$2,729.00	$813.51–$2,183.20	104% above	60%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 INJ FORAMEN EPIDURAL L/S	$1,091.60	$2,729.00	$813.51–$2,183.20	—	60%
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<	$698.80	$1,747.00	$349.65–$2,100.00	85% above	60%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC TR-EXT B9+MARG 0.5CM/<	$828.00	$2,070.00	$349.65–$2,100.00	119% above	60%
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<	$698.80	$1,747.00	$349.65–$2,100.00	—	60%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXC TR-EXT B9+MARG 0.5CM/<	$828.00	$2,070.00	$349.65–$2,100.00	—	60%
Nail removal (partial or complete), one nail CPT 11730 AVULSION NAIL PLATE, ONE	$120.80	$302.00	$90.02–$2,100.00	15% below	60%
Nail removal (partial or complete), one nail CPT 11730 REMOVAL OF NAIL PLATE	$202.00	$505.00	$150.54–$2,100.00	43% above	60%
Nail removal (partial or complete), one nail CPT 11730 SPL AVULSE NP; SGL - WCC	$239.20	$598.00	$178.26–$2,100.00	69% above	60%
Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSION NAIL PLATE, ONE	$120.80	$302.00	$90.02–$2,100.00	—	60%
Nail removal (partial or complete), one nail inpatient CPT 11730 REMOVAL OF NAIL PLATE	$202.00	$505.00	$150.54–$2,100.00	—	60%
Nail removal (partial or complete), one nail inpatient CPT 11730 SPL AVULSE NP; SGL - WCC	$239.20	$598.00	$178.26–$2,100.00	—	60%
Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS W/IMAGING	$758.00	$1,895.00	$564.89–$2,600.00	42% above	60%
Paracentesis with imaging guidance inpatient CPT 49083 ABD PARACENTESIS W/IMAGING	$758.00	$1,895.00	$564.89–$2,600.00	—	60%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXC OF NAIL, PERMANENT	$156.00	$390.00	$261.30–$2,100.00	61% below	60%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 REMOVAL OF NAIL BED	$388.40	$971.00	$349.65–$2,100.00	3% below	60%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 REMOVAL OF NAIL BED - WCC	$460.40	$1,151.00	$349.65–$2,100.00	15% above	60%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXC OF NAIL, PERMANENT	$156.00	$390.00	$261.30–$2,100.00	—	60%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 REMOVAL OF NAIL BED	$388.40	$971.00	$349.65–$2,100.00	—	60%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 REMOVAL OF NAIL BED - WCC	$460.40	$1,151.00	$349.65–$2,100.00	—	60%
Prostate biopsy CPT 55700 PROSTATE NEEDLE PUNCH BX	$2,009.20	$5,023.00	$468.30–$4,018.40	164% above	60%
Prostate biopsy inpatient CPT 55700 PROSTATE NEEDLE PUNCH BX	$2,009.20	$5,023.00	$468.30–$4,018.40	—	60%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 DESTROY LUMB/SAC FACET JNT	$2,327.60	$5,819.00	$1,734.64–$4,655.20	129% above	60%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 DESTROY LUMB/SAC FACET JNT	$2,327.60	$5,819.00	$1,734.64–$4,655.20	—	60%
Removal of a foreign object under the skin, simple CPT 10120 INC & REM FB, SUBQ TISS. SIMP	$376.80	$942.00	$349.65–$2,100.00	49% above	60%
Removal of a foreign object under the skin, simple CPT 10120 Remove Foreign Body	$409.60	$1,024.00	$349.65–$2,100.00	62% above	60%
Removal of a foreign object under the skin, simple CPT 10120 I&R FOREIGN BDY SUB TISS SMPL	$460.40	$1,151.00	$349.65–$2,100.00	82% above	60%
Removal of a foreign object under the skin, simple inpatient CPT 10120 INC & REM FB, SUBQ TISS. SIMP	$376.80	$942.00	$349.65–$2,100.00	—	60%
Removal of a foreign object under the skin, simple inpatient CPT 10120 Remove Foreign Body	$409.60	$1,024.00	$349.65–$2,100.00	—	60%
Removal of a foreign object under the skin, simple inpatient CPT 10120 I&R FOREIGN BDY SUB TISS SMPL	$460.40	$1,151.00	$349.65–$2,100.00	—	60%
Removal of one lobe of the thyroid (lobectomy) one side CPT 60220 TOTAL THYROID LOBECTOMY UNILAT	$5,678.00	$14,195.00	$661.50–$11,356.00	3% above	60%
Removal of one lobe of the thyroid (lobectomy) inpatient one side CPT 60220 TOTAL THYROID LOBECTOMY UNILAT	$5,678.00	$14,195.00	$661.50–$11,356.00	—	60%
Short arm cast (elbow to hand) CPT 29075 Application Cast Elbow Finger	$271.20	$678.00	$202.11–$542.40	56% above	60%
Short arm cast (elbow to hand) inpatient CPT 29075 Application Cast Elbow Finger	$271.20	$678.00	$202.11–$542.40	—	60%
Short arm splint (forearm and hand) CPT 29125 APP SHORT ARM SPLINT	$111.60	$279.00	$83.16–$341.77	9% below	60%
Short arm splint (forearm and hand) CPT 29125 Application Short Arm Splint F	$126.80	$317.00	$94.49–$341.77	3% above	60%
Short arm splint (forearm and hand) inpatient CPT 29125 APP SHORT ARM SPLINT	$111.60	$279.00	$83.16–$341.77	—	60%
Short arm splint (forearm and hand) inpatient CPT 29125 Application Short Arm Splint F	$126.80	$317.00	$94.49–$341.77	—	60%
Short leg cast (below the knee) CPT 29405 APP SHORT LEG CAST	$213.20	$533.00	$158.88–$426.40	2% above	60%
Short leg cast (below the knee) CPT 29405 Application Short Leg Cast Bel	$271.20	$678.00	$202.11–$542.40	30% above	60%
Short leg cast (below the knee) CPT 29405 APP SHORT LEG CAST WCC	$321.20	$803.00	$239.37–$642.40	54% above	60%
Short leg cast (below the knee) inpatient CPT 29405 APP SHORT LEG CAST	$213.20	$533.00	$158.88–$426.40	—	60%
Short leg cast (below the knee) inpatient CPT 29405 Application Short Leg Cast Bel	$271.20	$678.00	$202.11–$542.40	—	60%
Short leg cast (below the knee) inpatient CPT 29405 APP SHORT LEG CAST WCC	$321.20	$803.00	$239.37–$642.40	—	60%
Short leg splint (calf to foot) CPT 29515 APPLI SHORT LEG SPLINT	$138.40	$346.00	$103.14–$446.96	10% below	60%
Short leg splint (calf to foot) CPT 29515 Application Short Leg Splint C	$159.20	$398.00	$118.64–$446.96	4% above	60%
Short leg splint (calf to foot) inpatient CPT 29515 APPLI SHORT LEG SPLINT	$138.40	$346.00	$103.14–$446.96	—	60%
Short leg splint (calf to foot) inpatient CPT 29515 Application Short Leg Splint C	$159.20	$398.00	$118.64–$446.96	—	60%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 S REP S/N/A/G/TR/E; 2.5CM/<	$196.40	$491.00	$193.43–$2,100.00	at median	60%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 SREP S/N/A/G/TR/E; 2.5CM/<	$201.60	$504.00	$193.43–$2,100.00	3% above	60%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 S REP S/N/A/G/TR/E; 2.5CM/<	$196.40	$491.00	$193.43–$2,100.00	—	60%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 SREP S/N/A/G/TR/E; 2.5CM/<	$201.60	$504.00	$193.43–$2,100.00	—	60%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BX SKIN SINGLE LESION	$388.40	$971.00	$289.45–$2,100.00	45% above	60%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BX SKIN SINGLE LES	$460.40	$1,151.00	$343.11–$2,100.00	71% above	60%
Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BX SKIN SINGLE LESION	$388.40	$971.00	$289.45–$2,100.00	—	60%
Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BX SKIN SINGLE LES	$460.40	$1,151.00	$343.11–$2,100.00	—	60%
Skin tag removal, up to 15 tags CPT 11200 REMOVAL OF SKIN TAGS <W/15	$215.20	$538.00	$160.37–$2,100.00	63% above	60%
