Providence St Joseph Medical Center
Providence St Joseph Medical Center in Polson, MT publishes cash prices for 474 common procedures listed here, from its own machine-readable price file updated Apr 1, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Montana median for 365 of 470 procedures and above it for 95. By typical cash price it ranks #3 of 29 Montana hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.
6 13th Ave E, Polson, MT 59860 Collected Sep 23, 2026 Source price file Check a bill from this hospital (406) 883-5377
Critical access hospital (rural, 25 beds or fewer) Nonprofit hospital Emergency department CCN 271343 · CMS hospital register NPI 1821184888
Financial assistance
Nonprofit hospital: it must offer free or discounted care to patients who qualify. How to apply
Providence St Joseph Medical Center is a nonprofit hospital in the CMS register. Under section 501(r) of the federal tax code it must have a written Financial Assistance Policy with a free application, publish both on its website, and charge patients who qualify no more than the amounts generally billed to insured patients for emergency and other medically necessary care. Who qualifies depends on household income; the policy states the limits.
You can apply up to 240 days after the first bill. Before collection actions such as credit reporting or a lawsuit, the hospital must tell you about the policy and wait at least 120 days after that bill. Ask the billing office for the policy and the application before you pay, or search the hospital's website for “financial assistance”. Letters you can copy.
Source: IRS, section 501(r) requirements for nonprofit hospitals.
CMS price transparency record
The federal Centers for Medicare & Medicaid Services (CMS) enforces the rule that makes hospitals publish their prices. Its public enforcement list shows 1 action for a hospital named Providence St Joseph Medical Center in Polson, MT:
- Jun 10, 2025 Met requirements
Met requirements: CMS reviewed the hospital and found it met the requirements, so no further action was taken.
A notice records a step in a CMS review; it is not a court finding. Source: CMS, Hospital Price Transparency Enforcement Activities and Outcomes, actions through Jul 31, 2026.
Scans and imaging
| Procedure | Cash price | List price | Insurers pay | vs Montana | Off list |
|---|---|---|---|---|---|
| Abdominal CT scan without and with contrast CPT 74170 HC CT ABDOMEN W & W/O CONTRAST | $1,735.20 | $2,169.00 | — | 11% below | 20% |
| Abdominal CT scan without and with contrast inpatient CPT 74170 HC CT ABDOMEN W & W/O CONTRAST | $1,735.20 | $2,169.00 | — | — | 20% |
| Abdominal X-ray, 2 views CPT 74019 HC XR ABDOMEN 2 VIEWS | $188.80 | $236.00 | — | 30% below | 20% |
| Abdominal X-ray, 2 views inpatient CPT 74019 HC XR ABDOMEN 2 VIEWS | $188.80 | $236.00 | — | — | 20% |
| Ankle X-ray, complete, 3 or more views CPT 73610 HC XR ANKLE COMPLETE MIN 3 VIEWS | $238.40 | $298.00 | — | 10% above | 20% |
| Ankle X-ray, complete, 3 or more views inpatient CPT 73610 HC XR ANKLE COMPLETE MIN 3 VIEWS | $238.40 | $298.00 | — | — | 20% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 HC PR 93922 NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL RHC | $121.60 | $152.00 | — | 59% below | 20% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 HC NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL | $132.80 | $166.00 | — | 55% below | 20% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 HC NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL | $132.80 | $166.00 | — | — | 20% |
| Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 HC CT UPPER EXTREMITY WO CONTRAST | $1,345.60 | $1,682.00 | — | at median | 20% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 HC CT UPPER EXTREMITY WO CONTRAST | $1,345.60 | $1,682.00 | — | — | 20% |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 HC XR ESOPHAGUS W CONTRAST | $386.40 | $483.00 | — | 9% above | 20% |
| Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 HC XR ESOPHAGUS W CONTRAST | $386.40 | $483.00 | — | — | 20% |
| Breast ultrasound, complete, one breast CPT 76641 HC US BREAST UNI COMPLETE | $187.20 | $234.00 | — | 32% below | 20% |
| Breast ultrasound, complete, one breast inpatient CPT 76641 HC US BREAST UNI COMPLETE | $187.20 | $234.00 | — | — | 20% |
| Breast ultrasound, limited (one breast or one area) CPT 76642 HC US BREAST UNI LIMITED | $187.20 | $234.00 | — | 24% below | 20% |
| Breast ultrasound, limited (one breast or one area) CPT 76642 HC US ED BREAST UNI LIMITED CDM | $187.20 | $234.00 | — | 24% below | 20% |
| Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 HC US ED BREAST UNI LIMITED CDM | $187.20 | $234.00 | — | — | 20% |
| Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 HC US BREAST UNI LIMITED | $187.20 | $234.00 | — | — | 20% |
| CT angiography (CTA) of the abdomen and pelvis CPT 74174 HC CTA ABDOMEN PELVIS | $3,628.80 | $4,536.00 | — | 31% above | 20% |
| CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 HC CTA ABDOMEN PELVIS | $3,628.80 | $4,536.00 | — | — | 20% |
| CT angiography (CTA) of the head CPT 70496 HC CT ANGIOGRAPHY HEAD W CONTRAST | $1,233.60 | $1,542.00 | — | 42% below | 20% |
| CT angiography (CTA) of the head inpatient CPT 70496 HC CT ANGIOGRAPHY HEAD W CONTRAST | $1,233.60 | $1,542.00 | — | — | 20% |
| CT angiography (CTA) of the neck CPT 70498 HC CT ANGIOGRAPHY NECK W CONTRAST | $1,364.00 | $1,705.00 | — | 37% below | 20% |
| CT angiography (CTA) of the neck inpatient CPT 70498 HC CT ANGIOGRAPHY NECK W CONTRAST | $1,364.00 | $1,705.00 | — | — | 20% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HC CT ANGIOGRAPHY CHEST | $1,778.40 | $2,223.00 | — | 20% below | 20% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 HC CT ANGIOGRAPHY CHEST | $1,778.40 | $2,223.00 | — | — | 20% |
| CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 HC CCTA HEART ARTERIES/GRAFTS W/3D IMAGE W/ CONTRAST | $452.80 | $566.00 | — | 42% below | 20% |
| CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 HC CCTA HEART ARTERIES/GRAFTS W/3D IMAGE W/ CONTRAST | $452.80 | $566.00 | — | — | 20% |
| CT of the heart without contrast dye to measure coronary calcium CPT 75571 HC CCTA HEART W/ CALCIUM SCORING W/O CONTRAST | $238.40 | $298.00 | — | 42% below | 20% |
| CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 HC CCTA HEART W/ CALCIUM SCORING W/O CONTRAST | $238.40 | $298.00 | — | — | 20% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 HC CT ABD & PELVIS WO CONTRAST | $2,518.40 | $3,148.00 | — | 18% above | 20% |
| CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 HC CT ABD & PELVIS WO CONTRAST | $2,518.40 | $3,148.00 | — | — | 20% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT ABDOMEN & PELVIS W CONTRAST | $2,883.20 | $3,604.00 | — | 2% above | 20% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT ABDOMEN & PELVIS W CONTRAST | $2,883.20 | $3,604.00 | — | — | 20% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC CT ABDOMEN & PELVIS W & W/O CONTRAST | $3,709.60 | $4,637.00 | — | 19% above | 20% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 HC CT ABDOMEN & PELVIS W & W/O CONTRAST | $3,709.60 | $4,637.00 | — | — | 20% |
| CT scan of the abdomen with contrast CPT 74160 HC CT ABDOMEN W CONTRAST | $1,600.00 | $2,000.00 | — | 12% below | 20% |
| CT scan of the abdomen with contrast inpatient CPT 74160 HC CT ABDOMEN W CONTRAST | $1,600.00 | $2,000.00 | — | — | 20% |
| CT scan of the abdomen without contrast CPT 74150 HC CT ABDOMEN WO CONTRAST | $1,314.40 | $1,643.00 | — | 4% below | 20% |
| CT scan of the abdomen without contrast inpatient CPT 74150 HC CT ABDOMEN WO CONTRAST | $1,314.40 | $1,643.00 | — | — | 20% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT MAXILLOFACIAL WO CONTRAST | $799.20 | $999.00 | — | 33% below | 20% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT MAXILLOFACIAL W/O DYE LIMITED | $799.20 | $999.00 | — | 33% below | 20% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 HC CT MAXILLOFACIAL WO CONTRAST | $799.20 | $999.00 | — | — | 20% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 HC CT MAXILLOFACIAL W/O DYE LIMITED | $799.20 | $999.00 | — | — | 20% |
| CT scan of the head or brain, no contrast dye CPT 70450 HC CT HEAD/BRAIN WO CONTRAST | $829.60 | $1,037.00 | — | 30% below | 20% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT HEAD/BRAIN WO CONTRAST | $829.60 | $1,037.00 | — | — | 20% |
| CT scan of the head with contrast CPT 70460 HC CT HEAD/BRAIN W CONTRAST | $1,057.60 | $1,322.00 | — | 26% below | 20% |
| CT scan of the head with contrast inpatient CPT 70460 HC CT HEAD/BRAIN W CONTRAST | $1,057.60 | $1,322.00 | — | — | 20% |
| CT scan of the head without and with contrast CPT 70470 HC CT HEAD/BRAIN W & W/O CONTRAST | $1,296.00 | $1,620.00 | — | 28% below | 20% |
| CT scan of the head without and with contrast inpatient CPT 70470 HC CT HEAD/BRAIN W & W/O CONTRAST | $1,296.00 | $1,620.00 | — | — | 20% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 HC CT LUMBAR SPINE WO CONTRAST | $1,314.40 | $1,643.00 | — | 8% below | 20% |
| CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 HC CT LUMBAR SPINE WO CONTRAST | $1,314.40 | $1,643.00 | — | — | 20% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 HC CT NECK SPINE WO CONTRAST | $748.80 | $936.00 | — | 47% below | 20% |
| CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 HC CT NECK SPINE WO CONTRAST | $748.80 | $936.00 | — | — | 20% |
| CT scan of the pelvis, with contrast dye CPT 72193 HC CT PELVIS W CONTRAST | $1,429.60 | $1,787.00 | — | 11% below | 20% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT PELVIS W CONTRAST | $1,429.60 | $1,787.00 | — | — | 20% |
| Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 HC PR 93880 DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY RHC | $279.20 | $349.00 | — | — | 20% |
| Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 HC DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY | $458.40 | $573.00 | — | — | 20% |
| Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 HC DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY | $458.40 | $573.00 | — | — | 20% |
| Chest CT scan without and with contrast CPT 71270 HC CT THORAX W & W/O CONTRAST | $1,961.60 | $2,452.00 | — | 1% below | 20% |
| Chest CT scan without and with contrast inpatient CPT 71270 HC CT THORAX W & W/O CONTRAST | $1,961.60 | $2,452.00 | — | — | 20% |
| Chest X-ray, 2 views CPT 71046 HC XR CHEST 2 VIEWS | $231.20 | $289.00 | — | 4% above | 20% |
| Chest X-ray, 2 views inpatient CPT 71046 HC XR CHEST 2 VIEWS | $231.20 | $289.00 | — | — | 20% |
| Chest X-ray, single view CPT 71045 HC XR CHEST PORTABLE 1 VIEW | $183.20 | $229.00 | — | 1% below | 20% |
| Chest X-ray, single view CPT 71045 HC XR CHEST 1 VIEW | $183.20 | $229.00 | — | 1% below | 20% |
| Chest X-ray, single view inpatient CPT 71045 HC XR CHEST PORTABLE 1 VIEW | $183.20 | $229.00 | — | — | 20% |
| Chest X-ray, single view inpatient CPT 71045 HC XR CHEST 1 VIEW | $183.20 | $229.00 | — | — | 20% |
| Collarbone (clavicle) X-ray, complete CPT 73000 HC XR CLAVICLE COMPLETE | $172.80 | $216.00 | — | 9% below | 20% |
| Collarbone (clavicle) X-ray, complete inpatient CPT 73000 HC XR CLAVICLE COMPLETE | $172.80 | $216.00 | — | — | 20% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HC US RETROPERITONEAL COMPLETE | $626.40 | $783.00 | — | 25% above | 20% |
| Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 HC US RETROPERITONEAL COMPLETE | $626.40 | $783.00 | — | — | 20% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 HC PR 77080 BONE DENSITY AXIAL SKELETON | $55.20 | $69.00 | — | 83% below | 20% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 HC PR 77080 BONE DENSITY AXIAL SKELETON | $55.20 | $69.00 | — | 83% below | 20% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 HC XR DXA BONE DENSITY STUDY AXIAL | $368.00 | $460.00 | — | 15% above | 20% |
| DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 HC PR 77080 BONE DENSITY AXIAL SKELETON | $55.20 | $69.00 | — | — | 20% |
| DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 HC XR DXA BONE DENSITY STUDY AXIAL | $368.00 | $460.00 | — | — | 20% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 HC BONE DENSITY PERIPHERAL SKELETON | $95.20 | $119.00 | — | 35% below | 20% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 HC BONE DENSITY PERIPHERAL SKELETON | $95.20 | $119.00 | — | — | 20% |
| Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 HC PR 76811 US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION RHC | $264.00 | $330.00 | — | 39% below | 20% |
| Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 HC US OB DETAILED SINGLE FETUS CDM | $853.60 | $1,067.00 | — | 96% above | 20% |
| Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 HC US OB DETAILED SINGLE FETUS CDM | $853.60 | $1,067.00 | — | — | 20% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT THORAX W/O DYE F/U LUNG SCREENING | $1,380.00 | $1,725.00 | — | 1% below | 20% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT THORAX WO CONTRAST | $1,380.00 | $1,725.00 | — | 1% below | 20% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT THORAX WO CONTRAST | $1,380.00 | $1,725.00 | — | — | 20% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT THORAX W/O DYE F/U LUNG SCREENING | $1,380.00 | $1,725.00 | — | — | 20% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 HC CT THORAX W CONTRAST | $1,621.60 | $2,027.00 | — | 2% below | 20% |
| Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 HC CT THORAX W CONTRAST | $1,621.60 | $2,027.00 | — | — | 20% |
| Diagnostic mammogram, both breasts both sides CPT 77066 HC DX MAMMO INCL CAD BI | $314.40 | $393.00 | — | — | 20% |
| Diagnostic mammogram, both breasts CPT 77066 HC MAMMO DIAG BIL W CAD | $314.40 | $393.00 | — | 8% below | 20% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC DX MAMMO INCL CAD BI | $314.40 | $393.00 | — | — | 20% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 HC MAMMO DIAG BIL W CAD | $314.40 | $393.00 | — | — | 20% |
| Diagnostic mammogram, one breast CPT 77065 HC MAMMO DIAG UNI W CAD | $246.40 | $308.00 | — | 4% below | 20% |
| Diagnostic mammogram, one breast CPT 77065 HC DX MAMMO INCL CAD UNI | $246.40 | $308.00 | — | 4% below | 20% |
| Diagnostic mammogram, one breast inpatient CPT 77065 HC DX MAMMO INCL CAD UNI | $246.40 | $308.00 | — | — | 20% |
| Diagnostic mammogram, one breast inpatient CPT 77065 HC MAMMO DIAG UNI W CAD | $246.40 | $308.00 | — | — | 20% |
| Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 HC DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY | $716.80 | $896.00 | — | — | 20% |
| Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 HC DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY | $716.80 | $896.00 | — | — | 20% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HC DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY | $932.00 | $1,165.00 | — | — | 20% |
| Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 HC DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY | $932.00 | $1,165.00 | — | — | 20% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC PR 93306 ECHO TTE 2D W/COLOR & DOP RHC | $288.80 | $361.00 | — | 82% below | 20% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC ECHO TTE 2D W DOPPLER COMPLETE | $1,164.00 | $1,455.00 | — | 26% below | 20% |
| Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HC ECHO TTE 2D W DOPPLER COMPLETE | $1,164.00 | $1,455.00 | — | — | 20% |
| Elbow X-ray, 2 views CPT 73070 HC XR ELBOW LIMITED | $188.80 | $236.00 | — | 4% above | 20% |
| Elbow X-ray, 2 views CPT 73070 HC XR ELBOW 2 VIEWS | $192.00 | $240.00 | — | 6% above | 20% |
| Elbow X-ray, 2 views inpatient CPT 73070 HC XR ELBOW LIMITED | $188.80 | $236.00 | — | — | 20% |
| Elbow X-ray, 2 views inpatient CPT 73070 HC XR ELBOW 2 VIEWS | $192.00 | $240.00 | — | — | 20% |
| Elbow X-ray, complete, 3 or more views CPT 73080 HC XR ELBOW COMPLETE MIN 3 VIEWS | $193.60 | $242.00 | — | 10% below | 20% |
| Elbow X-ray, complete, 3 or more views inpatient CPT 73080 HC XR ELBOW COMPLETE MIN 3 VIEWS | $193.60 | $242.00 | — | — | 20% |
| Facial bones X-ray, complete, 3 or more views CPT 70150 HC XR FACIAL BONES MIN 3 VIEWS | $455.20 | $569.00 | — | 40% above | 20% |
| Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 HC XR FACIAL BONES MIN 3 VIEWS | $455.20 | $569.00 | — | — | 20% |
| Forearm X-ray (radius and ulna), 2 views CPT 73090 HC XR FOREARM 1 VIEW | $189.60 | $237.00 | — | 2% above | 20% |
| Forearm X-ray (radius and ulna), 2 views CPT 73090 HC XR FOREARM 2 VIEWS | $203.20 | $254.00 | — | 9% above | 20% |
| Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 HC XR FOREARM 1 VIEW | $189.60 | $237.00 | — | — | 20% |
| Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 HC XR FOREARM 2 VIEWS | $203.20 | $254.00 | — | — | 20% |
| Hand X-ray, 2 views CPT 73120 HC XR HAND 1 VIEW | $159.20 | $199.00 | — | 7% below | 20% |
| Hand X-ray, 2 views CPT 73120 HC XR HAND 2 VIEWS | $169.60 | $212.00 | — | 1% below | 20% |
| Hand X-ray, 2 views inpatient CPT 73120 HC XR HAND 1 VIEW | $159.20 | $199.00 | — | — | 20% |
| Hand X-ray, 2 views inpatient CPT 73120 HC XR HAND 2 VIEWS | $169.60 | $212.00 | — | — | 20% |
| Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 HC XR HEEL MIN 2 VIEWS | $179.20 | $224.00 | — | 6% below | 20% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 HC XR HEEL MIN 2 VIEWS | $179.20 | $224.00 | — | — | 20% |
| Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 HC PR 95806 SLEEP STD AIRFLOW HRT RATE&O2 SAT EFFORT UNATT RHC | $143.20 | $179.00 | — | 53% below | 20% |
| Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 HC SLEEP STUDY UNATT&RESP EFFT | $358.40 | $448.00 | — | 17% above | 20% |
| Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 HC SLEEP STUDY UNATT&RESP EFFT | $358.40 | $448.00 | — | — | 20% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 HC POLYSOMNOGRAPHY W/CPAP | $1,818.40 | $2,273.00 | — | 22% below | 20% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 HC POLYSOMNOGRAPHY W/CPAP | $1,818.40 | $2,273.00 | — | — | 20% |
| Knee X-ray, 3 views CPT 73562 HC XR KNEE 3 VIEWS | $193.60 | $242.00 | — | 8% below | 20% |
| Knee X-ray, 3 views inpatient CPT 73562 HC XR KNEE 3 VIEWS | $193.60 | $242.00 | — | — | 20% |
| Knee X-ray, complete, 4 or more views CPT 73564 HC XR KNEE 4/PLUS VIEWS | $260.80 | $326.00 | — | 6% above | 20% |
| Knee X-ray, complete, 4 or more views inpatient CPT 73564 HC XR KNEE 4/PLUS VIEWS | $260.80 | $326.00 | — | — | 20% |
| Leg CT scan without contrast (hip to foot, any part) CPT 73700 HC CT LOWER EXTREMITY WO CONTRAST | $1,307.20 | $1,634.00 | — | at median | 20% |
| Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 HC CT LOWER EXTREMITY WO CONTRAST | $1,307.20 | $1,634.00 | — | — | 20% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US ED ABDOMEN LIMITED CDM | $355.20 | $444.00 | — | 13% below | 20% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US ABDOMEN LIMITED | $355.20 | $444.00 | — | 13% below | 20% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC US ED ABDOMEN LIMITED CDM | $355.20 | $444.00 | — | — | 20% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC US ABDOMEN LIMITED | $355.20 | $444.00 | — | — | 20% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 HC PR 76882 US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG RHC | $96.00 | $120.00 | — | 59% below | 20% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 HC US ED LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG CDM | $191.20 | $239.00 | — | 18% below | 20% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 HC US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG CDM | $191.20 | $239.00 | — | 18% below | 20% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 HC US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG CDM | $191.20 | $239.00 | — | — | 20% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 HC US ED LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG CDM | $191.20 | $239.00 | — | — | 20% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 HC CT THORAX LW DOSE LNG CA SCR WO CONTRAST CDM | $293.60 | $367.00 | — | 59% below | 20% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 HC CT THORAX LW DOSE LNG CA SCR WO CONTRAST CDM | $293.60 | $367.00 | — | — | 20% |
| Lower leg X-ray (tibia and fibula), 2 views CPT 73590 HC XR LOWER LEG LIMITED | $141.60 | $177.00 | — | 27% below | 20% |
| Lower leg X-ray (tibia and fibula), 2 views CPT 73590 HC XR LOWER LEG 2 VIEWS | $192.00 | $240.00 | — | 1% below | 20% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 HC XR LOWER LEG LIMITED | $141.60 | $177.00 | — | — | 20% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 HC XR LOWER LEG 2 VIEWS | $192.00 | $240.00 | — | — | 20% |
| MR angiography (MRA) of the head without contrast CPT 70544 HC MRA HEAD WO CONTRAST | $1,759.20 | $2,199.00 | — | 3% below | 20% |
| MR angiography (MRA) of the head without contrast inpatient CPT 70544 HC MRA HEAD WO CONTRAST | $1,759.20 | $2,199.00 | — | — | 20% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI LOWER EXTREMITY JOINT WO CONTRAST | $1,724.00 | $2,155.00 | — | at median | 20% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MRI LOWER EXTREMITY JOINT WO CONTRAST | $1,724.00 | $2,155.00 | — | — | 20% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI LOWER EXTREMITY JOINT WO & W CONTRAST | $2,171.20 | $2,714.00 | — | 20% below | 20% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HC MRI LOWER EXTREMITY JOINT WO & W CONTRAST | $2,171.20 | $2,714.00 | — | — | 20% |
| MRI of the abdomen without contrast CPT 74181 HC MRI ABDOMEN WO CONTRAST | $1,623.20 | $2,029.00 | — | 9% below | 20% |
| MRI of the abdomen without contrast inpatient CPT 74181 HC MRI ABDOMEN WO CONTRAST | $1,623.20 | $2,029.00 | — | — | 20% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 HC MRI ABDOMEN WO & W CONTRAST | $2,933.60 | $3,667.00 | — | 1% above | 20% |
| MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 HC MRI ABDOMEN WO & W CONTRAST | $2,933.60 | $3,667.00 | — | — | 20% |
| MRI of the brain, no contrast dye CPT 70551 HC MRI BRAIN STEM W/O DYE | $1,764.00 | $2,205.00 | — | 2% below | 20% |
| MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI BRAIN STEM W/O DYE | $1,764.00 | $2,205.00 | — | — | 20% |
| MRI of the brain, with and without contrast dye CPT 70553 HC MRI BRAIN W/O & W/DYE | $2,816.80 | $3,521.00 | — | at median | 20% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI BRAIN W/O & W/DYE | $2,816.80 | $3,521.00 | — | — | 20% |
| MRI of the lower back, no contrast dye CPT 72148 HC MRI LUMBAR SPINE W/O DYE | $1,956.80 | $2,446.00 | — | 12% above | 20% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI LUMBAR SPINE W/O DYE | $1,956.80 | $2,446.00 | — | — | 20% |
| MRI of the lower back, without and then with contrast dye CPT 72158 HC MRI LUMBAR SPINE W/O & W/DYE | $2,889.60 | $3,612.00 | — | 8% above | 20% |
| MRI of the lower back, without and then with contrast dye inpatient CPT 72158 HC MRI LUMBAR SPINE W/O & W/DYE | $2,889.60 | $3,612.00 | — | — | 20% |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 HC MRI THORACIC SPINE W/O DYE | $1,821.60 | $2,277.00 | — | 4% above | 20% |
| MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 HC MRI THORACIC SPINE W/O DYE | $1,821.60 | $2,277.00 | — | — | 20% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 HC MRI CERVICAL SPINE W/O & W/DYE | $2,776.00 | $3,470.00 | — | 3% above | 20% |
| MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 HC MRI CERVICAL SPINE W/O & W/DYE | $2,776.00 | $3,470.00 | — | — | 20% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 HC MRI CERVICAL SPINE W/O DYE | $1,691.20 | $2,114.00 | — | 6% below | 20% |
| MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 HC MRI CERVICAL SPINE W/O DYE | $1,691.20 | $2,114.00 | — | — | 20% |
| MRI of the pelvis without and with contrast CPT 72197 HC MRI PELVIS WO & W CONTRAST | $3,043.20 | $3,804.00 | — | 10% above | 20% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 HC MRI PELVIS WO & W CONTRAST | $3,043.20 | $3,804.00 | — | — | 20% |
| MRI of the pelvis, no contrast dye CPT 72195 HC MRI PELVIS WO CONTRAST | $1,888.80 | $2,361.00 | — | at median | 20% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 HC MRI PELVIS WO CONTRAST | $1,888.80 | $2,361.00 | — | — | 20% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 HC MRI UPPER EXTREMITY JOINT WO CONTRAST | $1,850.40 | $2,313.00 | — | 18% above | 20% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 HC MRI UPPER EXTREMITY JOINT WO CONTRAST | $1,850.40 | $2,313.00 | — | — | 20% |
| Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 HC XR SPINE CERVICAL 4 OR 5 VIEWS | $359.20 | $449.00 | — | 11% above | 20% |
| Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 HC XR SPINE CERVICAL 4 OR 5 VIEWS | $359.20 | $449.00 | — | — | 20% |
| Neck soft tissue CT scan with contrast CPT 70491 HC CT SOFT TISSUE NECK W CONTRAST | $1,098.40 | $1,373.00 | — | 38% below | 20% |
| Neck soft tissue CT scan with contrast inpatient CPT 70491 HC CT SOFT TISSUE NECK W CONTRAST | $1,098.40 | $1,373.00 | — | — | 20% |
| Neck soft tissue CT scan without contrast CPT 70490 HC CT SOFT TISSUE NECK WO CONTRAST | $917.60 | $1,147.00 | — | 25% below | 20% |
| Neck soft tissue CT scan without contrast inpatient CPT 70490 HC CT SOFT TISSUE NECK WO CONTRAST | $917.60 | $1,147.00 | — | — | 20% |
| Neck soft tissue X-ray CPT 70360 HC XR NECK SOFT TISSUE | $224.80 | $281.00 | — | 15% above | 20% |
| Neck soft tissue X-ray inpatient CPT 70360 HC XR NECK SOFT TISSUE | $224.80 | $281.00 | — | — | 20% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC PR 78452 MYOCARDIAL MUSCLE IMAGE SPECT MULT RHC | $627.20 | $784.00 | — | 71% below | 20% |
| Pelvic CT scan without contrast CPT 72192 HC CT PELVIS WO CONTRAST | $1,332.80 | $1,666.00 | — | 4% below | 20% |
| Pelvic CT scan without contrast inpatient CPT 72192 HC CT PELVIS WO CONTRAST | $1,332.80 | $1,666.00 | — | — | 20% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC PR 76857 US EXAM PELVIC LIMITED | $71.20 | $89.00 | — | 77% below | 20% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC PR 76857 US EXAM PELVIC LIMITED | $71.20 | $89.00 | — | 77% below | 20% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC PR 76857 US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U RHC | $74.40 | $93.00 | — | 76% below | 20% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC US EXAM PELVIC FOLLICLE LIMITED | $281.60 | $352.00 | — | 9% below | 20% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC US ED EXAM PELVIC LIMITED CDM | $281.60 | $352.00 | — | 9% below | 20% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC US EXAM PELVIC LIMITED | $281.60 | $352.00 | — | 9% below | 20% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC PR 76857 US EXAM PELVIC LIMITED | $71.20 | $89.00 | — | — | 20% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC US ED EXAM PELVIC LIMITED CDM | $281.60 | $352.00 | — | — | 20% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC US EXAM PELVIC FOLLICLE LIMITED | $281.60 | $352.00 | — | — | 20% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC US EXAM PELVIC LIMITED | $281.60 | $352.00 | — | — | 20% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HC PR 76856 US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE RHC | $156.00 | $195.00 | — | 71% below | 20% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HC US PELVIC NON-OB COMPLETE | $561.60 | $702.00 | — | 4% above | 20% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 HC US PELVIC NON-OB COMPLETE | $561.60 | $702.00 | — | — | 20% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC PR 76805 US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION RHC | $200.00 | $250.00 | — | 58% below | 20% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US OB AFTER 1ST TRIMEST 1/1ST FETUS | $710.40 | $888.00 | — | 49% above | 20% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC US OB AFTER 1ST TRIMEST 1/1ST FETUS | $710.40 | $888.00 | — | — | 20% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 HC PR 76801 US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT RHC | $173.60 | $217.00 | — | 61% below | 20% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby one side CPT 76801 HC US OB LT 14 WKS SINGLE FETUS CDM | $375.20 | $469.00 | — | 15% below | 20% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient one side CPT 76801 HC US OB LT 14 WKS SINGLE FETUS CDM | $375.20 | $469.00 | — | — | 20% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC PR 76815 US PREGNANT UTERUS LIMITED 1/> FETUSES RHC | $120.80 | $151.00 | — | 64% below | 20% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC PR 76815 US OB LIMITED FETUS(S) | $121.60 | $152.00 | — | 63% below | 20% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC PR 76815 US OB LIMITED FETUS(S) | $121.60 | $152.00 | — | 63% below | 20% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC US ED OB LIMITED FETUS(S) CDM | $280.80 | $351.00 | — | 15% below | 20% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC US OB LIMITED FETUS(S) CDM | $280.80 | $351.00 | — | 15% below | 20% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC PR 76815 US OB LIMITED FETUS(S) | $121.60 | $152.00 | — | — | 20% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC US ED OB LIMITED FETUS(S) CDM | $280.80 | $351.00 | — | — | 20% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC US OB LIMITED FETUS(S) CDM | $280.80 | $351.00 | — | — | 20% |
| Rib X-ray, one side, 2 views CPT 71100 HC XR RIBS UNI 2 VIEWS | $308.80 | $386.00 | — | 33% above | 20% |
| Rib X-ray, one side, 2 views inpatient CPT 71100 HC XR RIBS UNI 2 VIEWS | $308.80 | $386.00 | — | — | 20% |
| Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 HC XR RIBS/CHEST UNI MIN 3 VIEWS | $357.60 | $447.00 | — | 28% above | 20% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient CPT 71101 HC XR RIBS/CHEST UNI MIN 3 VIEWS | $357.60 | $447.00 | — | — | 20% |
| Screening mammogram, both breasts both sides CPT 77067 HC SCREEN MAMMO BI INCL CAD | $283.20 | $354.00 | — | — | 20% |
| Screening mammogram, both breasts CPT 77067 HC MAMMO SCREEN UNIL/BIL W CAD | $283.20 | $354.00 | — | 3% above | 20% |
| Screening mammogram, both breasts CPT 77067 HC MAMMO SCREEN BIL W CAD | $283.20 | $354.00 | — | 3% above | 20% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 HC SCREEN MAMMO BI INCL CAD | $283.20 | $354.00 | — | — | 20% |
| Screening mammogram, both breasts inpatient CPT 77067 HC MAMMO SCREEN UNIL/BIL W CAD | $283.20 | $354.00 | — | — | 20% |
| Screening mammogram, both breasts inpatient CPT 77067 HC MAMMO SCREEN BIL W CAD | $283.20 | $354.00 | — | — | 20% |
| Shoulder X-ray, complete, 2 or more views CPT 73030 HC XR SHOULDER COMPLETE MIN 2 VIEWS | $239.20 | $299.00 | — | 10% above | 20% |
| Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 HC XR SHOULDER COMPLETE MIN 2 VIEWS | $239.20 | $299.00 | — | — | 20% |
| Sinus X-ray, complete, 3 or more views CPT 70220 HC XR SINUSES PARANASAL MIN 3 VIEWS | $290.40 | $363.00 | — | 13% above | 20% |
| Sinus X-ray, complete, 3 or more views inpatient CPT 70220 HC XR SINUSES PARANASAL MIN 3 VIEWS | $290.40 | $363.00 | — | — | 20% |
| Skull X-ray, fewer than 4 views CPT 70250 HC XR SKULL 1-3 VIEWS | $225.60 | $282.00 | — | 5% below | 20% |
| Skull X-ray, fewer than 4 views inpatient CPT 70250 HC XR SKULL 1-3 VIEWS | $225.60 | $282.00 | — | — | 20% |
| Sleep study in a lab (polysomnography) CPT 95810 HC PR 95810 POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND RHC | $933.60 | $1,167.00 | — | 55% below | 20% |
| Sleep study in a lab (polysomnography) CPT 95810 HC POLYSOMNOGRAPHY 4 OR MORE | $1,616.80 | $2,021.00 | — | 23% below | 20% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 HC POLYSOMNOGRAPHY 4 OR MORE | $1,616.80 | $2,021.00 | — | — | 20% |
| Stress echocardiogram, complete, including the stress test and supervision CPT 93351 HC PR 93351 ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG RHC | $341.60 | $427.00 | — | 71% below | 20% |
| Swallow study (modified barium swallow, video X-ray) CPT 74230 HC XR RADIOLOGIC EXAM SWALLOW FUNCTION CONTRAST STUDY | $475.20 | $594.00 | — | 10% above | 20% |
| Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 HC XR RADIOLOGIC EXAM SWALLOW FUNCTION CONTRAST STUDY | $475.20 | $594.00 | — | — | 20% |
| Thigh bone (femur) X-ray, 2 or more views CPT 73552 HC XR FEMUR MIN 2 VIEWS | $178.40 | $223.00 | — | 17% below | 20% |
| Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 HC XR FEMUR MIN 2 VIEWS | $178.40 | $223.00 | — | — | 20% |
| Thoracic spine (mid back) CT scan without contrast CPT 72128 HC CT CHEST SPINE WO CONTRAST | $1,428.00 | $1,785.00 | — | 1% above | 20% |
| Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 HC CT CHEST SPINE WO CONTRAST | $1,428.00 | $1,785.00 | — | — | 20% |
| Toe X-ray, 2 or more views CPT 73660 HC XR TOE(S) MIN 2 VIEWS | $148.00 | $185.00 | — | 15% below | 20% |
| Toe X-ray, 2 or more views inpatient CPT 73660 HC XR TOE(S) MIN 2 VIEWS | $148.00 | $185.00 | — | — | 20% |
| Transvaginal pelvic ultrasound CPT 76830 HC PR 76830 TRANSVAGINAL US NON-OB RHC | $175.20 | $219.00 | — | 58% below | 20% |
| Transvaginal pelvic ultrasound CPT 76830 HC US TRANSVAGINAL NON-OB | $457.60 | $572.00 | — | 9% above | 20% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 HC US TRANSVAGINAL NON-OB | $457.60 | $572.00 | — | — | 20% |
| Transvaginal ultrasound during pregnancy CPT 76817 HC PR 76817 US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG RHC | $136.80 | $171.00 | — | 66% below | 20% |
