Hospital

MaineHealth Waldo Hospital

Listed in its price file as “MaineHealth”.

MaineHealth Waldo Hospital in Belfast, ME publishes cash prices for 363 common procedures listed here, from its own machine-readable price file updated Oct 30, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Maine median for 332 of 359 procedures and below it for 21. By typical cash price it ranks #25 of 28 Maine hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.

118 Northport Ave, Belfast, ME 04915 Collected Nov 1, 2026 Source price file Check a bill from this hospital (207) 338-2500

Critical access hospital (rural, 25 beds or fewer) Nonprofit hospital Emergency department CMS star rating 3 of 5 CCN 201312 · CMS hospital register NPI 1841397932

The price file shows no self-pay discount

For 794 of the 794 prices listed here, the cash price in MaineHealth Waldo Hospital's file equals its full list price (chargemaster), so the file publishes no self-pay discount. That is why it compares as expensive. Many hospitals still reduce bills for uninsured patients or offer financial assistance based on income: before a planned visit, ask the billing office for its self-pay rate and discount policy in writing. Other US hospitals whose cash price is their full list price.

Financial assistance

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

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

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

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

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Maine	Off list
Abdominal CT scan without and with contrast CPT 74170 HC CT ABDOMEN W/O & W/ CONTRAST	$3,055.25	$3,055.25	$897.46–$2,875.30	119% above	—
Abdominal CT scan without and with contrast inpatient CPT 74170 HC CT ABDOMEN W/O & W/ CONTRAST	$3,055.25	$3,055.25	$2,718.87–$2,875.30	—	—
Abdominal X-ray, 2 views CPT 74019 HC X-RAY EXAM ABDOMEN 2 VIEWS	$510.95	$510.95	$199.27–$534.92	109% above	—
Abdominal X-ray, 2 views inpatient CPT 74019 HC X-RAY EXAM ABDOMEN 2 VIEWS	$510.95	$510.95	$454.69–$480.86	—	—
Ankle X-ray, complete, 3 or more views CPT 73610 HC XRAY EXAM OF ANKLE MIN 3 VIEWS	$442.80	$442.80	$172.69–$445.28	108% above	—
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 HC XRAY EXAM OF ANKLE MIN 3 VIEWS	$442.80	$442.80	$394.05–$416.72	—	—
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 HC UPR/L XTREMITY ART 2 LEVELS	$426.50	$426.50	$166.34–$680.78	192% above	—
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 HC UPR/L XTREMITY ART 2 LEVELS	$426.50	$426.50	$379.54–$401.38	—	—
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 HC CT UPPER EXTREMITY W/O CONTRAST	$2,002.25	$2,002.25	$534.92–$1,884.32	77% above	—
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 HC CT UPPER EXTREMITY W/O CONTRAST	$2,002.25	$2,002.25	$1,781.80–$1,884.32	—	—
Barium swallow (esophagus X-ray with contrast) CPT 74220 HC XRAY ESOPHAGUS SINGLE CONTRAST STUDY	$876.70	$876.70	$341.91–$897.46	148% above	—
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 HC XRAY ESOPHAGUS SINGLE CONTRAST STUDY	$876.70	$876.70	$780.18–$825.06	—	—
Bone scan, whole body (nuclear medicine) CPT 78306 HC BONE AND/OR JOINT IMAGING WHOLE BODY	$2,399.15	$2,399.15	$935.67–$2,257.84	104% above	—
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 HC BONE AND/OR JOINT IMAGING WHOLE BODY	$2,399.15	$2,399.15	$2,135.00–$2,257.84	—	—