Skin tag removal, up to 15 tags inpatient CPT 11200 REMOVAL OF SKIN TAGS <W/15	$215.20	$538.00	$160.37–$2,100.00	—	60%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL PUNCT. LUMBAR, DX	$703.20	$1,758.00	$349.65–$2,100.00	63% above	60%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL PUNCT LUMBAR DX	$754.00	$1,885.00	$349.65–$2,100.00	74% above	60%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL PUNCT, LUMBAR, DX	$785.60	$1,964.00	$349.65–$2,100.00	82% above	60%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL PUNCT. LUMBAR, DX	$703.20	$1,758.00	$349.65–$2,100.00	—	60%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL PUNCT LUMBAR DX	$754.00	$1,885.00	$349.65–$2,100.00	—	60%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL PUNCT, LUMBAR, DX	$785.60	$1,964.00	$349.65–$2,100.00	—	60%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 SIMP REP WND 2.6-7.5CM,SC	$196.40	$491.00	$193.43–$3,200.00	5% above	60%
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	$267.20	$668.00	$193.43–$3,200.00	43% above	60%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 SIMP REP WND 2.6-7.5CM,SC	$196.40	$491.00	$193.43–$3,200.00	—	60%
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	$267.20	$668.00	$193.43–$3,200.00	—	60%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 REP WND 2.5CM<, FACE,EAR E	$196.40	$491.00	$193.43–$3,200.00	7% above	60%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 SREP F/E/N/L/MM; 2.5 CM/<	$240.00	$600.00	$193.43–$3,200.00	31% above	60%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 REP WND 2.5CM<, FACE,EAR E	$196.40	$491.00	$193.43–$3,200.00	—	60%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 SREP F/E/N/L/MM; 2.5 CM/<	$240.00	$600.00	$193.43–$3,200.00	—	60%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGNTL BS SKIN SINGLE LES	$283.20	$708.00	$193.43–$2,100.00	65% above	60%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 TANGNTL BS SKIN SINGLE LES	$283.20	$708.00	$193.43–$2,100.00	—	60%
Thoracentesis with imaging guidance CPT 32555 ASPIRATE PLEURA W/IMAGING	$614.80	$1,537.00	$349.65–$2,100.00	4% below	60%
Thoracentesis with imaging guidance CPT 32555 THORACENTESIS W/IMG	$673.60	$1,684.00	$349.65–$2,100.00	5% above	60%
Thoracentesis with imaging guidance CPT 32555 ASPIRATE PLEURA W/ IMAGING	$686.80	$1,717.00	$349.65–$2,100.00	7% above	60%
Thoracentesis with imaging guidance inpatient CPT 32555 ASPIRATE PLEURA W/IMAGING	$614.80	$1,537.00	$349.65–$2,100.00	—	60%
Thoracentesis with imaging guidance inpatient CPT 32555 THORACENTESIS W/IMG	$673.60	$1,684.00	$349.65–$2,100.00	—	60%
Thoracentesis with imaging guidance inpatient CPT 32555 ASPIRATE PLEURA W/ IMAGING	$686.80	$1,717.00	$349.65–$2,100.00	—	60%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ,SING/MULT TRIG PTS 1or2 MU	$155.20	$388.00	$115.66–$2,100.00	6% above	60%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINT 1/2 MUSCL	$293.60	$734.00	$218.80–$2,100.00	100% above	60%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ,SING/MULT TRIG PTS 1or2 MU	$155.20	$388.00	$115.66–$2,100.00	—	60%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ TRIGGER POINT 1/2 MUSCL	$293.60	$734.00	$218.80–$2,100.00	—	60%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 U/S VACUUM ASSISTED BIOPSY	$1,574.40	$3,936.00	$468.30–$3,148.80	67% above	60%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 U/S VACUUM ASSISTED BIOPSY	$1,574.40	$3,936.00	$468.30–$3,148.80	—	60%
Wart removal, up to 14 warts CPT 17110 DESTRUCT B9 LESION 1-14	$264.40	$661.00	$193.43–$2,100.00	96% above	60%
Wart removal, up to 14 warts inpatient CPT 17110 DESTRUCT B9 LESION 1-14	$264.40	$661.00	$193.43–$2,100.00	—	60%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEB SUBQ TISSUE 20 SQ CM/<	$388.40	$971.00	$388.92–$2,600.00	1% below	60%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRID SKIN, SUB Q TISSUE	$416.00	$1,040.00	$388.92–$2,600.00	6% above	60%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEB SUBQ TISSUE 20 SQ CM/< WCC	$508.00	$1,270.00	$388.92–$2,600.00	30% above	60%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEB SUBQ TISSUE 20 SQ CM/<	$388.40	$971.00	$388.92–$2,600.00	—	60%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRID SKIN, SUB Q TISSUE	$416.00	$1,040.00	$388.92–$2,600.00	—	60%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEB SUBQ TISSUE 20 SQ CM/< WCC	$508.00	$1,270.00	$388.92–$2,600.00	—	60%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Louisiana	Off list
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSFUSION SERVICE	$472.80	$1,182.00	$352.35–$2,100.00	1% below	60%
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION BLOOD/COMPONE	$485.60	$1,214.00	$361.89–$2,100.00	2% above	60%
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION SERVICE	$494.00	$1,235.00	$368.15–$2,100.00	4% above	60%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD TRANSFUSION SERVICE	$472.80	$1,182.00	$352.35–$2,100.00	—	60%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSION BLOOD/COMPONE	$485.60	$1,214.00	$361.89–$2,100.00	—	60%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSION SERVICE	$494.00	$1,235.00	$368.15–$2,100.00	—	60%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 LECH AIRWAY INHALATION TREATME	$28.00	$70.00	$20.86–$197.99	66% below	60%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 LECH INITIAL NEBULIZER TX DAY	$148.00	$370.00	$61.56–$296.00	79% above	60%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 LECH INITIAL INC EXERCISE P D	$148.00	$370.00	$61.56–$296.00	79% above	60%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 IPPB TREATMENT INITIAL	$226.80	$567.00	$61.56–$453.60	174% above	60%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 INITIAL INC EXERCISE PER DAY	$230.80	$577.00	$61.56–$461.60	179% above	60%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 INITIAL NEBULIZER TX PER DAY	$230.80	$577.00	$61.56–$461.60	179% above	60%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 LECH AIRWAY INHALATION TREATME	$28.00	$70.00	$20.86–$197.99	—	60%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 LECH INITIAL INC EXERCISE P D	$148.00	$370.00	$61.56–$296.00	—	60%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 LECH INITIAL NEBULIZER TX DAY	$148.00	$370.00	$61.56–$296.00	—	60%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 IPPB TREATMENT INITIAL	$226.80	$567.00	$61.56–$453.60	—	60%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 INITIAL INC EXERCISE PER DAY	$230.80	$577.00	$61.56–$461.60	—	60%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 INITIAL NEBULIZER TX PER DAY	$230.80	$577.00	$61.56–$461.60	—	60%
Chemotherapy IV infusion, first hour CPT 96413 CHEMO IV INFUSION 1 HR	$367.20	$918.00	$273.65–$734.40	29% above	60%
Chemotherapy IV infusion, first hour CPT 96413 CHEMO IV INFUSION 1HR	$380.40	$951.00	$283.49–$760.80	33% above	60%
Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO IV INFUSION 1 HR	$367.20	$918.00	$273.65–$734.40	—	60%
Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO IV INFUSION 1HR	$380.40	$951.00	$283.49–$760.80	—	60%
Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 Compre Audiometry Threshold Ev	$157.20	$393.00	$117.15–$314.40	55% above	60%
Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 Compre Audiometry Threshold Ev	$157.20	$393.00	$117.15–$314.40	—	60%
EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG	$313.20	$783.00	$233.41–$626.40	2% above	60%
EEG (brain wave test), awake and drowsy, routine CPT 95816 LECH EEG	$465.20	$1,163.00	$303.13–$930.40	52% above	60%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 EEG	$313.20	$783.00	$233.41–$626.40	—	60%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 LECH EEG	$465.20	$1,163.00	$303.13–$930.40	—	60%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 12 LEAD EKG GLOBAL	$15.60	$39.00	$11.62–$146.23	62% below	60%
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 12 LEAD EKG GLOBAL	$15.60	$39.00	$11.62–$146.23	—	60%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 12 LEAD EKG - TRACING ONLY	$28.40	$71.00	$21.16–$117.00	63% below	60%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 12 LEAD EKG TRACE	$29.20	$73.00	$21.76–$117.00	62% below	60%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG	$72.00	$180.00	$32.55–$144.00	5% below	60%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 LECH EKG	$104.00	$260.00	$32.55–$208.00	37% above	60%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 12 LEAD EKG - TRACING ONLY	$28.40	$71.00	$21.16–$117.00	—	60%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 12 LEAD EKG TRACE	$29.20	$73.00	$21.76–$117.00	—	60%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG	$72.00	$180.00	$32.55–$144.00	—	60%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 LECH EKG	$104.00	$260.00	$32.55–$208.00	—	60%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER TRIAGE FEE	$30.00	$75.00	$22.35–$750.00	76% below	60%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER NURSING FEE LEVEL 1	$84.80	$212.00	$63.19–$750.00	31% below	60%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ER TRIAGE FEE	$30.00	$75.00	$22.35–$750.00	—	60%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ER NURSING FEE LEVEL 1	$84.80	$212.00	$63.19–$750.00	—	60%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ER NURSING FEE LEVEL 2	$170.80	$427.00	$127.28–$750.00	4% above	60%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ER NURSING FEE LEVEL 2	$170.80	$427.00	$127.28–$750.00	—	60%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ER NURSING FEE LEVEL 3	$298.00	$745.00	$222.08–$980.00	13% above	60%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ER NURSING FEE LEVEL 3	$298.00	$745.00	$222.08–$980.00	—	60%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ER NURSING FEE LEVEL 4	$462.00	$1,155.00	$344.30–$1,395.00	10% above	60%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ER NURSING FEE LEVEL 4	$462.00	$1,155.00	$344.30–$1,395.00	—	60%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ER NURSING FEE LEVEL 5	$576.40	$1,441.00	$429.56–$1,925.00	10% above	60%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ER NURSING FEE LEVEL 5	$576.40	$1,441.00	$429.56–$1,925.00	—	60%
Exercise stress test, tracing only, the hospital charge CPT 93017 STRESS ANALYSIS	$335.20	$838.00	$127.16–$670.40	1% below	60%
Exercise stress test, tracing only, the hospital charge CPT 93017 CARDIOVASCULAR STRESS TEST	$365.20	$913.00	$127.16–$730.40	8% above	60%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 STRESS ANALYSIS	$335.20	$838.00	$127.16–$670.40	—	60%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CARDIOVASCULAR STRESS TEST	$365.20	$913.00	$127.16–$730.40	—	60%
Family therapy with the patient, 50 minutes CPT 90847 FAMILY PSYCHOTHERAPY PER HOUR	$64.00	$160.00	$47.69–$156.40	43% below	60%
Family therapy with the patient, 50 minutes CPT 90847 FAMILY PSYCHOTHERAPY W/PT	$153.20	$383.00	$97.70–$306.40	36% above	60%
Family therapy with the patient, 50 minutes CPT 90847 FAMILY PSYTX W/PT 50 MIN	$153.20	$383.00	$97.70–$306.40	36% above	60%
Family therapy with the patient, 50 minutes inpatient CPT 90847 FAMILY PSYCHOTHERAPY PER HOUR	$64.00	$160.00	$47.69–$156.40	—	60%
Family therapy with the patient, 50 minutes inpatient CPT 90847 FAMILY PSYCHOTHERAPY W/PT	$153.20	$383.00	$97.70–$306.40	—	60%
Family therapy with the patient, 50 minutes inpatient CPT 90847 FAMILY PSYTX W/PT 50 MIN	$153.20	$383.00	$97.70–$306.40	—	60%
Family therapy without the patient, 50 minutes CPT 90846 FAMILY PSYTX W/O PT 50 MIN	$153.20	$383.00	$93.75–$306.40	19% above	60%
Family therapy without the patient, 50 minutes CPT 90846 FAMILY PSYCHOTHERAPY W/O PT	$153.20	$383.00	$93.75–$306.40	19% above	60%
Family therapy without the patient, 50 minutes inpatient CPT 90846 FAMILY PSYTX W/O PT 50 MIN	$153.20	$383.00	$93.75–$306.40	—	60%
Family therapy without the patient, 50 minutes inpatient CPT 90846 FAMILY PSYCHOTHERAPY W/O PT	$153.20	$383.00	$93.75–$306.40	—	60%
Group psychotherapy session CPT 90853 GROUP PSYCHOTHERAPY	$97.60	$244.00	$25.93–$241.28	2% above	60%
Group psychotherapy session inpatient CPT 90853 GROUP PSYCHOTHERAPY	$97.60	$244.00	$25.93–$241.28	—	60%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRATION IV INFUSION INIT	$244.40	$611.00	$99.00–$488.80	71% above	60%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRATION IV INFUSION, INIT	$245.20	$613.00	$182.73–$490.40	72% above	60%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HYDRATION IV INFUSION INIT	$244.40	$611.00	$99.00–$488.80	—	60%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HYDRATION IV INFUSION, INIT	$245.20	$613.00	$182.73–$490.40	—	60%
IV infusion of a medicine, first hour CPT 96365 THER/PROPH/DIAG IV INF, INIT	$245.20	$613.00	$144.31–$490.40	30% above	60%
IV infusion of a medicine, first hour CPT 96365 THER/PROPH/DIAG IV INF INIT	$275.20	$688.00	$144.31–$550.40	45% above	60%
IV infusion of a medicine, first hour inpatient CPT 96365 THER/PROPH/DIAG IV INF, INIT	$245.20	$613.00	$144.31–$490.40	—	60%
IV infusion of a medicine, first hour inpatient CPT 96365 THER/PROPH/DIAG IV INF INIT	$275.20	$688.00	$144.31–$550.40	—	60%
IV push of a medicine, first drug CPT 96374 THER/PROPH/DIAG INJ IV PUSH	$230.00	$575.00	$144.31–$460.00	136% above	60%
IV push of a medicine, first drug CPT 96374 THERAPEUT/DX INJ. INTRAVE	$230.80	$577.00	$99.00–$461.60	137% above	60%
IV push of a medicine, first drug CPT 96374 INJECTION THERAPEUTIC/DX	$253.20	$633.00	$144.31–$506.40	160% above	60%
IV push of a medicine, first drug CPT 96374 THER/PROPH/DIAG INJ IA	$275.20	$688.00	$144.31–$550.40	182% above	60%
IV push of a medicine, first drug inpatient CPT 96374 THER/PROPH/DIAG INJ IV PUSH	$230.00	$575.00	$144.31–$460.00	—	60%
IV push of a medicine, first drug inpatient CPT 96374 THERAPEUT/DX INJ. INTRAVE	$230.80	$577.00	$99.00–$461.60	—	60%
IV push of a medicine, first drug inpatient CPT 96374 INJECTION THERAPEUTIC/DX	$253.20	$633.00	$144.31–$506.40	—	60%