| Transvaginal ultrasound during pregnancy CPT 76817 HC PR 76817 US OB TRANSVAGINAL | $138.40 | $173.00 | — | 65% below | 20% |
| Transvaginal ultrasound during pregnancy CPT 76817 HC PR 76817 US OB TRANSVAGINAL | $138.40 | $173.00 | — | 65% below | 20% |
| Transvaginal ultrasound during pregnancy CPT 76817 HC US OB TRANSVAGINAL CDM | $544.00 | $680.00 | — | 37% above | 20% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 HC PR 76817 US OB TRANSVAGINAL | $138.40 | $173.00 | — | — | 20% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 HC US OB TRANSVAGINAL CDM | $544.00 | $680.00 | — | — | 20% |
| Ultrasound of the abdomen, complete CPT 76700 HC US EXAM ABDOMEN COMPLETE | $431.20 | $539.00 | — | 18% below | 20% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 HC US EXAM ABDOMEN COMPLETE | $431.20 | $539.00 | — | — | 20% |
| Ultrasound of the scrotum and testicles CPT 76870 HC US EXAM SCROTUM & CONTENTS | $477.60 | $597.00 | — | 4% below | 20% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 HC US EXAM SCROTUM & CONTENTS | $477.60 | $597.00 | — | — | 20% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC US EXAM OF HEAD AND NECK | $433.60 | $542.00 | — | 1% above | 20% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC US ED EXAM OF HEAD AND NECK CDM | $433.60 | $542.00 | — | 1% above | 20% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HC US EXAM OF HEAD AND NECK | $433.60 | $542.00 | — | — | 20% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HC US ED EXAM OF HEAD AND NECK CDM | $433.60 | $542.00 | — | — | 20% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 HC XR RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY CDM | $602.40 | $753.00 | — | 32% above | 20% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 HC XR RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY CDM | $602.40 | $753.00 | — | — | 20% |
| Upper arm X-ray (humerus), 2 views CPT 73060 HC XR HUMERUS 1 VIEW | $141.60 | $177.00 | — | 29% below | 20% |
| Upper arm X-ray (humerus), 2 views CPT 73060 HC XR HUMERUS MIN 2 VIEWS | $193.60 | $242.00 | — | 4% below | 20% |
| Upper arm X-ray (humerus), 2 views inpatient CPT 73060 HC XR HUMERUS 1 VIEW | $141.60 | $177.00 | — | — | 20% |
| Upper arm X-ray (humerus), 2 views inpatient CPT 73060 HC XR HUMERUS MIN 2 VIEWS | $193.60 | $242.00 | — | — | 20% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 HC DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY | $432.80 | $541.00 | — | 32% below | 20% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 HC DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY | $432.80 | $541.00 | — | — | 20% |
| Wrist X-ray, 2 views CPT 73100 HC XR WRIST 1 VIEW | $180.80 | $226.00 | — | 2% above | 20% |
| Wrist X-ray, 2 views CPT 73100 HC XR WRIST 2 VIEWS | $190.40 | $238.00 | — | 7% above | 20% |
| Wrist X-ray, 2 views inpatient CPT 73100 HC XR WRIST 1 VIEW | $180.80 | $226.00 | — | — | 20% |
| Wrist X-ray, 2 views inpatient CPT 73100 HC XR WRIST 2 VIEWS | $190.40 | $238.00 | — | — | 20% |
| Wrist X-ray, complete, 3 or more views CPT 73110 HC XR WRIST COMPLETE MIN 3 VIEWS | $239.20 | $299.00 | — | 10% above | 20% |
| Wrist X-ray, complete, 3 or more views inpatient CPT 73110 HC XR WRIST COMPLETE MIN 3 VIEWS | $239.20 | $299.00 | — | — | 20% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 HC XR HIPS UNI W PELVIS WHEN PERFORMED 2-3 VIEWS | $178.40 | $223.00 | — | 15% below | 20% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 HC XR HIPS UNI W PELVIS WHEN PERFORMED 2-3 VIEWS | $178.40 | $223.00 | — | — | 20% |
| X-ray of the abdomen, 1 view CPT 74018 HC XR ABDOMEN PORTABLE 1 VIEW | $180.00 | $225.00 | — | at median | 20% |
| X-ray of the abdomen, 1 view CPT 74018 HC XR ABDOMEN 1 VIEW | $180.00 | $225.00 | — | at median | 20% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 HC XR ABDOMEN 1 VIEW | $180.00 | $225.00 | — | — | 20% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 HC XR ABDOMEN PORTABLE 1 VIEW | $180.00 | $225.00 | — | — | 20% |
| X-ray of the ankle, 2 views CPT 73600 HC XR ANKLE 1 VIEW | $178.40 | $223.00 | — | at median | 20% |
| X-ray of the ankle, 2 views CPT 73600 HC XR ANKLE 2 VIEWS | $179.20 | $224.00 | — | at median | 20% |
| X-ray of the ankle, 2 views inpatient CPT 73600 HC XR ANKLE 1 VIEW | $178.40 | $223.00 | — | — | 20% |
| X-ray of the ankle, 2 views inpatient CPT 73600 HC XR ANKLE 2 VIEWS | $179.20 | $224.00 | — | — | 20% |
| X-ray of the finger(s), 2 or more views CPT 73140 HC XR FINGERS(S) MIN 2 VIEWS | $236.00 | $295.00 | — | 40% above | 20% |
| X-ray of the finger(s), 2 or more views inpatient CPT 73140 HC XR FINGERS(S) MIN 2 VIEWS | $236.00 | $295.00 | — | — | 20% |
| X-ray of the foot, 2 views CPT 73620 HC XR FOOT 1 VIEW | $112.80 | $141.00 | — | 34% below | 20% |
| X-ray of the foot, 2 views CPT 73620 HC XR FOOT 2 VIEWS | $172.80 | $216.00 | — | at median | 20% |
| X-ray of the foot, 2 views inpatient CPT 73620 HC XR FOOT 1 VIEW | $112.80 | $141.00 | — | — | 20% |
| X-ray of the foot, 2 views inpatient CPT 73620 HC XR FOOT 2 VIEWS | $172.80 | $216.00 | — | — | 20% |
| X-ray of the foot, complete, 3 or more views CPT 73630 HC XR FOOT MIN 3 VIEWS | $236.00 | $295.00 | — | at median | 20% |
| X-ray of the foot, complete, 3 or more views inpatient CPT 73630 HC XR FOOT MIN 3 VIEWS | $236.00 | $295.00 | — | — | 20% |
| X-ray of the hand, 3 or more views CPT 73130 HC XR HAND MIN 3 VIEWS | $225.60 | $282.00 | — | 1% below | 20% |
| X-ray of the hand, 3 or more views inpatient CPT 73130 HC XR HAND MIN 3 VIEWS | $225.60 | $282.00 | — | — | 20% |
| X-ray of the knee, 1 or 2 views CPT 73560 HC XR KNEE 1-2 VIEWS | $192.00 | $240.00 | — | 8% above | 20% |
| X-ray of the knee, 1 or 2 views inpatient CPT 73560 HC XR KNEE 1-2 VIEWS | $192.00 | $240.00 | — | — | 20% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HC XR SPINE LUMBOSACRAL 2 OR 3 VIEWS | $260.80 | $326.00 | — | 3% above | 20% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 HC XR SPINE LUMBOSACRAL 2 OR 3 VIEWS | $260.80 | $326.00 | — | — | 20% |
| X-ray of the lower back, 4 or more views CPT 72110 HC SPINE LUMBOSACRAL MIN 4 VIEWS | $330.40 | $413.00 | — | 1% below | 20% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 HC SPINE LUMBOSACRAL MIN 4 VIEWS | $330.40 | $413.00 | — | — | 20% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 HC XR SPINE THORACIC 2 VIEWS | $165.60 | $207.00 | — | 26% below | 20% |
| X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 HC XR SPINE THORACIC 2 VIEWS | $165.60 | $207.00 | — | — | 20% |
| X-ray of the nasal bones, 3 or more views CPT 70160 HC XR NASAL BONES MIN 3 VIEWS | $208.80 | $261.00 | — | 1% below | 20% |
| X-ray of the nasal bones, 3 or more views inpatient CPT 70160 HC XR NASAL BONES MIN 3 VIEWS | $208.80 | $261.00 | — | — | 20% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 HC XR SPINE CERVICAL 2 OR 3 VIEWS | $241.60 | $302.00 | — | 12% above | 20% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 HC XR SPINE CERVICAL 2 OR 3 VIEWS | $241.60 | $302.00 | — | — | 20% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 HC XR PELVIS 1-2 VIEWS NO HIP VIEWS | $198.40 | $248.00 | — | 9% below | 20% |
| X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 HC XR PELVIS 1-2 VIEWS NO HIP VIEWS | $198.40 | $248.00 | — | — | 20% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 HC XR TAILBONE MIN 2 VIEWS | $251.20 | $314.00 | — | 8% above | 20% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 HC XR TAILBONE MIN 2 VIEWS | $251.20 | $314.00 | — | — | 20% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Montana | Off list |
|---|---|---|---|---|---|
| ACTH blood test CPT 82024 HC ADRENOCORTICOTROPIC HORMONE ACTH CDM | $202.40 | $253.00 | — | 10% below | 20% |
| ACTH blood test inpatient CPT 82024 HC ADRENOCORTICOTROPIC HORMONE ACTH CDM | $202.40 | $253.00 | — | — | 20% |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC V FIBROSURE SGPT | $24.00 | $30.00 | — | 54% below | 20% |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC SGPT (ALT) | $35.20 | $44.00 | — | 32% below | 20% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 HC V FIBROSURE SGPT | $24.00 | $30.00 | — | — | 20% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 HC SGPT (ALT) | $35.20 | $44.00 | — | — | 20% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 HC SGOT (AST) | $35.20 | $44.00 | — | 30% below | 20% |
| AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 HC SGOT (AST) | $35.20 | $44.00 | — | — | 20% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HC HEPATITIS ACUTE PANEL | $173.60 | $217.00 | — | 16% below | 20% |
| Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HC HEPATITIS ACUTE PANEL | $173.60 | $217.00 | — | — | 20% |
| Albumin blood test CPT 82040 HC ALBUMIN SERUM PLASMA/WHOLE BLOOD CDM | $18.40 | $23.00 | — | 40% below | 20% |
| Albumin blood test CPT 82040 HC ASSAY OF SERUM ALBUMIN | $23.20 | $29.00 | — | 25% below | 20% |
| Albumin blood test CPT 82040 HC ALBUMIN SERUM PLASMA/WHOLE BLOOD LAB | $23.20 | $29.00 | — | 25% below | 20% |
| Albumin blood test inpatient CPT 82040 HC ALBUMIN SERUM PLASMA/WHOLE BLOOD CDM | $18.40 | $23.00 | — | — | 20% |
| Albumin blood test inpatient CPT 82040 HC ASSAY OF SERUM ALBUMIN | $23.20 | $29.00 | — | — | 20% |
| Albumin blood test inpatient CPT 82040 HC ALBUMIN SERUM PLASMA/WHOLE BLOOD LAB | $23.20 | $29.00 | — | — | 20% |
| Aldosterone blood test CPT 82088 HC ALDOSTERONE BLD | $80.00 | $100.00 | — | 60% below | 20% |
| Aldosterone blood test CPT 82088 HC ALDOSTERONE (24HR UR) | $148.80 | $186.00 | — | 25% below | 20% |
| Aldosterone blood test CPT 82088 HC ASSAY OF ALDOSTERONE CDM | $170.40 | $213.00 | — | 14% below | 20% |
| Aldosterone blood test CPT 82088 HC ASSAY OF ALDOSTERONE PLASMA LAB | $170.40 | $213.00 | — | 14% below | 20% |
| Aldosterone blood test inpatient CPT 82088 HC ALDOSTERONE BLD | $80.00 | $100.00 | — | — | 20% |
| Aldosterone blood test inpatient CPT 82088 HC ALDOSTERONE (24HR UR) | $148.80 | $186.00 | — | — | 20% |
| Aldosterone blood test inpatient CPT 82088 HC ASSAY OF ALDOSTERONE CDM | $170.40 | $213.00 | — | — | 20% |
| Aldosterone blood test inpatient CPT 82088 HC ASSAY OF ALDOSTERONE PLASMA LAB | $170.40 | $213.00 | — | — | 20% |
| Alkaline phosphatase (ALP) blood test CPT 84075 HC ASSAY OF PHOSPHATASE ALKALINE LAB | $35.20 | $44.00 | — | 39% below | 20% |
| Alkaline phosphatase (ALP) blood test CPT 84075 HC ALKALINE PHOS | $35.20 | $44.00 | — | 39% below | 20% |
| Alkaline phosphatase (ALP) blood test CPT 84075 HC ALK PHOS | $52.80 | $66.00 | — | 8% below | 20% |
| Alkaline phosphatase (ALP) blood test CPT 84075 HC ALK PHOS TOTAL | $52.80 | $66.00 | — | 8% below | 20% |
| Alkaline phosphatase (ALP) blood test inpatient CPT 84075 HC ASSAY OF PHOSPHATASE ALKALINE LAB | $35.20 | $44.00 | — | — | 20% |
| Alkaline phosphatase (ALP) blood test inpatient CPT 84075 HC ALKALINE PHOS | $35.20 | $44.00 | — | — | 20% |
| Alkaline phosphatase (ALP) blood test inpatient CPT 84075 HC ALK PHOS TOTAL | $52.80 | $66.00 | — | — | 20% |
| Alkaline phosphatase (ALP) blood test inpatient CPT 84075 HC ALK PHOS | $52.80 | $66.00 | — | — | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPECIFIC IGE - ADULT | $8.00 | $10.00 | — | 83% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPECIFIC IGE - 36 | $9.60 | $12.00 | — | 80% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPECIFIC IGE - 31 | $9.60 | $12.00 | — | 80% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPECIFIC IGE PANEL EACH ALLERGEN | $11.20 | $14.00 | — | 76% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH | $11.20 | $14.00 | — | 76% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPECIFIC IGE - INTERMT WST | $11.20 | $14.00 | — | 76% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPECIFIC IGE - PEDS | $13.60 | $17.00 | — | 71% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPECIFIC IGE - IGE QUANT | $14.40 | $18.00 | — | 70% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPECIFIC IGE - EA | $28.80 | $36.00 | — | 39% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB | $28.80 | $36.00 | — | 39% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH CDM | $52.80 | $66.00 | — | 11% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPECIFIC IGE - ROCKY MT | $67.20 | $84.00 | — | 42% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPECIFIC IGE - IGE ALLERGEN | $149.60 | $187.00 | — | 215% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPECIFIC IGE | $336.80 | $421.00 | — | 610% above | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPECIFIC IGE - ADULT | $8.00 | $10.00 | — | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPECIFIC IGE - 31 | $9.60 | $12.00 | — | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPECIFIC IGE - 36 | $9.60 | $12.00 | — | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPECIFIC IGE PANEL EACH ALLERGEN | $11.20 | $14.00 | — | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPECIFIC IGE - INTERMT WST | $11.20 | $14.00 | — | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH | $11.20 | $14.00 | — | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPECIFIC IGE - PEDS | $13.60 | $17.00 | — | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPECIFIC IGE - IGE QUANT | $14.40 | $18.00 | — | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB | $28.80 | $36.00 | — | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPECIFIC IGE - EA | $28.80 | $36.00 | — | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH CDM | $52.80 | $66.00 | — | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPECIFIC IGE - ROCKY MT | $67.20 | $84.00 | — | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPECIFIC IGE - IGE ALLERGEN | $149.60 | $187.00 | — | — | 20% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN SPECIFIC IGE | $336.80 | $421.00 | — | — | 20% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 HC ALPHA-FETOPROTEIN SERUM CDM | $144.80 | $181.00 | — | 25% above | 20% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 HC ALPHA-FETOPROTEIN SERUM LAB | $144.80 | $181.00 | — | 25% above | 20% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 HC ALPHA-FETOPROTEIN SERUM/TRIPLE SCREEN | $144.80 | $181.00 | — | 25% above | 20% |
| Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 HC ALPHA-FETOPROTEIN SERUM/TRIPLE SCREEN | $144.80 | $181.00 | — | — | 20% |
| Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 HC ALPHA-FETOPROTEIN SERUM LAB | $144.80 | $181.00 | — | — | 20% |
| Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 HC ALPHA-FETOPROTEIN SERUM CDM | $144.80 | $181.00 | — | — | 20% |
| Ammonia blood test CPT 82140 HC ASSAY OF AMMONIA LAB | $188.80 | $236.00 | — | 52% above | 20% |
| Ammonia blood test inpatient CPT 82140 HC ASSAY OF AMMONIA LAB | $188.80 | $236.00 | — | — | 20% |
| Amylase blood test CPT 82150 HC AMYLASE | $35.20 | $44.00 | — | 39% below | 20% |
| Amylase blood test CPT 82150 HC ASSAY OF AMYLASE LAB | $35.20 | $44.00 | — | 39% below | 20% |
| Amylase blood test CPT 82150 HC ASSAY OF AMYLASE | $35.20 | $44.00 | — | 39% below | 20% |
| Amylase blood test CPT 82150 HC ASSAY OF AMYLASE ISOENZYME PANCREATIC | $110.40 | $138.00 | — | 93% above | 20% |
| Amylase blood test CPT 82150 HC ASSAY OF AMYLASE ISOENZYME | $110.40 | $138.00 | — | 93% above | 20% |
| Amylase blood test inpatient CPT 82150 HC ASSAY OF AMYLASE | $35.20 | $44.00 | — | — | 20% |
| Amylase blood test inpatient CPT 82150 HC AMYLASE | $35.20 | $44.00 | — | — | 20% |
| Amylase blood test inpatient CPT 82150 HC ASSAY OF AMYLASE LAB | $35.20 | $44.00 | — | — | 20% |
| Amylase blood test inpatient CPT 82150 HC ASSAY OF AMYLASE ISOENZYME PANCREATIC | $110.40 | $138.00 | — | — | 20% |
| Amylase blood test inpatient CPT 82150 HC ASSAY OF AMYLASE ISOENZYME | $110.40 | $138.00 | — | — | 20% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 HC CCP ANTIBODY | $83.20 | $104.00 | — | 14% below | 20% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 HC CYCLIC CITRULLINATED PEPTIDE ANTIBODY LAB | $83.20 | $104.00 | — | 14% below | 20% |
| Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 HC CCP ANTIBODY | $83.20 | $104.00 | — | — | 20% |
| Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 HC CYCLIC CITRULLINATED PEPTIDE ANTIBODY LAB | $83.20 | $104.00 | — | — | 20% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANTINUCLEAR ANTIBODIES - ANA | $19.20 | $24.00 | — | 74% below | 20% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANTINUCLEAR ANTIBODIES3 | $48.80 | $61.00 | — | 35% below | 20% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANTINUCLEAR ANTIBODIES ANA LAB | $51.20 | $64.00 | — | 31% below | 20% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANTINUCLEAR ANTIBODIES - ANA AB | $51.20 | $64.00 | — | 31% below | 20% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANTINUCLEAR ANTIBODIES | $51.20 | $64.00 | — | 31% below | 20% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANTINUCLEAR ANTIBODIES_1 AB | $51.20 | $64.00 | — | 31% below | 20% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANTINUCLEAR ANTIBODIES PAML | $51.20 | $64.00 | — | 31% below | 20% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANTINUCLEAR ANTIBODIES SCREEN - REFLEXIVE | $55.20 | $69.00 | — | 26% below | 20% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC ANTINUCLEAR ANTIBODIES - ANA | $19.20 | $24.00 | — | — | 20% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC ANTINUCLEAR ANTIBODIES3 | $48.80 | $61.00 | — | — | 20% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC ANTINUCLEAR ANTIBODIES | $51.20 | $64.00 | — | — | 20% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC ANTINUCLEAR ANTIBODIES - ANA AB | $51.20 | $64.00 | — | — | 20% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC ANTINUCLEAR ANTIBODIES_1 AB | $51.20 | $64.00 | — | — | 20% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC ANTINUCLEAR ANTIBODIES ANA LAB | $51.20 | $64.00 | — | — | 20% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC ANTINUCLEAR ANTIBODIES PAML | $51.20 | $64.00 | — | — | 20% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC ANTINUCLEAR ANTIBODIES SCREEN - REFLEXIVE | $55.20 | $69.00 | — | — | 20% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HC NATRIURETIC PEPTIDE LAB | $174.40 | $218.00 | — | 23% below | 20% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HC NATRIURETIC PEPTIDE | $174.40 | $218.00 | — | 23% below | 20% |
| BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 HC NATRIURETIC PEPTIDE LAB | $174.40 | $218.00 | — | — | 20% |
| BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 HC NATRIURETIC PEPTIDE | $174.40 | $218.00 | — | — | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE BACTERIA OTHER - DIALYSIS/DIALYSATE | $46.40 | $58.00 | — | 38% below | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE BACTERIA OTHER - MISC/OTHER/ROUTINE | $81.60 | $102.00 | — | 8% above | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE BACTERIA OTHER - RESPIRATORY | $81.60 | $102.00 | — | 8% above | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL CDM | $81.60 | $102.00 | — | 8% above | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE BACTERIA OTHER | $118.40 | $148.00 | — | 57% above | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL LAB | $118.40 | $148.00 | — | 57% above | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC CULTURE BACTERIA OTHER - DIALYSIS/DIALYSATE | $46.40 | $58.00 | — | — | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC CULTURE BACTERIA OTHER - MISC/OTHER/ROUTINE | $81.60 | $102.00 | — | — | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC CULTURE BACTERIA OTHER - RESPIRATORY | $81.60 | $102.00 | — | — | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL CDM | $81.60 | $102.00 | — | — | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL LAB | $118.40 | $148.00 | — | — | 20% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC CULTURE BACTERIA OTHER | $118.40 | $148.00 | — | — | 20% |
| Basic metabolic panel (blood test) CPT 80048 HC BASIC METABOLIC PANEL | $85.60 | $107.00 | — | 9% below | 20% |
| Basic metabolic panel (blood test) inpatient CPT 80048 HC BASIC METABOLIC PANEL | $85.60 | $107.00 | — | — | 20% |
| Bilirubin blood test, total CPT 82247 HC V FIBROSURE BILIRUBIN TOTAL | $35.20 | $44.00 | — | 29% below | 20% |
| Bilirubin blood test, total CPT 82247 HC BILIRUBIN TOTAL CDM | $35.20 | $44.00 | — | 29% below | 20% |
| Bilirubin blood test, total CPT 82247 HC BILIRUBIN TOTAL LAB | $35.20 | $44.00 | — | 29% below | 20% |
| Bilirubin blood test, total CPT 82247 HC BILIRUBIN TOTAL | $35.20 | $44.00 | — | 29% below | 20% |
| Bilirubin blood test, total CPT 82247 HC BILIRUBIN TOTAL BODY FLUID | $52.80 | $66.00 | — | 6% above | 20% |
| Bilirubin blood test, total inpatient CPT 82247 HC V FIBROSURE BILIRUBIN TOTAL | $35.20 | $44.00 | — | — | 20% |
| Bilirubin blood test, total inpatient CPT 82247 HC BILIRUBIN TOTAL LAB | $35.20 | $44.00 | — | — | 20% |
| Bilirubin blood test, total inpatient CPT 82247 HC BILIRUBIN TOTAL | $35.20 | $44.00 | — | — | 20% |
| Bilirubin blood test, total inpatient CPT 82247 HC BILIRUBIN TOTAL CDM | $35.20 | $44.00 | — | — | 20% |
| Bilirubin blood test, total inpatient CPT 82247 HC BILIRUBIN TOTAL BODY FLUID | $52.80 | $66.00 | — | — | 20% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | $96.00 | $120.00 | — | 52% below | 20% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM MUSCLE BIOPSY | $216.00 | $270.00 | — | 7% above | 20% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC MULTKBXH | $223.20 | $279.00 | — | 11% above | 20% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM LAB | $96.00 | $120.00 | — | — | 20% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM MUSCLE BIOPSY | $216.00 | $270.00 | — | — | 20% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC MULTKBXH | $223.20 | $279.00 | — | — | 20% |
| Blood culture for bacteria CPT 87040 HC BLOOD CULTURE FOR BACTERIA | $140.80 | $176.00 | — | 7% below | 20% |
| Blood culture for bacteria inpatient CPT 87040 HC BLOOD CULTURE FOR BACTERIA | $140.80 | $176.00 | — | — | 20% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC PR 36415 ROUTINE VENIPUNCTURE | $18.40 | $23.00 | — | 3% below | 20% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC BLOOD DRAW VENIPUNCTURE CDM | $18.40 | $23.00 | — | 3% below | 20% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC PR 36415 ROUTINE VENIPUNCTURE | $18.40 | $23.00 | — | 3% below | 20% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC ROUTINE VENIPUNCTURE - PERIPHERAL LAB | $20.80 | $26.00 | — | 9% above | 20% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC BLOOD DRAW VENIPUNCTURE CDM | $20.80 | $26.00 | — | 9% above | 20% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC ROUTINE VENIPUNCTURE - COLLECTION VENOUS BLD CDM | $20.80 | $26.00 | — | 9% above | 20% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC COLLECTION VENOUS BLOOD VENIPUNCTURE CDM | $85.60 | $107.00 | — | 351% above | 20% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC PR 36415 ROUTINE VENIPUNCTURE | $18.40 | $23.00 | — | — | 20% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC ROUTINE VENIPUNCTURE - PERIPHERAL LAB | $20.80 | $26.00 | — | — | 20% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC ROUTINE VENIPUNCTURE - COLLECTION VENOUS BLD CDM | $20.80 | $26.00 | — | — | 20% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC BLOOD DRAW VENIPUNCTURE CDM | $20.80 | $26.00 | — | — | 20% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC COLLECTION VENOUS BLOOD VENIPUNCTURE CDM | $85.60 | $107.00 | — | — | 20% |
| Blood glucose (sugar) test CPT 82947 HC GLUCOSE QUANTITATIVE BLOOD (EXCEPT REAGENT STRIP) | $35.20 | $44.00 | — | 10% below | 20% |
| Blood glucose (sugar) test CPT 82947 HC ASSAY GLUCOSE BLOOD QUANT | $35.20 | $44.00 | — | 10% below | 20% |
| Blood glucose (sugar) test inpatient CPT 82947 HC ASSAY GLUCOSE BLOOD QUANT | $35.20 | $44.00 | — | — | 20% |
| Blood glucose (sugar) test inpatient CPT 82947 HC GLUCOSE QUANTITATIVE BLOOD (EXCEPT REAGENT STRIP) | $35.20 | $44.00 | — | — | 20% |
| Blood lead test CPT 83655 HC LEAD | $43.20 | $54.00 | — | 27% below | 20% |
| Blood lead test CPT 83655 HC HVY MET UR - LEAD | $92.80 | $116.00 | — | 58% above | 20% |
| Blood lead test CPT 83655 HC ASSAY OF LEAD CDM | $92.80 | $116.00 | — | 58% above | 20% |
| Blood lead test CPT 83655 HC LEAD RANDOM URINE | $92.80 | $116.00 | — | 58% above | 20% |
| Blood lead test CPT 83655 HC ASSAY OF LEAD SERUM LAB | $98.40 | $123.00 | — | 67% above | 20% |
| Blood lead test CPT 83655 HC LEAD BLOOD | $112.80 | $141.00 | — | 92% above | 20% |
| Blood lead test CPT 83655 HC HVY MET BLD - LEAD | $112.80 | $141.00 | — | 92% above | 20% |
| Blood lead test CPT 83655 HC ASSAY OF LEAD LAB | $112.80 | $141.00 | — | 92% above | 20% |
| Blood lead test inpatient CPT 83655 HC LEAD | $43.20 | $54.00 | — | — | 20% |
| Blood lead test inpatient CPT 83655 HC HVY MET UR - LEAD | $92.80 | $116.00 | — | — | 20% |
| Blood lead test inpatient CPT 83655 HC ASSAY OF LEAD CDM | $92.80 | $116.00 | — | — | 20% |
| Blood lead test inpatient CPT 83655 HC LEAD RANDOM URINE | $92.80 | $116.00 | — | — | 20% |
| Blood lead test inpatient CPT 83655 HC ASSAY OF LEAD SERUM LAB | $98.40 | $123.00 | — | — | 20% |
| Blood lead test inpatient CPT 83655 HC ASSAY OF LEAD LAB | $112.80 | $141.00 | — | — | 20% |
| Blood lead test inpatient CPT 83655 HC HVY MET BLD - LEAD | $112.80 | $141.00 | — | — | 20% |
| Blood lead test inpatient CPT 83655 HC LEAD BLOOD | $112.80 | $141.00 | — | — | 20% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HC CHORIONIC GONADOTROPIN QUAL | $35.20 | $44.00 | — | 51% below | 20% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HC GONADOTROPIN CHORIONIC QUALITATIVE CDM | $71.20 | $89.00 | — | at median | 20% |
| Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HC CHORIONIC GONADOTROPIN QUAL | $35.20 | $44.00 | — | — | 20% |
| Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HC GONADOTROPIN CHORIONIC QUALITATIVE CDM | $71.20 | $89.00 | — | — | 20% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HC BLOOD TYPING SEROLOGIC ABO | $9.60 | $12.00 | — | 87% below | 20% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HC BLOOD TYPING SEROLOGIC ABO CDM | $60.00 | $75.00 | — | 17% below | 20% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HC BLOOD TYPING SEROLOGIC ABO LAB | $64.80 | $81.00 | — | 10% below | 20% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HC BLOOD TYPING SEROLOGIC ABO | $9.60 | $12.00 | — | — | 20% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HC BLOOD TYPING SEROLOGIC ABO CDM | $60.00 | $75.00 | — | — | 20% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HC BLOOD TYPING SEROLOGIC ABO LAB | $64.80 | $81.00 | — | — | 20% |
| Blood urea nitrogen (BUN) test CPT 84520 HC BUN | $35.20 | $44.00 | — | 26% below | 20% |
| Blood urea nitrogen (BUN) test CPT 84520 HC ASSAY OF UREA NITROGEN QUANTITATIVE LAB | $35.20 | $44.00 | — | 26% below | 20% |
| Blood urea nitrogen (BUN) test CPT 84520 HC UREA NITROGEN BODY FLUID | $52.80 | $66.00 | — | 11% above | 20% |
| Blood urea nitrogen (BUN) test CPT 84520 HC BLOOD UREA NITROGEN-CD91 | $52.80 | $66.00 | — | 11% above | 20% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 HC ASSAY OF UREA NITROGEN QUANTITATIVE LAB | $35.20 | $44.00 | — | — | 20% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 HC BUN | $35.20 | $44.00 | — | — | 20% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 HC UREA NITROGEN BODY FLUID | $52.80 | $66.00 | — | — | 20% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 HC BLOOD UREA NITROGEN-CD91 | $52.80 | $66.00 | — | — | 20% |
| C-peptide blood test CPT 84681 HC ASSAY OF C-PEPTIDE CDM | $117.60 | $147.00 | — | 21% below | 20% |
| C-peptide blood test inpatient CPT 84681 HC ASSAY OF C-PEPTIDE CDM | $117.60 | $147.00 | — | — | 20% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC C-REACTIVE PROTEIN - AIP | $14.40 | $18.00 | — | 78% below | 20% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC C-REACTIVE PROTEIN LAB | $55.20 | $69.00 | — | 16% below | 20% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC C-REACTIVE PROTEIN | $55.20 | $69.00 | — | 16% below | 20% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC CRP | $81.60 | $102.00 | — | 24% above | 20% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 HC C-REACTIVE PROTEIN - AIP | $14.40 | $18.00 | — | — | 20% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 HC C-REACTIVE PROTEIN LAB | $55.20 | $69.00 | — | — | 20% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 HC C-REACTIVE PROTEIN | $55.20 | $69.00 | — | — | 20% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 HC CRP | $81.60 | $102.00 | — | — | 20% |
| C. difficile toxin gene test (stool PCR) CPT 87493 HC C DIFF PCR2 | $42.40 | $53.00 | — | 75% below | 20% |
| C. difficile toxin gene test (stool PCR) CPT 87493 HC INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE LAB | $98.40 | $123.00 | — | 42% below | 20% |
| C. difficile toxin gene test (stool PCR) CPT 87493 HC CLOSTRIDIUM DIFFICILE TOXINS AMPLIFIED PROBE | $237.60 | $297.00 | — | 41% above | 20% |
| C. difficile toxin gene test (stool PCR) inpatient CPT 87493 HC C DIFF PCR2 | $42.40 | $53.00 | — | — | 20% |
| C. difficile toxin gene test (stool PCR) inpatient CPT 87493 HC INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE LAB | $98.40 | $123.00 | — | — | 20% |
| C. difficile toxin gene test (stool PCR) inpatient CPT 87493 HC CLOSTRIDIUM DIFFICILE TOXINS AMPLIFIED PROBE | $237.60 | $297.00 | — | — | 20% |
| CA 19-9 blood test (tumor marker) CPT 86301 HC IMMUNOASSAY TUMOR CA 19-9 | $124.00 | $155.00 | — | 6% below | 20% |
| CA 19-9 blood test (tumor marker) inpatient CPT 86301 HC IMMUNOASSAY TUMOR CA 19-9 | $124.00 | $155.00 | — | — | 20% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125 LAB | $88.00 | $110.00 | — | 30% below | 20% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125 CDM | $88.00 | $110.00 | — | 30% below | 20% |
| CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125 LAB | $88.00 | $110.00 | — | — | 20% |
| CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125 CDM | $88.00 | $110.00 | — | — | 20% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ CDM | $117.60 | $147.00 | — | 3% below | 20% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ LAB | $117.60 | $147.00 | — | 3% below | 20% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ CDM | $117.60 | $147.00 | — | — | 20% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ LAB | $117.60 | $147.00 | — | — | 20% |
| Calcium blood test, total CPT 82310 HC CALCIUM TOTAL LAB | $35.20 | $44.00 | — | 1% above | 20% |
| Calcium blood test, total CPT 82310 HC CALCIUM SERUM | $35.20 | $44.00 | — | 1% above | 20% |
| Calcium blood test, total CPT 82310 HC CALCIUM TOTAL CDM | $52.80 | $66.00 | — | 52% above | 20% |
| Calcium blood test, total inpatient CPT 82310 HC CALCIUM SERUM | $35.20 | $44.00 | — | — | 20% |
| Calcium blood test, total inpatient CPT 82310 HC CALCIUM TOTAL LAB | $35.20 | $44.00 | — | — | 20% |
| Calcium blood test, total inpatient CPT 82310 HC CALCIUM TOTAL CDM | $52.80 | $66.00 | — | — | 20% |
| Carcinoembryonic antigen (CEA) test CPT 82378 HC CARCINOEMBRYONIC ANTIGEN CEA CDM | $91.20 | $114.00 | — | 15% below | 20% |
| Carcinoembryonic antigen (CEA) test inpatient CPT 82378 HC CARCINOEMBRYONIC ANTIGEN CEA CDM | $91.20 | $114.00 | — | — | 20% |
| Chickenpox (varicella) immunity blood test CPT 86787 HC ANTIBODY VARICELLA-ZOSTER CDM | $32.80 | $41.00 | — | 34% below | 20% |
| Chickenpox (varicella) immunity blood test CPT 86787 HC VARICELLA-ZOSTER ANTIBODY - IGG | $32.80 | $41.00 | — | 34% below | 20% |
| Chickenpox (varicella) immunity blood test CPT 86787 HC VARICELLA ZOSTER ANTIBODY | $68.80 | $86.00 | — | 39% above | 20% |
| Chickenpox (varicella) immunity blood test inpatient CPT 86787 HC VARICELLA-ZOSTER ANTIBODY - IGG | $32.80 | $41.00 | — | — | 20% |
| Chickenpox (varicella) immunity blood test inpatient CPT 86787 HC ANTIBODY VARICELLA-ZOSTER CDM | $32.80 | $41.00 | — | — | 20% |
| Chickenpox (varicella) immunity blood test inpatient CPT 86787 HC VARICELLA ZOSTER ANTIBODY | $68.80 | $86.00 | — | — | 20% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC CHLAMYDIA TRACHOMATIS PCR | $91.20 | $114.00 | — | at median | 20% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ LAB | $91.20 | $114.00 | — | at median | 20% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE | $91.20 | $114.00 | — | at median | 20% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ | $104.00 | $130.00 | — | 14% above | 20% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC CHLAMYDIA TRACHOMATIS AMPLIFIED DNA | $104.00 | $130.00 | — | 14% above | 20% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ LAB | $91.20 | $114.00 | — | — | 20% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HC CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE | $91.20 | $114.00 | — | — | 20% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HC CHLAMYDIA TRACHOMATIS PCR | $91.20 | $114.00 | — | — | 20% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ | $104.00 | $130.00 | — | — | 20% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HC CHLAMYDIA TRACHOMATIS AMPLIFIED DNA | $104.00 | $130.00 | — | — | 20% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC NMR-CHOLESTEROL TOTAL | $90.40 | $113.00 | — | 9% above | 20% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PANEL LAB | $90.40 | $113.00 | — | 9% above | 20% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PANEL | $90.40 | $113.00 | — | 9% above | 20% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC LIPID PANEL LAB | $90.40 | $113.00 | — | — | 20% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC LIPID PANEL | $90.40 | $113.00 | — | — | 20% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC NMR-CHOLESTEROL TOTAL | $90.40 | $113.00 | — | — | 20% |