Breast ultrasound, complete, one breast CPT 76641 HC US BREAST UNI COMPLETE INCL AXILLA REAL TIME	$576.20	$576.20	$224.72–$542.26	184% above	—
Breast ultrasound, complete, one breast inpatient CPT 76641 HC US BREAST UNI COMPLETE INCL AXILLA REAL TIME	$576.20	$576.20	$512.76–$542.26	—	—
Breast ultrasound, limited (one breast or one area) CPT 76642 HC US BREAST UNI LIMITED INCL AXILLA REAL TIME	$605.75	$605.75	$236.24–$570.07	157% above	—
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 HC US BREAST UNI LIMITED INCL AXILLA REAL TIME	$605.75	$605.75	$539.06–$570.07	—	—
CT angiography (CTA) of the abdomen and pelvis CPT 74174 HC CT ANGIO ABD & PELV W/ CONT INCL NONCONTRAST IMAGES IF PERFORMED	$4,087.40	$4,087.40	$1,594.09–$3,846.65	167% above	—
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 HC CT ANGIO ABD & PELV W/ CONT INCL NONCONTRAST IMAGES IF PERFORMED	$4,087.40	$4,087.40	$3,637.38–$3,846.65	—	—
CT angiography (CTA) of the head CPT 70496 HC CT ANGIO HEAD W/CONTRAST INCL NONCONTRAST IMAGE IF PERFORMED	$3,333.60	$3,333.60	$897.46–$3,137.25	115% above	—
CT angiography (CTA) of the head inpatient CPT 70496 HC CT ANGIO HEAD W/CONTRAST INCL NONCONTRAST IMAGE IF PERFORMED	$3,333.60	$3,333.60	$2,966.57–$3,137.25	—	—
CT angiography (CTA) of the neck CPT 70498 HC CT ANGIO NECK W/CONTRAST INCL NONCONTRAST IMAGE IF PERFORMED	$3,887.50	$3,887.50	$897.46–$3,658.53	146% above	—
CT angiography (CTA) of the neck inpatient CPT 70498 HC CT ANGIO NECK W/CONTRAST INCL NONCONTRAST IMAGE IF PERFORMED	$3,887.50	$3,887.50	$3,459.49–$3,658.53	—	—
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HC CT ANGIO CHEST W/CONTRAST INCL NONCONTRAST IMAGES IF PERFORMED	$3,983.80	$3,983.80	$897.46–$3,749.15	117% above	—
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 HC CT ANGIO CHEST W/CONTRAST INCL NONCONTRAST IMAGES IF PERFORMED	$3,983.80	$3,983.80	$3,545.18–$3,749.15	—	—
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 HC CT ANGIOGRAM CORONARY	$2,430.20	$2,430.20	$947.78–$2,287.06	362% above	—
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 HC CT ANGIOGRAM CORONARY	$2,430.20	$2,430.20	$2,162.63–$2,287.06	—	—
CT of the heart without contrast dye to measure coronary calcium CPT 75571 HC CALCIUM SCORING	$1,423.15	$1,423.15	$445.28–$1,339.33	984% above	—
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 HC CALCIUM SCORING	$1,423.15	$1,423.15	$1,266.46–$1,339.33	—	—
CT scan of abdomen and pelvis, no contrast dye CPT 74176 HC CT ABD & PELVIS W/O CONTRAST	$4,014.85	$4,014.85	$1,220.82–$3,778.38	189% above	—
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 HC CT ABD & PELVIS W/O CONTRAST	$4,014.85	$4,014.85	$3,572.82–$3,778.38	—	—
CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT ABD & PELVIS W/ CONTRAST	$5,246.95	$5,246.95	$1,785.04–$4,937.90	163% above	—
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT ABD & PELVIS W/ CONTRAST	$5,246.95	$5,246.95	$4,669.26–$4,937.90	—	—
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC CT ABD & PELV W/O & W CONTRAST 1/> REGIONS	$6,646.55	$6,646.55	$1,785.04–$6,255.07	202% above	—
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 HC CT ABD & PELV W/O & W CONTRAST 1/> REGIONS	$6,646.55	$6,646.55	$5,914.76–$6,255.07	—	—
CT scan of the abdomen with contrast CPT 74160 HC CT ABDOMEN W/ CONTRAST	$2,760.45	$2,760.45	$897.46–$2,597.86	147% above	—