IV push of a medicine, first drug inpatient CPT 96374 THER/PROPH/DIAG INJ IA	$275.20	$688.00	$144.31–$550.40	—	60%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION, SQ/IM	$61.20	$153.00	$45.60–$122.40	16% above	60%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Therapeutic Prophylactic/Dx In	$70.00	$175.00	$52.16–$140.00	32% above	60%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 DX INJECT IM	$74.40	$186.00	$55.44–$148.80	41% above	60%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION SQ/IM	$76.40	$191.00	$56.93–$152.80	44% above	60%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 therapeutic prophylactic dx in	$78.00	$195.00	$58.12–$156.00	47% above	60%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DIAG INJ SC/IM	$82.80	$207.00	$61.70–$165.60	56% above	60%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HBO-THER/PROPH/DIAG INJ SC/IM	$87.60	$219.00	$65.28–$175.20	65% above	60%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJECTION, SQ/IM	$61.20	$153.00	$45.60–$122.40	—	60%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Therapeutic Prophylactic/Dx In	$70.00	$175.00	$52.16–$140.00	—	60%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 DX INJECT IM	$74.40	$186.00	$55.44–$148.80	—	60%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJECTION SQ/IM	$76.40	$191.00	$56.93–$152.80	—	60%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 therapeutic prophylactic dx in	$78.00	$195.00	$58.12–$156.00	—	60%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THER/PROPH/DIAG INJ SC/IM	$82.80	$207.00	$61.70–$165.60	—	60%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HBO-THER/PROPH/DIAG INJ SC/IM	$87.60	$219.00	$65.28–$175.20	—	60%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 PSYCHOSOCIAL ASSESSMENT	$153.20	$383.00	$114.17–$306.40	41% above	60%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 PSYCH DIAGNOSTIC EVALUATION	$153.20	$383.00	$114.17–$306.40	41% above	60%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 NURSING ASSESSMENT	$153.20	$383.00	$114.17–$306.40	41% above	60%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 AT ASSESSMENT	$153.20	$383.00	$114.17–$306.40	41% above	60%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 NURSING ASSESSMENT	$153.20	$383.00	$114.17–$306.40	—	60%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 AT ASSESSMENT	$153.20	$383.00	$114.17–$306.40	—	60%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 PSYCH DIAGNOSTIC EVALUATION	$153.20	$383.00	$114.17–$306.40	—	60%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 PSYCHOSOCIAL ASSESSMENT	$153.20	$383.00	$114.17–$306.40	—	60%
Neuromuscular re-education, 15 minutes CPT 97112 LECH PT NEUROMUSC RE ED EA 15	$56.40	$141.00	$42.03–$141.00	46% above	60%
Neuromuscular re-education, 15 minutes CPT 97112 LECH OT NEUROMUSC RE ED EA 15	$58.00	$145.00	$43.22–$145.00	50% above	60%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 LECH PT NEUROMUSC RE ED EA 15	$56.40	$141.00	$42.03–$141.00	—	60%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 LECH OT NEUROMUSC RE ED EA 15	$58.00	$145.00	$43.22–$145.00	—	60%
New patient office visit, about 30 minutes CPT 99203 OFFICE VISIT NEW LEVEL 3	$46.80	$117.00	$34.87–$181.83	36% below	60%
New patient office visit, about 30 minutes CPT 99203 Office Outpatient New 30 Minut	$115.20	$288.00	$85.85–$288.00	58% above	60%
New patient office visit, about 30 minutes CPT 99203 OFFICE O/P NEW LOW 30-44 MIN	$126.80	$317.00	$94.49–$317.00	74% above	60%
New patient office visit, about 30 minutes CPT 99203 level 3 new patient office vis	$135.20	$338.00	$100.75–$338.00	85% above	60%
New patient office visit, about 30 minutes CPT 99203 OFFICE VISIT/NEW/LVL 3	$148.80	$372.00	$110.89–$372.00	104% above	60%
New patient office visit, about 30 minutes CPT 99203 NEW PATIENT - LEVEL 3 WCC	$190.80	$477.00	$142.19–$477.00	161% above	60%
New patient office visit, about 30 minutes CPT 99203 NEW PATIENT LEVEL 3	$210.40	$526.00	$156.80–$526.00	188% above	60%
New patient office visit, about 30 minutes CPT 99203 OFFICE O/P NEW LOW 30-44MIN	$220.40	$551.00	$164.25–$551.00	202% above	60%
New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE VISIT NEW LEVEL 3	$46.80	$117.00	$34.87–$181.83	—	60%
New patient office visit, about 30 minutes inpatient CPT 99203 Office Outpatient New 30 Minut	$115.20	$288.00	$85.85–$288.00	—	60%
New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE O/P NEW LOW 30-44 MIN	$126.80	$317.00	$94.49–$317.00	—	60%
New patient office visit, about 30 minutes inpatient CPT 99203 level 3 new patient office vis	$135.20	$338.00	$100.75–$338.00	—	60%
New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE VISIT/NEW/LVL 3	$148.80	$372.00	$110.89–$372.00	—	60%
New patient office visit, about 30 minutes inpatient CPT 99203 NEW PATIENT - LEVEL 3 WCC	$190.80	$477.00	$142.19–$477.00	—	60%
New patient office visit, about 30 minutes inpatient CPT 99203 NEW PATIENT LEVEL 3	$210.40	$526.00	$156.80–$526.00	—	60%
New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE O/P NEW LOW 30-44MIN	$220.40	$551.00	$164.25–$551.00	—	60%
New patient office visit, about 45 minutes CPT 99204 OFFICE VISIT NEW LEVEL 4	$74.00	$185.00	$55.14–$264.56	19% below	60%
New patient office visit, about 45 minutes CPT 99204 OFFICE VISIT/NEW/LVL 4	$162.00	$405.00	$120.73–$405.00	78% above	60%
New patient office visit, about 45 minutes CPT 99204 Office Outpatient New 45 Minut	$166.40	$416.00	$124.00–$416.00	82% above	60%
New patient office visit, about 45 minutes CPT 99204 OFFICE O/P NEW MOD 45-59 MIN	$180.80	$452.00	$134.74–$452.00	98% above	60%
New patient office visit, about 45 minutes CPT 99204 level 4 new patient office vis	$204.00	$510.00	$152.03–$510.00	124% above	60%
New patient office visit, about 45 minutes CPT 99204 NEW PATIENT - LEVEL 4 WCC	$252.00	$630.00	$187.80–$630.00	176% above	60%
New patient office visit, about 45 minutes CPT 99204 NEW PATIENT LEVEL 4	$306.00	$765.00	$228.04–$765.00	235% above	60%
New patient office visit, about 45 minutes CPT 99204 OFFICE O/P NEW MOD 45-49MIN	$320.40	$801.00	$238.77–$801.00	251% above	60%
New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE VISIT NEW LEVEL 4	$74.00	$185.00	$55.14–$264.56	—	60%
New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE VISIT/NEW/LVL 4	$162.00	$405.00	$120.73–$405.00	—	60%
New patient office visit, about 45 minutes inpatient CPT 99204 Office Outpatient New 45 Minut	$166.40	$416.00	$124.00–$416.00	—	60%
New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE O/P NEW MOD 45-59 MIN	$180.80	$452.00	$134.74–$452.00	—	60%
New patient office visit, about 45 minutes inpatient CPT 99204 level 4 new patient office vis	$204.00	$510.00	$152.03–$510.00	—	60%
New patient office visit, about 45 minutes inpatient CPT 99204 NEW PATIENT - LEVEL 4 WCC	$252.00	$630.00	$187.80–$630.00	—	60%
New patient office visit, about 45 minutes inpatient CPT 99204 NEW PATIENT LEVEL 4	$306.00	$765.00	$228.04–$765.00	—	60%
New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE O/P NEW MOD 45-49MIN	$320.40	$801.00	$238.77–$801.00	—	60%
New patient office visit, about 60 minutes CPT 99205 OFFICE VISIT NEW LEVEL 5	$90.80	$227.00	$67.66–$264.56	16% below	60%