| Complete blood count (CBC) with differential CPT 85025 HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC LAB | $40.80 | $51.00 | — | 48% below | 20% |
| Complete blood count (CBC) with differential CPT 85025 HC CBC WITH DIFF AUTO | $64.00 | $80.00 | — | 19% below | 20% |
| Complete blood count (CBC) with differential CPT 85025 HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC | $64.00 | $80.00 | — | 19% below | 20% |
| Complete blood count (CBC) with differential CPT 85025 HC ABSOLUTE LYMPH COUNT | $103.20 | $129.00 | — | 31% above | 20% |
| Complete blood count (CBC) with differential inpatient CPT 85025 HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC LAB | $40.80 | $51.00 | — | — | 20% |
| Complete blood count (CBC) with differential inpatient CPT 85025 HC CBC WITH DIFF AUTO | $64.00 | $80.00 | — | — | 20% |
| Complete blood count (CBC) with differential inpatient CPT 85025 HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC | $64.00 | $80.00 | — | — | 20% |
| Complete blood count (CBC) with differential inpatient CPT 85025 HC ABSOLUTE LYMPH COUNT | $103.20 | $129.00 | — | — | 20% |
| Complete blood count (CBC), no differential CPT 85027 HC CBC WITH NO DIFFERENTIAL | $62.40 | $78.00 | — | 24% above | 20% |
| Complete blood count (CBC), no differential CPT 85027 HC BLOOD COUNT COMPLETE AUTOMATED | $62.40 | $78.00 | — | 24% above | 20% |
| Complete blood count (CBC), no differential CPT 85027 HC BLOOD COUNT COMPLETE AUTOMATED LAB | $62.40 | $78.00 | — | 24% above | 20% |
| Complete blood count (CBC), no differential inpatient CPT 85027 HC BLOOD COUNT COMPLETE AUTOMATED | $62.40 | $78.00 | — | — | 20% |
| Complete blood count (CBC), no differential inpatient CPT 85027 HC BLOOD COUNT COMPLETE AUTOMATED LAB | $62.40 | $78.00 | — | — | 20% |
| Complete blood count (CBC), no differential inpatient CPT 85027 HC CBC WITH NO DIFFERENTIAL | $62.40 | $78.00 | — | — | 20% |
| Comprehensive metabolic panel (blood test) CPT 80053 HC COMPREHEN METABOLIC PANEL | $113.60 | $142.00 | — | 13% below | 20% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC COMPREHEN METABOLIC PANEL | $113.60 | $142.00 | — | — | 20% |
| Cortisol blood test, total CPT 82533 HC CORTISOL TOTAL | $110.40 | $138.00 | — | 1% below | 20% |
| Cortisol blood test, total CPT 82533 HC CORTISOL | $110.40 | $138.00 | — | 1% below | 20% |
| Cortisol blood test, total CPT 82533 HC CORTISOL TOTAL LAB | $110.40 | $138.00 | — | 1% below | 20% |
| Cortisol blood test, total inpatient CPT 82533 HC CORTISOL TOTAL LAB | $110.40 | $138.00 | — | — | 20% |
| Cortisol blood test, total inpatient CPT 82533 HC CORTISOL | $110.40 | $138.00 | — | — | 20% |
| Cortisol blood test, total inpatient CPT 82533 HC CORTISOL TOTAL | $110.40 | $138.00 | — | — | 20% |
| Creatine kinase (CK) blood test, total CPT 82550 HC CREATINE KINASE TOTAL LAB | $35.20 | $44.00 | — | 37% below | 20% |
| Creatine kinase (CK) blood test, total CPT 82550 HC CK TOTAL | $35.20 | $44.00 | — | 37% below | 20% |
| Creatine kinase (CK) blood test, total inpatient CPT 82550 HC CREATINE KINASE TOTAL LAB | $35.20 | $44.00 | — | — | 20% |
| Creatine kinase (CK) blood test, total inpatient CPT 82550 HC CK TOTAL | $35.20 | $44.00 | — | — | 20% |
| Creatinine blood test CPT 82565 HC CREATININE BLOOD | $30.40 | $38.00 | — | 30% below | 20% |
| Creatinine blood test CPT 82565 HC CREATININE-BODY FLUID | $35.20 | $44.00 | — | 19% below | 20% |
| Creatinine blood test CPT 82565 HC ASSAY OF CREATININE | $46.40 | $58.00 | — | 7% above | 20% |
| Creatinine blood test CPT 82565 HC ASSAY CREATININE | $48.00 | $60.00 | — | 11% above | 20% |
| Creatinine blood test inpatient CPT 82565 HC CREATININE BLOOD | $30.40 | $38.00 | — | — | 20% |
| Creatinine blood test inpatient CPT 82565 HC CREATININE-BODY FLUID | $35.20 | $44.00 | — | — | 20% |
| Creatinine blood test inpatient CPT 82565 HC ASSAY OF CREATININE | $46.40 | $58.00 | — | — | 20% |
| Creatinine blood test inpatient CPT 82565 HC ASSAY CREATININE | $48.00 | $60.00 | — | — | 20% |
| Cytomegalovirus (CMV) antibody test CPT 86644 HC CMV ANTIBODY | $80.00 | $100.00 | — | 23% below | 20% |
| Cytomegalovirus (CMV) antibody test CPT 86644 HC ANTIBODY CYTOMEGALOVIRUS CMV LAB | $80.00 | $100.00 | — | 23% below | 20% |
| Cytomegalovirus (CMV) antibody test CPT 86644 HC ANTIBODY CYTOMEGALOVIRUS CMV CDM | $80.00 | $100.00 | — | 23% below | 20% |
| Cytomegalovirus (CMV) antibody test inpatient CPT 86644 HC ANTIBODY CYTOMEGALOVIRUS CMV CDM | $80.00 | $100.00 | — | — | 20% |
| Cytomegalovirus (CMV) antibody test inpatient CPT 86644 HC CMV ANTIBODY | $80.00 | $100.00 | — | — | 20% |
| Cytomegalovirus (CMV) antibody test inpatient CPT 86644 HC ANTIBODY CYTOMEGALOVIRUS CMV LAB | $80.00 | $100.00 | — | — | 20% |
| D-dimer blood test (blood clot marker) CPT 85379 HC DDIMER QUANT | $144.00 | $180.00 | — | 28% above | 20% |
| D-dimer blood test (blood clot marker) CPT 85379 HC FIBRIN DEGRADATION QUANT | $168.00 | $210.00 | — | 49% above | 20% |
| D-dimer blood test (blood clot marker) inpatient CPT 85379 HC DDIMER QUANT | $144.00 | $180.00 | — | — | 20% |
| D-dimer blood test (blood clot marker) inpatient CPT 85379 HC FIBRIN DEGRADATION QUANT | $168.00 | $210.00 | — | — | 20% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 HC DEHYDROEPIANDROSTERONE-SULFATE CDM | $102.40 | $128.00 | — | 33% below | 20% |
| DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 HC DEHYDROEPIANDROSTERONE-SULFATE CDM | $102.40 | $128.00 | — | — | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR SALICYLATE PER DOS LAB | $55.20 | $69.00 | — | 71% below | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR ALCOHOL PER DOS | $67.20 | $84.00 | — | 64% below | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR PROPOXY PER DOS LAB | $106.40 | $133.00 | — | 43% below | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR NONCHROMO DRUGS OF ABUSE 4 PER DOS LAB | $106.40 | $133.00 | — | 43% below | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR NONCHROMO DRUGS OF ABUSE 6 PER DOS | $106.40 | $133.00 | — | 43% below | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR ETHYLGLCURONIDE PER DOS | $106.40 | $133.00 | — | 43% below | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR COCAINE PER DOS LAB | $106.40 | $133.00 | — | 43% below | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR BENZODIAZEPINE PER DOS LAB | $106.40 | $133.00 | — | 43% below | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR OPIATES PER DOS | $106.40 | $133.00 | — | 43% below | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR PER DOS | $106.40 | $133.00 | — | 43% below | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE CDM | $106.40 | $133.00 | — | 43% below | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR NONCHROMO DRUGS OF ABUSE 8 PER DOS | $106.40 | $133.00 | — | 43% below | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR METH PER DOS LAB | $112.80 | $141.00 | — | 40% below | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR NICOTINE PER DOS LAB | $120.80 | $151.00 | — | 36% below | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR MECONIUM PER DOS | $136.00 | $170.00 | — | 28% below | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR THC URINE PER DOS LAB | $139.20 | $174.00 | — | 26% below | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR OPIATES URINE PER DOS LAB | $140.80 | $176.00 | — | 25% below | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR CORDSTAT PER DOS | $182.40 | $228.00 | — | 3% below | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR BARBITURATES PER DOS | $182.40 | $228.00 | — | 3% below | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB | $182.40 | $228.00 | — | 3% below | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE | $182.40 | $228.00 | — | 3% below | 20% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR TRICYCLICS PER DOS LAB | $787.20 | $984.00 | — | 319% above | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR SALICYLATE PER DOS LAB | $55.20 | $69.00 | — | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR ALCOHOL PER DOS | $67.20 | $84.00 | — | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR OPIATES PER DOS | $106.40 | $133.00 | — | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR PROPOXY PER DOS LAB | $106.40 | $133.00 | — | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR NONCHROMO DRUGS OF ABUSE 8 PER DOS | $106.40 | $133.00 | — | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR NONCHROMO DRUGS OF ABUSE 6 PER DOS | $106.40 | $133.00 | — | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR NONCHROMO DRUGS OF ABUSE 4 PER DOS LAB | $106.40 | $133.00 | — | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR ETHYLGLCURONIDE PER DOS | $106.40 | $133.00 | — | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR COCAINE PER DOS LAB | $106.40 | $133.00 | — | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR BENZODIAZEPINE PER DOS LAB | $106.40 | $133.00 | — | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR PER DOS | $106.40 | $133.00 | — | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE CDM | $106.40 | $133.00 | — | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR METH PER DOS LAB | $112.80 | $141.00 | — | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR NICOTINE PER DOS LAB | $120.80 | $151.00 | — | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR MECONIUM PER DOS | $136.00 | $170.00 | — | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR THC URINE PER DOS LAB | $139.20 | $174.00 | — | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR OPIATES URINE PER DOS LAB | $140.80 | $176.00 | — | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR CORDSTAT PER DOS | $182.40 | $228.00 | — | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE | $182.40 | $228.00 | — | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE LAB | $182.40 | $228.00 | — | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR BARBITURATES PER DOS | $182.40 | $228.00 | — | — | 20% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR TRICYCLICS PER DOS LAB | $787.20 | $984.00 | — | — | 20% |
| Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 HC ELECTROLYTE PANEL | $51.20 | $64.00 | — | 30% below | 20% |
| Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 HC ELECTROLYTE PANEL | $51.20 | $64.00 | — | — | 20% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 HC EPSTEIN-BARR ANTIBODY - VIRAL CAPSID | $104.80 | $131.00 | — | 11% above | 20% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 HC ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA LAB | $104.80 | $131.00 | — | 11% above | 20% |
| Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 HC ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA LAB | $104.80 | $131.00 | — | — | 20% |
| Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 HC EPSTEIN-BARR ANTIBODY - VIRAL CAPSID | $104.80 | $131.00 | — | — | 20% |
| Estradiol blood test CPT 82670 HC ESTRADIOL | $120.80 | $151.00 | — | 19% below | 20% |
| Estradiol blood test CPT 82670 HC ASSAY OF TOTAL ESTRADIOL CDM | $120.80 | $151.00 | — | 19% below | 20% |
| Estradiol blood test CPT 82670 HC ASSAY OF ESTRADIOL LAB | $120.80 | $151.00 | — | 19% below | 20% |
| Estradiol blood test CPT 82670 HC ASSAY OF ESTRADIOL | $120.80 | $151.00 | — | 19% below | 20% |
| Estradiol blood test inpatient CPT 82670 HC ASSAY OF TOTAL ESTRADIOL CDM | $120.80 | $151.00 | — | — | 20% |
| Estradiol blood test inpatient CPT 82670 HC ASSAY OF ESTRADIOL | $120.80 | $151.00 | — | — | 20% |
| Estradiol blood test inpatient CPT 82670 HC ASSAY OF ESTRADIOL LAB | $120.80 | $151.00 | — | — | 20% |
| Estradiol blood test inpatient CPT 82670 HC ESTRADIOL | $120.80 | $151.00 | — | — | 20% |
| FSH (follicle-stimulating hormone) test CPT 83001 HC GONADOTROPIN FOLLICLE STIMULATING HORMONE CDM | $127.20 | $159.00 | — | 2% above | 20% |
| FSH (follicle-stimulating hormone) test CPT 83001 HC FSH(FOLLICLE STIMULATE HORMONE) | $127.20 | $159.00 | — | 2% above | 20% |
| FSH (follicle-stimulating hormone) test inpatient CPT 83001 HC GONADOTROPIN FOLLICLE STIMULATING HORMONE CDM | $127.20 | $159.00 | — | — | 20% |
| FSH (follicle-stimulating hormone) test inpatient CPT 83001 HC FSH(FOLLICLE STIMULATE HORMONE) | $127.20 | $159.00 | — | — | 20% |
| Fecal calprotectin (stool inflammation test) CPT 83993 HC ASSAY OF CALPROTECTIN FECAL CDM | $324.00 | $405.00 | — | 25% above | 20% |
| Fecal calprotectin (stool inflammation test) inpatient CPT 83993 HC ASSAY OF CALPROTECTIN FECAL CDM | $324.00 | $405.00 | — | — | 20% |
| Ferritin blood test (iron stores) CPT 82728 HC ASSAY OF FERRITIN CDM | $92.80 | $116.00 | — | at median | 20% |
| Ferritin blood test (iron stores) inpatient CPT 82728 HC ASSAY OF FERRITIN CDM | $92.80 | $116.00 | — | — | 20% |
| Fibrinogen blood test CPT 85384 HC FIBRINOGEN | $122.40 | $153.00 | — | 32% above | 20% |
| Fibrinogen blood test inpatient CPT 85384 HC FIBRINOGEN | $122.40 | $153.00 | — | — | 20% |
| Folate (folic acid) blood test CPT 82746 HC ASSAY OF FOLIC ACID SERUM CDM | $80.00 | $100.00 | — | 12% below | 20% |
| Folate (folic acid) blood test inpatient CPT 82746 HC ASSAY OF FOLIC ACID SERUM CDM | $80.00 | $100.00 | — | — | 20% |
| Free T3 thyroid hormone test CPT 84481 HC ASSAY OF TRIIODOTHYRONINE T3 FREE CDM | $178.40 | $223.00 | — | 61% above | 20% |
| Free T3 thyroid hormone test CPT 84481 HC ASSAY OF TRIIODOTHYRONINE T3 FREE LAB | $178.40 | $223.00 | — | 61% above | 20% |
| Free T3 thyroid hormone test inpatient CPT 84481 HC ASSAY OF TRIIODOTHYRONINE T3 FREE CDM | $178.40 | $223.00 | — | — | 20% |
| Free T3 thyroid hormone test inpatient CPT 84481 HC ASSAY OF TRIIODOTHYRONINE T3 FREE LAB | $178.40 | $223.00 | — | — | 20% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 HC ASSAY OF FREE THYROXINE LAB | $127.20 | $159.00 | — | 69% above | 20% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 HC ASSAY OF FREE THYROXINE CDM | $127.20 | $159.00 | — | 69% above | 20% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HC ASSAY OF FREE THYROXINE CDM | $127.20 | $159.00 | — | — | 20% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HC ASSAY OF FREE THYROXINE LAB | $127.20 | $159.00 | — | — | 20% |
| Free testosterone test CPT 84402 HC TESTOSTERONE FREE | $34.40 | $43.00 | — | 74% below | 20% |
| Free testosterone test CPT 84402 HC ASSAY OF TESTOSTERONE FREE LAB | $120.80 | $151.00 | — | 9% below | 20% |
| Free testosterone test CPT 84402 HC ASSAY OF TESTOSTERONE FREE | $120.80 | $151.00 | — | 9% below | 20% |
| Free testosterone test CPT 84402 HC ASSAY OF TESTOSTERONE FREE CDM | $120.80 | $151.00 | — | 9% below | 20% |
| Free testosterone test CPT 84402 HC BIO-T-TESTOSTERON FREE | $120.80 | $151.00 | — | 9% below | 20% |
| Free testosterone test inpatient CPT 84402 HC TESTOSTERONE FREE | $34.40 | $43.00 | — | — | 20% |
| Free testosterone test inpatient CPT 84402 HC BIO-T-TESTOSTERON FREE | $120.80 | $151.00 | — | — | 20% |
| Free testosterone test inpatient CPT 84402 HC ASSAY OF TESTOSTERONE FREE | $120.80 | $151.00 | — | — | 20% |
| Free testosterone test inpatient CPT 84402 HC ASSAY OF TESTOSTERONE FREE CDM | $120.80 | $151.00 | — | — | 20% |
| Free testosterone test inpatient CPT 84402 HC ASSAY OF TESTOSTERONE FREE LAB | $120.80 | $151.00 | — | — | 20% |
| Gamma-glutamyl transferase (GGT) blood test CPT 82977 HC GAMMA GT TOTAL | $35.20 | $44.00 | — | 17% below | 20% |
| Gamma-glutamyl transferase (GGT) blood test CPT 82977 HC V FIBROSURE GGT | $35.20 | $44.00 | — | 17% below | 20% |
| Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 HC V FIBROSURE GGT | $35.20 | $44.00 | — | — | 20% |
| Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 HC GAMMA GT TOTAL | $35.20 | $44.00 | — | — | 20% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC GLUCOSE TEST 2 HR PP | $41.60 | $52.00 | — | 32% below | 20% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC GESTATIONAL GLUCOSE 1 HOUR | $42.40 | $53.00 | — | 31% below | 20% |
| Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 HC GLUCOSE TEST 2 HR PP | $41.60 | $52.00 | — | — | 20% |
| Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 HC GESTATIONAL GLUCOSE 1 HOUR | $42.40 | $53.00 | — | — | 20% |
| Glucose tolerance test, 3 samples CPT 82951 HC GLUCOSE TOLERANCE TEST 2 HRS | $104.80 | $131.00 | — | at median | 20% |
| Glucose tolerance test, 3 samples CPT 82951 HC GLUCOSE TOLERANCE(3 SPEC) | $117.60 | $147.00 | — | 12% above | 20% |
| Glucose tolerance test, 3 samples CPT 82951 HC LACTOSE TOLER | $127.20 | $159.00 | — | 21% above | 20% |
| Glucose tolerance test, 3 samples CPT 82951 HC GLUCOSE TOLERANCE TEST | $136.00 | $170.00 | — | 30% above | 20% |
| Glucose tolerance test, 3 samples CPT 82951 HC GLUCOSE TOLERANCE TEST (GTT) 3 SPECIMENS | $136.00 | $170.00 | — | 30% above | 20% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 HC GLUCOSE TOLERANCE TEST 2 HRS | $104.80 | $131.00 | — | — | 20% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 HC GLUCOSE TOLERANCE(3 SPEC) | $117.60 | $147.00 | — | — | 20% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 HC LACTOSE TOLER | $127.20 | $159.00 | — | — | 20% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 HC GLUCOSE TOLERANCE TEST | $136.00 | $170.00 | — | — | 20% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 HC GLUCOSE TOLERANCE TEST (GTT) 3 SPECIMENS | $136.00 | $170.00 | — | — | 20% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC N.GONORRHOEAE DNA AMPLIFIED PROBE | $104.00 | $130.00 | — | 4% above | 20% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ LAB | $104.00 | $130.00 | — | 4% above | 20% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ | $109.60 | $137.00 | — | 10% above | 20% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ CDM | $109.60 | $137.00 | — | 10% above | 20% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC N.GONORRHOEAE DNA APTIMA | $109.60 | $137.00 | — | 10% above | 20% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ LAB | $104.00 | $130.00 | — | — | 20% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC N.GONORRHOEAE DNA AMPLIFIED PROBE | $104.00 | $130.00 | — | — | 20% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC N.GONORRHOEAE DNA APTIMA | $109.60 | $137.00 | — | — | 20% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ CDM | $109.60 | $137.00 | — | — | 20% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ | $109.60 | $137.00 | — | — | 20% |
| H. pylori antibody blood test CPT 86677 HC ANTIBODY HELICOBACTER PYLORI CDM | $53.60 | $67.00 | — | 58% below | 20% |
| H. pylori antibody blood test CPT 86677 HC HELICOBACTER PYLORI - IGG | $73.60 | $92.00 | — | 43% below | 20% |
| H. pylori antibody blood test CPT 86677 HC HELICOBACTER PYLORI | $92.80 | $116.00 | — | 28% below | 20% |
| H. pylori antibody blood test CPT 86677 HC HELICOBACTER PYLORI ANTIBODY - IGA | $92.80 | $116.00 | — | 28% below | 20% |
| H. pylori antibody blood test CPT 86677 HC HELICOBACTER PYLORI ANTIGEN | $149.60 | $187.00 | — | 16% above | 20% |
| H. pylori antibody blood test inpatient CPT 86677 HC ANTIBODY HELICOBACTER PYLORI CDM | $53.60 | $67.00 | — | — | 20% |
| H. pylori antibody blood test inpatient CPT 86677 HC HELICOBACTER PYLORI - IGG | $73.60 | $92.00 | — | — | 20% |
| H. pylori antibody blood test inpatient CPT 86677 HC HELICOBACTER PYLORI | $92.80 | $116.00 | — | — | 20% |
| H. pylori antibody blood test inpatient CPT 86677 HC HELICOBACTER PYLORI ANTIBODY - IGA | $92.80 | $116.00 | — | — | 20% |
| H. pylori antibody blood test inpatient CPT 86677 HC HELICOBACTER PYLORI ANTIGEN | $149.60 | $187.00 | — | — | 20% |
| H. pylori stool antigen test CPT 87338 HC IAAD IA HPYLORI STOOL CDM | $79.20 | $99.00 | — | 7% below | 20% |
| H. pylori stool antigen test inpatient CPT 87338 HC IAAD IA HPYLORI STOOL CDM | $79.20 | $99.00 | — | — | 20% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HC HIV-1 RNA BY BRANCHED DNA | $196.00 | $245.00 | — | 47% below | 20% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HC IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION LAB | $292.00 | $365.00 | — | 21% below | 20% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HC HIV ULTRA SENSITIVE PCR | $292.00 | $365.00 | — | 21% below | 20% |
| HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HC HIV-1 RNA BY BRANCHED DNA | $196.00 | $245.00 | — | — | 20% |
| HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HC IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION LAB | $292.00 | $365.00 | — | — | 20% |
| HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HC HIV ULTRA SENSITIVE PCR | $292.00 | $365.00 | — | — | 20% |
| HIV-1 and HIV-2 antibody test CPT 86703 HC HIV 1-2 OBSTETRIC | $86.40 | $108.00 | — | 4% above | 20% |
| HIV-1 and HIV-2 antibody test CPT 86703 HC HIV-1/HIV-2 SINGLE ASSAY - REFLEXIVE | $86.40 | $108.00 | — | 4% above | 20% |
| HIV-1 and HIV-2 antibody test CPT 86703 HC HIV-1/HIV-2 SINGLE ASSAY | $91.20 | $114.00 | — | 10% above | 20% |
| HIV-1 and HIV-2 antibody test inpatient CPT 86703 HC HIV 1-2 OBSTETRIC | $86.40 | $108.00 | — | — | 20% |
| HIV-1 and HIV-2 antibody test inpatient CPT 86703 HC HIV-1/HIV-2 SINGLE ASSAY - REFLEXIVE | $86.40 | $108.00 | — | — | 20% |
| HIV-1 and HIV-2 antibody test inpatient CPT 86703 HC HIV-1/HIV-2 SINGLE ASSAY | $91.20 | $114.00 | — | — | 20% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HC HIV-1 AG W/HIV-1 & HIV-2 AB | $84.80 | $106.00 | — | 8% above | 20% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HC ANTI-HIV 1/2 AB & P24 AG | $84.80 | $106.00 | — | 8% above | 20% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HC ANTI-HIV 1/2 AB & P24 AG | $84.80 | $106.00 | — | — | 20% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HC HIV-1 AG W/HIV-1 & HIV-2 AB | $84.80 | $106.00 | — | — | 20% |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES | $145.60 | $182.00 | — | 3% below | 20% |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES LAB | $145.60 | $182.00 | — | 3% below | 20% |
| HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES | $145.60 | $182.00 | — | — | 20% |
| HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES LAB | $145.60 | $182.00 | — | — | 20% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC HEMOGLOBIN GLYCOSYLATED A1C LAB | $36.80 | $46.00 | — | 45% below | 20% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC PR 83036 GLYCOSYLATED HEMOGLOBIN TEST | $40.80 | $51.00 | — | 39% below | 20% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC PR 83036 HEMOGLOBIN GLYCOSYLATED A1C RHC | $40.80 | $51.00 | — | 39% below | 20% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC PR 83036 GLYCOSYLATED HEMOGLOBIN TEST | $40.80 | $51.00 | — | 39% below | 20% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC HEMOGLOBIN GLYCOSYLATED A1C CDM | $63.20 | $79.00 | — | 5% below | 20% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HC HEMOGLOBIN GLYCOSYLATED A1C LAB | $36.80 | $46.00 | — | — | 20% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HC PR 83036 GLYCOSYLATED HEMOGLOBIN TEST | $40.80 | $51.00 | — | — | 20% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HC HEMOGLOBIN GLYCOSYLATED A1C CDM | $63.20 | $79.00 | — | — | 20% |
| Hemoglobin blood test CPT 85018 HC BLOOD COUNT HEMOGLOBIN LAB | $26.40 | $33.00 | — | 8% below | 20% |
| Hemoglobin blood test CPT 85018 HC BLOOD COUNT HEMOGLOBIN CDM | $29.60 | $37.00 | — | 3% above | 20% |
| Hemoglobin blood test CPT 85018 HC HEMOGLOBIN (HGB) | $29.60 | $37.00 | — | 3% above | 20% |
| Hemoglobin blood test CPT 85018 HC BLOOD COUNT HEMOGLOBIN | $29.60 | $37.00 | — | 3% above | 20% |
| Hemoglobin blood test inpatient CPT 85018 HC BLOOD COUNT HEMOGLOBIN LAB | $26.40 | $33.00 | — | — | 20% |
| Hemoglobin blood test inpatient CPT 85018 HC HEMOGLOBIN (HGB) | $29.60 | $37.00 | — | — | 20% |
| Hemoglobin blood test inpatient CPT 85018 HC BLOOD COUNT HEMOGLOBIN CDM | $29.60 | $37.00 | — | — | 20% |
| Hemoglobin blood test inpatient CPT 85018 HC BLOOD COUNT HEMOGLOBIN | $29.60 | $37.00 | — | — | 20% |
| Hepatitis B core antibody test (total) CPT 86704 HC HEPATITIS B CORE ANTIBODY HBCAB TOTAL LAB | $94.40 | $118.00 | — | 5% above | 20% |
| Hepatitis B core antibody test (total) CPT 86704 HC HEPATITIS B CORE ANTIBODY HBCAB TOTAL CDM | $94.40 | $118.00 | — | 5% above | 20% |
| Hepatitis B core antibody test (total) inpatient CPT 86704 HC HEPATITIS B CORE ANTIBODY HBCAB TOTAL LAB | $94.40 | $118.00 | — | — | 20% |
| Hepatitis B core antibody test (total) inpatient CPT 86704 HC HEPATITIS B CORE ANTIBODY HBCAB TOTAL CDM | $94.40 | $118.00 | — | — | 20% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HC HEPATITIS B SURF ANTIBODY HBSAB LAB | $102.40 | $128.00 | — | 25% above | 20% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HC HEPATITIS B SURF ANTIBODY HBSAB CDM | $102.40 | $128.00 | — | 25% above | 20% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HC HEPATITIS B SURF ANTIBODY HBSAB CDM | $102.40 | $128.00 | — | — | 20% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HC HEPATITIS B SURF ANTIBODY HBSAB LAB | $102.40 | $128.00 | — | — | 20% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 HC IAAD IA HEPATITIS B SURFACE ANTIGEN CDM | $63.20 | $79.00 | — | 17% below | 20% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 HC IAAD IA HEPATITIS B SURFACE ANTIGEN LAB | $63.20 | $79.00 | — | 17% below | 20% |
| Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HC IAAD IA HEPATITIS B SURFACE ANTIGEN CDM | $63.20 | $79.00 | — | — | 20% |
| Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HC IAAD IA HEPATITIS B SURFACE ANTIGEN LAB | $63.20 | $79.00 | — | — | 20% |
| Hepatitis C antibody blood test (screening) CPT 86803 HC HEPATITIS C ANTIBODY CDM | $131.20 | $164.00 | — | 14% above | 20% |
| Hepatitis C antibody blood test (screening) CPT 86803 HC HEPATITIS C ANTIBODY LAB | $131.20 | $164.00 | — | 14% above | 20% |
| Hepatitis C antibody blood test (screening) CPT 86803 HC HEPATITIS C ANTIBODY | $131.20 | $164.00 | — | 14% above | 20% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 HC HEPATITIS C ANTIBODY CDM | $131.20 | $164.00 | — | — | 20% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 HC HEPATITIS C ANTIBODY | $131.20 | $164.00 | — | — | 20% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 HC HEPATITIS C ANTIBODY LAB | $131.20 | $164.00 | — | — | 20% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 HC HEP C PCR (QUANT) REFLEX | $206.40 | $258.00 | — | 59% below | 20% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 HC HEPATITIS C RNA QUANTIFICATION | $220.00 | $275.00 | — | 57% below | 20% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION CDM | $296.80 | $371.00 | — | 42% below | 20% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION LAB | $296.80 | $371.00 | — | 42% below | 20% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 HC HEPATITIS C QUANTITATIVE PCR | $1,024.00 | $1,280.00 | — | 101% above | 20% |
| Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HC HEP C PCR (QUANT) REFLEX | $206.40 | $258.00 | — | — | 20% |
| Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HC HEPATITIS C RNA QUANTIFICATION | $220.00 | $275.00 | — | — | 20% |
| Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION LAB | $296.80 | $371.00 | — | — | 20% |
| Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION CDM | $296.80 | $371.00 | — | — | 20% |
| Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HC HEPATITIS C QUANTITATIVE PCR | $1,024.00 | $1,280.00 | — | — | 20% |
| Herpes blood test, HSV-1 antibody CPT 86695 HC HSV TYPE 1 BY IMMUNOBLOT | $390.40 | $488.00 | — | 328% above | 20% |
| Herpes blood test, HSV-1 antibody CPT 86695 HC ANTIBODY HERPES SMPLX TYPE 1 LAB | $390.40 | $488.00 | — | 328% above | 20% |
| Herpes blood test, HSV-1 antibody CPT 86695 HC ANTIBODY HERPES SMPLX TYPE 1 CDM | $390.40 | $488.00 | — | 328% above | 20% |
| Herpes blood test, HSV-1 antibody CPT 86695 HC ANTIBODY HERPES SMPLX TYPE 1 IGG/IGM LAB | $390.40 | $488.00 | — | 328% above | 20% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 HC ANTIBODY HERPES SMPLX TYPE 1 CDM | $390.40 | $488.00 | — | — | 20% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 HC ANTIBODY HERPES SMPLX TYPE 1 IGG/IGM LAB | $390.40 | $488.00 | — | — | 20% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 HC ANTIBODY HERPES SMPLX TYPE 1 LAB | $390.40 | $488.00 | — | — | 20% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 HC HSV TYPE 1 BY IMMUNOBLOT | $390.40 | $488.00 | — | — | 20% |
| Herpes blood test, HSV-2 antibody CPT 86696 HC ANTIBODY HERPES SMPLX TYPE 2 LAB | $55.20 | $69.00 | — | 43% below | 20% |
| Herpes blood test, HSV-2 antibody CPT 86696 HC HERPES SIMPLEX TYPE 2 - TYPE 2 IGG | $55.20 | $69.00 | — | 43% below | 20% |
| Herpes blood test, HSV-2 antibody CPT 86696 HC ANTIBODY HERPES SMPLX TYPE 2 CDM | $55.20 | $69.00 | — | 43% below | 20% |
| Herpes blood test, HSV-2 antibody CPT 86696 HC HSV TYPE 2 BY IMMUNOBLOT | $55.20 | $69.00 | — | 43% below | 20% |
| Herpes blood test, HSV-2 antibody CPT 86696 HC HSV 2 ANTIBODY IGG | $55.20 | $69.00 | — | 43% below | 20% |
| Herpes blood test, HSV-2 antibody CPT 86696 HC HERPES SIMPLEX TYPE 2 | $68.80 | $86.00 | — | 29% below | 20% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 HC HSV 2 ANTIBODY IGG | $55.20 | $69.00 | — | — | 20% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 HC HSV TYPE 2 BY IMMUNOBLOT | $55.20 | $69.00 | — | — | 20% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 HC ANTIBODY HERPES SMPLX TYPE 2 LAB | $55.20 | $69.00 | — | — | 20% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 HC ANTIBODY HERPES SMPLX TYPE 2 CDM | $55.20 | $69.00 | — | — | 20% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 HC HERPES SIMPLEX TYPE 2 - TYPE 2 IGG | $55.20 | $69.00 | — | — | 20% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 HC HERPES SIMPLEX TYPE 2 | $68.80 | $86.00 | — | — | 20% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 HC C-REACTIVE PROTEIN HIGH SENSITIVITY CDM | $47.20 | $59.00 | — | 39% below | 20% |
| High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 HC C-REACTIVE PROTEIN HIGH SENSITIVITY CDM | $47.20 | $59.00 | — | — | 20% |
| Homocysteine blood test CPT 83090 HC ASSAY OF HOMOCYSTEINE LAB | $77.60 | $97.00 | — | 42% below | 20% |
| Homocysteine blood test CPT 83090 HC HOMOCYSTINE PLASMA (HYPERC) | $77.60 | $97.00 | — | 42% below | 20% |
| Homocysteine blood test CPT 83090 HC ASSAY OF HOMOCYSTEINE CDM | $77.60 | $97.00 | — | 42% below | 20% |
| Homocysteine blood test CPT 83090 HC ASSAY HOMOCYSTINE | $104.00 | $130.00 | — | 23% below | 20% |
| Homocysteine blood test inpatient CPT 83090 HC ASSAY OF HOMOCYSTEINE LAB | $77.60 | $97.00 | — | — | 20% |
| Homocysteine blood test inpatient CPT 83090 HC ASSAY OF HOMOCYSTEINE CDM | $77.60 | $97.00 | — | — | 20% |
| Homocysteine blood test inpatient CPT 83090 HC HOMOCYSTINE PLASMA (HYPERC) | $77.60 | $97.00 | — | — | 20% |
| Homocysteine blood test inpatient CPT 83090 HC ASSAY HOMOCYSTINE | $104.00 | $130.00 | — | — | 20% |
| Insulin blood test CPT 83525 HC ASSAY OF INSULIN TOTAL CDM | $131.20 | $164.00 | — | 50% above | 20% |
| Insulin blood test CPT 83525 HC INSULIN LEVEL ASSAY | $131.20 | $164.00 | — | 50% above | 20% |
| Insulin blood test CPT 83525 HC ASSAY OF INSULIN TOTAL LAB | $131.20 | $164.00 | — | 50% above | 20% |
| Insulin blood test inpatient CPT 83525 HC ASSAY OF INSULIN TOTAL LAB | $131.20 | $164.00 | — | — | 20% |
| Insulin blood test inpatient CPT 83525 HC INSULIN LEVEL ASSAY | $131.20 | $164.00 | — | — | 20% |
| Insulin blood test inpatient CPT 83525 HC ASSAY OF INSULIN TOTAL CDM | $131.20 | $164.00 | — | — | 20% |
| Iron blood test (serum iron) CPT 83540 HC ASSAY OF IRON CDM | $91.20 | $114.00 | — | 45% above | 20% |
| Iron blood test (serum iron) CPT 83540 HC IRON | $91.20 | $114.00 | — | 45% above | 20% |
| Iron blood test (serum iron) CPT 83540 HC ASSAY OF IRON LAB | $304.00 | $380.00 | — | 383% above | 20% |
| Iron blood test (serum iron) inpatient CPT 83540 HC ASSAY OF IRON CDM | $91.20 | $114.00 | — | — | 20% |
| Iron blood test (serum iron) inpatient CPT 83540 HC IRON | $91.20 | $114.00 | — | — | 20% |
| Iron blood test (serum iron) inpatient CPT 83540 HC ASSAY OF IRON LAB | $304.00 | $380.00 | — | — | 20% |
| Iron-binding capacity (TIBC) test CPT 83550 HC IRON BINDING CAPACITY CDM | $131.20 | $164.00 | — | 98% above | 20% |
| Iron-binding capacity (TIBC) test inpatient CPT 83550 HC IRON BINDING CAPACITY CDM | $131.20 | $164.00 | — | — | 20% |
| Kidney function blood test panel CPT 80069 HC RENAL FUNCTION PANEL CDM | $88.80 | $111.00 | — | 20% below | 20% |
| Kidney function blood test panel inpatient CPT 80069 HC RENAL FUNCTION PANEL CDM | $88.80 | $111.00 | — | — | 20% |
| LH (luteinizing hormone) test CPT 83002 HC LUTENIZING HORMONE | $77.60 | $97.00 | — | 32% below | 20% |
| LH (luteinizing hormone) test CPT 83002 HC GONADOTROPIN LUTEINIZING HORMONE CDM | $77.60 | $97.00 | — | 32% below | 20% |
| LH (luteinizing hormone) test inpatient CPT 83002 HC GONADOTROPIN LUTEINIZING HORMONE CDM | $77.60 | $97.00 | — | — | 20% |
| LH (luteinizing hormone) test inpatient CPT 83002 HC LUTENIZING HORMONE | $77.60 | $97.00 | — | — | 20% |
| Lactate (lactic acid) blood test CPT 83605 HC ASSAY OF LACTATE LAB | $108.00 | $135.00 | — | 22% below | 20% |