CT scan of the abdomen with contrast inpatient CPT 74160 HC CT ABDOMEN W/ CONTRAST	$2,760.45	$2,760.45	$2,456.52–$2,597.86	—	—
CT scan of the abdomen without contrast CPT 74150 HC CT ABDOMEN W/O CONTRAST	$2,215.50	$2,215.50	$534.92–$2,085.01	164% above	—
CT scan of the abdomen without contrast inpatient CPT 74150 HC CT ABDOMEN W/O CONTRAST	$2,215.50	$2,215.50	$1,971.57–$2,085.01	—	—
CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT MAXILLOFACIAL W/O CONTRAST	$1,694.30	$1,694.30	$534.92–$1,594.51	93% above	—
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 HC CT MAXILLOFACIAL W/O CONTRAST	$1,694.30	$1,694.30	$1,507.76–$1,594.51	—	—
CT scan of the head or brain, no contrast dye CPT 70450 HC CT HEAD OR BRAIN W/O CONTRAST	$1,882.30	$1,882.30	$534.92–$1,771.43	92% above	—
CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT HEAD OR BRAIN W/O CONTRAST	$1,882.30	$1,882.30	$1,675.06–$1,771.43	—	—
CT scan of the head with contrast CPT 70460 HC CT SCAN HEAD CONTRAST	$2,274.75	$2,274.75	$887.15–$2,140.77	114% above	—
CT scan of the head with contrast inpatient CPT 70460 HC CT SCAN HEAD CONTRAST	$2,274.75	$2,274.75	$2,024.30–$2,140.77	—	—
CT scan of the head without and with contrast CPT 70470 HC CT HEAD OR BRAIN W/O & W/ CONTRAST	$2,643.50	$2,643.50	$897.46–$2,487.80	81% above	—
CT scan of the head without and with contrast inpatient CPT 70470 HC CT HEAD OR BRAIN W/O & W/ CONTRAST	$2,643.50	$2,643.50	$2,352.45–$2,487.80	—	—
CT scan of the lower back (lumbar spine) without contrast CPT 72131 HC CT LUMBAR SPINE W/O CONTRAST	$2,033.35	$2,033.35	$534.92–$1,913.59	107% above	—
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 HC CT LUMBAR SPINE W/O CONTRAST	$2,033.35	$2,033.35	$1,809.48–$1,913.59	—	—
CT scan of the neck (cervical spine), no contrast dye CPT 72125 HC CT NECK CERVICAL SPINE W/O CONTRAST	$1,926.65	$1,926.65	$534.92–$1,813.17	96% above	—
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 HC CT NECK CERVICAL SPINE W/O CONTRAST	$1,926.65	$1,926.65	$1,714.53–$1,813.17	—	—
CT scan of the pelvis, with contrast dye CPT 72193 HC CT PELVIS W/ CONTRAST	$2,255.45	$2,255.45	$879.63–$2,122.60	125% above	—
CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT PELVIS W/ CONTRAST	$2,255.45	$2,255.45	$2,007.12–$2,122.60	—	—
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 HC EXTRACRANIAL BILAT STUDY COMPLETE	$1,463.25	$1,463.25	$570.67–$1,377.06	—	—
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 HC EXTRACRANIAL BILAT STUDY COMPLETE	$1,463.25	$1,463.25	$1,302.15–$1,377.06	—	—
Chest CT scan without and with contrast CPT 71270 HC CT THORAX W/O & W/ CONTRAST	$3,403.25	$3,403.25	$897.46–$3,202.80	99% above	—
Chest CT scan without and with contrast inpatient CPT 71270 HC CT THORAX W/O & W/ CONTRAST	$3,403.25	$3,403.25	$3,028.55–$3,202.80	—	—
Chest X-ray, 2 views CPT 71046 HC X-RAY EXAM CHEST 2 VIEWS	$516.85	$516.85	$201.57–$486.41	144% above	—
Chest X-ray, 2 views inpatient CPT 71046 HC X-RAY EXAM CHEST 2 VIEWS	$516.85	$516.85	$459.94–$486.41	—	—
Chest X-ray, single view CPT 71045 HC X-RAY EXAM CHEST 1 VIEW	$364.30	$364.30	$142.08–$445.28	81% above	—
Chest X-ray, single view inpatient CPT 71045 HC X-RAY EXAM CHEST 1 VIEW	$364.30	$364.30	$324.19–$342.84	—	—
Collarbone (clavicle) X-ray, complete CPT 73000 HC XRAY EXAM OF COLLAR BONE	$364.30	$364.30	$142.08–$445.28	66% above	—
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 HC XRAY EXAM OF COLLAR BONE	$364.30	$364.30	$324.19–$342.84	—	—