New patient office visit, about 60 minutes CPT 99205 Office Outpatient New 60 Minut	$166.40	$416.00	$124.00–$416.00	53% above	60%
New patient office visit, about 60 minutes CPT 99205 OFFICE VISIT/NEW/LVL 5	$175.60	$439.00	$130.86–$439.00	62% above	60%
New patient office visit, about 60 minutes CPT 99205 level 5 new patient office vis	$266.40	$666.00	$198.53–$666.00	146% above	60%
New patient office visit, about 60 minutes CPT 99205 NEW PATIENT LEVEL 5	$306.00	$765.00	$228.04–$765.00	182% above	60%
New patient office visit, about 60 minutes CPT 99205 OFFICE O/P NEW HI 60-74 MIN	$320.40	$801.00	$238.77–$801.00	195% above	60%
New patient office visit, about 60 minutes CPT 99205 NEW PATIENT - LEVEL 5 WCC	$345.20	$863.00	$257.26–$863.00	218% above	60%
New patient office visit, about 60 minutes inpatient CPT 99205 OFFICE VISIT NEW LEVEL 5	$90.80	$227.00	$67.66–$264.56	—	60%
New patient office visit, about 60 minutes inpatient CPT 99205 Office Outpatient New 60 Minut	$166.40	$416.00	$124.00–$416.00	—	60%
New patient office visit, about 60 minutes inpatient CPT 99205 OFFICE VISIT/NEW/LVL 5	$175.60	$439.00	$130.86–$439.00	—	60%
New patient office visit, about 60 minutes inpatient CPT 99205 level 5 new patient office vis	$266.40	$666.00	$198.53–$666.00	—	60%
New patient office visit, about 60 minutes inpatient CPT 99205 NEW PATIENT LEVEL 5	$306.00	$765.00	$228.04–$765.00	—	60%
New patient office visit, about 60 minutes inpatient CPT 99205 OFFICE O/P NEW HI 60-74 MIN	$320.40	$801.00	$238.77–$801.00	—	60%
New patient office visit, about 60 minutes inpatient CPT 99205 NEW PATIENT - LEVEL 5 WCC	$345.20	$863.00	$257.26–$863.00	—	60%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 OFFICE OP NEW LOW 10-29 MIN	$34.00	$85.00	$25.33–$158.04	43% below	60%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 Level 2 new patient office vis	$87.60	$219.00	$65.28–$175.20	47% above	60%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 Office Outpatient New 10 Minut	$99.20	$248.00	$67.96–$198.40	67% above	60%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 Office Outpatient New 20 Minut	$99.20	$248.00	$67.96–$198.40	67% above	60%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW PATIENT - LEVEL 1 WCC	$112.00	$280.00	$67.96–$224.00	88% above	60%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW PATIENT - LEVEL 2 WCC	$164.80	$412.00	$67.96–$329.60	177% above	60%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW PATIENT LEVEL 2	$183.20	$458.00	$67.96–$366.40	208% above	60%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 OFFICE O/P NEW SF 15-29MIN	$191.20	$478.00	$67.96–$382.40	222% above	60%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 OFFICE OP NEW LOW 10-29 MIN	$34.00	$85.00	$25.33–$158.04	—	60%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 Level 2 new patient office vis	$87.60	$219.00	$65.28–$175.20	—	60%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 Office Outpatient New 10 Minut	$99.20	$248.00	$67.96–$198.40	—	60%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 Office Outpatient New 20 Minut	$99.20	$248.00	$67.96–$198.40	—	60%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 NEW PATIENT - LEVEL 1 WCC	$112.00	$280.00	$67.96–$224.00	—	60%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 NEW PATIENT - LEVEL 2 WCC	$164.80	$412.00	$67.96–$329.60	—	60%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 NEW PATIENT LEVEL 2	$183.20	$458.00	$67.96–$366.40	—	60%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 OFFICE O/P NEW SF 15-29MIN	$191.20	$478.00	$67.96–$382.40	—	60%
Occupational therapy evaluation, low complexity CPT 97165 LECH OT EVAL LOW COMPLEX 30 MI	$84.00	$210.00	$62.60–$344.02	26% below	60%
Occupational therapy evaluation, low complexity CPT 97165 OT EVAL LOW COMPLEX 30 MIN	$111.60	$279.00	$83.16–$344.02	2% below	60%
Occupational therapy evaluation, low complexity inpatient CPT 97165 LECH OT EVAL LOW COMPLEX 30 MI	$84.00	$210.00	$62.60–$344.02	—	60%
Occupational therapy evaluation, low complexity inpatient CPT 97165 OT EVAL LOW COMPLEX 30 MIN	$111.60	$279.00	$83.16–$344.02	—	60%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 LECH PT EVAL HIGH COMPLEX 45 M	$108.00	$270.00	$80.48–$325.36	15% below	60%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 LECH PT EVAL HIGH COMPLEX 45 M	$108.00	$270.00	$80.48–$325.36	—	60%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 LECH PT EVAL MOD COMPLEX 30 MI	$96.00	$240.00	$71.54–$325.36	21% below	60%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 LECH PT EVAL MOD COMPLEX 30 MI	$96.00	$240.00	$71.54–$325.36	—	60%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 LECH PT MANUAL THERAPY EA 15 M	$49.60	$124.00	$36.96–$124.00	28% above	60%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 LECH OT MANUAL THERAPY EA 15 M	$49.60	$124.00	$36.96–$124.00	28% above	60%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 LECH OT MANUAL THERAPY EA 15 M	$49.60	$124.00	$36.96–$124.00	—	60%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 LECH PT MANUAL THERAPY EA 15 M	$49.60	$124.00	$36.96–$124.00	—	60%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 LECH OT THERAPEUTIC EXER EA 15	$60.00	$150.00	$44.71–$150.00	58% above	60%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 LECH PT THERAPEUTIC EXER EA 15	$60.00	$150.00	$44.71–$150.00	58% above	60%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 LECH PT THERAPEUTIC EXER EA 15	$60.00	$150.00	$44.71–$150.00	—	60%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 LECH OT THERAPEUTIC EXER EA 15	$60.00	$150.00	$44.71–$150.00	—	60%
Preventive checkup, new patient aged 18–39 CPT 99385 Initial Preventive Medicine Ne	$130.80	$327.00	$97.47–$261.60	13% below	60%
Preventive checkup, new patient aged 18–39 CPT 99385 PREV VISIT NEW AGE 18-39	$137.20	$343.00	$102.24–$274.40	8% below	60%
Preventive checkup, new patient aged 18–39 CPT 99385 Int Preventive Med New Pat 18-	$137.20	$343.00	$102.24–$274.40	8% below	60%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 Initial Preventive Medicine Ne	$130.80	$327.00	$97.47–$261.60	—	60%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 Int Preventive Med New Pat 18-	$137.20	$343.00	$102.24–$274.40	—	60%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 PREV VISIT NEW AGE 18-39	$137.20	$343.00	$102.24–$274.40	—	60%
Preventive checkup, new patient aged 40–64 CPT 99386 Initial Preventive Medicine Ne	$142.80	$357.00	$106.42–$285.60	2% above	60%
Preventive checkup, new patient aged 40–64 CPT 99386 Int Preventive Med New Pat 40-	$150.00	$375.00	$111.78–$300.00	7% above	60%
Preventive checkup, new patient aged 40–64 CPT 99386 PREV VISIT NEW AGE 40-64	$150.00	$375.00	$111.78–$300.00	7% above	60%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 Initial Preventive Medicine Ne	$142.80	$357.00	$106.42–$285.60	—	60%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 PREV VISIT NEW AGE 40-64	$150.00	$375.00	$111.78–$300.00	—	60%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 Int Preventive Med New Pat 40-	$150.00	$375.00	$111.78–$300.00	—	60%