| Lactate (lactic acid) blood test CPT 83605 HC ASSAY OF LACTATE | $118.40 | $148.00 | — | 14% below | 20% |
| Lactate (lactic acid) blood test inpatient CPT 83605 HC ASSAY OF LACTATE LAB | $108.00 | $135.00 | — | — | 20% |
| Lactate (lactic acid) blood test inpatient CPT 83605 HC ASSAY OF LACTATE | $118.40 | $148.00 | — | — | 20% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 HC LACTATE DEHYDROGENASE LDH CDM | $35.20 | $44.00 | — | 25% below | 20% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 HC LDH SERUM | $52.80 | $66.00 | — | 12% above | 20% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HC LACTATE DEHYDROGENASE LDH CDM | $35.20 | $44.00 | — | — | 20% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HC LDH SERUM | $52.80 | $66.00 | — | — | 20% |
| Lipase blood test (pancreas enzyme) CPT 83690 HC ASSAY OF LIPASE LAB | $73.60 | $92.00 | — | 15% below | 20% |
| Lipase blood test (pancreas enzyme) CPT 83690 HC ASSAY OF LIPASE CDM | $73.60 | $92.00 | — | 15% below | 20% |
| Lipase blood test (pancreas enzyme) CPT 83690 HC ASSAY OF LIPASE | $73.60 | $92.00 | — | 15% below | 20% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 HC ASSAY OF LIPASE | $73.60 | $92.00 | — | — | 20% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 HC ASSAY OF LIPASE CDM | $73.60 | $92.00 | — | — | 20% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 HC ASSAY OF LIPASE LAB | $73.60 | $92.00 | — | — | 20% |
| Liver function blood test panel CPT 80076 HC HEPATIC FUNCTION PANEL CDM | $76.80 | $96.00 | — | 1% below | 20% |
| Liver function blood test panel inpatient CPT 80076 HC HEPATIC FUNCTION PANEL CDM | $76.80 | $96.00 | — | — | 20% |
| Lyme disease antibody test CPT 86618 HC LYME DISEASE ANTIBODY - CSF | $92.80 | $116.00 | — | 25% below | 20% |
| Lyme disease antibody test CPT 86618 HC LYME DISEASE ANTIBODY - IGG-IGM | $130.40 | $163.00 | — | 5% above | 20% |
| Lyme disease antibody test CPT 86618 HC LYME DISEASE ANTIBODY | $274.40 | $343.00 | — | 121% above | 20% |
| Lyme disease antibody test inpatient CPT 86618 HC LYME DISEASE ANTIBODY - CSF | $92.80 | $116.00 | — | — | 20% |
| Lyme disease antibody test inpatient CPT 86618 HC LYME DISEASE ANTIBODY - IGG-IGM | $130.40 | $163.00 | — | — | 20% |
| Lyme disease antibody test inpatient CPT 86618 HC LYME DISEASE ANTIBODY | $274.40 | $343.00 | — | — | 20% |
| Magnesium blood test CPT 83735 HC MAGNESIUM QUANT URINE | $60.00 | $75.00 | — | 8% below | 20% |
| Magnesium blood test CPT 83735 HC MAGNESIUM BLOOD | $60.00 | $75.00 | — | 8% below | 20% |
| Magnesium blood test CPT 83735 HC ASSAY OF MAGNESIUM CDM | $60.00 | $75.00 | — | 8% below | 20% |
| Magnesium blood test CPT 83735 HC MAGNESIUM (24HR UR) | $60.00 | $75.00 | — | 8% below | 20% |
| Magnesium blood test CPT 83735 HC ASSAY OF MAGNESIUM LAB | $112.00 | $140.00 | — | 73% above | 20% |
| Magnesium blood test inpatient CPT 83735 HC MAGNESIUM (24HR UR) | $60.00 | $75.00 | — | — | 20% |
| Magnesium blood test inpatient CPT 83735 HC ASSAY OF MAGNESIUM CDM | $60.00 | $75.00 | — | — | 20% |
| Magnesium blood test inpatient CPT 83735 HC MAGNESIUM BLOOD | $60.00 | $75.00 | — | — | 20% |
| Magnesium blood test inpatient CPT 83735 HC MAGNESIUM QUANT URINE | $60.00 | $75.00 | — | — | 20% |
| Magnesium blood test inpatient CPT 83735 HC ASSAY OF MAGNESIUM LAB | $112.00 | $140.00 | — | — | 20% |
| Measles (rubeola) antibody test CPT 86765 HC RUBEOLA ANTIBODY - IGG | $29.60 | $37.00 | — | 53% below | 20% |
| Measles (rubeola) antibody test CPT 86765 HC ANTIBODY RUBEOLA CDM | $75.20 | $94.00 | — | 20% above | 20% |
| Measles (rubeola) antibody test inpatient CPT 86765 HC RUBEOLA ANTIBODY - IGG | $29.60 | $37.00 | — | — | 20% |
| Measles (rubeola) antibody test inpatient CPT 86765 HC ANTIBODY RUBEOLA CDM | $75.20 | $94.00 | — | — | 20% |
| Mono test (heterophile antibody, Monospot) CPT 86308 HC HETEROPHILE ANTIBODIES | $96.00 | $120.00 | — | 46% above | 20% |
| Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HC HETEROPHILE ANTIBODIES | $96.00 | $120.00 | — | — | 20% |
| Mumps immunity blood test CPT 86735 HC ANTIBODY MUMPS CDM | $29.60 | $37.00 | — | 42% below | 20% |
| Mumps immunity blood test CPT 86735 HC MUMPS ANTIBODY - IGM | $52.80 | $66.00 | — | 3% above | 20% |
| Mumps immunity blood test CPT 86735 HC ANTIBODY MUMPS LAB | $148.80 | $186.00 | — | 190% above | 20% |
| Mumps immunity blood test CPT 86735 HC ANTIBODY MUMPS | $148.80 | $186.00 | — | 190% above | 20% |
| Mumps immunity blood test inpatient CPT 86735 HC ANTIBODY MUMPS CDM | $29.60 | $37.00 | — | — | 20% |
| Mumps immunity blood test inpatient CPT 86735 HC MUMPS ANTIBODY - IGM | $52.80 | $66.00 | — | — | 20% |
| Mumps immunity blood test inpatient CPT 86735 HC ANTIBODY MUMPS LAB | $148.80 | $186.00 | — | — | 20% |
| Mumps immunity blood test inpatient CPT 86735 HC ANTIBODY MUMPS | $148.80 | $186.00 | — | — | 20% |
| Obstetric blood test panel CPT 80055 HC OBSTETRIC PANEL LAB | $325.60 | $407.00 | — | 9% above | 20% |
| Obstetric blood test panel inpatient CPT 80055 HC OBSTETRIC PANEL LAB | $325.60 | $407.00 | — | — | 20% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 HC PROSTATE SPECIFIC ANTIGEN FREE | $149.60 | $187.00 | — | 31% above | 20% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE LAB | $149.60 | $187.00 | — | 31% above | 20% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 HC PSA FREE | $149.60 | $187.00 | — | 31% above | 20% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC PSA FREE | $149.60 | $187.00 | — | — | 20% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC PROSTATE SPECIFIC ANTIGEN FREE | $149.60 | $187.00 | — | — | 20% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE LAB | $149.60 | $187.00 | — | — | 20% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL LAB | $143.20 | $179.00 | — | 28% above | 20% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC FREE PSA PSA TOTAL | $158.40 | $198.00 | — | 41% above | 20% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL CDM | $158.40 | $198.00 | — | 41% above | 20% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL LAB | $143.20 | $179.00 | — | — | 20% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL CDM | $158.40 | $198.00 | — | — | 20% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC FREE PSA PSA TOTAL | $158.40 | $198.00 | — | — | 20% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 HC PAP-THIN PREP SCREENING | $94.40 | $118.00 | — | 52% above | 20% |
| Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 HC PAP-THIN PREP SCREENING | $94.40 | $118.00 | — | — | 20% |
| Parathyroid hormone (PTH) blood test CPT 83970 HC PARATHORMONE (PARATHYROID HORMONE) | $161.60 | $202.00 | — | 22% below | 20% |
| Parathyroid hormone (PTH) blood test CPT 83970 HC ASSAY OF PARATHORMONE LAB | $171.20 | $214.00 | — | 17% below | 20% |
| Parathyroid hormone (PTH) blood test CPT 83970 HC PTH INTRAOPERATIVE | $212.80 | $266.00 | — | 3% above | 20% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 HC PARATHORMONE (PARATHYROID HORMONE) | $161.60 | $202.00 | — | — | 20% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 HC ASSAY OF PARATHORMONE LAB | $171.20 | $214.00 | — | — | 20% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 HC PTH INTRAOPERATIVE | $212.80 | $266.00 | — | — | 20% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC PART THROMBOPLASTIN TIME | $20.00 | $25.00 | — | 66% below | 20% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC THROMBOPLASTIN TIME PARTIAL | $40.80 | $51.00 | — | 30% below | 20% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD LAB | $40.80 | $51.00 | — | 30% below | 20% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD CDM | $62.40 | $78.00 | — | 7% above | 20% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC PTT (LUPUS ANTICOAG) PLASMA | $62.40 | $78.00 | — | 7% above | 20% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC APTT | $62.40 | $78.00 | — | 7% above | 20% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC PARTIAL THROMBOPLASTIN-TIME | $114.40 | $143.00 | — | 97% above | 20% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC PART THROMBOPLASTIN TIME | $20.00 | $25.00 | — | — | 20% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC THROMBOPLASTIN TIME PARTIAL | $40.80 | $51.00 | — | — | 20% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD LAB | $40.80 | $51.00 | — | — | 20% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC APTT | $62.40 | $78.00 | — | — | 20% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD CDM | $62.40 | $78.00 | — | — | 20% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC PTT (LUPUS ANTICOAG) PLASMA | $62.40 | $78.00 | — | — | 20% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC PARTIAL THROMBOPLASTIN-TIME | $114.40 | $143.00 | — | — | 20% |
| Phosphorus (phosphate) blood test CPT 84100 HC ASSAY PHOSPHORUS | $35.20 | $44.00 | — | 34% below | 20% |
| Phosphorus (phosphate) blood test inpatient CPT 84100 HC ASSAY PHOSPHORUS | $35.20 | $44.00 | — | — | 20% |
| Potassium blood test CPT 84132 HC POTASSIUM | $35.20 | $44.00 | — | 27% below | 20% |
| Potassium blood test CPT 84132 HC POTASSIUM SERUM PLASMA/WHOLE BLOOD CDM | $35.20 | $44.00 | — | 27% below | 20% |
| Potassium blood test inpatient CPT 84132 HC POTASSIUM SERUM PLASMA/WHOLE BLOOD CDM | $35.20 | $44.00 | — | — | 20% |
| Potassium blood test inpatient CPT 84132 HC POTASSIUM | $35.20 | $44.00 | — | — | 20% |
| Progesterone blood test CPT 84144 HC ASSAY OF PROGESTERONE CDM | $96.00 | $120.00 | — | 28% below | 20% |
| Progesterone blood test inpatient CPT 84144 HC ASSAY OF PROGESTERONE CDM | $96.00 | $120.00 | — | — | 20% |
| Prolactin blood test CPT 84146 HC ASSAY OF PROLACTIN CDM | $102.40 | $128.00 | — | 15% below | 20% |
| Prolactin blood test inpatient CPT 84146 HC ASSAY OF PROLACTIN CDM | $102.40 | $128.00 | — | — | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TM | $13.60 | $17.00 | — | 59% below | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME 85610 | $15.20 | $19.00 | — | 54% below | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC PT INR CONFIRMATION | $59.20 | $74.00 | — | 79% above | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTIME | $59.20 | $74.00 | — | 79% above | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC PT COAG PANEL | $59.20 | $74.00 | — | 79% above | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME CDM | $59.20 | $74.00 | — | 79% above | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN | $59.20 | $74.00 | — | 79% above | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME LAB | $74.40 | $93.00 | — | 125% above | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTIME (LUPUS ANTICOAG) | $74.40 | $93.00 | — | 125% above | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME | $114.40 | $143.00 | — | 247% above | 20% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TM | $13.60 | $17.00 | — | — | 20% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME 85610 | $15.20 | $19.00 | — | — | 20% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PT COAG PANEL | $59.20 | $74.00 | — | — | 20% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN | $59.20 | $74.00 | — | — | 20% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTIME | $59.20 | $74.00 | — | — | 20% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PT INR CONFIRMATION | $59.20 | $74.00 | — | — | 20% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME CDM | $59.20 | $74.00 | — | — | 20% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTIME (LUPUS ANTICOAG) | $74.40 | $93.00 | — | — | 20% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME LAB | $74.40 | $93.00 | — | — | 20% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME | $114.40 | $143.00 | — | — | 20% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HC DRUG TEST PRSMV DIRECT OPT OBS PER DOS | $15.20 | $19.00 | — | 87% below | 20% |
| Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 HC DRUG TEST PRSMV DIRECT OPT OBS PER DOS | $15.20 | $19.00 | — | — | 20% |
| Rapid flu test (influenza antigen) CPT 87804 HC IAADIADOO INFLUENZA CDM | $51.20 | $64.00 | — | 9% below | 20% |
| Rapid flu test (influenza antigen) inpatient CPT 87804 HC IAADIADOO INFLUENZA CDM | $51.20 | $64.00 | — | — | 20% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC PR 87880 RAPID STREP SCREEN | $48.00 | $60.00 | — | 2% below | 20% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC PR 87880 RAPID STREP SCREEN | $48.00 | $60.00 | — | 2% below | 20% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC IAADIADOO STREPTOCOCCUS GROUP A LAB | $73.60 | $92.00 | — | 51% above | 20% |
| Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HC PR 87880 RAPID STREP SCREEN | $48.00 | $60.00 | — | — | 20% |
| Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HC IAADIADOO STREPTOCOCCUS GROUP A LAB | $73.60 | $92.00 | — | — | 20% |
| Renin blood test CPT 84244 HC RENIN | $79.20 | $99.00 | — | 54% below | 20% |
| Renin blood test CPT 84244 HC ASSAY OF RENIN CDM | $188.00 | $235.00 | — | 10% above | 20% |
| Renin blood test inpatient CPT 84244 HC RENIN | $79.20 | $99.00 | — | — | 20% |
| Renin blood test inpatient CPT 84244 HC ASSAY OF RENIN CDM | $188.00 | $235.00 | — | — | 20% |
| Rh blood typing CPT 86901 HC RH TYPE | $9.60 | $12.00 | — | 83% below | 20% |
| Rh blood typing CPT 86901 HC BLOOD TYPING SEROLOGIC RH (D) LAB | $9.60 | $12.00 | — | 83% below | 20% |
| Rh blood typing inpatient CPT 86901 HC RH TYPE | $9.60 | $12.00 | — | — | 20% |
| Rh blood typing inpatient CPT 86901 HC BLOOD TYPING SEROLOGIC RH (D) LAB | $9.60 | $12.00 | — | — | 20% |
| Rheumatoid factor (RF) test CPT 86431 HC RHEUMATOID FACTOR QUANT - AIP RA | $14.40 | $18.00 | — | 76% below | 20% |
| Rheumatoid factor (RF) test CPT 86431 HC RHEUMATOID FACTOR QUANTITATIVE LAB | $40.80 | $51.00 | — | 32% below | 20% |
| Rheumatoid factor (RF) test CPT 86431 HC RHEUMATOID FACTOR QUANT | $40.80 | $51.00 | — | 32% below | 20% |
| Rheumatoid factor (RF) test CPT 86431 HC RHEUMATOID FACTOR QUANT -RA | $41.60 | $52.00 | — | 31% below | 20% |
| Rheumatoid factor (RF) test inpatient CPT 86431 HC RHEUMATOID FACTOR QUANT - AIP RA | $14.40 | $18.00 | — | — | 20% |
| Rheumatoid factor (RF) test inpatient CPT 86431 HC RHEUMATOID FACTOR QUANT | $40.80 | $51.00 | — | — | 20% |
| Rheumatoid factor (RF) test inpatient CPT 86431 HC RHEUMATOID FACTOR QUANTITATIVE LAB | $40.80 | $51.00 | — | — | 20% |
| Rheumatoid factor (RF) test inpatient CPT 86431 HC RHEUMATOID FACTOR QUANT -RA | $41.60 | $52.00 | — | — | 20% |
| Rubella antibody test (immunity check) CPT 86762 HC ANTIBODY RUBELLA IGG LAB | $29.60 | $37.00 | — | 54% below | 20% |
| Rubella antibody test (immunity check) CPT 86762 HC RUBELLA ANTIBODY IGM | $68.80 | $86.00 | — | 6% above | 20% |
| Rubella antibody test (immunity check) CPT 86762 HC RUBELLA ANTIBODY | $102.40 | $128.00 | — | 58% above | 20% |
| Rubella antibody test (immunity check) CPT 86762 HC ANTIBODY RUBELLA CDM | $102.40 | $128.00 | — | 58% above | 20% |
| Rubella antibody test (immunity check) inpatient CPT 86762 HC ANTIBODY RUBELLA IGG LAB | $29.60 | $37.00 | — | — | 20% |
| Rubella antibody test (immunity check) inpatient CPT 86762 HC RUBELLA ANTIBODY IGM | $68.80 | $86.00 | — | — | 20% |
| Rubella antibody test (immunity check) inpatient CPT 86762 HC ANTIBODY RUBELLA CDM | $102.40 | $128.00 | — | — | 20% |
| Rubella antibody test (immunity check) inpatient CPT 86762 HC RUBELLA ANTIBODY | $102.40 | $128.00 | — | — | 20% |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 HC RBC SED RATE AUTOMATED | $48.80 | $61.00 | — | 15% above | 20% |
| Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 HC RBC SED RATE AUTOMATED | $48.80 | $61.00 | — | — | 20% |
| Semen analysis: volume, sperm count, motility and morphology CPT 89320 HC SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT CDM | $263.20 | $329.00 | — | 66% above | 20% |
| Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 HC SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT CDM | $263.20 | $329.00 | — | — | 20% |
| Sodium blood test CPT 84295 HC SODIUM | $35.20 | $44.00 | — | 24% below | 20% |
| Sodium blood test inpatient CPT 84295 HC SODIUM | $35.20 | $44.00 | — | — | 20% |
| Stool ova and parasites exam CPT 87177 HC OVA AND PARASITES SMEARS | $71.20 | $89.00 | — | 3% above | 20% |
| Stool ova and parasites exam inpatient CPT 87177 HC OVA AND PARASITES SMEARS | $71.20 | $89.00 | — | — | 20% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 HC OCCULT BLOOD FECES | $14.40 | $18.00 | — | 60% below | 20% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 HC HEMOCULT TEST - SINGLE | $51.20 | $64.00 | — | 42% above | 20% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 HC BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER CDM | $68.00 | $85.00 | — | 88% above | 20% |
| Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HC OCCULT BLOOD FECES | $14.40 | $18.00 | — | — | 20% |
| Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HC HEMOCULT TEST - SINGLE | $51.20 | $64.00 | — | — | 20% |
| Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HC BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER CDM | $68.00 | $85.00 | — | — | 20% |
| Stool test for hidden blood by immunoassay (FIT) CPT 82274 HC BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3 CDM | $67.20 | $84.00 | — | 33% above | 20% |
| Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 HC BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3 CDM | $67.20 | $84.00 | — | — | 20% |
| Syphilis antibody test (Treponema pallidum) CPT 86780 HC TREPONEMA PALLIDUM - AB | $53.60 | $67.00 | — | 20% below | 20% |
| Syphilis antibody test (Treponema pallidum) CPT 86780 HC ANTIBODY TREPONEMA PALLIDUM LAB | $89.60 | $112.00 | — | 34% above | 20% |
| Syphilis antibody test (Treponema pallidum) CPT 86780 HC ANTIBODY TREPONEMA PALLIDUM CDM | $89.60 | $112.00 | — | 34% above | 20% |
| Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 HC TREPONEMA PALLIDUM - AB | $53.60 | $67.00 | — | — | 20% |
| Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 HC ANTIBODY TREPONEMA PALLIDUM CDM | $89.60 | $112.00 | — | — | 20% |
| Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 HC ANTIBODY TREPONEMA PALLIDUM LAB | $89.60 | $112.00 | — | — | 20% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL LAB | $53.60 | $67.00 | — | 6% above | 20% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC SYPHILIS TEST NON-TREP QUAL | $53.60 | $67.00 | — | 6% above | 20% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC SYPHILIS TEST NON-TREP QUAL - CSF | $79.20 | $99.00 | — | 56% above | 20% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL LAB | $53.60 | $67.00 | — | — | 20% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC SYPHILIS TEST NON-TREP QUAL | $53.60 | $67.00 | — | — | 20% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC SYPHILIS TEST NON-TREP QUAL - CSF | $79.20 | $99.00 | — | — | 20% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON | $91.20 | $114.00 | — | 52% below | 20% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC QUANTIFERON TB GOLD | $91.20 | $114.00 | — | 52% below | 20% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON LAB | $91.20 | $114.00 | — | 52% below | 20% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON CDM | $289.60 | $362.00 | — | 52% above | 20% |
| TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON | $91.20 | $114.00 | — | — | 20% |
| TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON LAB | $91.20 | $114.00 | — | — | 20% |
| TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HC QUANTIFERON TB GOLD | $91.20 | $114.00 | — | — | 20% |
| TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON CDM | $289.60 | $362.00 | — | — | 20% |
| Testosterone blood test, total (not free testosterone) CPT 84403 HC TESTOSTERONE TOTAL | $47.20 | $59.00 | — | 65% below | 20% |
| Testosterone blood test, total (not free testosterone) CPT 84403 HC TESTOSTERONE -TOTAL | $98.40 | $123.00 | — | 26% below | 20% |
| Testosterone blood test, total (not free testosterone) CPT 84403 HC ASSAY OF TESTOSTERONE TOTAL LAB | $98.40 | $123.00 | — | 26% below | 20% |
| Testosterone blood test, total (not free testosterone) CPT 84403 HC BIO-T-TESTOSTERONE TOTAL | $98.40 | $123.00 | — | 26% below | 20% |
| Testosterone blood test, total (not free testosterone) CPT 84403 HC TESTOSTERONE | $173.60 | $217.00 | — | 31% above | 20% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC TESTOSTERONE TOTAL | $47.20 | $59.00 | — | — | 20% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC TESTOSTERONE -TOTAL | $98.40 | $123.00 | — | — | 20% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC BIO-T-TESTOSTERONE TOTAL | $98.40 | $123.00 | — | — | 20% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC ASSAY OF TESTOSTERONE TOTAL LAB | $98.40 | $123.00 | — | — | 20% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC TESTOSTERONE | $173.60 | $217.00 | — | — | 20% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 HC MICROSOMAL ANTIBODIES EACH CDM | $92.80 | $116.00 | — | 1% above | 20% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 HC MICROSOMAL ANTIBODY | $120.80 | $151.00 | — | 31% above | 20% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 HC MICROSOMAL ANTIBODIES EACH LAB | $120.80 | $151.00 | — | 31% above | 20% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC MICROSOMAL ANTIBODIES EACH CDM | $92.80 | $116.00 | — | — | 20% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC MICROSOMAL ANTIBODIES EACH LAB | $120.80 | $151.00 | — | — | 20% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC MICROSOMAL ANTIBODY | $120.80 | $151.00 | — | — | 20% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC ASSAY OF THYROID STIMULATING HORMONE TSH LAB | $73.60 | $92.00 | — | 19% below | 20% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC THYROID STIMULATING HORMONE TSH | $73.60 | $92.00 | — | 19% below | 20% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC TSH | $73.60 | $92.00 | — | 19% below | 20% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC THYROID STIMULATING HORMONE (TSH) | $136.00 | $170.00 | — | 50% above | 20% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC TSH REFLEX TO FT4 | $136.00 | $170.00 | — | 50% above | 20% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC TSH | $73.60 | $92.00 | — | — | 20% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC THYROID STIMULATING HORMONE TSH | $73.60 | $92.00 | — | — | 20% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC ASSAY OF THYROID STIMULATING HORMONE TSH LAB | $73.60 | $92.00 | — | — | 20% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC TSH REFLEX TO FT4 | $136.00 | $170.00 | — | — | 20% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC THYROID STIMULATING HORMONE (TSH) | $136.00 | $170.00 | — | — | 20% |
| Total IgE blood test CPT 82785 HC ASSAY OF GAMMAGLOBULIN IGE | $117.60 | $147.00 | — | 39% above | 20% |
| Total IgE blood test CPT 82785 HC IGE SERUM TOTAL | $117.60 | $147.00 | — | 39% above | 20% |
| Total IgE blood test CPT 82785 HC ASSAY OF GAMMAGLOBULIN IGE CDM | $117.60 | $147.00 | — | 39% above | 20% |
| Total IgE blood test CPT 82785 HC IMMUNOGLOBULIN E | $117.60 | $147.00 | — | 39% above | 20% |
| Total IgE blood test CPT 82785 HC ASSAY OF GAMMAGLOBULIN IGE LAB | $117.60 | $147.00 | — | 39% above | 20% |
| Total IgE blood test inpatient CPT 82785 HC ASSAY OF GAMMAGLOBULIN IGE CDM | $117.60 | $147.00 | — | — | 20% |
| Total IgE blood test inpatient CPT 82785 HC ASSAY OF GAMMAGLOBULIN IGE | $117.60 | $147.00 | — | — | 20% |
| Total IgE blood test inpatient CPT 82785 HC ASSAY OF GAMMAGLOBULIN IGE LAB | $117.60 | $147.00 | — | — | 20% |
| Total IgE blood test inpatient CPT 82785 HC IGE SERUM TOTAL | $117.60 | $147.00 | — | — | 20% |
| Total IgE blood test inpatient CPT 82785 HC IMMUNOGLOBULIN E | $117.60 | $147.00 | — | — | 20% |
| Total cholesterol blood test CPT 82465 HC CHOLESTEROL | $35.20 | $44.00 | — | at median | 20% |
| Total cholesterol blood test inpatient CPT 82465 HC CHOLESTEROL | $35.20 | $44.00 | — | — | 20% |
| Total thyroxine (T4) blood test CPT 84436 HC ASSAY OF THYROXINE TOTAL LAB | $94.40 | $118.00 | — | 67% above | 20% |
| Total thyroxine (T4) blood test CPT 84436 HC THYROXINE T4 | $94.40 | $118.00 | — | 67% above | 20% |
| Total thyroxine (T4) blood test inpatient CPT 84436 HC THYROXINE T4 | $94.40 | $118.00 | — | — | 20% |
| Total thyroxine (T4) blood test inpatient CPT 84436 HC ASSAY OF THYROXINE TOTAL LAB | $94.40 | $118.00 | — | — | 20% |
| Total triiodothyronine (T3) blood test CPT 84480 HC ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3 LAB | $91.20 | $114.00 | — | 1% above | 20% |
| Total triiodothyronine (T3) blood test CPT 84480 HC ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3 | $91.20 | $114.00 | — | 1% above | 20% |
| Total triiodothyronine (T3) blood test CPT 84480 HC ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3 CDM | $91.20 | $114.00 | — | 1% above | 20% |
| Total triiodothyronine (T3) blood test inpatient CPT 84480 HC ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3 | $91.20 | $114.00 | — | — | 20% |
| Total triiodothyronine (T3) blood test inpatient CPT 84480 HC ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3 LAB | $91.20 | $114.00 | — | — | 20% |
| Total triiodothyronine (T3) blood test inpatient CPT 84480 HC ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3 CDM | $91.20 | $114.00 | — | — | 20% |
| Transferrin blood test CPT 84466 HC ASSAY TRANSFERRIN | $102.40 | $128.00 | — | 8% below | 20% |
| Transferrin blood test inpatient CPT 84466 HC ASSAY TRANSFERRIN | $102.40 | $128.00 | — | — | 20% |
| Trichomonas test (NAAT) CPT 87661 HC IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH LAB | $44.00 | $55.00 | — | 59% below | 20% |
| Trichomonas test (NAAT) CPT 87661 HC IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH CDM | $44.00 | $55.00 | — | 59% below | 20% |
| Trichomonas test (NAAT) inpatient CPT 87661 HC IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH CDM | $44.00 | $55.00 | — | — | 20% |
| Trichomonas test (NAAT) inpatient CPT 87661 HC IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH LAB | $44.00 | $55.00 | — | — | 20% |
| Triglycerides blood test CPT 84478 HC ASSAY OF TRIGLYCERIDES LAB | $35.20 | $44.00 | — | 16% below | 20% |
| Triglycerides blood test CPT 84478 HC ASSAY OF TRIGLYCERIDES CDM | $35.20 | $44.00 | — | 16% below | 20% |
| Triglycerides blood test CPT 84478 HC TRIGLYCERIDES | $35.20 | $44.00 | — | 16% below | 20% |
| Triglycerides blood test CPT 84478 HC TRIGLYCERIDES LEVEL | $35.20 | $44.00 | — | 16% below | 20% |
| Triglycerides blood test CPT 84478 HC ASSAY OF TRIGLYCERIDES | $54.40 | $68.00 | — | 30% above | 20% |
| Triglycerides blood test inpatient CPT 84478 HC ASSAY OF TRIGLYCERIDES LAB | $35.20 | $44.00 | — | — | 20% |
| Triglycerides blood test inpatient CPT 84478 HC TRIGLYCERIDES | $35.20 | $44.00 | — | — | 20% |
| Triglycerides blood test inpatient CPT 84478 HC TRIGLYCERIDES LEVEL | $35.20 | $44.00 | — | — | 20% |
| Triglycerides blood test inpatient CPT 84478 HC ASSAY OF TRIGLYCERIDES CDM | $35.20 | $44.00 | — | — | 20% |
| Triglycerides blood test inpatient CPT 84478 HC ASSAY OF TRIGLYCERIDES | $54.40 | $68.00 | — | — | 20% |
| Troponin test, quantitative CPT 84484 HC TROPONIN-T | $67.20 | $84.00 | — | 27% below | 20% |
| Troponin test, quantitative CPT 84484 HC ASSAY OF TROPONIN QUANTITATIVE LAB | $124.80 | $156.00 | — | 36% above | 20% |
| Troponin test, quantitative CPT 84484 HC TROPONIN I | $124.80 | $156.00 | — | 36% above | 20% |
| Troponin test, quantitative CPT 84484 HC TROPONIN QUANTITATIVE | $124.80 | $156.00 | — | 36% above | 20% |
| Troponin test, quantitative inpatient CPT 84484 HC TROPONIN-T | $67.20 | $84.00 | — | — | 20% |
| Troponin test, quantitative inpatient CPT 84484 HC ASSAY OF TROPONIN QUANTITATIVE LAB | $124.80 | $156.00 | — | — | 20% |
| Troponin test, quantitative inpatient CPT 84484 HC TROPONIN QUANTITATIVE | $124.80 | $156.00 | — | — | 20% |
| Troponin test, quantitative inpatient CPT 84484 HC TROPONIN I | $124.80 | $156.00 | — | — | 20% |
| Uric acid blood test CPT 84550 HC ASSAY OF BLOOD/URIC ACID LAB | $55.20 | $69.00 | — | 34% above | 20% |
| Uric acid blood test CPT 84550 HC ASSAY OF BLOOD/URIC ACID CDM | $55.20 | $69.00 | — | 34% above | 20% |
| Uric acid blood test inpatient CPT 84550 HC ASSAY OF BLOOD/URIC ACID CDM | $55.20 | $69.00 | — | — | 20% |
| Uric acid blood test inpatient CPT 84550 HC ASSAY OF BLOOD/URIC ACID LAB | $55.20 | $69.00 | — | — | 20% |
| Urinalysis with microscope exam, automated CPT 81001 HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY LAB | $52.80 | $66.00 | — | 20% above | 20% |
| Urinalysis with microscope exam, automated CPT 81001 HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY CDM | $57.60 | $72.00 | — | 31% above | 20% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY LAB | $52.80 | $66.00 | — | — | 20% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY CDM | $57.60 | $72.00 | — | — | 20% |
| Urinalysis with microscope exam, manual CPT 81000 HC URINALYSIS BY DIPSTICK | $19.20 | $24.00 | — | 6% above | 20% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 HC URINALYSIS BY DIPSTICK | $19.20 | $24.00 | — | — | 20% |
| Urinalysis without microscope exam, automated CPT 81003 HC URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY LAB | $40.00 | $50.00 | — | 47% above | 20% |
| Urinalysis without microscope exam, automated CPT 81003 HC URINALYSIS AUTO W/O SCOPE | $44.00 | $55.00 | — | 62% above | 20% |
| Urinalysis without microscope exam, automated CPT 81003 HC KETONE URINE QUALITATIVE | $44.00 | $55.00 | — | 62% above | 20% |
| Urinalysis without microscope exam, automated CPT 81003 HC PROTEIN URINE QUALITATIVE | $44.00 | $55.00 | — | 62% above | 20% |
| Urinalysis without microscope exam, automated CPT 81003 HC SPECIFIC GRAVITY URINE | $44.00 | $55.00 | — | 62% above | 20% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY LAB | $40.00 | $50.00 | — | — | 20% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC SPECIFIC GRAVITY URINE | $44.00 | $55.00 | — | — | 20% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC URINALYSIS AUTO W/O SCOPE | $44.00 | $55.00 | — | — | 20% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC KETONE URINE QUALITATIVE | $44.00 | $55.00 | — | — | 20% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC PROTEIN URINE QUALITATIVE | $44.00 | $55.00 | — | — | 20% |
| Urinalysis without microscope exam, manual CPT 81002 HC PR 81002 URINALYSIS NONAUTO W/O SCOPE | $7.20 | $9.00 | — | 53% below | 20% |
| Urinalysis without microscope exam, manual CPT 81002 HC PR 81002 URINALYSIS NONAUTO W/O SCOPE | $7.20 | $9.00 | — | 53% below | 20% |
| Urinalysis without microscope exam, manual CPT 81002 HC URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP CDM | $10.40 | $13.00 | — | 31% below | 20% |
| Urinalysis without microscope exam, manual CPT 81002 HC DIP UA IF NOT SENT TO LAB | $25.60 | $32.00 | — | 69% above | 20% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 HC PR 81002 URINALYSIS NONAUTO W/O SCOPE | $7.20 | $9.00 | — | — | 20% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 HC URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP CDM | $10.40 | $13.00 | — | — | 20% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 HC DIP UA IF NOT SENT TO LAB | $25.60 | $32.00 | — | — | 20% |
| Urine culture for bacteria, with colony count CPT 87086 HC URINE CULTURE/COLONY COUNT | $88.00 | $110.00 | — | 3% below | 20% |
| Urine culture for bacteria, with colony count CPT 87086 HC CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE LAB | $88.00 | $110.00 | — | 3% below | 20% |
| Urine culture for bacteria, with colony count CPT 87086 HC CULTURE-URINE | $88.00 | $110.00 | — | 3% below | 20% |
| Urine culture for bacteria, with colony count inpatient CPT 87086 HC URINE CULTURE/COLONY COUNT | $88.00 | $110.00 | — | — | 20% |
| Urine culture for bacteria, with colony count inpatient CPT 87086 HC CULTURE-URINE | $88.00 | $110.00 | — | — | 20% |
| Urine culture for bacteria, with colony count inpatient CPT 87086 HC CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE LAB | $88.00 | $110.00 | — | — | 20% |
| Urine microalbumin (albumin) test CPT 82043 HC URINE ALBUMIN QUANTITATIVE LAB | $59.20 | $74.00 | — | 8% above | 20% |
| Urine microalbumin (albumin) test CPT 82043 HC MICROALBUMIN QUANTITATIVE | $59.20 | $74.00 | — | 8% above | 20% |
| Urine microalbumin (albumin) test inpatient CPT 82043 HC MICROALBUMIN QUANTITATIVE | $59.20 | $74.00 | — | — | 20% |
| Urine microalbumin (albumin) test inpatient CPT 82043 HC URINE ALBUMIN QUANTITATIVE LAB | $59.20 | $74.00 | — | — | 20% |
| Urine pregnancy test, read by color change CPT 81025 HC PR 81025 URINE PREGNANCY TEST | $44.00 | $55.00 | — | at median | 20% |
| Urine pregnancy test, read by color change CPT 81025 HC PR 81025 URINE PREGNANCY TEST | $44.00 | $55.00 | — | at median | 20% |
| Urine pregnancy test, read by color change CPT 81025 HC URINE PREGNANCY TEST | $61.60 | $77.00 | — | 40% above | 20% |
| Urine pregnancy test, read by color change inpatient CPT 81025 HC PR 81025 URINE PREGNANCY TEST | $44.00 | $55.00 | — | — | 20% |
| Urine pregnancy test, read by color change inpatient CPT 81025 HC URINE PREGNANCY TEST | $61.60 | $77.00 | — | — | 20% |
| Vitamin B12 (cobalamin) blood test CPT 82607 HC VITAMIN-B12 | $80.00 | $100.00 | — | 13% below | 20% |
| Vitamin B12 (cobalamin) blood test inpatient CPT 82607 HC VITAMIN-B12 | $80.00 | $100.00 | — | — | 20% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED LAB | $68.80 | $86.00 | — | 50% below | 20% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED CDM | $68.80 | $86.00 | — | 50% below | 20% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HC 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED LAB | $68.80 | $86.00 | — | — | 20% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HC 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED CDM | $68.80 | $86.00 | — | — | 20% |
| Vitamin D, 1,25-dihydroxy blood test CPT 82652 HC 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED CDM | $249.60 | $312.00 | — | 13% above | 20% |
| Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 HC 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED CDM | $249.60 | $312.00 | — | — | 20% |
| Zinc blood test CPT 84630 HC ASSAY OF ZINC CDM | $110.40 | $138.00 | — | 16% above | 20% |
| Zinc blood test CPT 84630 HC ASSAY OF ZINC LAB | $110.40 | $138.00 | — | 16% above | 20% |
| Zinc blood test inpatient CPT 84630 HC ASSAY OF ZINC CDM | $110.40 | $138.00 | — | — | 20% |
| Zinc blood test inpatient CPT 84630 HC ASSAY OF ZINC LAB | $110.40 | $138.00 | — | — | 20% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC HCG QUANTITATIVE | $118.40 | $148.00 | — | 3% above | 20% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC GONADOTROPIN CHORIONIC QUANTITATIVE LAB | $118.40 | $148.00 | — | 3% above | 20% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC GONADOTROPIN CHORIONIC (HCG) QUANTITATIVE | $118.40 | $148.00 | — | 3% above | 20% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC GONADOTROPIN CHORIONIC QUANTITATIVE CDM | $118.40 | $148.00 | — | 3% above | 20% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC GONADOTROPIN CHORIONIC (HCG) QUANTITATIVE | $118.40 | $148.00 | — | — | 20% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC GONADOTROPIN CHORIONIC QUANTITATIVE LAB | $118.40 | $148.00 | — | — | 20% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC GONADOTROPIN CHORIONIC QUANTITATIVE CDM | $118.40 | $148.00 | — | — | 20% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC HCG QUANTITATIVE | $118.40 | $148.00 | — | — | 20% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Montana | Off list |
|---|---|---|---|---|---|
| Appendectomy for a ruptured appendix with abscess or peritonitis CPT 44960 HC PR 44960 APPENDECTOMY, RUPTURED | $1,301.60 | $1,627.00 | — | 37% below | 20% |
| Appendectomy for a ruptured appendix with abscess or peritonitis CPT 44960 HC PR 44960 APPENDECTOMY, RUPTURED | $1,301.60 | $1,627.00 | — | 37% below | 20% |
| Appendectomy for a ruptured appendix with abscess or peritonitis inpatient CPT 44960 HC PR 44960 APPENDECTOMY, RUPTURED | $1,301.60 | $1,627.00 | — | — | 20% |
| Appendectomy, open surgery CPT 44950 HC PR 44950 APPENDECTOMY | $952.00 | $1,190.00 | — | 37% below | 20% |
| Appendectomy, open surgery CPT 44950 HC PR 44950 APPENDECTOMY | $952.00 | $1,190.00 | — | 37% below | 20% |
| Appendectomy, open surgery inpatient CPT 44950 HC PR 44950 APPENDECTOMY | $952.00 | $1,190.00 | — | — | 20% |
| Arthroscopic ACL reconstruction or repair of the knee CPT 29888 HC PR 29888 KNEE SCOPE,AID ANT CRUCIATE REPAIR | $1,438.40 | $1,798.00 | — | 78% below | 20% |
| Arthroscopic ACL reconstruction or repair of the knee CPT 29888 HC PR 29888 KNEE SCOPE,AID ANT CRUCIATE REPAIR | $1,438.40 | $1,798.00 | — | 78% below | 20% |
| Arthroscopic ACL reconstruction or repair of the knee inpatient CPT 29888 HC PR 29888 KNEE SCOPE,AID ANT CRUCIATE REPAIR | $1,438.40 | $1,798.00 | — | — | 20% |
| Arthroscopic rotator cuff repair of the shoulder CPT 29827 HC PR 29827 SHLDR ARTHROSCOP,SURG,W/ROTAT CUFF REPR | $1,573.60 | $1,967.00 | — | 61% below | 20% |
| Arthroscopic rotator cuff repair of the shoulder CPT 29827 HC PR 29827 SHLDR ARTHROSCOP,SURG,W/ROTAT CUFF REPR | $1,573.60 | $1,967.00 | — | 61% below | 20% |
| Arthroscopic rotator cuff repair of the shoulder inpatient CPT 29827 HC PR 29827 SHLDR ARTHROSCOP,SURG,W/ROTAT CUFF REPR | $1,573.60 | $1,967.00 | — | — | 20% |
| Botox injections for chronic migraine CPT 64615 HC PR 64615 CHEMODENERV MUSC MIGRAINE | $180.80 | $226.00 | — | 24% below | 20% |
| Botox injections for chronic migraine CPT 64615 HC PR 64615 CHEMODENERV MUSC MIGRAINE | $228.00 | $285.00 | — | 5% below | 20% |
| Botox injections for chronic migraine CPT 64615 HC PR 64615 CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE RHC | $228.80 | $286.00 | — | 4% below | 20% |
| Botox injections for chronic migraine inpatient CPT 64615 HC PR 64615 CHEMODENERV MUSC MIGRAINE | $180.80 | $226.00 | — | — | 20% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 HC BX BREAST 1ST LESION STEREO | $1,720.00 | $2,150.00 | — | 20% below | 20% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 HC BX BREAST 1ST LESION STEREO | $1,720.00 | $2,150.00 | — | — | 20% |
| Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 HC PR 27786 CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ RHC | $489.60 | $612.00 | — | 1% above | 20% |
| Broken foot (metatarsal) treatment without surgery or setting CPT 28470 HC PR 28470 CLOSED TX METATARSAL FRACTURE W/O MANIPULATION RHC | $338.40 | $423.00 | — | at median | 20% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 HC PR ED 92960 CARDIOVERSION ELECTIVE EXTERNAL CDM | $156.80 | $196.00 | — | 82% below | 20% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 HC PR 92960 CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL RHC | $227.20 | $284.00 | — | 74% below | 20% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 HC PR ED 92960 CARDIOVERSION ELECTIVE EXTERNAL CDM | $228.80 | $286.00 | — | 74% below | 20% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 HC CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL | $628.00 | $785.00 | — | 28% below | 20% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC PR ED 92960 CARDIOVERSION ELECTIVE EXTERNAL CDM | $156.80 | $196.00 | — | — | 20% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL | $628.00 | $785.00 | — | — | 20% |
| Carpal tunnel release, open surgery CPT 64721 HC PR 64721 CARPAL TUNNEL SURGERY | $644.00 | $805.00 | — | 60% below | 20% |
| Carpal tunnel release, open surgery CPT 64721 HC PR 64721 CARPAL TUNNEL SURGERY | $656.00 | $820.00 | — | 60% below | 20% |
| Carpal tunnel release, open surgery inpatient CPT 64721 HC PR 64721 CARPAL TUNNEL SURGERY | $644.00 | $805.00 | — | — | 20% |
| Cervical biopsy CPT 57500 HC PR 57500 BIOPSY OF CERVIX | $110.40 | $138.00 | — | 69% below | 20% |
| Cervical biopsy CPT 57500 HC PR 57500 BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX RHC | $224.80 | $281.00 | — | 37% below | 20% |
| Cervical biopsy CPT 57500 HC PR 57500 BIOPSY OF CERVIX | $233.60 | $292.00 | — | 35% below | 20% |
| Cervical biopsy inpatient CPT 57500 HC PR 57500 BIOPSY OF CERVIX | $110.40 | $138.00 | — | — | 20% |
| Cesarean delivery, including prenatal and postpartum care CPT 59510 HC PR 59510 TOTAL OB/CESAREAN DELIVERY/PP CAR | $3,296.80 | $4,121.00 | — | 42% below | 20% |
| Cesarean delivery, including prenatal and postpartum care CPT 59510 HC PR 59510 TOTAL OB/CESAREAN DELIVERY/PP CAR | $3,296.80 | $4,121.00 | — | 42% below | 20% |
| Cesarean delivery, including prenatal and postpartum care inpatient CPT 59510 HC PR 59510 TOTAL OB/CESAREAN DELIVERY/PP CAR | $3,296.80 | $4,121.00 | — | — | 20% |
| Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 HC PR 54161 CIRCUMCISION 28 DAYS OR OLDER | $287.20 | $359.00 | — | 49% below | 20% |
| Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 HC PR 54161 CIRCUMCISION 28 DAYS OR OLDER | $287.20 | $359.00 | — | 49% below | 20% |
| Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 HC PR 54161 CIRCUMCISION AGE >28 DAYS RHC | $287.20 | $359.00 | — | 49% below | 20% |
| Circumcision by surgical excision, older than 28 days (children and adults) inpatient CPT 54161 HC PR 54161 CIRCUMCISION 28 DAYS OR OLDER | $287.20 | $359.00 | — | — | 20% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 HC PR 54150 CIRCUMCISION W/REGIONAL BLOCK | $141.60 | $177.00 | — | 32% below | 20% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 HC PR 54150 CIRCUMCISION W/REGIONAL BLOCK | $220.00 | $275.00 | — | 5% above | 20% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 HC PR 54150 CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK RHC | $220.80 | $276.00 | — | 6% above | 20% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 HC CIRCUMCISION W/REGIONL BLOCK CDM | $240.00 | $300.00 | — | 15% above | 20% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 HC PR 54150 CIRCUMCISION W/REGIONAL BLOCK | $141.60 | $177.00 | — | — | 20% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 HC CIRCUMCISION W/REGIONL BLOCK CDM | $240.00 | $300.00 | — | — | 20% |
| Circumcision, surgical, older than a newborn CPT 54160 HC PR 54160 CIRCUMCISION NEONATE | $211.20 | $264.00 | — | 33% below | 20% |
| Circumcision, surgical, older than a newborn CPT 54160 HC PR 54160 CIRCUMCISION NEONATE | $324.00 | $405.00 | — | 2% above | 20% |
| Circumcision, surgical, older than a newborn CPT 54160 HC PR 54160 CIRCUMCISION NEONATE RHC | $324.00 | $405.00 | — | 2% above | 20% |
| Circumcision, surgical, older than a newborn inpatient CPT 54160 HC PR 54160 CIRCUMCISION NEONATE | $211.20 | $264.00 | — | — | 20% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 HC ED TREAT DISTAL RADIAL FRACTURE RADIUS/ULNA W/O MANIP CDM | $394.40 | $493.00 | — | 14% below | 20% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 HC PR ED 25600 TREAT DISTAL RADIAL FRACTURE RADIUS/UNA W/O MANIP CDM | $484.00 | $605.00 | — | 6% above | 20% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 HC PR 25600 CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ RHC | $505.60 | $632.00 | — | 11% above | 20% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 HC PR ED 25600 TREAT DISTAL RADIAL FRACTURE RADIUS/UNA W/O MANIP CDM | $505.60 | $632.00 | — | 11% above | 20% |
| Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 HC ED TREAT DISTAL RADIAL FRACTURE RADIUS/ULNA W/O MANIP CDM | $394.40 | $493.00 | — | — | 20% |
| Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 HC PR ED 25600 TREAT DISTAL RADIAL FRACTURE RADIUS/UNA W/O MANIP CDM | $484.00 | $605.00 | — | — | 20% |
| Colonoscopy with polyp removal CPT 45385 HC PR 45385 COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ CDM | $369.60 | $462.00 | — | 83% below | 20% |
| Colonoscopy with polyp removal CPT 45385 HC PR 45385 COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ CDM | $686.40 | $858.00 | — | 68% below | 20% |
| Colonoscopy with polyp removal inpatient CPT 45385 HC PR 45385 COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ CDM | $369.60 | $462.00 | — | — | 20% |
| Colonoscopy with tissue sample CPT 45380 HC PR 45380 COLONOSCOPY FLEXIBLE W/BIOPSY SINGLE/MULTIPLE CDM | $291.20 | $364.00 | — | 85% below | 20% |
| Colonoscopy with tissue sample CPT 45380 HC PR 45380 COLONOSCOPY FLEXIBLE W/BIOPSY SINGLE/MULTIPLE CDM | $660.00 | $825.00 | — | 66% below | 20% |
| Colonoscopy with tissue sample inpatient CPT 45380 HC PR 45380 COLONOSCOPY FLEXIBLE W/BIOPSY SINGLE/MULTIPLE CDM | $291.20 | $364.00 | — | — | 20% |
| Colonoscopy, diagnostic CPT 45378 HC PR 45378 COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD CDM | $268.00 | $335.00 | — | 85% below | 20% |
| Colonoscopy, diagnostic CPT 45378 HC PR 45378 DX COLONOSCOPY FLEXIBLE W/COLLTN SPEC WHEN PFRMD CDM | $321.60 | $402.00 | — | 82% below | 20% |
| Colonoscopy, diagnostic CPT 45378 HC PR 45378 COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD CDM | $512.00 | $640.00 | — | 71% below | 20% |
| Colonoscopy, diagnostic CPT 45378 HC PR 45378 DX COLONOSCOPY FLEXIBLE W/COLLTN SPEC WHEN PFRMD CDM | $614.40 | $768.00 | — | 66% below | 20% |
| Colonoscopy, diagnostic inpatient CPT 45378 HC PR 45378 COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD CDM | $268.00 | $335.00 | — | — | 20% |
| Colonoscopy, diagnostic inpatient CPT 45378 HC PR 45378 DX COLONOSCOPY FLEXIBLE W/COLLTN SPEC WHEN PFRMD CDM | $321.60 | $402.00 | — | — | 20% |
| Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 HC PR 57460 BX OF CERVIX W/SCOPE LEEP | $232.80 | $291.00 | — | 74% below | 20% |
| Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 HC PR 57460 BX OF CERVIX W/SCOPE LEEP | $475.20 | $594.00 | — | 46% below | 20% |
| Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 HC PR 57460 COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERVIX RHC | $475.20 | $594.00 | — | 46% below | 20% |
| Colposcopy with LEEP (loop electrosurgical excision) inpatient CPT 57460 HC PR 57460 BX OF CERVIX W/SCOPE LEEP | $232.80 | $291.00 | — | — | 20% |
| Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 HC PR 57454 BX/CURETT OF CERVIX W/SCOPE | $196.00 | $245.00 | — | 44% below | 20% |
| Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 HC PR 57454 COLPOSCOPY CERVIX BX CERVIX & ENDOCRV CURRETAGE RHC | $252.00 | $315.00 | — | 28% below | 20% |
| Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 HC PR 57454 BX/CURETT OF CERVIX W/SCOPE | $252.00 | $315.00 | — | 28% below | 20% |
| Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 HC PR 57454 BX/CURETT OF CERVIX W/SCOPE | $196.00 | $245.00 | — | — | 20% |
| Cystoscopy with ureteral stent placement CPT 52332 HC PR 52332 CYSTO W/INSERT URETERAL STENT RHC | $556.80 | $696.00 | — | 10% below | 20% |
| Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 HC PR 52000 CYSTOURETHROSCOPY | $116.80 | $146.00 | — | 74% below | 20% |
| Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 HC PR 52000 CYSTOURETHROSCOPY RHC | $363.20 | $454.00 | — | 18% below | 20% |
| Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 HC PR 52000 CYSTOURETHROSCOPY | $363.20 | $454.00 | — | 18% below | 20% |
| Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 HC PR 52000 CYSTOURETHROSCOPY | $116.80 | $146.00 | — | — | 20% |
| D&C (dilation and curettage), not related to pregnancy CPT 58120 HC PR 58120 DILATION AND CURETTAGE | $346.40 | $433.00 | — | 53% below | 20% |
| D&C (dilation and curettage), not related to pregnancy CPT 58120 HC PR 58120 DILATION AND CURETTAGE RHC | $444.80 | $556.00 | — | 40% below | 20% |
| D&C (dilation and curettage), not related to pregnancy CPT 58120 HC PR 58120 DILATION AND CURETTAGE | $444.80 | $556.00 | — | 40% below | 20% |
| D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 HC PR 58120 DILATION AND CURETTAGE | $346.40 | $433.00 | — | — | 20% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 HC PR 17000 DESTRUCT PREMALG LESION FIRST LESION | $80.00 | $100.00 | — | 54% below | 20% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 HC PR 17000 DESTRUCTION PREMALIGNANT LESION 1ST RHC | $99.20 | $124.00 | — | 42% below | 20% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 HC PR 17000 DESTRUCT PREMALG LESION FIRST LESION | $99.20 | $124.00 | — | 42% below | 20% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 HC PR 17000 DESTRUCT PREMALG LESION FIRST LESION | $80.00 | $100.00 | — | — | 20% |
| Ear tube placement (tympanostomy) under general anesthesia, one ear both sides CPT 69436 HC PR 69436 CREATE EARDRUM OPENING GENERAL ANESTHESIA BILATERAL | $234.40 | $293.00 | — | — | 20% |
| Ear tube placement (tympanostomy) under general anesthesia, one ear both sides CPT 69436 HC PR 69436 CREATE EARDRUM OPENING GENERAL ANESTHESIA BILATERAL | $234.40 | $293.00 | — | — | 20% |
| Ear tube placement (tympanostomy) under general anesthesia, one ear inpatient both sides CPT 69436 HC PR 69436 CREATE EARDRUM OPENING GENERAL ANESTHESIA BILATERAL | $234.40 | $293.00 | — | — | 20% |
| Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 HC PR 69433 CREATE EARDRUM OPENING LOCAL ANESTHESIA | $193.60 | $242.00 | — | 56% below | 20% |
| Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 HC PR 69433 CREATE EARDRUM OPENING LOCAL ANESTHESIA | $300.00 | $375.00 | — | 31% below | 20% |
| Ear tube placement (tympanostomy) with local anesthesia, one ear inpatient CPT 69433 HC PR 69433 CREATE EARDRUM OPENING LOCAL ANESTHESIA | $193.60 | $242.00 | — | — | 20% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 HC ED REMOVE IMPACTED EAR WAX UNI CDM | $92.80 | $116.00 | — | 111% above | 20% |
| Earwax removal by irrigation (rinsing), one ear one side CPT 69209 HC PR ED 69209 REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT CDM | $22.40 | $28.00 | — | 49% below | 20% |
| Earwax removal by irrigation (rinsing), one ear one side CPT 69209 HC PR ED 69209 REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT CDM | $22.40 | $28.00 | — | 49% below | 20% |
| Earwax removal by irrigation (rinsing), one ear one side CPT 69209 HC PR 69209 REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT CDM | $24.00 | $30.00 | — | 45% below | 20% |
| Earwax removal by irrigation (rinsing), one ear one side CPT 69209 HC PR 69209 REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT RHC | $24.00 | $30.00 | — | 45% below | 20% |
| Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 HC ED REMOVE IMPACTED EAR WAX UNI CDM | $92.80 | $116.00 | — | — | 20% |
| Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 HC PR ED 69209 REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT CDM | $22.40 | $28.00 | — | — | 20% |
| Earwax removal with instruments, one ear one side CPT 69210 HC PR ED 69210 REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT CDM | $48.80 | $61.00 | — | 43% below | 20% |
| Earwax removal with instruments, one ear one side CPT 69210 HC PR 69210 REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT CDM | $48.80 | $61.00 | — | 43% below | 20% |
| Earwax removal with instruments, one ear one side CPT 69210 HC ED REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT CDM | $60.00 | $75.00 | — | 30% below | 20% |
| Earwax removal with instruments, one ear one side CPT 69210 HC PR ED 69210 REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT CDM | $69.60 | $87.00 | — | 18% below | 20% |
| Earwax removal with instruments, one ear one side CPT 69210 HC PR 69210 REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT CDM | $69.60 | $87.00 | — | 18% below | 20% |
| Earwax removal with instruments, one ear one side CPT 69210 HC PR 69210 REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT RHC | $72.00 | $90.00 | — | 16% below | 20% |
| Earwax removal with instruments, one ear inpatient one side CPT 69210 HC PR ED 69210 REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT CDM | $48.80 | $61.00 | — | — | 20% |
| Earwax removal with instruments, one ear inpatient one side CPT 69210 HC PR 69210 REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT CDM | $48.80 | $61.00 | — | — | 20% |
| Earwax removal with instruments, one ear inpatient one side CPT 69210 HC ED REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT CDM | $60.00 | $75.00 | — | — | 20% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 HC PR 58100 BIOPSY OF UTERUS LINING | $93.60 | $117.00 | — | 62% below | 20% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 HC PR 58100 ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX RHC | $152.80 | $191.00 | — | 38% below | 20% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 HC PR 58100 BIOPSY OF UTERUS LINING | $152.80 | $191.00 | — | 38% below | 20% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 HC BIOPSY OF UTERUS LINING | $269.60 | $337.00 | — | 10% above | 20% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 HC PR 58100 BIOPSY OF UTERUS LINING | $93.60 | $117.00 | — | — | 20% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 HC BIOPSY OF UTERUS LINING | $269.60 | $337.00 | — | — | 20% |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 HC PR 62321 INJ W/NDL OR CATH PLCMNT EPIDRL C/T W/IMG | $150.40 | $188.00 | — | 87% below | 20% |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 HC INJ W/NDL OR CATH PLCMNT EPIDRL C/T W/IMG | $872.00 | $1,090.00 | — | 25% below | 20% |
| Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 HC PR 62321 INJ W/NDL OR CATH PLCMNT EPIDRL C/T W/IMG | $150.40 | $188.00 | — | — | 20% |
| Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 HC INJ W/NDL OR CATH PLCMNT EPIDRL C/T W/IMG | $872.00 | $1,090.00 | — | — | 20% |
| Facet joint injection, lower back, one level, with imaging guidance CPT 64493 HC INJ PARAVERT F JNT L/S 1 LEV | $996.00 | $1,245.00 | — | 11% below | 20% |
| Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 HC INJ PARAVERT F JNT L/S 1 LEV | $996.00 | $1,245.00 | — | — | 20% |
| First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 HC PR 49591 RPR AA HERNIA 1ST/LESS THAN 3 CM REDUCIBLE CDM | $508.80 | $636.00 | — | 5% above | 20% |
| First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm inpatient CPT 49591 HC PR 49591 RPR AA HERNIA 1ST/LESS THAN 3 CM REDUCIBLE CDM | $508.80 | $636.00 | — | — | 20% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 HC PR 45330 DIAGNOSTIC SIGMOIDOSCOPY | $281.60 | $352.00 | — | 74% below | 20% |
| Gallbladder removal, laparoscopic CPT 47562 HC PR 47562 LAPAROSCOPIC CHOLECYSTECTOMY | $980.80 | $1,226.00 | — | 47% below | 20% |
| Gallbladder removal, laparoscopic CPT 47562 HC PR 47562 LAPAROSCOPIC CHOLECYSTECTOMY | $980.80 | $1,226.00 | — | 47% below | 20% |
| Gallbladder removal, laparoscopic inpatient CPT 47562 HC PR 47562 LAPAROSCOPIC CHOLECYSTECTOMY | $980.80 | $1,226.00 | — | — | 20% |
| Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 HC PR 47563 LAPAROSCOPY CHOLECYSTECTOMY/GRAPH | $1,066.40 | $1,333.00 | — | 46% below | 20% |
| Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 HC PR 47563 LAPAROSCOPY CHOLECYSTECTOMY/GRAPH | $1,066.40 | $1,333.00 | — | 46% below | 20% |
| Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery inpatient CPT 47563 HC PR 47563 LAPAROSCOPY CHOLECYSTECTOMY/GRAPH | $1,066.40 | $1,333.00 | — | — | 20% |
| Gallbladder removal, open surgery through a larger incision CPT 47600 HC PR 47600 CHOLECYSTECTOMY | $1,584.00 | $1,980.00 | — | 45% below | 20% |
| Gallbladder removal, open surgery through a larger incision CPT 47600 HC PR 47600 CHOLECYSTECTOMY | $1,584.00 | $1,980.00 | — | 45% below | 20% |
| Gallbladder removal, open surgery through a larger incision inpatient CPT 47600 HC PR 47600 CHOLECYSTECTOMY | $1,584.00 | $1,980.00 | — | — | 20% |
| Hemorrhoid banding (rubber band ligation) CPT 46221 HC PR ED 46221 LIGATION OF HEMORRHOID(S) CDM | $287.20 | $359.00 | — | 57% below | 20% |
| Hemorrhoid banding (rubber band ligation) CPT 46221 HC PR ED 46221 LIGATION OF HEMORRHOID(S) CDM | $427.20 | $534.00 | — | 35% below | 20% |
| Hemorrhoid banding (rubber band ligation) CPT 46221 HC PR 46221 HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS RHC | $428.00 | $535.00 | — | 35% below | 20% |
| Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 HC PR ED 46221 LIGATION OF HEMORRHOID(S) CDM | $287.20 | $359.00 | — | — | 20% |
| Hemorrhoidectomy (internal and external), one area CPT 46255 HC PR 46255 REMOVE INTERNAL/EXTERNAL HEMORROID SINGLE GROUP | $528.80 | $661.00 | — | 36% below | 20% |
| Hemorrhoidectomy (internal and external), one area CPT 46255 HC PR 46255 REMOVE INTERNAL/EXTERNAL HEMORROID SINGLE GROUP | $783.20 | $979.00 | — | 5% below | 20% |
| Hemorrhoidectomy (internal and external), one area inpatient CPT 46255 HC PR 46255 REMOVE INTERNAL/EXTERNAL HEMORROID SINGLE GROUP | $528.80 | $661.00 | — | — | 20% |
| Hysterectomy through an abdominal incision (total) CPT 58150 HC PR 58150 TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY CDM | $1,491.20 | $1,864.00 | — | 58% below | 20% |
| Hysterectomy through an abdominal incision (total) CPT 58150 HC PR 58150 TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY CDM | $1,491.20 | $1,864.00 | — | 58% below | 20% |
| Hysterectomy through an abdominal incision (total) inpatient CPT 58150 HC PR 58150 TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY CDM | $1,491.20 | $1,864.00 | — | — | 20% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HC PR 58340 CATHETER FOR HYSTEROGRAPHY | $82.40 | $103.00 | — | 72% below | 20% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HC CATHETER FOR HYSTEROGRAPHY | $344.80 | $431.00 | — | 17% above | 20% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HC PR 58340 CATHETER FOR HYSTEROGRAPHY | $376.00 | $470.00 | — | 27% above | 20% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 HC PR 58340 CATHETER FOR HYSTEROGRAPHY | $82.40 | $103.00 | — | — | 20% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 HC CATHETER FOR HYSTEROGRAPHY | $344.80 | $431.00 | — | — | 20% |
| Hysteroscopy with endometrial ablation CPT 58563 HC PR 58563 HYSTEROSCOPY ENDOMETRIAL ABLATION RHC | $3,291.20 | $4,114.00 | — | 35% above | 20% |
| Hysteroscopy with endometrial ablation CPT 58563 HC PR 58563 HYSTEROSCOPY ABLATION | $3,291.20 | $4,114.00 | — | 35% above | 20% |
| Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 HC PR 58558 HYSTEROSCOPY BIOPSY | $337.60 | $422.00 | — | 87% below | 20% |
| Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 HC PR 58558 HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C RHC | $2,062.40 | $2,578.00 | — | 19% below | 20% |
| Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 HC PR 58558 HYSTEROSCOPY BIOPSY | $2,062.40 | $2,578.00 | — | 19% below | 20% |
| Hysteroscopy with uterine lining sampling and/or polyp removal inpatient CPT 58558 HC PR 58558 HYSTEROSCOPY BIOPSY | $337.60 | $422.00 | — | — | 20% |
| IUD insertion (the device itself billed separately) CPT 58300 HC PR 58300 INSERT INTRAUTERINE DEVICE | $74.40 | $93.00 | — | 74% below | 20% |
| IUD insertion (the device itself billed separately) CPT 58300 HC PR 58300 INSERT INTRAUTERINE DEVICE | $166.40 | $208.00 | — | 42% below | 20% |
| IUD insertion (the device itself billed separately) CPT 58300 HC PR 58300 INSERTION INTRAUTERINE DEVICE IUD RHC | $166.40 | $208.00 | — | 42% below | 20% |
| IUD insertion (the device itself billed separately) inpatient CPT 58300 HC PR 58300 INSERT INTRAUTERINE DEVICE | $74.40 | $93.00 | — | — | 20% |
| Incision and drainage of a simple or single skin abscess CPT 10060 HC PR ED 10060 DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE CDM | $152.80 | $191.00 | — | 31% below | 20% |
| Incision and drainage of a simple or single skin abscess CPT 10060 HC PR 10060 DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE | $152.80 | $191.00 | — | 31% below | 20% |
| Incision and drainage of a simple or single skin abscess CPT 10060 HC PR ED 10060 DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE CDM | $183.20 | $229.00 | — | 17% below | 20% |
| Incision and drainage of a simple or single skin abscess CPT 10060 HC PR 10060 INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE RHC | $183.20 | $229.00 | — | 17% below | 20% |
| Incision and drainage of a simple or single skin abscess CPT 10060 HC PR 10060 DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE | $183.20 | $229.00 | — | 17% below | 20% |
| Incision and drainage of a simple or single skin abscess CPT 10060 HC ED DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE CDM | $191.20 | $239.00 | — | 13% below | 20% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC PR ED 10060 DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE CDM | $152.80 | $191.00 | — | — | 20% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC PR 10060 DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE | $152.80 | $191.00 | — | — | 20% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC ED DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE CDM | $191.20 | $239.00 | — | — | 20% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 HC PR 49505 REPAIR INGUINAL HERNIA INITIAL BLOCK >5 YR REDUCIBLE | $776.80 | $971.00 | — | 72% below | 20% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 HC PR 49505 REPAIR INGUINAL HERNIA INITIAL BLOCK >5 YR REDUCIBLE | $776.80 | $971.00 | — | 72% below | 20% |
| Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 HC PR 49505 REPAIR INGUINAL HERNIA INITIAL BLOCK >5 YR REDUCIBLE | $776.80 | $971.00 | — | — | 20% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC PR 20550 INJ TENDON SHEAT,LIG,TRIG | $57.60 | $72.00 | — | 60% below | 20% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC PR ED 20550 INJ TENDON SHEATH/LIGAMENT CDM | $57.60 | $72.00 | — | 60% below | 20% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC PR ED 20550 INJ TENDON SHEATH/LIGAMENT CDM | $84.80 | $106.00 | — | 42% below | 20% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC PR 20550 INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS RHC | $84.80 | $106.00 | — | 42% below | 20% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC PR 20550 INJ TENDON SHEAT,LIG,TRIG | $84.80 | $106.00 | — | 42% below | 20% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC PR 20550 INJ TENDON SHEATH/LIGAMENT | $86.40 | $108.00 | — | 41% below | 20% |
| Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 HC PR 20550 INJ TENDON SHEAT,LIG,TRIG | $57.60 | $72.00 | — | — | 20% |
| Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 HC PR ED 20550 INJ TENDON SHEATH/LIGAMENT CDM | $57.60 | $72.00 | — | — | 20% |
| Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 HC PR 20550 INJ TENDON SHEATH/LIGAMENT | $86.40 | $108.00 | — | — | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC PR ED 20610 DRAIN/INJECT JOINT/BURSA MAJOR JOINT W/O US GUIDANCE CDM | $66.40 | $83.00 | — | 76% below | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC PR ED 20610 DRAIN/INJECT JOINT/BURSA MAJOR CDM | $66.40 | $83.00 | — | 76% below | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC PR ED 20610 DRAIN/INJECT JOINT/BURSA MAJOR JOINT W/O US GUIDANCE CDM | $96.00 | $120.00 | — | 65% below | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC PR 20610 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US RHC | $96.00 | $120.00 | — | 65% below | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC PR ED 20610 DRAIN/INJECT JOINT/BURSA MAJOR CDM | $96.00 | $120.00 | — | 65% below | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC PR 20610 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US CDM | $97.60 | $122.00 | — | 65% below | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC ED ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US CDM | $594.40 | $743.00 | — | 115% above | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US | $649.60 | $812.00 | — | 135% above | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC PR ED 20610 DRAIN/INJECT JOINT/BURSA MAJOR JOINT W/O US GUIDANCE CDM | $66.40 | $83.00 | — | — | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC PR ED 20610 DRAIN/INJECT JOINT/BURSA MAJOR CDM | $66.40 | $83.00 | — | — | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC PR 20610 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US CDM | $97.60 | $122.00 | — | — | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC ED ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US CDM | $594.40 | $743.00 | — | — | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US | $649.60 | $812.00 | — | — | 20% |
| Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 HC PR 11981 INSERT DRUG IMPLANT DEVICE | $92.80 | $116.00 | — | 68% below | 20% |
| Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 HC PR 11981 INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT RHC | $149.60 | $187.00 | — | 48% below | 20% |
| Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 HC PR 11981 INSERT DRUG IMPLANT DEVICE | $149.60 | $187.00 | — | 48% below | 20% |
| Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 HC PR 11981 INSERT DRUG IMPLANT DEVICE | $92.80 | $116.00 | — | — | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC PR ED 20605 DRAIN/INJECT JOINT/BURSA INTERM W/O ULTRASOUND GUIDANCE CDM | $54.40 | $68.00 | — | 73% below | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC PR 20605 INJ MED JOINT | $54.40 | $68.00 | — | 73% below | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC PR ED 20605 DRAIN/INJECT JOINT/BURSA INTERM W/O ULTRASOUND GUIDANCE CDM | $80.80 | $101.00 | — | 61% below | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC PR 20605 INJ MED JOINT | $80.80 | $101.00 | — | 61% below | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC PR 20605 ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US RHC | $82.40 | $103.00 | — | 60% below | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC ED ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US CDM | $415.20 | $519.00 | — | 103% above | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC DRAIN/INJECT JOINT/BURSA INTERM W/O ULTRASOUND GUIDANCE | $612.00 | $765.00 | — | 199% above | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC DRAIN/INJECT JOINT/BURSA INTERMED | $612.00 | $765.00 | — | 199% above | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC PR 20605 INJ MED JOINT | $54.40 | $68.00 | — | — | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC PR ED 20605 DRAIN/INJECT JOINT/BURSA INTERM W/O ULTRASOUND GUIDANCE CDM | $54.40 | $68.00 | — | — | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC ED ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US CDM | $415.20 | $519.00 | — | — | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC DRAIN/INJECT JOINT/BURSA INTERMED | $612.00 | $765.00 | — | — | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC DRAIN/INJECT JOINT/BURSA INTERM W/O ULTRASOUND GUIDANCE | $612.00 | $765.00 | — | — | 20% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC PR ED 20600 DRAIN/INJECT JOINT/BURSA SMALL W/O ULTRASOUND GUIDANCE CDM | $52.80 | $66.00 | — | 69% below | 20% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC PR ED 20600 DRAIN/INJECT JOINT/BURSA SMALL W/O ULTRASOUND GUIDANCE CDM | $78.40 | $98.00 | — | 54% below | 20% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC PR 20600 DRAIN/INJECT JOINT/BURSA SMALL W/O ULTRASOUND GUIDAN | $80.80 | $101.00 | — | 53% below | 20% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC PR 20600 ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US RHC | $80.80 | $101.00 | — | 53% below | 20% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC DRAIN/INJECT JOINT/BURSA SMALL W/O ULTRASOUND GUIDANCE | $594.40 | $743.00 | — | 246% above | 20% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC ED ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US CDM | $594.40 | $743.00 | — | 246% above | 20% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC PR ED 20600 DRAIN/INJECT JOINT/BURSA SMALL W/O ULTRASOUND GUIDANCE CDM | $52.80 | $66.00 | — | — | 20% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC DRAIN/INJECT JOINT/BURSA SMALL W/O ULTRASOUND GUIDANCE | $594.40 | $743.00 | — | — | 20% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC ED ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US CDM | $594.40 | $743.00 | — | — | 20% |