Preventive checkup, new patient aged 65 or older CPT 99387 Initial Preventive Medicine Ne	$119.20	$298.00	$88.83–$238.40	13% below	60%
Preventive checkup, new patient aged 65 or older CPT 99387 INIT PM E/M NEW PAT 65+ YRS	$124.80	$312.00	$93.00–$249.60	9% below	60%
Preventive checkup, new patient aged 65 or older CPT 99387 PREV VISIT NEW AGE 65 +	$126.80	$317.00	$94.49–$253.60	7% below	60%
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 Initial Preventive Medicine Ne	$119.20	$298.00	$88.83–$238.40	—	60%
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 INIT PM E/M NEW PAT 65+ YRS	$124.80	$312.00	$93.00–$249.60	—	60%
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 PREV VISIT NEW AGE 65 +	$126.80	$317.00	$94.49–$253.60	—	60%
Preventive checkup, returning patient aged 18–39 CPT 99395 Periodic Preventive Med Est Pa	$130.80	$327.00	$97.47–$261.60	31% above	60%
Preventive checkup, returning patient aged 18–39 CPT 99395 PREV VISIT EST AGE 18-39	$137.20	$343.00	$102.24–$274.40	38% above	60%
Preventive checkup, returning patient aged 18–39 CPT 99395 PREV VISIT EST 18-39	$139.60	$349.00	$104.03–$279.20	40% above	60%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 Periodic Preventive Med Est Pa	$130.80	$327.00	$97.47–$261.60	—	60%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 PREV VISIT EST AGE 18-39	$137.20	$343.00	$102.24–$274.40	—	60%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 PREV VISIT EST 18-39	$139.60	$349.00	$104.03–$279.20	—	60%
Preventive checkup, returning patient aged 40–64 CPT 99396 Periodic Preventive Med Est Pa	$142.80	$357.00	$106.42–$285.60	21% above	60%
Preventive checkup, returning patient aged 40–64 CPT 99396 PREV VISIT EST AGE 40-64	$150.00	$375.00	$111.78–$300.00	27% above	60%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 Periodic Preventive Med Est Pa	$142.80	$357.00	$106.42–$285.60	—	60%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 PREV VISIT EST AGE 40-64	$150.00	$375.00	$111.78–$300.00	—	60%
Preventive checkup, returning patient aged 65 or older CPT 99397 PREV VISIT EST AGE 65 +	$59.20	$148.00	$44.11–$136.86	51% below	60%
Preventive checkup, returning patient aged 65 or older CPT 99397 Periodic Preventive Med Est Pa	$95.60	$239.00	$71.24–$191.20	22% below	60%
Preventive checkup, returning patient aged 65 or older CPT 99397 PER PM REEVAL EST PAT 65+ YR	$104.00	$260.00	$77.50–$208.00	15% below	60%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 PREV VISIT EST AGE 65 +	$59.20	$148.00	$44.11–$136.86	—	60%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 Periodic Preventive Med Est Pa	$95.60	$239.00	$71.24–$191.20	—	60%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 PER PM REEVAL EST PAT 65+ YR	$104.00	$260.00	$77.50–$208.00	—	60%
Psychiatric evaluation with medical services CPT 90792 PSYCH DIAG EVAL W/MED SRVCS	$153.20	$383.00	$114.17–$306.40	30% above	60%
Psychiatric evaluation with medical services inpatient CPT 90792 PSYCH DIAG EVAL W/MED SRVCS	$153.20	$383.00	$114.17–$306.40	—	60%
Psychotherapy for crisis, first 60 minutes CPT 90839 PSYTX CRISIS INITIAL 60MIN	$153.20	$383.00	$114.17–$306.40	62% above	60%
Psychotherapy for crisis, first 60 minutes CPT 90839 PSYTX CRISIS INITIAL 60 MIN	$183.20	$458.00	$136.52–$366.40	93% above	60%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 PSYTX CRISIS INITIAL 60MIN	$153.20	$383.00	$114.17–$306.40	—	60%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 PSYTX CRISIS INITIAL 60 MIN	$183.20	$458.00	$136.52–$366.40	—	60%
Psychotherapy session, 30 minutes CPT 90832 IND PSYCHOTHERAPY 20-30 MIN.	$140.40	$351.00	$73.17–$280.80	63% above	60%
Psychotherapy session, 30 minutes CPT 90832 PSYTX W PT 30 MIN	$153.20	$383.00	$73.17–$306.40	78% above	60%
Psychotherapy session, 30 minutes CPT 90832 INDIVIDAUL PSYCHOTHERAPY 20-30	$153.20	$383.00	$73.17–$306.40	78% above	60%
Psychotherapy session, 30 minutes CPT 90832 PSYTX W PT 30 MINUTES	$154.40	$386.00	$73.17–$308.80	80% above	60%
Psychotherapy session, 30 minutes inpatient CPT 90832 IND PSYCHOTHERAPY 20-30 MIN.	$140.40	$351.00	$73.17–$280.80	—	60%
Psychotherapy session, 30 minutes inpatient CPT 90832 INDIVIDAUL PSYCHOTHERAPY 20-30	$153.20	$383.00	$73.17–$306.40	—	60%
Psychotherapy session, 30 minutes inpatient CPT 90832 PSYTX W PT 30 MIN	$153.20	$383.00	$73.17–$306.40	—	60%
Psychotherapy session, 30 minutes inpatient CPT 90832 PSYTX W PT 30 MINUTES	$154.40	$386.00	$73.17–$308.80	—	60%
Psychotherapy session, 45 minutes CPT 90834 PSYTX W PT 45 MIN	$153.20	$383.00	$96.82–$306.40	41% above	60%
Psychotherapy session, 45 minutes CPT 90834 INDIVIDUAL PSYCHOTHERAPY 45-50	$153.20	$383.00	$96.82–$306.40	41% above	60%
Psychotherapy session, 45 minutes CPT 90834 PSYTX W PT 45 MINUTES	$183.20	$458.00	$96.82–$366.40	68% above	60%
Psychotherapy session, 45 minutes inpatient CPT 90834 PSYTX W PT 45 MIN	$153.20	$383.00	$96.82–$306.40	—	60%
Psychotherapy session, 45 minutes inpatient CPT 90834 INDIVIDUAL PSYCHOTHERAPY 45-50	$153.20	$383.00	$96.82–$306.40	—	60%
Psychotherapy session, 45 minutes inpatient CPT 90834 PSYTX W PT 45 MINUTES	$183.20	$458.00	$96.82–$366.40	—	60%
Psychotherapy session, 60 minutes CPT 90837 PSYTX W PT 60 MIN	$153.20	$383.00	$114.17–$306.40	41% above	60%
Psychotherapy session, 60 minutes CPT 90837 INDIVIDUAL PSYCHOTHERAPY 75-80	$153.20	$383.00	$114.17–$306.40	41% above	60%
Psychotherapy session, 60 minutes CPT 90837 PSYTX W PT 60 MINUTES	$183.20	$458.00	$136.52–$366.40	68% above	60%
Psychotherapy session, 60 minutes inpatient CPT 90837 INDIVIDUAL PSYCHOTHERAPY 75-80	$153.20	$383.00	$114.17–$306.40	—	60%
Psychotherapy session, 60 minutes inpatient CPT 90837 PSYTX W PT 60 MIN	$153.20	$383.00	$114.17–$306.40	—	60%
Psychotherapy session, 60 minutes inpatient CPT 90837 PSYTX W PT 60 MINUTES	$183.20	$458.00	$136.52–$366.40	—	60%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 CHNG SMOKING 3-10 MIN	$32.00	$80.00	$14.15–$64.00	71% above	60%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 CHNG SMOKING 3-10 MIN	$32.00	$80.00	$14.15–$64.00	—	60%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE VISIT EST LEVEL 5	$63.60	$159.00	$47.39–$264.56	11% below	60%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Office Outpatient Visit 40 Min	$166.40	$416.00	$124.00–$332.80	133% above	60%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE VISIT/EST/LVL 5	$175.60	$439.00	$130.86–$351.20	145% above	60%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Office visit, est level 5	$183.20	$458.00	$136.52–$366.40	156% above	60%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 EST PATIENT - LEVEL 5 WCC	$252.00	$630.00	$169.96–$504.00	252% above	60%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 ESTABLISHED LEVEL 5	$306.00	$765.00	$169.96–$612.00	328% above	60%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE O/P EST HI 40-54 MIN	$320.40	$801.00	$169.96–$640.80	348% above	60%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OFFICE VISIT EST LEVEL 5	$63.60	$159.00	$47.39–$264.56	—	