| Knee arthroscopy with meniscus repair (one side of the knee) CPT 29882 HC PR 29882 KNEE ARTHROSCOPY/SURGERY MENISCUS | $1,016.00 | $1,270.00 | — | 57% below | 20% |
| Knee arthroscopy with meniscus repair (one side of the knee) CPT 29882 HC PR 29882 KNEE ARTHROSCOPY/SURGERY MENISCUS | $1,016.00 | $1,270.00 | — | 57% below | 20% |
| Knee arthroscopy with meniscus repair (one side of the knee) inpatient CPT 29882 HC PR 29882 KNEE ARTHROSCOPY/SURGERY MENISCUS | $1,016.00 | $1,270.00 | — | — | 20% |
| Knee arthroscopy with meniscus trim CPT 29881 HC PR 29881 KNEE ARTHROSCOPY/SURGERY MENISECTOMY | $960.00 | $1,200.00 | — | 65% below | 20% |
| Knee arthroscopy with meniscus trim CPT 29881 HC PR 29881 KNEE ARTHROSCOPY/SURGERY MENISECTOMY | $960.00 | $1,200.00 | — | 65% below | 20% |
| Knee arthroscopy with meniscus trim inpatient CPT 29881 HC PR 29881 KNEE ARTHROSCOPY/SURGERY MENISECTOMY | $960.00 | $1,200.00 | — | — | 20% |
| Knee arthroscopy with removal of both torn meniscus parts CPT 29880 HC PR 29880 ARTHRSCP M/L MENISECTOMY | $830.40 | $1,038.00 | — | 77% below | 20% |
| Knee arthroscopy with removal of both torn meniscus parts CPT 29880 HC PR 29880 ARTHRSCP M/L MENISECTOMY | $830.40 | $1,038.00 | — | 77% below | 20% |
| Knee arthroscopy with removal of both torn meniscus parts inpatient CPT 29880 HC PR 29880 ARTHRSCP M/L MENISECTOMY | $830.40 | $1,038.00 | — | — | 20% |
| Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 HC PR 29877 KNEE ARTHROSCOPY/CHONDROPLASTY | $917.60 | $1,147.00 | — | 54% below | 20% |
| Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 HC PR 29877 ARTHRS KNEE DEBRIDEMENT/SHAVING ARTCLR CRTLG RHC | $917.60 | $1,147.00 | — | 54% below | 20% |
| Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 HC PR 29877 KNEE ARTHROSCOPY/CHONDROPLASTY | $917.60 | $1,147.00 | — | 54% below | 20% |
| Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) inpatient CPT 29877 HC PR 29877 KNEE ARTHROSCOPY/CHONDROPLASTY | $917.60 | $1,147.00 | — | — | 20% |
| Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 HC PR 44970 LAPAROSCOPY APPENDECTOMY | $893.60 | $1,117.00 | — | 35% below | 20% |
| Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 HC PR 44970 LAPAROSCOPY APPENDECTOMY | $893.60 | $1,117.00 | — | 35% below | 20% |
| Laparoscopic appendectomy (appendix removal through small cuts) inpatient CPT 44970 HC PR 44970 LAPAROSCOPY APPENDECTOMY | $893.60 | $1,117.00 | — | — | 20% |
| Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 HC PR 49650 LAPAROSCOPY INGUINAL HERNIA REPAIR, INITIAL | $642.40 | $803.00 | — | 34% below | 20% |
| Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 HC PR 49650 LAPAROSCOPY INGUINAL HERNIA REPAIR, INITIAL | $642.40 | $803.00 | — | 34% below | 20% |
| Laparoscopic inguinal (groin) hernia repair, first repair on that side inpatient CPT 49650 HC PR 49650 LAPAROSCOPY INGUINAL HERNIA REPAIR, INITIAL | $642.40 | $803.00 | — | — | 20% |
| Laparoscopic removal of an adjustable gastric band and its port CPT 43774 HC PR 43774 LAPAROSCOPY REMOVAL GASTRIC ADJ ALL PARTS | $1,424.80 | $1,781.00 | — | 42% below | 20% |
| Laparoscopic removal of an adjustable gastric band and its port CPT 43774 HC PR 43774 LAPAROSCOPY REMOVAL GASTRIC ADJ ALL PARTS | $1,424.80 | $1,781.00 | — | 42% below | 20% |
| Laparoscopic removal of an adjustable gastric band and its port inpatient CPT 43774 HC PR 43774 LAPAROSCOPY REMOVAL GASTRIC ADJ ALL PARTS | $1,424.80 | $1,781.00 | — | — | 20% |
| Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 HC PR 58661 LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES RHC | $961.60 | $1,202.00 | — | 34% below | 20% |
| Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 HC PR 58661 LAPAROSCOPY REMOVE ADNEXA | $961.60 | $1,202.00 | — | 34% below | 20% |
| Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 HC PR 58661 LAPAROSCOPY REMOVE ADNEXA | $961.60 | $1,202.00 | — | 34% below | 20% |
| Laparoscopic removal of fallopian tubes and/or ovaries inpatient CPT 58661 HC PR 58661 LAPAROSCOPY REMOVE ADNEXA | $961.60 | $1,202.00 | — | — | 20% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC PR ED 12031 INTMD WND REPAIR S/TR/EXT UP TO 2.5CM CDM | $220.00 | $275.00 | — | 47% below | 20% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC ED INTMD WND REPAIR S/TR/EXT UP TO 2.5CM CDM | $302.40 | $378.00 | — | 27% below | 20% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC PR ED 12031 INTMD WND REPAIR S/TR/EXT UP TO 2.5CM CDM | $392.00 | $490.00 | — | 5% below | 20% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC PR 12031 REPAIR INTERMEDIATE SCLP/AXL/TRK/EXTM LTE 2.5 CM RHC | $392.80 | $491.00 | — | 5% below | 20% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC PR 12031 INTMD WND REPAIR S/TR/EXT UP TO 2.5CM | $392.80 | $491.00 | — | 5% below | 20% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HC PR ED 12031 INTMD WND REPAIR S/TR/EXT UP TO 2.5CM CDM | $220.00 | $275.00 | — | — | 20% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HC ED INTMD WND REPAIR S/TR/EXT UP TO 2.5CM CDM | $302.40 | $378.00 | — | — | 20% |
| Lower-back epidural injection, with imaging guidance CPT 62323 HC PR 62323 INJ W/NDL OR CATH PLCMNT EPIDRL L/S W/IMG | $138.40 | $173.00 | — | 77% below | 20% |
| Lower-back epidural injection, with imaging guidance CPT 62323 HC INJ W/NDL OR CATH PLCMNT EPIDRL L/S W/IMG | $872.00 | $1,090.00 | — | 42% above | 20% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC PR 62323 INJ W/NDL OR CATH PLCMNT EPIDRL L/S W/IMG | $138.40 | $173.00 | — | — | 20% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC INJ W/NDL OR CATH PLCMNT EPIDRL L/S W/IMG | $872.00 | $1,090.00 | — | — | 20% |
| Lower-back epidural injection, without imaging guidance CPT 62322 HC PR 62322 INJ INTERLAMINAR LMBR/SAC W/O IMG | $180.00 | $225.00 | — | 57% below | 20% |
| Lower-back epidural injection, without imaging guidance CPT 62322 HC PR 62322 NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN RHC | $196.00 | $245.00 | — | 54% below | 20% |
| Lower-back epidural injection, without imaging guidance CPT 62322 HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN | $841.60 | $1,052.00 | — | 99% above | 20% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 HC PR 62322 INJ INTERLAMINAR LMBR/SAC W/O IMG | $180.00 | $225.00 | — | — | 20% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN | $841.60 | $1,052.00 | — | — | 20% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC PR 64483 INJ FORAMEN EPIDURAL L/S | $146.40 | $183.00 | — | 86% below | 20% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC PR 64483 NJX AA&/STRD TFRML EPI LUMBAR/SACRAL 1 LEVEL RHC | $362.40 | $453.00 | — | 66% below | 20% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC INJ FORAMEN EPIDURAL L/S | $916.00 | $1,145.00 | — | 13% below | 20% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HC PR 64483 INJ FORAMEN EPIDURAL L/S | $146.40 | $183.00 | — | — | 20% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HC INJ FORAMEN EPIDURAL L/S | $916.00 | $1,145.00 | — | — | 20% |
| Lumpectomy (partial mastectomy) CPT 19301 HC PR 19301 MASTECTOMY PARTIAL CDM | $979.20 | $1,224.00 | — | 41% below | 20% |
| Lumpectomy (partial mastectomy) CPT 19301 HC PR 19301 PARTIAL MASTECTOMY | $979.20 | $1,224.00 | — | 41% below | 20% |
| Lumpectomy (partial mastectomy) CPT 19301 HC PR 19301 MASTECTOMY PARTIAL CDM | $979.20 | $1,224.00 | — | 41% below | 20% |
| Lumpectomy (partial mastectomy) CPT 19301 HC PR 19301 PARTIAL MASTECTOMY | $979.20 | $1,224.00 | — | 41% below | 20% |
| Lumpectomy (partial mastectomy) inpatient CPT 19301 HC PR 19301 PARTIAL MASTECTOMY | $979.20 | $1,224.00 | — | — | 20% |
| Lumpectomy (partial mastectomy) inpatient CPT 19301 HC PR 19301 MASTECTOMY PARTIAL CDM | $979.20 | $1,224.00 | — | — | 20% |
| Mastectomy (total removal of the breast) CPT 19303 HC PR 19303 MAST SIMPLE COMPLETE | $1,419.20 | $1,774.00 | — | 45% below | 20% |
| Mastectomy (total removal of the breast) CPT 19303 HC PR 19303 MAST SIMPLE COMPLETE | $1,419.20 | $1,774.00 | — | 45% below | 20% |
| Mastectomy (total removal of the breast) inpatient CPT 19303 HC PR 19303 MAST SIMPLE COMPLETE | $1,419.20 | $1,774.00 | — | — | 20% |
| Miscarriage treatment with D&C, first trimester CPT 59820 HC PR 59820 TX MISSED ABORTION FIRST TRIMESTER SURGICAL | $570.40 | $713.00 | — | 80% below | 20% |
| Miscarriage treatment with D&C, first trimester CPT 59820 HC PR 59820 CARE OF MISCARRIAGE | $570.40 | $713.00 | — | 80% below | 20% |
| Miscarriage treatment with D&C, first trimester CPT 59820 HC PR 59820 TX MISSED ABORTION FIRST TRIMESTER SURGICAL | $654.40 | $818.00 | — | 77% below | 20% |
| Miscarriage treatment with D&C, first trimester CPT 59820 HC PR 59820 CARE OF MISCARRIAGE | $654.40 | $818.00 | — | 77% below | 20% |
| Miscarriage treatment with D&C, first trimester inpatient CPT 59820 HC PR 59820 TX MISSED ABORTION FIRST TRIMESTER SURGICAL | $570.40 | $713.00 | — | — | 20% |
| Miscarriage treatment with D&C, first trimester inpatient CPT 59820 HC PR 59820 CARE OF MISCARRIAGE | $570.40 | $713.00 | — | — | 20% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 HC PR11400 EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/OR LESS | $121.60 | $152.00 | — | 46% below | 20% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 HC PR11400 EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/OR LESS RHC | $189.60 | $237.00 | — | 15% below | 20% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 HC PR11400 EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/OR LESS | $189.60 | $237.00 | — | 15% below | 20% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 HC PR11400 EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/OR LESS | $121.60 | $152.00 | — | — | 20% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 HC PR 11440 EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/OR LESS | $153.60 | $192.00 | — | 48% below | 20% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 HC PR 11440 EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/OR LESS | $212.80 | $266.00 | — | 28% below | 20% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 HC PR 11440 EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/OR LESS RHC | $212.80 | $266.00 | — | 28% below | 20% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 HC PR 11440 EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/OR LESS | $153.60 | $192.00 | — | — | 20% |
| Nail removal (partial or complete), one nail CPT 11730 HC PR ED 11730 REMOVAL OF NAIL PLATE CDM | $78.40 | $98.00 | — | 59% below | 20% |
| Nail removal (partial or complete), one nail CPT 11730 HC ED REMOVAL OF NAIL PLATE CDM | $91.20 | $114.00 | — | 52% below | 20% |
| Nail removal (partial or complete), one nail CPT 11730 HC PR ED 11730 REMOVAL OF NAIL PLATE CDM | $170.40 | $213.00 | — | 10% below | 20% |
| Nail removal (partial or complete), one nail CPT 11730 HC PR 11730 AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 RHC | $172.00 | $215.00 | — | 9% below | 20% |
| Nail removal (partial or complete), one nail CPT 11730 HC PR 11730 REMOVAL OF NAIL PLATE | $172.00 | $215.00 | — | 9% below | 20% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 HC PR ED 11730 REMOVAL OF NAIL PLATE CDM | $78.40 | $98.00 | — | — | 20% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 HC ED REMOVAL OF NAIL PLATE CDM | $91.20 | $114.00 | — | — | 20% |
| Occipital nerve block (injection for headaches) CPT 64405 HC PR 64405 NERVE BLOCK INJ OCCIPITAL | $77.60 | $97.00 | — | 74% below | 20% |
| Occipital nerve block (injection for headaches) CPT 64405 HC PR 64405 INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NRV RHC | $111.20 | $139.00 | — | 62% below | 20% |
| Occipital nerve block (injection for headaches) CPT 64405 HC PR 64405 NERVE BLOCK INJ OCCIPITAL | $111.20 | $139.00 | — | 62% below | 20% |
| Occipital nerve block (injection for headaches) inpatient CPT 64405 HC PR 64405 NERVE BLOCK INJ OCCIPITAL | $77.60 | $97.00 | — | — | 20% |
| Paracentesis with imaging guidance CPT 49083 HC PR ED 49083 ABD PARACENT W/IMAG GUIDANCE CDM | $154.40 | $193.00 | — | 81% below | 20% |
| Paracentesis with imaging guidance CPT 49083 HC PR 49083 ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE CDM | $154.40 | $193.00 | — | 81% below | 20% |
| Paracentesis with imaging guidance CPT 49083 HC PR 49083 ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE CDM | $445.60 | $557.00 | — | 45% below | 20% |
| Paracentesis with imaging guidance CPT 49083 HC PR ED 49083 ABD PARACENT W/IMAG GUIDANCE CDM | $445.60 | $557.00 | — | 45% below | 20% |
| Paracentesis with imaging guidance CPT 49083 HC ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE CDM | $1,271.20 | $1,589.00 | — | 57% above | 20% |
| Paracentesis with imaging guidance inpatient CPT 49083 HC PR ED 49083 ABD PARACENT W/IMAG GUIDANCE CDM | $154.40 | $193.00 | — | — | 20% |
| Paracentesis with imaging guidance inpatient CPT 49083 HC PR 49083 ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE CDM | $154.40 | $193.00 | — | — | 20% |
| Paracentesis with imaging guidance inpatient CPT 49083 HC ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE CDM | $1,271.20 | $1,589.00 | — | — | 20% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC PR ED 11750 REMOVAL OF NAIL BED CDM | $148.00 | $185.00 | — | 60% below | 20% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC PR ED 11750 REMOVAL OF NAIL BED CDM | $236.80 | $296.00 | — | 37% below | 20% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC PR 11750 EXCISION NAIL MATRIX PERMANENT REMOVAL RHC | $236.80 | $296.00 | — | 37% below | 20% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC ED REMOVAL OF NAIL BED CDM | $480.00 | $600.00 | — | 29% above | 20% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 HC PR ED 11750 REMOVAL OF NAIL BED CDM | $148.00 | $185.00 | — | — | 20% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 HC ED REMOVAL OF NAIL BED CDM | $480.00 | $600.00 | — | — | 20% |
| Prostate biopsy CPT 55700 HC PR 55700 PROSTATE NEEDLE BIOPSY ANY APPROACH RHC | $358.40 | $448.00 | — | 46% below | 20% |
| Removal of a breast lump, open surgery CPT 19120 HC PR 19120 REMOVAL OF BREAST LESION 1 OR MORE LESIONS | $616.80 | $771.00 | — | 45% below | 20% |
| Removal of a breast lump, open surgery CPT 19120 HC PR 19120 REMOVAL OF BREAST LESION 1 OR MORE LESIONS | $771.20 | $964.00 | — | 31% below | 20% |
| Removal of a breast lump, open surgery CPT 19120 HC PR 19120 EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION RHC | $771.20 | $964.00 | — | 31% below | 20% |
| Removal of a breast lump, open surgery inpatient CPT 19120 HC PR 19120 REMOVAL OF BREAST LESION 1 OR MORE LESIONS | $616.80 | $771.00 | — | — | 20% |
| Removal of a foreign object under the skin, simple CPT 10120 HC PR 10120 INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE CDM | $151.20 | $189.00 | — | 51% below | 20% |
| Removal of a foreign object under the skin, simple CPT 10120 HC PR ED 10120 REMOVE FOREIGN BODY SIMPLE CDM | $151.20 | $189.00 | — | 51% below | 20% |
| Removal of a foreign object under the skin, simple CPT 10120 HC PR 10120 INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE CDM | $221.60 | $277.00 | — | 29% below | 20% |
| Removal of a foreign object under the skin, simple CPT 10120 HC PR ED 10120 REMOVE FOREIGN BODY SIMPLE CDM | $221.60 | $277.00 | — | 29% below | 20% |
| Removal of a foreign object under the skin, simple CPT 10120 HC PR 10120 INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE RHC | $228.00 | $285.00 | — | 27% below | 20% |
| Removal of a foreign object under the skin, simple CPT 10120 HC PR 10120 REMOVE FOREIGN BODY SIMPLE | $228.00 | $285.00 | — | 27% below | 20% |
| Removal of a foreign object under the skin, simple CPT 10120 HC ED REMOVE FOREIGN BODY SIMPLE CDM | $253.60 | $317.00 | — | 18% below | 20% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 HC PR 10120 INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE CDM | $151.20 | $189.00 | — | — | 20% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 HC PR ED 10120 REMOVE FOREIGN BODY SIMPLE CDM | $151.20 | $189.00 | — | — | 20% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 HC ED REMOVE FOREIGN BODY SIMPLE CDM | $253.60 | $317.00 | — | — | 20% |
| Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 HC PR G0121 COLORECTAL SCRN NOT HI RISK IND | $268.80 | $336.00 | — | 86% below | 20% |
| Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 HC PR G0121 COLORECTAL SCRN NOT HI RISK IND | $512.80 | $641.00 | — | 73% below | 20% |
| Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 HC PR G0121 COLORECTAL SCRN NOT HI RISK IND | $268.80 | $336.00 | — | — | 20% |
| Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 HC PR G0105 COLORECTAL SCRN HI RISK IND | $268.00 | $335.00 | — | 80% below | 20% |
| Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 HC PR G0105 COLORECTAL SCRN HI RISK IND | $512.00 | $640.00 | — | 62% below | 20% |
| Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 HC PR G0105 COLORECTAL SCRN HI RISK IND | $268.00 | $335.00 | — | — | 20% |
| Septoplasty to straighten the nasal septum CPT 30520 HC PR 30520 REPAIR OF NASAL SEPTUM | $1,008.00 | $1,260.00 | — | 28% below | 20% |
| Septoplasty to straighten the nasal septum CPT 30520 HC PR 30520 REPAIR OF NASAL SEPTUM | $1,008.00 | $1,260.00 | — | 28% below | 20% |
| Septoplasty to straighten the nasal septum inpatient CPT 30520 HC PR 30520 REPAIR OF NASAL SEPTUM | $1,008.00 | $1,260.00 | — | — | 20% |
| Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 HC PR 50590 LITHOTRIPSY XTRCORP SHOCK WAVE RHC | $1,099.20 | $1,374.00 | — | 48% below | 20% |
| Short arm cast (elbow to hand) CPT 29075 HC ED SHORT ARM CAST APPLICATION CDM | $71.20 | $89.00 | — | 67% below | 20% |
| Short arm cast (elbow to hand) CPT 29075 HC PR ED 29075 APPLICATION CAST ELBOW FINGER SHORT ARM CDM | $90.40 | $113.00 | — | 58% below | 20% |
| Short arm cast (elbow to hand) CPT 29075 HC PR ED 29075 APPLICATION CAST ELBOW FINGER SHORT ARM CDM | $126.40 | $158.00 | — | 41% below | 20% |
| Short arm cast (elbow to hand) CPT 29075 HC PR 29075 APPLICATION CAST ELBOW FINGER SHORT ARM RHC | $126.40 | $158.00 | — | 41% below | 20% |
| Short arm cast (elbow to hand) inpatient CPT 29075 HC ED SHORT ARM CAST APPLICATION CDM | $71.20 | $89.00 | — | — | 20% |
| Short arm cast (elbow to hand) inpatient CPT 29075 HC PR ED 29075 APPLICATION CAST ELBOW FINGER SHORT ARM CDM | $90.40 | $113.00 | — | — | 20% |
| Short arm splint (forearm and hand) CPT 29125 HC ED SHORT ARM SPLINT APPLICATION CDM | $56.80 | $71.00 | — | 64% below | 20% |
| Short arm splint (forearm and hand) CPT 29125 HC PR ED 29125 SHORT ARM SPLINT APPLICATION CDM | $58.40 | $73.00 | — | 63% below | 20% |
| Short arm splint (forearm and hand) CPT 29125 HC PR 29125 SHORT ARM SPLINT APPLICATION | $58.40 | $73.00 | — | 63% below | 20% |
| Short arm splint (forearm and hand) CPT 29125 HC PR ED 29125 SHORT ARM SPLINT APPLICATION CDM | $96.00 | $120.00 | — | 40% below | 20% |
| Short arm splint (forearm and hand) CPT 29125 HC PR 29125 APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC RHC | $96.00 | $120.00 | — | 40% below | 20% |
| Short arm splint (forearm and hand) CPT 29125 HC PR 29125 SHORT ARM SPLINT APPLICATION | $96.00 | $120.00 | — | 40% below | 20% |
| Short arm splint (forearm and hand) inpatient CPT 29125 HC ED SHORT ARM SPLINT APPLICATION CDM | $56.80 | $71.00 | — | — | 20% |
| Short arm splint (forearm and hand) inpatient CPT 29125 HC PR 29125 SHORT ARM SPLINT APPLICATION | $58.40 | $73.00 | — | — | 20% |
| Short arm splint (forearm and hand) inpatient CPT 29125 HC PR ED 29125 SHORT ARM SPLINT APPLICATION CDM | $58.40 | $73.00 | — | — | 20% |
| Short leg cast (below the knee) CPT 29405 HC PR ED 29405 SHORT LEG CAST APPLICATION CDM | $84.80 | $106.00 | — | 62% below | 20% |
| Short leg cast (below the knee) CPT 29405 HC PR 29405 SHORT LEG CAST APPLICATION | $88.00 | $110.00 | — | 61% below | 20% |
| Short leg cast (below the knee) CPT 29405 HC PR ED 29405 SHORT LEG CAST APPLICATION CDM | $116.00 | $145.00 | — | 48% below | 20% |
| Short leg cast (below the knee) CPT 29405 HC PR 29405 APPLICATION SHORT LEG CAST BELOW KNEE-TOE RHC | $116.00 | $145.00 | — | 48% below | 20% |
| Short leg cast (below the knee) inpatient CPT 29405 HC PR ED 29405 SHORT LEG CAST APPLICATION CDM | $84.80 | $106.00 | — | — | 20% |
| Short leg cast (below the knee) inpatient CPT 29405 HC PR 29405 SHORT LEG CAST APPLICATION | $88.00 | $110.00 | — | — | 20% |
| Short leg splint (calf to foot) CPT 29515 HC ED SHORT LEG SPLINT APPLICATION CDM | $56.80 | $71.00 | — | 70% below | 20% |
| Short leg splint (calf to foot) CPT 29515 HC PR ED 29515 SHORT LEG SPLINT APPLICATION CDM | $72.00 | $90.00 | — | 62% below | 20% |
| Short leg splint (calf to foot) CPT 29515 HC PR ED 29515 SHORT LEG SPLINT APPLICATION CDM | $103.20 | $129.00 | — | 46% below | 20% |
| Short leg splint (calf to foot) CPT 29515 HC PR 29515 APPLICATION SHORT LEG SPLINT CALF FOOT RHC | $103.20 | $129.00 | — | 46% below | 20% |
| Short leg splint (calf to foot) inpatient CPT 29515 HC ED SHORT LEG SPLINT APPLICATION CDM | $56.80 | $71.00 | — | — | 20% |
| Short leg splint (calf to foot) inpatient CPT 29515 HC PR ED 29515 SHORT LEG SPLINT APPLICATION CDM | $72.00 | $90.00 | — | — | 20% |
| Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 HC PR 29824 SHOULDER ARTHROSCOPY/SURGERY | $1,000.00 | $1,250.00 | — | 59% below | 20% |
| Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 HC PR 29824 SHOULDER ARTHROSCOPY/SURGERY | $1,000.00 | $1,250.00 | — | 59% below | 20% |
| Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) inpatient CPT 29824 HC PR 29824 SHOULDER ARTHROSCOPY/SURGERY | $1,000.00 | $1,250.00 | — | — | 20% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 HC PR 29826 SHOULDER ARTHROSCOPY/SURGERY SUBACRMIAL DCMP | $253.60 | $317.00 | — | 83% below | 20% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 HC PR 29826 SHOULDER ARTHROSCOPY/SURGERY SUBACRMIAL DCMP | $253.60 | $317.00 | — | 83% below | 20% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 HC PR 29826 SHOULDER ARTHROSCOPY/SURGERY SUBACRMIAL DCMP | $253.60 | $317.00 | — | — | 20% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC PR 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/OR LESS | $66.40 | $83.00 | — | 73% below | 20% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC PR ED 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/OR LESS CDM | $66.40 | $83.00 | — | 73% below | 20% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC PR 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/OR LESS RHC | $139.20 | $174.00 | — | 44% below | 20% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC PR 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/OR LESS | $139.20 | $174.00 | — | 44% below | 20% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC PR ED 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/OR LESS CDM | $139.20 | $174.00 | — | 44% below | 20% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC ED REPAIR SUPERFIC WOUND(S)LT/2.5CM SLP NK AX EXGEN TRNK EXTR HND FT CDM | $176.00 | $220.00 | — | 29% below | 20% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HC PR ED 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/OR LESS CDM | $66.40 | $83.00 | — | — | 20% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HC PR 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/OR LESS | $66.40 | $83.00 | — | — | 20% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HC ED REPAIR SUPERFIC WOUND(S)LT/2.5CM SLP NK AX EXGEN TRNK EXTR HND FT CDM | $176.00 | $220.00 | — | — | 20% |
| Skin biopsy, punch, one lesion CPT 11104 HC PR 11104 PUNCH BIOPSY SKIN SINGLE LESION | $68.00 | $85.00 | — | 79% below | 20% |
| Skin biopsy, punch, one lesion CPT 11104 HC PR 11104 PUNCH BIOPSY SKIN SINGLE LESION | $188.00 | $235.00 | — | 41% below | 20% |
| Skin biopsy, punch, one lesion CPT 11104 HC PR 11104 PUNCH BIOPSY SKIN SINGLE LESION RHC | $188.00 | $235.00 | — | 41% below | 20% |
| Skin biopsy, punch, one lesion inpatient CPT 11104 HC PR 11104 PUNCH BIOPSY SKIN SINGLE LESION | $68.00 | $85.00 | — | — | 20% |
| Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 HC PR 11600 EXCISION MAL LESION TRUNK/ARM/LEG 0.5 CM/OR LESS | $177.60 | $222.00 | — | 46% below | 20% |
| Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 HC PR 11600 EXCISION MAL LESION TRUNK/ARM/LEG 0.5 CM/OR LESS RHC | $293.60 | $367.00 | — | 11% below | 20% |
| Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 HC PR 11600 EXCISION MAL LESION TRUNK/ARM/LEG 0.5 CM/OR LESS | $293.60 | $367.00 | — | 11% below | 20% |
| Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 HC PR 11600 EXCISION MAL LESION TRUNK/ARM/LEG 0.5 CM/OR LESS | $177.60 | $222.00 | — | — | 20% |
| Skin tag removal, up to 15 tags CPT 11200 HC PR 11200 REMOVAL OF SKIN TAGS | $110.40 | $138.00 | — | 40% below | 20% |
| Skin tag removal, up to 15 tags CPT 11200 HC PR 11200 REMOVAL OF SKIN TAGS | $132.80 | $166.00 | — | 28% below | 20% |
| Skin tag removal, up to 15 tags CPT 11200 HC PR 11200 REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15 RHC | $132.80 | $166.00 | — | 28% below | 20% |
| Skin tag removal, up to 15 tags CPT 11200 HC ED REMOVAL OF SKIN TAGS CDM | $293.60 | $367.00 | — | 59% above | 20% |
| Skin tag removal, up to 15 tags inpatient CPT 11200 HC PR 11200 REMOVAL OF SKIN TAGS | $110.40 | $138.00 | — | — | 20% |
| Skin tag removal, up to 15 tags inpatient CPT 11200 HC ED REMOVAL OF SKIN TAGS CDM | $293.60 | $367.00 | — | — | 20% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 HC PR ED 62270 SPINAL FLUID TAP DIAGNOSTIC CDM | $108.80 | $136.00 | — | 75% below | 20% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 HC PR 62270 ANES/SPINAL PUNC | $155.20 | $194.00 | — | 64% below | 20% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 HC PR ED 62270 SPINAL FLUID TAP DIAGNOSTIC CDM | $224.80 | $281.00 | — | 48% below | 20% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE | $363.20 | $454.00 | — | 17% below | 20% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 HC ED SPINAL PUNCTURE LUMBAR DIAGNOSTIC CDM | $363.20 | $454.00 | — | 17% below | 20% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC PR ED 62270 SPINAL FLUID TAP DIAGNOSTIC CDM | $108.80 | $136.00 | — | — | 20% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC PR 62270 ANES/SPINAL PUNC | $155.20 | $194.00 | — | — | 20% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC ED SPINAL PUNCTURE LUMBAR DIAGNOSTIC CDM | $363.20 | $454.00 | — | — | 20% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE | $363.20 | $454.00 | — | — | 20% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC PR ED 12002 REPAIR SUPERFIC WOUND(S) 2.6 TO 7.5CM SLP NK AX EXGEN T CDM | $86.40 | $108.00 | — | 69% below | 20% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC PR ED 12002 REPAIR SUPERFIC WOUND(S) 2.6 TO 7.5CM SLP NK AX EXGEN T CDM | $167.20 | $209.00 | — | 40% below | 20% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC PR 12002 SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM RHC | $171.20 | $214.00 | — | 38% below | 20% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC PR 12002 REPAIR SUPERFICIAL WOUND(S) 2.6 TO 7.5CM SLP NK AX E | $171.20 | $214.00 | — | 38% below | 20% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC ED REPAIR SUPERFICIAL WND(S) 2.6-7.5CM SLP NK AX EXGEN TRNK E CDM | $192.00 | $240.00 | — | 31% below | 20% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 HC PR ED 12002 REPAIR SUPERFIC WOUND(S) 2.6 TO 7.5CM SLP NK AX EXGEN T CDM | $86.40 | $108.00 | — | — | 20% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 HC ED REPAIR SUPERFICIAL WND(S) 2.6-7.5CM SLP NK AX EXGEN TRNK E CDM | $192.00 | $240.00 | — | — | 20% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HC PR ED 12011 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/OR LESS CDM | $81.60 | $102.00 | — | 77% below | 20% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HC PR 12011 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/OR LESS CDM | $104.00 | $130.00 | — | 70% below | 20% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HC PR 12011 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/OR LESS RHC | $166.40 | $208.00 | — | 53% below | 20% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HC PR ED 12011 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/OR LESS CDM | $166.40 | $208.00 | — | 53% below | 20% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair one side CPT 12011 HC ED REPAIR SUPERFICIAL WOUND(S) LT/2.5 FACE ERS EYLD NSE LPS MUC CDM | $176.00 | $220.00 | — | 50% below | 20% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 HC PR ED 12011 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/OR LESS CDM | $81.60 | $102.00 | — | — | 20% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 HC PR 12011 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/OR LESS CDM | $104.00 | $130.00 | — | — | 20% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient one side CPT 12011 HC ED REPAIR SUPERFICIAL WOUND(S) LT/2.5 FACE ERS EYLD NSE LPS MUC CDM | $176.00 | $220.00 | — | — | 20% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC PR 11102 TANGENTIAL BIOPSY SKIN SINGLE LESION | $55.20 | $69.00 | — | 76% below | 20% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC PR 11102 TANGENTIAL BIOPSY SKIN SINGLE LESION | $152.00 | $190.00 | — | 35% below | 20% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC PR 11102 TANGENTIAL BIOPSY SKIN SINGLE LESION RHC | $152.00 | $190.00 | — | 35% below | 20% |
| Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 HC PR 11102 TANGENTIAL BIOPSY SKIN SINGLE LESION | $55.20 | $69.00 | — | — | 20% |
| Thoracentesis with imaging guidance CPT 32555 HC PR ED 32555 THORACENTESIS/ASPIR W IMG GD CDM | $160.00 | $200.00 | — | 83% below | 20% |
| Thoracentesis with imaging guidance CPT 32555 HC PR 32555 THORANCENTESIS NEEDLE/CATH PLEURA W IMAGING | $160.00 | $200.00 | — | 83% below | 20% |
| Thoracentesis with imaging guidance CPT 32555 HC PR ED 32555 THORACENTESIS/ASPIR W IMG GD CDM | $479.20 | $599.00 | — | 48% below | 20% |
| Thoracentesis with imaging guidance CPT 32555 HC PR 32555 THORANCENTESIS NEEDLE/CATH PLEURA W IMAGING | $479.20 | $599.00 | — | 48% below | 20% |
| Thoracentesis with imaging guidance CPT 32555 HC ED THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING CDM | $1,165.60 | $1,457.00 | — | 26% above | 20% |
| Thoracentesis with imaging guidance CPT 32555 HC THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING | $1,165.60 | $1,457.00 | — | 26% above | 20% |
| Thoracentesis with imaging guidance inpatient CPT 32555 HC PR 32555 THORANCENTESIS NEEDLE/CATH PLEURA W IMAGING | $160.00 | $200.00 | — | — | 20% |
| Thoracentesis with imaging guidance inpatient CPT 32555 HC PR ED 32555 THORACENTESIS/ASPIR W IMG GD CDM | $160.00 | $200.00 | — | — | 20% |
| Thoracentesis with imaging guidance inpatient CPT 32555 HC ED THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING CDM | $1,165.60 | $1,457.00 | — | — | 20% |
| Thoracentesis with imaging guidance inpatient CPT 32555 HC THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING | $1,165.60 | $1,457.00 | — | — | 20% |
| Tonsil and adenoid removal, age 12 or older CPT 42821 HC PR 42821 REMOVE TONSILS AND ADENOIDS > 12 YEARS | $446.40 | $558.00 | — | 45% below | 20% |
| Tonsil and adenoid removal, age 12 or older CPT 42821 HC PR 42821 REMOVE TONSILS AND ADENOIDS > 12 YEARS | $446.40 | $558.00 | — | 45% below | 20% |
| Tonsil and adenoid removal, age 12 or older inpatient CPT 42821 HC PR 42821 REMOVE TONSILS AND ADENOIDS > 12 YEARS | $446.40 | $558.00 | — | — | 20% |
| Tonsil removal (tonsillectomy) only, age 12 or older CPT 42826 HC PR 42826 REMOVAL OF TONSILS >12YEARS | $375.20 | $469.00 | — | 44% below | 20% |
| Tonsil removal (tonsillectomy) only, age 12 or older CPT 42826 HC PR 42826 REMOVAL OF TONSILS >12YEARS | $375.20 | $469.00 | — | 44% below | 20% |
| Tonsil removal (tonsillectomy) only, age 12 or older inpatient CPT 42826 HC PR 42826 REMOVAL OF TONSILS >12YEARS | $375.20 | $469.00 | — | — | 20% |
| Tonsil removal (tonsillectomy) only, child under 12 CPT 42825 HC PR 42825 REMOVAL OF TONSILLS PRIMARY OR SECONDARY/YOUNGER THAN 12 YRS | $394.40 | $493.00 | — | 54% below | 20% |
| Tonsil removal (tonsillectomy) only, child under 12 CPT 42825 HC PR 42825 REMOVAL OF TONSILLS PRIMARY OR SECONDARY/YOUNGER THAN 12 YRS | $394.40 | $493.00 | — | 54% below | 20% |
| Tonsil removal (tonsillectomy) only, child under 12 inpatient CPT 42825 HC PR 42825 REMOVAL OF TONSILLS PRIMARY OR SECONDARY/YOUNGER THAN 12 YRS | $394.40 | $493.00 | — | — | 20% |
| Total hip replacement CPT 27130 HC PR 27130 TOTAL HIP ARTHROPLASTY | $1,886.40 | $2,358.00 | — | 71% below | 20% |
| Total hip replacement CPT 27130 HC PR 27130 ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT | $1,886.40 | $2,358.00 | — | 71% below | 20% |
| Total hip replacement CPT 27130 HC PR 27130 ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT | $1,886.40 | $2,358.00 | — | 71% below | 20% |
| Total hip replacement CPT 27130 HC PR 27130 TOTAL HIP ARTHROPLASTY | $1,886.40 | $2,358.00 | — | 71% below | 20% |
| Total hip replacement inpatient CPT 27130 HC PR 27130 ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT | $1,886.40 | $2,358.00 | — | — | 20% |
| Total hip replacement inpatient CPT 27130 HC PR 27130 TOTAL HIP ARTHROPLASTY | $1,886.40 | $2,358.00 | — | — | 20% |
| Total knee replacement CPT 27447 HC PR 27447 TOTAL KNEE ARTHROPLASTY | $1,884.00 | $2,355.00 | — | 79% below | 20% |
| Total knee replacement CPT 27447 HC PR 27447 TOTAL KNEE ARTHROPLASTY | $1,884.00 | $2,355.00 | — | 79% below | 20% |
| Total knee replacement inpatient CPT 27447 HC PR 27447 TOTAL KNEE ARTHROPLASTY | $1,884.00 | $2,355.00 | — | — | 20% |
| Total shoulder replacement CPT 23472 HC PR 23472 ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER | $1,916.80 | $2,396.00 | — | 79% below | 20% |
| Total shoulder replacement inpatient CPT 23472 HC PR 23472 ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER | $1,916.80 | $2,396.00 | — | — | 20% |
| Total thyroid removal (thyroidectomy) CPT 60240 HC PR 60240 REMOVAL OF THYROID | $1,352.80 | $1,691.00 | — | 59% below | 20% |
| Total thyroid removal (thyroidectomy) CPT 60240 HC PR 60240 REMOVAL OF THYROID | $1,352.80 | $1,691.00 | — | 59% below | 20% |
| Total thyroid removal (thyroidectomy) inpatient CPT 60240 HC PR 60240 REMOVAL OF THYROID | $1,352.80 | $1,691.00 | — | — | 20% |
| Trigger finger release surgery CPT 26055 HC PR 26055 INCISE FINGER TENDON SHEATH | $431.20 | $539.00 | — | 39% below | 20% |
| Trigger finger release surgery CPT 26055 HC PR 26055 TENDON SHEATH INCISION RHC | $890.40 | $1,113.00 | — | 26% above | 20% |
| Trigger finger release surgery CPT 26055 HC PR 26055 INCISE FINGER TENDON SHEATH | $890.40 | $1,113.00 | — | 26% above | 20% |
| Trigger finger release surgery inpatient CPT 26055 HC PR 26055 INCISE FINGER TENDON SHEATH | $431.20 | $539.00 | — | — | 20% |
| Trigger point injections, 1 or 2 muscles CPT 20552 HC PR 20552 INJ TRIGGER POINT 1/2 MUSCL | $55.20 | $69.00 | — | 70% below | 20% |
| Trigger point injections, 1 or 2 muscles CPT 20552 HC PR ED 20552 INJ TRIGGER POINT 1/2 MUSCL CDM | $66.40 | $83.00 | — | 64% below | 20% |
| Trigger point injections, 1 or 2 muscles CPT 20552 HC PR 20552 INJ TRIGGER POINT 1/2 MUSCL | $79.20 | $99.00 | — | 57% below | 20% |
| Trigger point injections, 1 or 2 muscles CPT 20552 HC PR 20552 INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES RHC | $79.20 | $99.00 | — | 57% below | 20% |
| Trigger point injections, 1 or 2 muscles CPT 20552 HC PR ED 20552 INJ TRIGGER POINT 1/2 MUSCL CDM | $95.20 | $119.00 | — | 48% below | 20% |
| Trigger point injections, 1 or 2 muscles CPT 20552 HC ED INJ TRIGGER POINT 1/2 MUSCL CDM | $350.40 | $438.00 | — | 92% above | 20% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC PR 20552 INJ TRIGGER POINT 1/2 MUSCL | $55.20 | $69.00 | — | — | 20% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC PR ED 20552 INJ TRIGGER POINT 1/2 MUSCL CDM | $66.40 | $83.00 | — | — | 20% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC ED INJ TRIGGER POINT 1/2 MUSCL CDM | $350.40 | $438.00 | — | — | 20% |
| Tubal ligation, laparoscopic (tubes sealed by cautery) CPT 58670 HC PR 58670 LAPAROSCOPY TUBAL CAUTERY | $550.40 | $688.00 | — | 72% below | 20% |
| Tubal ligation, laparoscopic (tubes sealed by cautery) CPT 58670 HC PR 58670 LAPAROSCOPY TUBAL CAUTERY | $550.40 | $688.00 | — | 72% below | 20% |
| Tubal ligation, laparoscopic (tubes sealed by cautery) CPT 58670 HC PR 58670 LAPAROSCOPY FULGURATION OVIDUCTS RHC | $550.40 | $688.00 | — | 72% below | 20% |
| Tubal ligation, laparoscopic (tubes sealed by cautery) inpatient CPT 58670 HC PR 58670 LAPAROSCOPY TUBAL CAUTERY | $550.40 | $688.00 | — | — | 20% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 HC PR 19083 BX BREAST 1ST LESION US IMAG | $225.60 | $282.00 | — | 86% below | 20% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 HC PR 19083 BX BREAST 1ST LESION US IMAG | $770.40 | $963.00 | — | 51% below | 20% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 HC PR 19083 BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID RHC | $770.40 | $963.00 | — | 51% below | 20% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 HC BX BREAST 1ST LESION US IMAG | $1,720.00 | $2,150.00 | — | 10% above | 20% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 HC PR 19083 BX BREAST 1ST LESION US IMAG | $225.60 | $282.00 | — | — | 20% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 HC BX BREAST 1ST LESION US IMAG | $1,720.00 | $2,150.00 | — | — | 20% |
| Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 HC PR 43249 EGD BALLOON DILATION ESOPHAGUS/LESS THAN 30MM | $223.20 | $279.00 | — | 83% below | 20% |
| Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 HC PR 43249 EGD BALLOON DILATION ESOPHAGUS/LESS THAN 30MM | $1,692.00 | $2,115.00 | — | 27% above | 20% |
| Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 HC PR 43249 EGD BALLOON DILATION ESOPHAGUS/LESS THAN 30MM | $223.20 | $279.00 | — | — | 20% |
| Upper endoscopy (EGD) with biopsy CPT 43239 HC PR 43239 EGD BIOPSY SINGLE/MULTIPLE | $200.80 | $251.00 | — | 87% below | 20% |
| Upper endoscopy (EGD) with biopsy CPT 43239 HC PR 43239 EGD BIOPSY SINGLE/MULTIPLE | $577.60 | $722.00 | — | 63% below | 20% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 HC PR 43239 EGD BIOPSY SINGLE/MULTIPLE | $200.80 | $251.00 | — | — | 20% |
| Upper endoscopy (EGD) with polyp removal by snare CPT 43251 HC PR 43251 EGD REMOVE LESION SNARE | $284.80 | $356.00 | — | 84% below | 20% |
| Upper endoscopy (EGD) with polyp removal by snare CPT 43251 HC PR 43251 EGD REMOVE LESION SNARE | $760.00 | $950.00 | — | 59% below | 20% |
| Upper endoscopy (EGD) with polyp removal by snare CPT 43251 HC PR 43251 EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH RHC | $760.00 | $950.00 | — | 59% below | 20% |
| Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 HC PR 43251 EGD REMOVE LESION SNARE | $284.80 | $356.00 | — | — | 20% |
| Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 HC PR 43248 EGD GUIDE WIRE INSERTION | $240.80 | $301.00 | — | 63% below | 20% |
| Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 HC PR 43248 EGD GUIDE WIRE INSERTION | $631.20 | $789.00 | — | 4% below | 20% |
| Upper endoscopy (EGD) with widening of the esophagus over a guide wire inpatient CPT 43248 HC PR 43248 EGD GUIDE WIRE INSERTION | $240.80 | $301.00 | — | — | 20% |
| Upper endoscopy (EGD), diagnostic CPT 43235 HC PR 43235 EGD DIAGNOSTIC BRUSH WASH | $178.40 | $223.00 | — | 83% below | 20% |
| Upper endoscopy (EGD), diagnostic CPT 43235 HC PR 43235 EGD DIAGNOSTIC BRUSH WASH | $451.20 | $564.00 | — | 57% below | 20% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 HC PR 43235 EGD DIAGNOSTIC BRUSH WASH | $178.40 | $223.00 | — | — | 20% |
| Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 HC PR 52353 CYSTO W/URETEROSCOPY W/LITHOTRIPSY RHC | $576.00 | $720.00 | — | 83% below | 20% |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care CPT 59610 HC PR 59610 TOTAL OB/VBAC/PP CARE | $3,066.40 | $3,833.00 | — | 41% below | 20% |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care CPT 59610 HC PR 59610 TOTAL OB/VBAC/PP CARE | $3,066.40 | $3,833.00 | — | 41% below | 20% |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care inpatient CPT 59610 HC PR 59610 TOTAL OB/VBAC/PP CARE | $3,066.40 | $3,833.00 | — | — | 20% |
| Vaginal delivery, including prenatal and postpartum care CPT 59400 HC PR 59400 TOTAL OB/VAGINAL DELIVERY/PP CARE | $2,908.80 | $3,636.00 | — | 40% below | 20% |
| Vaginal delivery, including prenatal and postpartum care CPT 59400 HC PR 59400 TOTAL OB/VAGINAL DELIVERY/PP CARE | $2,908.80 | $3,636.00 | — | 40% below | 20% |
| Vaginal delivery, including prenatal and postpartum care inpatient CPT 59400 HC PR 59400 TOTAL OB/VAGINAL DELIVERY/PP CARE | $2,908.80 | $3,636.00 | — | — | 20% |
| Vasectomy, one or both sides, including follow-up semen testing both sides CPT 55250 HC PR 55250 VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS RHC | $496.80 | $621.00 | — | — | 20% |
| Vasectomy, one or both sides, including follow-up semen testing CPT 55250 HC PR 55250 REMOVAL OF SPERM DUCT(S) | $332.80 | $416.00 | — | 80% below | 20% |
| Vasectomy, one or both sides, including follow-up semen testing CPT 55250 HC PR 55250 REMOVAL OF SPERM DUCT(S) | $496.80 | $621.00 | — | 70% below | 20% |
| Vasectomy, one or both sides, including follow-up semen testing inpatient CPT 55250 HC PR 55250 REMOVAL OF SPERM DUCT(S) | $332.80 | $416.00 | — | — | 20% |
| Wart removal, up to 14 warts CPT 17110 HC PR 17110 DESTRUCT B9 LESION 1-14 | $96.80 | $121.00 | — | 49% below | 20% |
| Wart removal, up to 14 warts CPT 17110 HC PR 17110 DESTRUCTION BENIGN LESIONS UP TO 14 RHC | $167.20 | $209.00 | — | 12% below | 20% |
| Wart removal, up to 14 warts CPT 17110 HC PR 17110 DESTRUCT B9 LESION 1-14 | $167.20 | $209.00 | — | 12% below | 20% |
| Wart removal, up to 14 warts inpatient CPT 17110 HC PR 17110 DESTRUCT B9 LESION 1-14 | $96.80 | $121.00 | — | — | 20% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC PR ED 11042 DEB SUBQ TISSUE FIRST 20 SQ CM OR LESS CDM | $88.00 | $110.00 | — | 67% below | 20% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC PR ED 11042 DEB SUBQ TISSUE FIRST 20 SQ CM OR LESS CDM | $192.00 | $240.00 | — | 28% below | 20% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC PR 11042 DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM OR LESS RHC | $192.00 | $240.00 | — | 28% below | 20% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HC PR ED 11042 DEB SUBQ TISSUE FIRST 20 SQ CM OR LESS CDM | $88.00 | $110.00 | — | — | 20% |
| Wrist fracture surgery (plate and screws), distal radius CPT 25607 HC PR 25607 TREAT FX RAD EXTRA-ARTICUL | $1,090.40 | $1,363.00 | — | 83% below | 20% |
| Wrist fracture surgery (plate and screws), distal radius CPT 25607 HC PR 25607 TREAT FX RAD EXTRA-ARTICUL | $1,090.40 | $1,363.00 | — | 83% below | 20% |
| Wrist fracture surgery (plate and screws), distal radius inpatient CPT 25607 HC PR 25607 TREAT FX RAD EXTRA-ARTICUL | $1,090.40 | $1,363.00 | — | — | 20% |
Doctor visits and therapy
| Procedure | Cash price | List price | Insurers pay | vs Montana | Off list |
|---|---|---|---|---|---|
| Blood transfusion (giving blood or blood components) CPT 36430 HC BLOOD TRANSFUSION EA UNIT CDM | $295.20 | $369.00 | — | 61% below | 20% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC BLOOD TRANSFUSION EA UNIT CDM | $295.20 | $369.00 | — | — | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC INHALATION TREATMENT DAILY | $446.40 | $558.00 | — | 307% above | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC ED INHALATION TREATMENT CDM | $446.40 | $558.00 | — | 307% above | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC INHALATION TREATMENT DAILY | $446.40 | $558.00 | — | — | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC ED INHALATION TREATMENT CDM | $446.40 | $558.00 | — | — | 20% |
| Chemotherapy IV infusion, first hour CPT 96413 HC TYSABRI INFUSION FIRST HR | $309.60 | $387.00 | — | 39% below | 20% |
| Chemotherapy IV infusion, first hour CPT 96413 HC CHEMO IV INFUSION INITIAL HR CDM | $613.60 | $767.00 | — | 22% above | 20% |
| Chemotherapy IV infusion, first hour inpatient CPT 96413 HC TYSABRI INFUSION FIRST HR | $309.60 | $387.00 | — | — | 20% |
| Chemotherapy IV infusion, first hour inpatient CPT 96413 HC CHEMO IV INFUSION INITIAL HR CDM | $613.60 | $767.00 | — | — | 20% |
| Critical care, first 30 to 74 minutes CPT 99291 HC PR ED 99291 CRITICAL CARE FIRST HOUR CDM | $314.40 | $393.00 | — | 83% below | 20% |
| Critical care, first 30 to 74 minutes CPT 99291 HC PR ED 99291 CRITICAL CARE FIRST HOUR CDM | $404.80 | $506.00 | — | 78% below | 20% |
| Critical care, first 30 to 74 minutes CPT 99291 HC ED CRITICAL CARE FIRST HOUR CDM | $1,226.40 | $1,533.00 | — | 34% below | 20% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 HC PR ED 99291 CRITICAL CARE FIRST HOUR CDM | $314.40 | $393.00 | — | — | 20% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 HC ED CRITICAL CARE FIRST HOUR CDM | $1,226.40 | $1,533.00 | — | — | 20% |
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 HC PR 93000 ECG ROUTINE ECG W/LEAST 12 LDS W/I&R RHC | $21.60 | $27.00 | — | 61% below | 20% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC ECG 12 LEAD TRACING ONLY | $127.20 | $159.00 | — | 18% below | 20% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 HC ECG 12 LEAD TRACING ONLY | $127.20 | $159.00 | — | — | 20% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 HC ED FAC E&M VISIT LEVEL 1 CDM | $160.80 | $201.00 | — | 23% below | 20% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 HC ED FAC E&M VISIT LEVEL 1 CDM | $160.80 | $201.00 | — | — | 20% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 HC ED FAC E&M VISIT LEVEL 2 CDM | $356.80 | $446.00 | — | 1% above | 20% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 HC ED FAC E&M VISIT LEVEL 2 CDM | $356.80 | $446.00 | — | — | 20% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 HC ED FAC E&M VISIT LEVEL 3 CDM | $513.60 | $642.00 | — | 3% below | 20% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 HC ED FAC E&M VISIT LEVEL 3 CDM | $513.60 | $642.00 | — | — | 20% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC ED FAC E&M VISIT LEVEL 4 CDM | $787.20 | $984.00 | — | 7% below | 20% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HC ED FAC E&M VISIT LEVEL 4 CDM | $787.20 | $984.00 | — | — | 20% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC ED FAC E&M VISIT LEVEL 5 CDM | $1,182.40 | $1,478.00 | — | 8% below | 20% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HC ED FAC E&M VISIT LEVEL 5 CDM | $1,182.40 | $1,478.00 | — | — | 20% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 HC CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY | $403.20 | $504.00 | — | 30% below | 20% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HC CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY | $403.20 | $504.00 | — | — | 20% |
| Family therapy with the patient, 50 minutes CPT 90847 HC PR 90847 FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS | $145.60 | $182.00 | — | 9% below | 20% |
| Family therapy with the patient, 50 minutes CPT 90847 HC PR 90847 FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS | $146.40 | $183.00 | — | 8% below | 20% |
| Family therapy with the patient, 50 minutes CPT 90847 HC PR 90847 PSYTX FAMILY W PT 50 MIN RHC | $146.40 | $183.00 | — | 8% below | 20% |
| Family therapy with the patient, 50 minutes CPT 90847 HC PR 90847 FAMILY PSYTX W/PATIENT | $158.40 | $198.00 | — | 1% below | 20% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 HC PR 90847 FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS | $145.60 | $182.00 | — | — | 20% |
| Family therapy without the patient, 50 minutes CPT 90846 HC PR 90846 FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS | $140.00 | $175.00 | — | 11% below | 20% |
| Family therapy without the patient, 50 minutes CPT 90846 HC PR 90846 FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS | $141.60 | $177.00 | — | 10% below | 20% |
| Family therapy without the patient, 50 minutes CPT 90846 HC PR 90846 PSYTX FAMILY WO PT 50 MIN RHC | $141.60 | $177.00 | — | 10% below | 20% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 HC PR 90846 FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS | $140.00 | $175.00 | — | — | 20% |
| Group psychotherapy session CPT 90853 HC PR 90853 GROUP PSYCHOTHERAPY 120 MIN | $34.40 | $43.00 | — | 51% below | 20% |
| Group psychotherapy session CPT 90853 HC PR 90853 PSYTX GROUP RHC | $39.20 | $49.00 | — | 44% below | 20% |
| Group psychotherapy session CPT 90853 HC PR 90853 GROUP PSYCHOTHERAPY 120 MIN | $39.20 | $49.00 | — | 44% below | 20% |
| Group psychotherapy session inpatient CPT 90853 HC PR 90853 GROUP PSYCHOTHERAPY 120 MIN | $34.40 | $43.00 | — | — | 20% |
| Holter monitor, heart rhythm recording up to 48 hours, with report CPT 93224 HC PR 93224 XTRNL ECG & 48 HR RECORD SCAN STOR W/R&I RHC | $104.80 | $131.00 | — | 74% below | 20% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC PR 96360 IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR RHC | $46.40 | $58.00 | — | 82% below | 20% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC PR 96360 IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR | $50.40 | $63.00 | — | 80% below | 20% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC PR 96360 IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR | $50.40 | $63.00 | — | 80% below | 20% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC ED IV HYDRATION INITIAL HR CDM | $311.20 | $389.00 | — | 23% above | 20% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC IV HYDRATION INITIAL HR CDM | $416.00 | $520.00 | — | 64% above | 20% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC PR 96360 IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR | $50.40 | $63.00 | — | — | 20% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC ED IV HYDRATION INITIAL HR CDM | $311.20 | $389.00 | — | — | 20% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC IV HYDRATION INITIAL HR CDM | $416.00 | $520.00 | — | — | 20% |
| IV infusion of a medicine, first hour CPT 96365 HC PR 96365 IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR RHC | $88.80 | $111.00 | — | 74% below | 20% |
| IV infusion of a medicine, first hour CPT 96365 HC ED IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR CDM | $311.20 | $389.00 | — | 10% below | 20% |
| IV infusion of a medicine, first hour CPT 96365 HC IV INFUSION INITIAL HR CDM | $516.80 | $646.00 | — | 50% above | 20% |
| IV infusion of a medicine, first hour inpatient CPT 96365 HC ED IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR CDM | $311.20 | $389.00 | — | — | 20% |
| IV infusion of a medicine, first hour inpatient CPT 96365 HC IV INFUSION INITIAL HR CDM | $516.80 | $646.00 | — | — | 20% |
| IV push of a medicine, first drug CPT 96374 HC PR 96374 THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG RHC | $52.80 | $66.00 | — | 67% below | 20% |
| IV push of a medicine, first drug CPT 96374 HC PR 96374 THER/PROPH/DIAG INJ IV PUSH | $57.60 | $72.00 | — | 64% below | 20% |
| IV push of a medicine, first drug CPT 96374 HC PR 96374 THER/PROPH/DIAG INJ IV PUSH | $57.60 | $72.00 | — | 64% below | 20% |
| IV push of a medicine, first drug CPT 96374 HC INJ IV PUSH INITIAL DRUG CDM | $264.80 | $331.00 | — | 66% above | 20% |
| IV push of a medicine, first drug CPT 96374 HC ED IV INJECTION THERAPEUTIC PROPH/DX PUSH SINGLE/1ST SBST/DRUG CDM | $264.80 | $331.00 | — | 66% above | 20% |
| IV push of a medicine, first drug inpatient CPT 96374 HC PR 96374 THER/PROPH/DIAG INJ IV PUSH | $57.60 | $72.00 | — | — | 20% |
| IV push of a medicine, first drug inpatient CPT 96374 HC ED IV INJECTION THERAPEUTIC PROPH/DX PUSH SINGLE/1ST SBST/DRUG CDM | $264.80 | $331.00 | — | — | 20% |
| IV push of a medicine, first drug inpatient CPT 96374 HC INJ IV PUSH INITIAL DRUG CDM | $264.80 | $331.00 | — | — | 20% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC PR 96372 THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM RHC | $21.60 | $27.00 | — | 72% below | 20% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC PR 96372 THER/PROPH/DIAG INJ SC/IM | $21.60 | $27.00 | — | 72% below | 20% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC PR 96372 THER/PROPH/DIAG INJ SC/IM | $21.60 | $27.00 | — | 72% below | 20% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC ED THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM CDM | $131.20 | $164.00 | — | 67% above | 20% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC INJ SQ OR IM CDM | $170.40 | $213.00 | — | 117% above | 20% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC PR 96372 THER/PROPH/DIAG INJ SC/IM | $21.60 | $27.00 | — | — | 20% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC ED THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM CDM | $131.20 | $164.00 | — | — | 20% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC INJ SQ OR IM CDM | $170.40 | $213.00 | — | — | 20% |
| Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC PR 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION | $220.80 | $276.00 | — | at median | 20% |
| Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC PR 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION | $256.80 | $321.00 | — | 16% above | 20% |
| Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC PR 90791 PSYCH DIAG EVAL RHC | $256.80 | $321.00 | — | 16% above | 20% |
| Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC PR 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION | $220.80 | $276.00 | — | — | 20% |
| Nerve conduction study, 7 or 8 nerve studies CPT 95910 HC PR 95910 NERVE CONDUCTION STUDIES 7-8 STUDIES RHC | $257.60 | $322.00 | — | 2% above | 20% |
| Neuromuscular re-education, 15 minutes CPT 97112 HC CRISIS TELEH 97112 NEUROMUSCUL REEDUCAT EA 15 MIN CDM | $55.20 | $69.00 | — | 38% below | 20% |
| Neuromuscular re-education, 15 minutes CPT 97112 HC NEUROMUSC REEDUCA THER PX 1 OR MORE AREAS EACH 15 MIN | $55.20 | $69.00 | — | 38% below | 20% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC NEUROMUSC REEDUCA THER PX 1 OR MORE AREAS EACH 15 MIN | $55.20 | $69.00 | — | — | 20% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC CRISIS TELEH 97112 NEUROMUSCUL REEDUCAT EA 15 MIN CDM | $55.20 | $69.00 | — | — | 20% |
| New patient office visit, about 30 minutes CPT 99203 HC NEW PT VISIT - LEVEL 3 | $115.20 | $144.00 | — | 31% below | 20% |
| New patient office visit, about 30 minutes CPT 99203 HC L&D TRIAGE NEW PATIENT LVL 3 CDM | $115.20 | $144.00 | — | 31% below | 20% |
| New patient office visit, about 30 minutes CPT 99203 HC PR 99203 NEW PT VISIT - LEVEL 3 | $121.60 | $152.00 | — | 27% below | 20% |
| New patient office visit, about 30 minutes CPT 99203 HC PR 99203 NEW PT VISIT - LEVEL 3 | $163.20 | $204.00 | — | 2% below | 20% |
| New patient office visit, about 30 minutes CPT 99203 HC PR 99203 OFFICE OUTPATIENT NEW RHC | $167.20 | $209.00 | — | at median | 20% |
| New patient office visit, about 30 minutes inpatient CPT 99203 HC L&D TRIAGE NEW PATIENT LVL 3 CDM | $115.20 | $144.00 | — | — | 20% |
| New patient office visit, about 30 minutes inpatient CPT 99203 HC NEW PT VISIT - LEVEL 3 | $115.20 | $144.00 | — | — | 20% |
| New patient office visit, about 30 minutes inpatient CPT 99203 HC PR 99203 NEW PT VISIT - LEVEL 3 | $121.60 | $152.00 | — | — | 20% |
| New patient office visit, about 45 minutes CPT 99204 HC PR 99204 NEW PT VISIT - LEVEL 4 | $196.00 | $245.00 | — | 17% below | 20% |
| New patient office visit, about 45 minutes CPT 99204 HC L&D TRIAGE NEW PATIENT LVL 4 CDM | $231.20 | $289.00 | — | 2% below | 20% |
| New patient office visit, about 45 minutes CPT 99204 HC NEW PT VISIT - LEVEL 4 | $242.40 | $303.00 | — | 2% above | 20% |
| New patient office visit, about 45 minutes CPT 99204 HC PR 99204 NEW PT VISIT - LEVEL 4 | $243.20 | $304.00 | — | 3% above | 20% |
| New patient office visit, about 45 minutes CPT 99204 HC PR 99204 OFFICE OUTPATIENT NEW RHC | $251.20 | $314.00 | — | 6% above | 20% |
| New patient office visit, about 45 minutes inpatient CPT 99204 HC PR 99204 NEW PT VISIT - LEVEL 4 | $196.00 | $245.00 | — | — | 20% |
| New patient office visit, about 45 minutes inpatient CPT 99204 HC L&D TRIAGE NEW PATIENT LVL 4 CDM | $231.20 | $289.00 | — | — | 20% |
| New patient office visit, about 45 minutes inpatient CPT 99204 HC NEW PT VISIT - LEVEL 4 | $242.40 | $303.00 | — | — | 20% |
| New patient office visit, about 60 minutes CPT 99205 HC NEW PT VISIT - LEVEL 5 | $255.20 | $319.00 | — | 23% below | 20% |
| New patient office visit, about 60 minutes CPT 99205 HC L&D TRIAGE NEW PATIENT LVL 5 CDM | $260.00 | $325.00 | — | 22% below | 20% |
| New patient office visit, about 60 minutes CPT 99205 HC PR 99205 NEW PT VISIT - LEVEL 5 | $266.40 | $333.00 | — | 20% below | 20% |
| New patient office visit, about 60 minutes CPT 99205 HC PR 99205 NEW PT VISIT - LEVEL 5 | $321.60 | $402.00 | — | 3% below | 20% |
| New patient office visit, about 60 minutes CPT 99205 HC PR 99205 OFFICE OUTPATIENT NEW RHC | $331.20 | $414.00 | — | at median | 20% |
| New patient office visit, about 60 minutes inpatient CPT 99205 HC NEW PT VISIT - LEVEL 5 | $255.20 | $319.00 | — | — | 20% |
| New patient office visit, about 60 minutes inpatient CPT 99205 HC L&D TRIAGE NEW PATIENT LVL 5 CDM | $260.00 | $325.00 | — | — | 20% |
| New patient office visit, about 60 minutes inpatient CPT 99205 HC PR 99205 NEW PT VISIT - LEVEL 5 | $266.40 | $333.00 | — | — | 20% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC PR 99202 NEW PT VISIT - LEVEL 2 | $71.20 | $89.00 | — | 50% below | 20% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC L&D TRIAGE NEW PATIENT LVL 2 CDM | $105.60 | $132.00 | — | 26% below | 20% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC L&D TRIAGE NEW PATIENT LVL 1 CDM | $105.60 | $132.00 | — | 26% below | 20% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC PR 99202 NEW PT VISIT - LEVEL 2 | $106.40 | $133.00 | — | 26% below | 20% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC PR 99202 OFFICE OUTPATIENT NEW RHC | $107.20 | $134.00 | — | 25% below | 20% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC PR 99202 NEW PT VISIT - LEVEL 2 | $71.20 | $89.00 | — | — | 20% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC L&D TRIAGE NEW PATIENT LVL 1 CDM | $105.60 | $132.00 | — | — | 20% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC L&D TRIAGE NEW PATIENT LVL 2 CDM | $105.60 | $132.00 | — | — | 20% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC PR 97802 MEDICAL NUTRITION INDIV INITIAL THERAPY EA 15 MIN | $47.20 | $59.00 | — | 4% above | 20% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC PR 97802 MEDICAL NUTRITION INDIV INITIAL THERAPY EA 15 MIN | $53.60 | $67.00 | — | 18% above | 20% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC PR 97802 MED NUTRITION ASSMT&IVNTJ INITIAL INDIV THERAPY EACH 15MIN RHC | $55.20 | $69.00 | — | 22% above | 20% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC MEDICAL NUTRITION INITIAL ASSMT&IVNTJ INDIVIDUAL THERAPY EACH 15MIN | $66.40 | $83.00 | — | 46% above | 20% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC MEDICAL NUTRITION INDIV INITIAL THERAPY EA 15 MIN CDM | $66.40 | $83.00 | — | 46% above | 20% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HC PR 97802 MEDICAL NUTRITION INDIV INITIAL THERAPY EA 15 MIN | $47.20 | $59.00 | — | — | 20% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HC MEDICAL NUTRITION INITIAL ASSMT&IVNTJ INDIVIDUAL THERAPY EACH 15MIN | $66.40 | $83.00 | — | — | 20% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HC MEDICAL NUTRITION INDIV INITIAL THERAPY EA 15 MIN CDM | $66.40 | $83.00 | — | — | 20% |
| Occupational therapy evaluation, low complexity CPT 97165 HC OT EVALUATION LOW COMPLEX | $92.80 | $116.00 | — | 46% below | 20% |
| Occupational therapy evaluation, low complexity CPT 97165 HC CRISIS TELEH 97165 OT EVALUATION LOW COMPLEX CDM | $92.80 | $116.00 | — | 46% below | 20% |
| Occupational therapy evaluation, low complexity CPT 97165 HC PR 97165 OT EVAL LOW COMPLEX 30 MINS CDM | $154.40 | $193.00 | — | 10% below | 20% |
| Occupational therapy evaluation, low complexity inpatient CPT 97165 HC CRISIS TELEH 97165 OT EVALUATION LOW COMPLEX CDM | $92.80 | $116.00 | — | — | 20% |
| Occupational therapy evaluation, low complexity inpatient CPT 97165 HC OT EVALUATION LOW COMPLEX | $92.80 | $116.00 | — | — | 20% |
| Occupational therapy evaluation, low complexity inpatient CPT 97165 HC PR 97165 OT EVAL LOW COMPLEX 30 MINS CDM | $154.40 | $193.00 | — | — | 20% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC CRISIS TELEH 97163 PT EVALUATION HIGH COMPLEX CDM | $153.60 | $192.00 | — | 23% below | 20% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC PT EVALUATION HIGH COMPLEX | $153.60 | $192.00 | — | 23% below | 20% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC PT EVALUATION HIGH COMPLEX | $153.60 | $192.00 | — | — | 20% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC CRISIS TELEH 97163 PT EVALUATION HIGH COMPLEX CDM | $153.60 | $192.00 | — | — | 20% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC CRISIS TELEH 97161 PT EVALUATION LOW COMPLEX CDM | $92.80 | $116.00 | — | 45% below | 20% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC PT EVALUATION LOW COMPLEX CDM | $92.80 | $116.00 | — | 45% below | 20% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HC PT EVALUATION LOW COMPLEX CDM | $92.80 | $116.00 | — | — | 20% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HC CRISIS TELEH 97161 PT EVALUATION LOW COMPLEX CDM | $92.80 | $116.00 | — | — | 20% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC PT EVALUATION MOD COMPLEX CDM | $123.20 | $154.00 | — | 35% below | 20% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC CRISIS TELEH 97162 PT EVALUATION MOD COMPLEX CDM | $123.20 | $154.00 | — | 35% below | 20% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC CRISIS TELEH 97162 PT EVALUATION MOD COMPLEX CDM | $123.20 | $154.00 | — | — | 20% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC PT EVALUATION MOD COMPLEX CDM | $123.20 | $154.00 | — | — | 20% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC MANUAL THERAPY TQS 1 OR MORE REGIONS EACH 15 MINUTES | $66.40 | $83.00 | — | 15% below | 20% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC MANUAL THERAPY TQS 1 OR MORE REGIONS EACH 15 MINUTES | $66.40 | $83.00 | — | — | 20% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THER EXERCISES PX 1 OR MORE AREAS EACH 15 MIN | $68.00 | $85.00 | — | 19% below | 20% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC CRISIS TELEH 97110 THERAPEUTIC EXERCISES EA 15 MIN CDM | $68.00 | $85.00 | — | 19% below | 20% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THER EXERCISES PX 1 OR MORE AREAS EACH 15 MIN | $68.00 | $85.00 | — | — | 20% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC CRISIS TELEH 97110 THERAPEUTIC EXERCISES EA 15 MIN CDM | $68.00 | $85.00 | — | — | 20% |
| Preventive checkup, new patient aged 18–39 CPT 99385 HC PR 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS RHC | $140.80 | $176.00 | — | 29% below | 20% |
| Preventive checkup, new patient aged 18–39 CPT 99385 HC PR 99385 PREV VISIT NEW AGE 18-39 | $140.80 | $176.00 | — | 29% below | 20% |
| Preventive checkup, new patient aged 18–39 CPT 99385 HC PR 99385 PREV VISIT NEW AGE 18-39 | $191.20 | $239.00 | — | 4% below | 20% |
| Preventive checkup, new patient aged 18–39 CPT 99385 HC PR 99385 DOT PHYSICAL AGE 18-39 NEW PT RHC | $191.20 | $239.00 | — | 4% below | 20% |
| Preventive checkup, new patient aged 18–39 CPT 99385 HC PR 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS RHC | $193.60 | $242.00 | — | 3% below | 20% |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 HC PR 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS RHC | $140.80 | $176.00 | — | — | 20% |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 HC PR 99385 PREV VISIT NEW AGE 18-39 | $140.80 | $176.00 | — | — | 20% |
| Preventive checkup, new patient aged 40–64 CPT 99386 HC PR 99386 PREV VISIT NEW AGE 40-64 | $170.40 | $213.00 | — | 26% below | 20% |
| Preventive checkup, new patient aged 40–64 CPT 99386 HC PR 99386 PREVENTIVE VISIT NEW 40-64 RHC | $170.40 | $213.00 | — | 26% below | 20% |
| Preventive checkup, new patient aged 40–64 CPT 99386 HC PR 99386 PREV VISIT NEW AGE 40-64 | $220.80 | $276.00 | — | 4% below | 20% |
| Preventive checkup, new patient aged 40–64 CPT 99386 HC PR 99386 DOT PHYSICAL AGE 40-64 NEW PT RHC | $223.20 | $279.00 | — | 3% below | 20% |
| Preventive checkup, new patient aged 40–64 CPT 99386 HC PR 99386 PREVENTIVE VISIT NEW 40-64 RHC | $223.20 | $279.00 | — | 3% below | 20% |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 HC PR 99386 PREV VISIT NEW AGE 40-64 | $170.40 | $213.00 | — | — | 20% |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 HC PR 99386 PREVENTIVE VISIT NEW 40-64 RHC | $170.40 | $213.00 | — | — | 20% |
| Preventive checkup, new patient aged 65 or older CPT 99387 HC PR 99387 INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&> RHC | $183.20 | $229.00 | — | 19% below | 20% |
| Preventive checkup, new patient aged 65 or older CPT 99387 HC PR 99387 INIT PM E/M NEW PAT 65+ YRS | $183.20 | $229.00 | — | 19% below | 20% |
| Preventive checkup, new patient aged 65 or older CPT 99387 HC PR 99387 INIT PM E/M NEW PAT 65+ YRS | $238.40 | $298.00 | — | 5% above | 20% |
| Preventive checkup, new patient aged 65 or older CPT 99387 HC PR 99387 DOT PHYSICAL AGE GT 65 YRS NEW RHC | $242.40 | $303.00 | — | 7% above | 20% |