60%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Office Outpatient Visit 40 Min	$166.40	$416.00	$124.00–$332.80	—	60%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OFFICE VISIT/EST/LVL 5	$175.60	$439.00	$130.86–$351.20	—	60%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Office visit, est level 5	$183.20	$458.00	$136.52–$366.40	—	60%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 EST PATIENT - LEVEL 5 WCC	$252.00	$630.00	$169.96–$504.00	—	60%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 ESTABLISHED LEVEL 5	$306.00	$765.00	$169.96–$612.00	—	60%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OFFICE O/P EST HI 40-54 MIN	$320.40	$801.00	$169.96–$640.80	—	60%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE VISIT EST LEVEL 3	$32.00	$80.00	$23.84–$181.83	44% below	60%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Office visit, est level 3	$100.00	$250.00	$74.52–$200.00	76% above	60%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Office Outpatient Visit 15 Min	$115.20	$288.00	$85.30–$230.40	103% above	60%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE VISIT/EST/LVL 3	$148.80	$372.00	$85.30–$297.60	162% above	60%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 EST PATIENT - LEVEL 3 WCC	$164.80	$412.00	$85.30–$329.60	190% above	60%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 ESTABLISHED LEVEL3	$210.40	$526.00	$85.30–$420.80	271% above	60%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE O/P EST LOW 20-29 MIN	$220.40	$551.00	$85.30–$440.80	288% above	60%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OFFICE VISIT EST LEVEL 3	$32.00	$80.00	$23.84–$181.83	—	60%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Office visit, est level 3	$100.00	$250.00	$74.52–$200.00	—	60%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Office Outpatient Visit 15 Min	$115.20	$288.00	$85.30–$230.40	—	60%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OFFICE VISIT/EST/LVL 3	$148.80	$372.00	$85.30–$297.60	—	60%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 EST PATIENT - LEVEL 3 WCC	$164.80	$412.00	$85.30–$329.60	—	60%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 ESTABLISHED LEVEL3	$210.40	$526.00	$85.30–$420.80	—	60%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OFFICE O/P EST LOW 20-29 MIN	$220.40	$551.00	$85.30–$440.80	—	60%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Office Consultation New/Estab	$40.00	$100.00	$29.81–$264.56	39% below	60%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE VISIT EST LEVEL 4	$46.80	$117.00	$34.87–$264.56	29% below	60%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Office visit, est level 4	$141.60	$354.00	$105.52–$283.20	115% above	60%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE O/P EST MOD 30 MIN	$150.00	$375.00	$111.78–$300.00	127% above	60%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE VISIT/EST/LVL 4	$162.00	$405.00	$120.73–$324.00	145% above	60%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Office Outpatient Visit 25 Min	$166.40	$416.00	$120.96–$332.80	152% above	60%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 EST PATIENT - LEVEL 4 WCC	$190.80	$477.00	$120.96–$381.60	189% above	60%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 ESTABLISHED LEVEL4	$306.00	$765.00	$120.96–$612.00	364% above	60%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE O/P EST MOD 30-39 MIN	$320.40	$801.00	$120.96–$640.80	385% above	60%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Office Consultation New/Estab	$40.00	$100.00	$29.81–$264.56	—	60%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OFFICE VISIT EST LEVEL 4	$46.80	$117.00	$34.87–$264.56	—	60%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Office visit, est level 4	$141.60	$354.00	$105.52–$283.20	—	60%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OFFICE O/P EST MOD 30 MIN	$150.00	$375.00	$111.78–$300.00	—	60%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OFFICE VISIT/EST/LVL 4	$162.00	$405.00	$120.73–$324.00	—	60%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Office Outpatient Visit 25 Min	$166.40	$416.00	$120.96–$332.80	—	60%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 EST PATIENT - LEVEL 4 WCC	$190.80	$477.00	$120.96–$381.60	—	60%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 ESTABLISHED LEVEL4	$306.00	$765.00	$120.96–$612.00	—	60%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OFFICE O/P EST MOD 30-39 MIN	$320.40	$801.00	$120.96–$640.80	—	60%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE VISIT EST LEVEL 2	$21.20	$53.00	$15.79–$158.04	59% below	60%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Office visit, est level 2	$60.40	$151.00	$45.01–$158.04	16% above	60%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Office Outpatient Visit 10 Min	$99.20	$248.00	$52.97–$198.40	91% above	60%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 EST PATIENT - LEVEL 2 WCC	$122.40	$306.00	$52.97–$244.80	136% above	60%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE VISIT/EST/LVL 2	$135.20	$338.00	$52.97–$270.40	160% above	60%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 ESTABLISHED LEVEL2	$183.20	$458.00	$52.97–$366.40	253% above	60%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE O/P EST SF 10-19MIN	$191.20	$478.00	$52.97–$382.40	268% above	60%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE O/P EST SF 10-19 MIN	$194.40	$486.00	$52.97–$388.80	274% above	60%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OFFICE VISIT EST LEVEL 2	$21.20	$53.00	$15.79–$158.04	—	60%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Office visit, est level 2	$60.40	$151.00	$45.01–$158.04	—	60%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Office Outpatient Visit 10 Min	$99.20	$248.00	$52.97–$198.40	—	60%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 EST PATIENT - LEVEL 2 WCC	$122.40	$306.00	$52.97–$244.80	—	60%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OFFICE VISIT/EST/LVL 2	$135.20	$338.00	$52.97–$270.40	—	60%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 ESTABLISHED LEVEL2	$183.20	$458.00	$52.97–$366.40	—	60%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OFFICE O/P EST SF 10-19MIN	$191.20	$478.00	$52.97–$382.40	—	60%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OFFICE O/P EST SF 10-19 MIN	$194.40	$486.00	$52.97–$388.80	—	60%
Specialist consultation, low complexity or 30+ minutes CPT 99243 Office Consultation New/Estab	$99.20	$248.00	$73.92–$198.40	34% below	60%
Specialist consultation, low complexity or 30+ minutes CPT 99243 Office Consult New/Est 45 min	$135.20	$338.00	$100.75–$270.40	9% below	60%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 Office Consultation New/Estab	$99.20	$248.00	$73.92–$198.40	—	60%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 Office Consult New/Est 45 min	$135.20	$338.00	$100.75–$270.40	—	60%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 Office Consultation New/Estab	$138.80	$347.00	$103.44–$277.60	9% below	60%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 Office Consult MDM 40 Min	$204.00	$510.00	$152.03–$408.00	34% above	60%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 Office Consultation New/Estab	$138.80	$347.00	$103.44–$277.60	—	60%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 Office Consult MDM 40 Min	$204.00	$510.00	$152.03–$408.00	—	60%
Speech and language evaluation CPT 92523 LECH ST EVAL SPEECH SOUND LANG	$140.00	$350.00	$104.33–$714.67	25% below	60%
Speech and language evaluation CPT 92523 SPEECH SOUND LANG COMPREHEND	$199.20	$498.00	$110.00–$714.67	7% above	60%
Speech and language evaluation inpatient CPT 92523 LECH ST EVAL SPEECH SOUND LANG	$140.00	$350.00	$104.33–$714.67	—	60%
Speech and language evaluation inpatient CPT 92523 SPEECH SOUND LANG COMPREHEND	$199.20	$498.00	$110.00–$714.67	—	60%
Speech therapy session, individual CPT 92507 TX/TRAINING VOICE PROSTHESIS	$80.00	$200.00	$59.62–$293.83	4% below	60%
Speech therapy session, individual CPT 92507 LECH ST SPEECH HEARING THRPY B	$86.00	$215.00	$64.09–$293.83	4% above	60%
Speech therapy session, individual CPT 92507 LECH ST SPEECH HEARING THRPY E	$86.00	$215.00	$64.09–$293.83	4% above	60%
Speech therapy session, individual CPT 92507 LECH ST SPEECH HEARING THRPY I	$86.00	$215.00	$64.09–$293.83	4% above	60%
Speech therapy session, individual CPT 92507 SPEECH/HEARING THERAPY	$100.40	$251.00	$74.82–$293.83	21% above	60%
Speech therapy session, individual inpatient CPT 92507 TX/TRAINING VOICE PROSTHESIS	$80.00	$200.00	$59.62–$293.83	—	60%
Speech therapy session, individual inpatient CPT 92507 LECH ST SPEECH HEARING THRPY E	$86.00	$215.00	$64.09–$293.83	—	60%
Speech therapy session, individual inpatient CPT 92507 LECH ST SPEECH HEARING THRPY B	$86.00	$215.00	$64.09–$293.83	—	60%
Speech therapy session, individual inpatient CPT 92507 LECH ST SPEECH HEARING THRPY I	$86.00	$215.00	$64.09–$293.83	—	60%
Speech therapy session, individual inpatient CPT 92507 SPEECH/HEARING THERAPY	$100.40	$251.00	$74.82–$293.83	—	60%
Spirometry (breathing test) CPT 94010 PULMONARY FUNCTION	$168.00	$420.00	$125.20–$336.00	33% above	60%
Spirometry (breathing test) inpatient CPT 94010 PULMONARY FUNCTION	$168.00	$420.00	$125.20–$336.00	—	60%
Spirometry before and after a bronchodilator CPT 94060 PFT (PRE & POST)	$314.80	$787.00	$171.84–$629.60	53% above	60%
Spirometry before and after a bronchodilator inpatient CPT 94060 PFT (PRE & POST)	$314.80	$787.00	$171.84–$629.60	—	60%
Therapeutic activities (functional training), 15 minutes CPT 97530 LECH OT THERAP DYNAMIC EA 15 M	$48.00	$120.00	$35.77–$147.88	22% above	60%
Therapeutic activities (functional training), 15 minutes CPT 97530 LECH PT THERAP DYNAMIC EA 15 M	$48.00	$120.00	$35.77–$147.88	22% above	60%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 LECH PT THERAP DYNAMIC EA 15 M	$48.00	$120.00	$35.77–$147.88	—	60%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 LECH OT THERAP DYNAMIC EA 15 M	$48.00	$120.00	$35.77–$147.88	—	60%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY	$134.80	$337.00	$100.22–$3,200.00	34% above	60%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY THERAPEUTIC	$157.20	$393.00	$100.22–$3,200.00	57% above	60%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY	$134.80	$337.00	$100.22–$3,200.00	—	60%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY THERAPEUTIC	$157.20	$393.00	$100.22–$3,200.00	—	60%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Louisiana	Off list
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DAPTACEL DTAP VACCINE	$115.60	$289.00	$32.40–$231.20	227% above	60%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DAPTACEL DTAP VACCINE	$115.60	$289.00	$32.40–$231.20	—	60%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 vaccine preserv free	$87.60	$219.00	$65.28–$219.00	36% above	60%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 vaccine preserv free	$87.60	$219.00	$65.28–$219.00	—	60%
Rabies vaccine, one dose CPT 90675 IMOVAX RABIES VACCINE	$226.00	$565.00	$168.42–$784.09	68% below	60%
Rabies vaccine, one dose inpatient CPT 90675 IMOVAX RABIES VACCINE	$226.00	$565.00	$168.42–$784.09	—	60%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TD 7 YEARS OR OLDER	$12.80	$32.00	$9.53–$45.73	71% below	60%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS DIPH TOX(AGE 7&UP)	$115.60	$289.00	$20.71–$289.00	160% above	60%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TD 7 YEARS OR OLDER	$12.80	$32.00	$9.53–$45.73	—	60%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS DIPH TOX(AGE 7&UP)	$115.60	$289.00	$20.71–$289.00	—	60%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDAP VACCINE 7 YRS >IM	$17.20	$43.00	$12.81–$94.94	73% below	60%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 DIPH PERTUSS(ACELL) TET VAC/PF	$74.00	$185.00	$43.00–$185.00	16% above	60%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TDAP VACCINE 7 YRS >IM	$17.20	$43.00	$12.81–$94.94	—	60%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 DIPH PERTUSS(ACELL) TET VAC/PF	$74.00	$185.00	$43.00–$185.00	—	60%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMM ADMIN	$76.40	$191.00	$19.31–$152.80	91% above	60%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADM; 1 VACCINE	$76.40	$191.00	$19.31–$152.80	91% above	60%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADM: 1 VACCINE	$77.60	$194.00	$19.31–$155.20	94% above	60%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 im adm prq id subq/ 1 vaccine	$78.00	$195.00	$19.31–$156.00	95% above	60%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN 1 VACCINE	$84.80	$212.00	$19.31–$169.60	112% above	60%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMM ADMIN	$76.40	$191.00	$19.31–$152.80	—	60%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADM; 1 VACCINE	$76.40	$191.00	$19.31–$152.80	—	60%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADM: 1 VACCINE	$77.60	$194.00	$19.31–$155.20	—	60%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 im adm prq id subq/ 1 vaccine	$78.00	$195.00	$19.31–$156.00	—	60%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMIN 1 VACCINE	$84.80	$212.00	$19.31–$169.60	—	60%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADM; ED ADDTL VAC	$28.00	$70.00	$14.92–$70.00	5% above	60%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUNIZATION ADM; ED ADDTL VAC	$28.00	$70.00	$14.92–$70.00	—	60%

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

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

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

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

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

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

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

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

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

Source file: https://mrfs.hyvehealthcare.com/NatchitochesRegionalMedical/726013916_natchitoches-parish-hospital-service-district_standardcharges.json