| Preventive checkup, new patient aged 65 or older CPT 99387 HC PR 99387 INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&> RHC | $242.40 | $303.00 | — | 7% above | 20% |
| Preventive checkup, new patient aged 65 or older inpatient CPT 99387 HC PR 99387 INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&> RHC | $183.20 | $229.00 | — | — | 20% |
| Preventive checkup, new patient aged 65 or older inpatient CPT 99387 HC PR 99387 INIT PM E/M NEW PAT 65+ YRS | $183.20 | $229.00 | — | — | 20% |
| Preventive checkup, returning patient aged 18–39 CPT 99395 HC PR 99395 PREV VISIT EST AGE 18-39 | $127.20 | $159.00 | — | 29% below | 20% |
| Preventive checkup, returning patient aged 18–39 CPT 99395 HC PR 99395 PREVENTIVE VISIT EST 18-39 RHC | $127.20 | $159.00 | — | 29% below | 20% |
| Preventive checkup, returning patient aged 18–39 CPT 99395 HC PR 99395 PREV VISIT EST AGE 18-39 | $170.40 | $213.00 | — | 4% below | 20% |
| Preventive checkup, returning patient aged 18–39 CPT 99395 HC PR 99395 DOT PHYSICAL AGE 18-39 EST PT RHC | $175.20 | $219.00 | — | 2% below | 20% |
| Preventive checkup, returning patient aged 18–39 CPT 99395 HC PR 99395 PREVENTIVE VISIT EST 18-39 RHC | $175.20 | $219.00 | — | 2% below | 20% |
| Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 HC PR 99395 PREV VISIT EST AGE 18-39 | $127.20 | $159.00 | — | — | 20% |
| Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 HC PR 99395 PREVENTIVE VISIT EST 18-39 RHC | $127.20 | $159.00 | — | — | 20% |
| Preventive checkup, returning patient aged 40–64 CPT 99396 HC PR 99396 PREV VISIT EST AGE 40-64 | $139.20 | $174.00 | — | 27% below | 20% |
| Preventive checkup, returning patient aged 40–64 CPT 99396 HC PR 99396 PREVENTIVE VISIT EST 40-64 RHC | $139.20 | $174.00 | — | 27% below | 20% |
| Preventive checkup, returning patient aged 40–64 CPT 99396 HC PR 99396 PREV VISIT EST AGE 40-64 | $183.20 | $229.00 | — | 4% below | 20% |
| Preventive checkup, returning patient aged 40–64 CPT 99396 HC PR 99396 DOT PHYSICAL AGE 40-64 EST PT RHC | $185.60 | $232.00 | — | 3% below | 20% |
| Preventive checkup, returning patient aged 40–64 CPT 99396 HC PR 99396 PREVENTIVE VISIT EST 40-64 RHC | $185.60 | $232.00 | — | 3% below | 20% |
| Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 HC PR 99396 PREV VISIT EST AGE 40-64 | $139.20 | $174.00 | — | — | 20% |
| Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 HC PR 99396 PREVENTIVE VISIT EST 40-64 RHC | $139.20 | $174.00 | — | — | 20% |
| Preventive checkup, returning patient aged 65 or older CPT 99397 HC PR 99397 PREVENTIVE VISIT EST 65 & OVER RHC | $146.40 | $183.00 | — | 22% below | 20% |
| Preventive checkup, returning patient aged 65 or older CPT 99397 HC PR 99397 PER PM REEVAL EST PAT 65+ YR | $146.40 | $183.00 | — | 22% below | 20% |
| Preventive checkup, returning patient aged 65 or older CPT 99397 HC PR 99397 PER PM REEVAL EST PAT 65+ YR | $197.60 | $247.00 | — | 6% above | 20% |
| Preventive checkup, returning patient aged 65 or older CPT 99397 HC PR 99397 DOT PHYSICAL AGE GT 65 YRS EST RHC | $200.00 | $250.00 | — | 7% above | 20% |
| Preventive checkup, returning patient aged 65 or older CPT 99397 HC PR 99397 PREVENTIVE VISIT EST 65 & OVER RHC | $200.00 | $250.00 | — | 7% above | 20% |
| Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 HC PR 99397 PER PM REEVAL EST PAT 65+ YR | $146.40 | $183.00 | — | — | 20% |
| Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 HC PR 99397 PREVENTIVE VISIT EST 65 & OVER RHC | $146.40 | $183.00 | — | — | 20% |
| Psychiatric evaluation with medical services CPT 90792 HC PR 90792 PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES | $252.00 | $315.00 | — | 18% below | 20% |
| Psychiatric evaluation with medical services CPT 90792 HC PR 90792 PSYCH DIAG EVAL W MED SRVCS RHC | $287.20 | $359.00 | — | 6% below | 20% |
| Psychiatric evaluation with medical services CPT 90792 HC PR 90792 PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES | $287.20 | $359.00 | — | 6% below | 20% |
| Psychiatric evaluation with medical services inpatient CPT 90792 HC PR 90792 PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES | $252.00 | $315.00 | — | — | 20% |
| Psychotherapy for crisis, first 60 minutes CPT 90839 HC PR 90839 PSYCHOTHERAPY FOR CRISIS INITIAL 60 MIN | $183.20 | $229.00 | — | 13% below | 20% |
| Psychotherapy for crisis, first 60 minutes CPT 90839 HC PR 90839 PSYTX FOR CRISIS INITIAL 60 MIN RHC | $207.20 | $259.00 | — | 1% below | 20% |
| Psychotherapy for crisis, first 60 minutes CPT 90839 HC PR 90839 PSYCHOTHERAPY FOR CRISIS INITIAL 60 MIN | $207.20 | $259.00 | — | 1% below | 20% |
| Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 HC PR 90839 PSYCHOTHERAPY FOR CRISIS INITIAL 60 MIN | $183.20 | $229.00 | — | — | 20% |
| Psychotherapy session, 30 minutes CPT 90832 HC PR 90832 PSYCHOTHERAPY W/PATIENT 30 MINUTES | $99.20 | $124.00 | — | 11% below | 20% |
| Psychotherapy session, 30 minutes CPT 90832 HC PR 90832 PSYCHOTHERAPY W/PATIENT 30 MINUTES | $112.00 | $140.00 | — | at median | 20% |
| Psychotherapy session, 30 minutes CPT 90832 HC PR 90832 PSYTX W PT 30 MIN RHC | $112.00 | $140.00 | — | at median | 20% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 HC PR 90832 PSYCHOTHERAPY W/PATIENT 30 MINUTES | $99.20 | $124.00 | — | — | 20% |
| Psychotherapy session, 45 minutes CPT 90834 HC PR 90834 PSYCHOTHERAPY W/PATIENT 45 MINUTES | $130.40 | $163.00 | — | 9% below | 20% |
| Psychotherapy session, 45 minutes CPT 90834 HC PR 90834 PSYTX W PT 45 MIN RHC | $148.00 | $185.00 | — | 3% above | 20% |
| Psychotherapy session, 45 minutes CPT 90834 HC PR 90834 PSYCHOTHERAPY W/PATIENT 45 MINUTES | $148.00 | $185.00 | — | 3% above | 20% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 HC PR 90834 PSYCHOTHERAPY W/PATIENT 45 MINUTES | $130.40 | $163.00 | — | — | 20% |
| Psychotherapy session, 60 minutes CPT 90837 HC PR 90837 PSYCHOTHERAPY W/PATIENT 60 MINUTES | $191.20 | $239.00 | — | 4% above | 20% |
| Psychotherapy session, 60 minutes CPT 90837 HC PR 90837 PSYCHOTHERAPY W/PATIENT 60 MINUTES | $216.80 | $271.00 | — | 18% above | 20% |
| Psychotherapy session, 60 minutes CPT 90837 HC PR 90837 PSYTX W PT 60 MIN RHC | $216.80 | $271.00 | — | 18% above | 20% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 HC PR 90837 PSYCHOTHERAPY W/PATIENT 60 MINUTES | $191.20 | $239.00 | — | — | 20% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 HC BEHAV CHNG SMOKING 3-10 MIN | $8.80 | $11.00 | — | 71% below | 20% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 HC PR 99406 BEHAV CHNG SMOKING 3-10 MIN | $17.60 | $22.00 | — | 41% below | 20% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 HC PR 99406 BEHAV CHNG SMOKING 3-10 MIN RHC | $21.60 | $27.00 | — | 28% below | 20% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 HC PR 99406 BEHAV CHNG SMOKING 3-10 MIN | $22.40 | $28.00 | — | 25% below | 20% |
| Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 HC BEHAV CHNG SMOKING 3-10 MIN | $8.80 | $11.00 | — | — | 20% |
| Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 HC PR 99406 BEHAV CHNG SMOKING 3-10 MIN | $17.60 | $22.00 | — | — | 20% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC PR 99215 ESTAB PT VISIT - LEVEL 5 | $211.20 | $264.00 | — | 23% below | 20% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC L&D TRIAGE ESTAB PATIENT LVL 5 CDM | $226.40 | $283.00 | — | 17% below | 20% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC PR 99215 ESTAB PT VISIT - LEVEL 5 | $262.40 | $328.00 | — | 4% below | 20% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC PR 99215 OFFICE OUTPATIENT VISIT RHC | $269.60 | $337.00 | — | 2% below | 20% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC PR 99215 ESTAB PT VISIT - LEVEL 5 | $211.20 | $264.00 | — | — | 20% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC L&D TRIAGE ESTAB PATIENT LVL 5 CDM | $226.40 | $283.00 | — | — | 20% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC ESTAB PT VISIT - LEVEL 3 | $88.00 | $110.00 | — | 38% below | 20% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC PR 99213 RHC POST PARTUM CHECK | $96.80 | $121.00 | — | 31% below | 20% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC PR 99213 ESTAB PT VISIT - LEVEL 3 | $96.80 | $121.00 | — | 31% below | 20% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC PR 99213 OFFICE OUTPATIENT VISIT RHC | $96.80 | $121.00 | — | 31% below | 20% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC PR 99213 RHC POST PARTUM CHECK | $132.00 | $165.00 | — | 6% below | 20% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC PR 99213 ESTAB PT VISIT - LEVEL 3 | $132.00 | $165.00 | — | 6% below | 20% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC PR 99213 OFFICE OUTPATIENT VISIT RHC | $136.80 | $171.00 | — | 3% below | 20% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC L&D TRIAGE ESTAB PATIENT LVL 3 CDM | $150.40 | $188.00 | — | 7% above | 20% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC ESTAB PT VISIT - LEVEL 3 | $88.00 | $110.00 | — | — | 20% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC PR 99213 OFFICE OUTPATIENT VISIT RHC | $96.80 | $121.00 | — | — | 20% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC PR 99213 ESTAB PT VISIT - LEVEL 3 | $96.80 | $121.00 | — | — | 20% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC PR 99213 RHC POST PARTUM CHECK | $96.80 | $121.00 | — | — | 20% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC L&D TRIAGE ESTAB PATIENT LVL 3 CDM | $150.40 | $188.00 | — | — | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC ESTAB PT VISIT - LEVEL 4 | $92.00 | $115.00 | — | 54% below | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC PR 99214 ESTAB PT VISIT - LEVEL 4 | $142.40 | $178.00 | — | 29% below | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC PR 99214 COSMETIC CONSULT LEVEL 4 | $142.40 | $178.00 | — | 29% below | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC PR 99214 ESTAB PT VISIT - LEVEL 4 | $186.40 | $233.00 | — | 7% below | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC PR 99214 COSMETIC CONSULT LEVEL 4 | $186.40 | $233.00 | — | 7% below | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC L&D TRIAGE ESTAB PATIENT LVL 4 CDM | $189.60 | $237.00 | — | 5% below | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC PR 99214 OFFICE OUTPATIENT VISIT RHC | $192.00 | $240.00 | — | 4% below | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC ESTAB PT VISIT - LEVEL 4 | $92.00 | $115.00 | — | — | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC PR 99214 ESTAB PT VISIT - LEVEL 4 | $142.40 | $178.00 | — | — | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC PR 99214 COSMETIC CONSULT LEVEL 4 | $142.40 | $178.00 | — | — | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC L&D TRIAGE ESTAB PATIENT LVL 4 CDM | $189.60 | $237.00 | — | — | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC PR 99212 ESTAB PT VISIT - LEVEL 2 | $52.80 | $66.00 | — | 50% below | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC PR 99212 RHC OB OFFICE OUTPATIENT VISIT, EST | $52.80 | $66.00 | — | 50% below | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC ESTAB PT VISIT - LEVEL 2 | $74.40 | $93.00 | — | 30% below | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC PR 99212 ESTAB PT VISIT - LEVEL 2 | $82.40 | $103.00 | — | 22% below | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC PR 99212 RHC OB OFFICE OUTPATIENT VISIT, EST | $82.40 | $103.00 | — | 22% below | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC PR 99212 OFFICE OUTPATIENT VISIT RHC | $84.80 | $106.00 | — | 20% below | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC L&D TRIAGE ESTAB PATIENT LVL 2 CDM | $113.60 | $142.00 | — | 7% above | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC PR 99212 RHC OB OFFICE OUTPATIENT VISIT, EST | $52.80 | $66.00 | — | — | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC PR 99212 ESTAB PT VISIT - LEVEL 2 | $52.80 | $66.00 | — | — | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC ESTAB PT VISIT - LEVEL 2 | $74.40 | $93.00 | — | — | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC L&D TRIAGE ESTAB PATIENT LVL 2 CDM | $113.60 | $142.00 | — | — | 20% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 HC PR 99243 OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES CDM | $137.60 | $172.00 | — | 54% below | 20% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 HC PR 99243 OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES RHC | $168.00 | $210.00 | — | 44% below | 20% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 HC PR 99243 OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES CDM | $174.40 | $218.00 | — | 42% below | 20% |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 HC PR 99243 OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES CDM | $137.60 | $172.00 | — | — | 20% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 HC PR 99244 OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES CDM | $219.20 | $274.00 | — | 43% below | 20% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 HC PR 99244 OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES RHC | $239.20 | $299.00 | — | 38% below | 20% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 HC PR 99244 OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES CDM | $260.00 | $325.00 | — | 33% below | 20% |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 HC PR 99244 OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES CDM | $219.20 | $274.00 | — | — | 20% |
| Speech and language evaluation CPT 92523 HC CRISIS TELEH 92523 SPEECH SOUND LANG COMPREHEN CDM | $202.40 | $253.00 | — | 44% below | 20% |
| Speech and language evaluation CPT 92523 HC EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION CDM | $202.40 | $253.00 | — | 44% below | 20% |
| Speech and language evaluation CPT 92523 HC PR 92523 EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION RHC | $343.20 | $429.00 | — | 5% below | 20% |
| Speech and language evaluation inpatient CPT 92523 HC EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION CDM | $202.40 | $253.00 | — | — | 20% |
| Speech and language evaluation inpatient CPT 92523 HC CRISIS TELEH 92523 SPEECH SOUND LANG COMPREHEN CDM | $202.40 | $253.00 | — | — | 20% |
| Speech therapy session, individual CPT 92507 HC TX SPEECH/LANG/VOICE COMMJ/AUDITORY PROCESS - INDIVIDUAL | $118.40 | $148.00 | — | 36% below | 20% |
| Speech therapy session, individual CPT 92507 HC CRISIS TELEH 92507 SPEECH/HEARING THERAPY - INDIV CDM | $118.40 | $148.00 | — | 36% below | 20% |
| Speech therapy session, individual inpatient CPT 92507 HC CRISIS TELEH 92507 SPEECH/HEARING THERAPY - INDIV CDM | $118.40 | $148.00 | — | — | 20% |
| Speech therapy session, individual inpatient CPT 92507 HC TX SPEECH/LANG/VOICE COMMJ/AUDITORY PROCESS - INDIVIDUAL | $118.40 | $148.00 | — | — | 20% |
| Spirometry (breathing test) CPT 94010 HC PR 94010 SPIROMETRY | $39.20 | $49.00 | — | 74% below | 20% |
| Spirometry (breathing test) CPT 94010 HC PR 94010 SPIROMETRY | $39.20 | $49.00 | — | 74% below | 20% |
| Spirometry (breathing test) CPT 94010 HC PR 94010 SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ RHC | $40.80 | $51.00 | — | 73% below | 20% |
| Spirometry (breathing test) CPT 94010 HC SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ | $178.40 | $223.00 | — | 17% above | 20% |
| Spirometry (breathing test) CPT 94010 HC BEDSIDE SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ CDM | $178.40 | $223.00 | — | 17% above | 20% |
| Spirometry (breathing test) inpatient CPT 94010 HC PR 94010 SPIROMETRY | $39.20 | $49.00 | — | — | 20% |
| Spirometry (breathing test) inpatient CPT 94010 HC BEDSIDE SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ CDM | $178.40 | $223.00 | — | — | 20% |
| Spirometry (breathing test) inpatient CPT 94010 HC SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ | $178.40 | $223.00 | — | — | 20% |
| Spirometry before and after a bronchodilator CPT 94060 HC PR 94060 SPIROMETRY PRE POST BRONCHODILATOR | $57.60 | $72.00 | — | 87% below | 20% |
| Spirometry before and after a bronchodilator CPT 94060 HC PR 94060 SPIROMETRY PRE POST BRONCHODILATOR | $57.60 | $72.00 | — | 87% below | 20% |
| Spirometry before and after a bronchodilator CPT 94060 HC PR 94060 BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN RHC | $58.40 | $73.00 | — | 87% below | 20% |
| Spirometry before and after a bronchodilator CPT 94060 HC SPIROMETRY PRE POST BRONCHODILATOR CDM | $302.40 | $378.00 | — | 32% below | 20% |
| Spirometry before and after a bronchodilator inpatient CPT 94060 HC PR 94060 SPIROMETRY PRE POST BRONCHODILATOR | $57.60 | $72.00 | — | — | 20% |
| Spirometry before and after a bronchodilator inpatient CPT 94060 HC SPIROMETRY PRE POST BRONCHODILATOR CDM | $302.40 | $378.00 | — | — | 20% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 HC THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN | $48.80 | $61.00 | — | 44% below | 20% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN | $48.80 | $61.00 | — | — | 20% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HC PR 99195 PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE RHC | $133.60 | $167.00 | — | 18% below | 20% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HC PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE | $253.60 | $317.00 | — | 55% above | 20% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HC THERAPUTIC PHLEBOTOMY | $253.60 | $317.00 | — | 55% above | 20% |
| Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 HC THERAPUTIC PHLEBOTOMY | $253.60 | $317.00 | — | — | 20% |
| Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 HC PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE | $253.60 | $317.00 | — | — | 20% |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs Montana | Off list |
|---|---|---|---|---|---|
| Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 HC PR RX INFLUENZA INACTIVATED IIV ADJUVANTED IM 0.5 ML | $48.80 | $61.00 | — | 9% below | 20% |
| Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 INFLUENZA VAC TYPE A&B SURFACE ANT ADJ SUSP PREF SYR 0.5 ML | $339.74 | $424.68 | — | 534% above | 20% |
| Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 HC PR RX INFLUENZA INACTIVATED IIV ADJUVANTED IM 0.5 ML | $48.80 | $61.00 | — | — | 20% |
| Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 INFLUENZA VAC TYPE A&B SURFACE ANT ADJ SUSP PREF SYR 0.5 ML | $339.74 | $424.68 | — | — | 20% |
| COVID-19 vaccine (Moderna), age 12 and older CPT 91322 HC PR RX COVID-19 VACCINE SINGLE DOSE (MODERNA) PF IM 50 MCG/0.5 ML | $233.47 | $291.84 | — | 43% above | 20% |
| COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 HC PR RX COVID-19 VACCINE SINGLE DOSE (MODERNA) PF IM 50 MCG/0.5 ML | $233.47 | $291.84 | — | — | 20% |
| COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 HC PR RX COVID-19 VACCINE SINGLE DOSE (PFIZER) PF TRIS-SUC IM 30 MCG/0.3 ML | $209.76 | $262.20 | — | 52% above | 20% |
| COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 HC PR RX COVID-19 VACCINE SINGLE DOSE (PFIZER) PF TRIS-SUC IM 30 MCG/0.3 ML | $209.76 | $262.20 | — | — | 20% |
| Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 HC PR RX VARICELLA VACCINE LIVE SQ 0.5 ML | $145.60 | $182.00 | — | 32% below | 20% |
| Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 HC PR RX VARICELLA VACCINE LIVE SQ 0.5 ML | $145.60 | $182.00 | — | — | 20% |
| DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 HC PR RX DTAP-IPV VACCINE CHILD 4-6 YRS IM 0.5 ML | $41.60 | $52.00 | — | 50% below | 20% |
| DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 DIPH-TETANUS TOX AD-ACELL PERT & POLIO VIRUS, IPV VAC INJ | $235.06 | $293.83 | — | 183% above | 20% |
| DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 HC PR RX DTAP-IPV VACCINE CHILD 4-6 YRS IM 0.5 ML | $41.60 | $52.00 | — | — | 20% |
| DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 DIPH-TETANUS TOX AD-ACELL PERT & POLIO VIRUS, IPV VAC INJ | $235.06 | $293.83 | — | — | 20% |
| DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 HC PR RX DIPHTH TETANUS TOX ACELL PERTUSSIS VACC/YOUNGER THAN 7 YRS/IM | $20.00 | $25.00 | — | 61% below | 20% |
| DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DIPH, ACELLULAR PERT & TET TOX INJ 25 LF-58 MCG-10 LF/0.5ML | $157.21 | $196.51 | — | 208% above | 20% |
| DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 HC PR RX DIPHTH TETANUS TOX ACELL PERTUSSIS VACC/YOUNGER THAN 7 YRS/IM | $20.00 | $25.00 | — | — | 20% |
| DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DIPH, ACELLULAR PERT & TET TOX INJ 25 LF-58 MCG-10 LF/0.5ML | $157.21 | $196.51 | — | — | 20% |
| DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 HC PR RX DTAP-HEPB-IPV VACCINE IM 0.5 ML | $88.00 | $110.00 | — | 21% below | 20% |
| DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 HC PR RX DTAP-HEPB-IPV VACCINE IM 0.5 ML | $88.00 | $110.00 | — | — | 20% |
| DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 HC PR RX DTAP-IPV/HIB VACCINE IM 0.5 ML | $61.60 | $77.00 | — | 53% below | 20% |
| DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 HC PR RX DTAP-IPV/HIB VACCINE IM 0.5 ML | $61.60 | $77.00 | — | — | 20% |
| DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) CPT 90697 HC PR RX DTAP-IPV-HIB-HEPB VACCINE IM 1 EA | $88.00 | $110.00 | — | 49% below | 20% |
| DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) inpatient CPT 90697 HC PR RX DTAP-IPV-HIB-HEPB VACCINE IM 1 EA | $88.00 | $110.00 | — | — | 20% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 HC PR RX INFLUENZA TRIVALENT IIV3 SPLIT VIRUS PF IM 0.5 ML | $13.60 | $17.00 | — | 44% below | 20% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 HC PR RX INFLUENZA TRIVALENT IIV3 SPLIT VIRUS PF IM 0.5 ML | $13.60 | $17.00 | — | — | 20% |
| HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HC PR RX 9VHPV VACCINE 2/3 DOSE IM 0.5 ML | $218.40 | $273.00 | — | 37% below | 20% |
| HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HC PR RX 9VHPV VACCINE 2/3 DOSE IM 0.5 ML | $218.40 | $273.00 | — | — | 20% |
| Hepatitis A vaccine, adult dose CPT 90632 HC PR RX HEPATITIS A VACCINE ADULT IM 1 ML | $40.00 | $50.00 | — | 58% below | 20% |
| Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VACCINE SUSP PREFILLED SYR 1440 EL UNIT/ML | $391.94 | $489.92 | — | 308% above | 20% |
| Hepatitis A vaccine, adult dose inpatient CPT 90632 HC PR RX HEPATITIS A VACCINE ADULT IM 1 ML | $40.00 | $50.00 | — | — | 20% |
| Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITIS A VACCINE SUSP PREFILLED SYR 1440 EL UNIT/ML | $391.94 | $489.92 | — | — | 20% |
| Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HC PR RX HEPATITIS A VACCINE PEDIATRIC 2 DOSE IM 0.5 ML | $24.80 | $31.00 | — | 49% below | 20% |
| Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 HC PR RX HEPATITIS A VACCINE PEDIATRIC 2 DOSE IM 0.5 ML | $24.80 | $31.00 | — | — | 20% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HC PR RX HEPB VACCINE ADULT 3 DOSE IM 1 ML | $40.00 | $50.00 | — | 58% below | 20% |
| Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HC PR RX HEPB VACCINE ADULT 3 DOSE IM 1 ML | $40.00 | $50.00 | — | — | 20% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HC PR RX HEPB VACCINE PED/ADOLESC 3 DOSE IM 0.5 ML | $16.00 | $20.00 | — | 56% below | 20% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HC PR RX HEPB VACCINE PED/ADOLESC 3 DOSE IM 0.5 ML | $16.00 | $20.00 | — | — | 20% |
| Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 HC PR RX HIB PRP-T VACCINE 4 DOSE IM 1 EA | $10.40 | $13.00 | — | 71% below | 20% |
| Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 HC PR RX HIB PRP-T VACCINE 4 DOSE IM 1 EA | $10.40 | $13.00 | — | — | 20% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 HC PR RX IIV VACCINE PF INCREASED AG CONTENT IM 1 EA | $55.20 | $69.00 | — | 35% below | 20% |
| High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 HC PR RX IIV VACCINE PF INCREASED AG CONTENT IM 1 EA | $55.20 | $69.00 | — | — | 20% |
| MMR vaccine (measles, mumps and rubella), live CPT 90707 HC PR RX MEASLES MUMPS RUBELLA VACCINE LIVE SQ 1 EA | $74.40 | $93.00 | — | 43% below | 20% |
| MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 HC PR RX MEASLES MUMPS RUBELLA VACCINE LIVE SQ 1 EA | $74.40 | $93.00 | — | — | 20% |
| MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 HC PR RX MEASLES MUMPS RUBELLA VARICELLA VACCINE LIVE SQ 0.5 ML | $228.80 | $286.00 | — | 38% below | 20% |
| MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 HC PR RX MEASLES MUMPS RUBELLA VARICELLA VACCINE LIVE SQ 0.5 ML | $228.80 | $286.00 | — | — | 20% |
| Meningococcal ACWY (MenACWY) vaccine CPT 90734 HC PR RX MENACWYD/MENACWY-CRM CONJ VACCINE GRPS ACYW IM 0.5 ML | $96.00 | $120.00 | — | 47% below | 20% |
| Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 HC PR RX MENACWYD/MENACWY-CRM CONJ VACCINE GRPS ACYW IM 0.5 ML | $96.00 | $120.00 | — | — | 20% |
| Meningococcal ACWY vaccine (MenQuadfi) CPT 90619 HC PR RX MENINGOCOCCAL CONJ QUADRIVALENT (MENQUADFI) IM 1 EA | $96.00 | $120.00 | — | 69% below | 20% |
| Meningococcal ACWY vaccine (MenQuadfi) inpatient CPT 90619 HC PR RX MENINGOCOCCAL CONJ QUADRIVALENT (MENQUADFI) IM 1 EA | $96.00 | $120.00 | — | — | 20% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 HC PR RX MENB-4C RECOMBNT PROT & OUTER MEMB VESIC VACC IM 0.5 ML | $147.20 | $184.00 | — | 47% below | 20% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 HC PR RX MENB-4C RECOMBNT PROT & OUTER MEMB VESIC VACC IM 0.5 ML | $147.20 | $184.00 | — | — | 20% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 HC PR RX PNEUMOCOCCAL VACCINE 13 VALENT IM 0.5 ML | $192.80 | $241.00 | — | 33% below | 20% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 HC PR RX PNEUMOCOCCAL VACCINE 13 VALENT IM 0.5 ML | $192.80 | $241.00 | — | — | 20% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 HC PR RX PNEUMOCOCCAL CONJ 20 VALENT VACCINE (PCV20) IM 1 EA | $217.60 | $272.00 | — | 31% below | 20% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCOCCAL 20-VALENT CONJUGATE VACCINE SUS PREF SYR 0.5 ML | $634.68 | $793.35 | — | 100% above | 20% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 HC PR RX PNEUMOCOCCAL CONJ 20 VALENT VACCINE (PCV20) IM 1 EA | $217.60 | $272.00 | — | — | 20% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOCOCCAL 20-VALENT CONJUGATE VACCINE SUS PREF SYR 0.5 ML | $634.68 | $793.35 | — | — | 20% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 HC PR RX PNEUMOCOCCAL VACCINE 23 VALENT 2 YRS OR OLDER SQ/IM 0.5 | $100.80 | $126.00 | — | 29% below | 20% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 HC PR RX PNEUMOCOCCAL VACCINE 23 VALENT 2 YRS OR OLDER SQ/IM 0.5 | $100.80 | $126.00 | — | — | 20% |
| Polio vaccine, inactivated (IPV) CPT 90713 HC PR RX POLIOVIRUS VACCINE INACTIVATED SQ/IM 0.5 ML | $212.80 | $266.00 | — | 156% above | 20% |
| Polio vaccine, inactivated (IPV) inpatient CPT 90713 HC PR RX POLIOVIRUS VACCINE INACTIVATED SQ/IM 0.5 ML | $212.80 | $266.00 | — | — | 20% |
| RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 HC PR RX RSV MONOCLONAL ANTIBODY IM 1 ML | $376.00 | $470.00 | — | 67% below | 20% |
| RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 HC PR RX RSV MONOCLONAL ANTIBODY IM 1 ML | $376.00 | $470.00 | — | — | 20% |
| RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 HC PR RX RSV MONOCLONAL ANTIBODY IM 0.5 ML | $376.00 | $470.00 | — | 69% below | 20% |
| RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 HC PR RX RSV MONOCLONAL ANTIBODY IM 0.5 ML | $376.00 | $470.00 | — | — | 20% |
| Rabies vaccine, one dose CPT 90675 HC PR RX RABIES VACCINE IM 1 ML | $274.40 | $343.00 | — | 49% below | 20% |
| Rabies vaccine, one dose CPT 90675 RABIES VACCINE, PCEC FOR INJ | $1,609.96 | $2,012.45 | — | 196% above | 20% |
| Rabies vaccine, one dose inpatient CPT 90675 HC PR RX RABIES VACCINE IM 1 ML | $274.40 | $343.00 | — | — | 20% |
| Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE, PCEC FOR INJ | $1,609.96 | $2,012.45 | — | — | 20% |
| Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 HC PR RX ROTOVIRUS VACCINE (RV5) 3 DOSE ORAL 2 ML | $72.00 | $90.00 | — | 40% below | 20% |
| Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 HC PR RX ROTOVIRUS VACCINE (RV5) 3 DOSE ORAL 2 ML | $72.00 | $90.00 | — | — | 20% |
| Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 HC PR RX HZV ZOSTER VACCINE RECOMBINANT ADJUVANTED IM 0.5 ML | $144.80 | $181.00 | — | 36% below | 20% |
| Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 HC PR RX HZV ZOSTER VACCINE RECOMBINANT ADJUVANTED IM 0.5 ML | $144.80 | $181.00 | — | — | 20% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 HC PR RX TD VACCINE PF 7 YRS OR OLDER IM 0.5 ML | $20.80 | $26.00 | — | 69% below | 20% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 HC PR RX TD VACCINE PF 7 YRS OR OLDER IM 0.5 ML | $20.80 | $26.00 | — | — | 20% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 HC PR RX TDAP VACCINE 7 YRS OR OLDER IM 0.5 ML | $32.80 | $41.00 | — | 68% below | 20% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TET-DIPH-ACELL PERTUSS AD PREF SYR 5-2.5-18.5 LF-MCG/0.5ML | $220.49 | $275.61 | — | 112% above | 20% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 HC PR RX TDAP VACCINE 7 YRS OR OLDER IM 0.5 ML | $32.80 | $41.00 | — | — | 20% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TET-DIPH-ACELL PERTUSS AD PREF SYR 5-2.5-18.5 LF-MCG/0.5ML | $220.49 | $275.61 | — | — | 20% |
| Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 HC PR RX TYPHOID VACCINE VI CAPSULAR POLYSACCHARIDE IM 0.5 ML | $80.80 | $101.00 | — | 47% below | 20% |
| Typhoid vaccine, injectable (Vi polysaccharide) inpatient CPT 90691 HC PR RX TYPHOID VACCINE VI CAPSULAR POLYSACCHARIDE IM 0.5 ML | $80.80 | $101.00 | — | — | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC PR ADMIN VACCINE INITIAL VFC CDM | $16.80 | $21.00 | — | 66% below | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC PR ADMIN VACCINE INITIAL VFC CDM | $16.80 | $21.00 | — | 66% below | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC PR ADMIN VACCINE INITIAL CDM | $16.80 | $21.00 | — | 66% below | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC PR ADMIN VACCINE INITIAL CDM | $16.80 | $21.00 | — | 66% below | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC ADMIN HEPATITIS B VACCINE CDM | $17.06 | $21.32 | — | 65% below | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC PR ADMIN VACCINE INFLUENZA CDM | $35.20 | $44.00 | — | 28% below | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC PR ADMIN VACCINE HEPATITIS B CDM | $35.20 | $44.00 | — | 28% below | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC PR ADMIN VACCINE HEPATITIS B CDM | $35.20 | $44.00 | — | 28% below | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC PR ADMIN VACCINE PNEUMONIA CDM | $35.20 | $44.00 | — | 28% below | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC PR ADMIN VACCINE PNEUMONIA CDM | $35.20 | $44.00 | — | 28% below | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC PR ADMIN VACCINE INFLUENZA CDM | $35.20 | $44.00 | — | 28% below | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC ADMIN INFLUENZA VIRUS VAC CDM | $52.00 | $65.00 | — | 7% above | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC ADMIN PNEUMOCOCCAL VACCINE CDM | $52.00 | $65.00 | — | 7% above | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC IMMUNIZATION ADMIN CDM | $52.00 | $65.00 | — | 7% above | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC PR ADMIN VACCINE INITIAL CDM | $16.80 | $21.00 | — | — | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC PR ADMIN VACCINE INITIAL VFC CDM | $16.80 | $21.00 | — | — | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC ADMIN HEPATITIS B VACCINE CDM | $17.06 | $21.32 | — | — | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC PR ADMIN VACCINE HEPATITIS B CDM | $35.20 | $44.00 | — | — | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC PR ADMIN VACCINE PNEUMONIA CDM | $35.20 | $44.00 | — | — | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC PR ADMIN VACCINE INFLUENZA CDM | $35.20 | $44.00 | — | — | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC ADMIN PNEUMOCOCCAL VACCINE CDM | $52.00 | $65.00 | — | — | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC IMMUNIZATION ADMIN CDM | $52.00 | $65.00 | — | — | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC ADMIN INFLUENZA VIRUS VAC CDM | $52.00 | $65.00 | — | — | 20% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 HC PR 90472 ADMIN VACCINE EA ADDL CDM | $16.80 | $21.00 | — | 48% below | 20% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 HC PR ADMIN VACCINE EA ADDL VFC CDM | $16.80 | $21.00 | — | 48% below | 20% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 HC PR 90472 ADMIN VACCINE EA ADDL CDM | $16.80 | $21.00 | — | 48% below | 20% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 HC PR ADMIN VACCINE EA ADDL VFC CDM | $16.80 | $21.00 | — | 48% below | 20% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 HC IMMUNIZATION ADMIN EACH ADD CDM | $52.00 | $65.00 | — | 62% above | 20% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 HC PR 90472 ADMIN VACCINE EA ADDL CDM | $16.80 | $21.00 | — | — | 20% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 HC PR ADMIN VACCINE EA ADDL VFC CDM | $16.80 | $21.00 | — | — | 20% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 HC IMMUNIZATION ADMIN EACH ADD CDM | $52.00 | $65.00 | — | — | 20% |
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://pricetransparency.providence.org/wamt/live/810463482_providence-st-joseph-medical-center_standardcharges.json