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HC US RETROPERITONEAL COMPLETE REAL TIME	$857.50	$857.50	$334.43–$806.99	89% above	—
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 HC US RETROPERITONEAL COMPLETE REAL TIME	$857.50	$857.50	$763.09–$806.99	—	—
DEXA bone density scan of the hip, pelvis or spine CPT 77080 HC DXA BONE DENSITY AXIAL 1/> SITES	$414.70	$414.70	$161.73–$534.92	65% above	—
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 HC DXA BONE DENSITY AXIAL 1/> SITES	$414.70	$414.70	$369.04–$390.27	—	—
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 HC DXA BONE DENSITY/PERIPHERAL 1/> SITES	$207.30	$207.30	$80.85–$445.28	29% above	—
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 HC DXA BONE DENSITY/PERIPHERAL 1/> SITES	$207.30	$207.30	$184.48–$195.09	—	—
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 HC US DETAILED SINGLE FETUS REAL TIME	$962.60	$962.60	$375.41–$1,220.82	133% above	—
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 HC US DETAILED SINGLE FETUS REAL TIME	$962.60	$962.60	$856.62–$905.90	—	—
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT THORAX W/O CONTRAST	$2,083.70	$2,083.70	$534.92–$1,960.97	122% above	—
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT THORAX W/O CONTRAST	$2,083.70	$2,083.70	$1,854.28–$1,960.97	—	—
Diagnostic CT scan of the chest, with contrast dye CPT 71260 HC CT THORAX W/ CONTRAST	$2,581.25	$2,581.25	$897.46–$2,429.21	101% above	—
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 HC CT THORAX W/ CONTRAST	$2,581.25	$2,581.25	$2,297.05–$2,429.21	—	—
Diagnostic mammogram, both breasts both sides CPT 77066 HC DX MAMMO INCL CAD BI	$552.30	$552.30	$215.40–$519.77	—	—
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC DX MAMMO INCL CAD BI	$552.30	$552.30	$491.49–$519.77	—	—
Diagnostic mammogram, one breast CPT 77065 HC DX MAMMO INCL CAD UNI	$459.10	$459.10	$179.05–$432.06	191% above	—
Diagnostic mammogram, one breast inpatient CPT 77065 HC DX MAMMO INCL CAD UNI	$459.10	$459.10	$408.55–$432.06	—	—
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 HCHG DUPLEX LO EXTREM ART BILAT	$1,414.20	$1,414.20	$551.54–$1,330.90	—	—
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 HCHG DUPLEX LO EXTREM ART BILAT	$1,414.20	$1,414.20	$1,258.50–$1,330.90	—	—
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HC STUDY EXTREMITY COMPLETE BILATERAL	$1,475.05	$1,475.05	$575.27–$1,388.17	—	—
Duplex ultrasound of the leg veins, both legs CPT 93970 HC DUPLEX EXTREM VEINS BIL	$1,475.05	$1,475.05	$575.27–$1,388.17	187% above	—
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 HC STUDY EXTREMITY COMPLETE BILATERAL	$1,475.05	$1,475.05	$1,312.65–$1,388.17	—	—
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 HC DUPLEX EXTREM VEINS BIL	$1,475.05	$1,475.05	$1,312.65–$1,388.17	—	—
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC 2-D ECHOCARD COMPLETE, W/COLOR & DPLR	$2,563.60	$2,563.60	$999.80–$2,795.82	136% above	—
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HC 2-D ECHOCARD COMPLETE, W/COLOR & DPLR	$2,563.60	$2,563.60	$2,281.35–$2,412.60	—	—
Elbow X-ray, 2 views CPT 73070 HC XRAY EXAM OF ELBOW MIN 2 VIEWS	$364.30	$364.30	$142.08–$445.28	67% above	—
Elbow X-ray, 2 views inpatient CPT 73070 HC XRAY EXAM OF ELBOW MIN 2 VIEWS	$364.30	$364.30	$324.19–$342.84	—	—
Elbow X-ray, complete, 3 or more views CPT 73080 HC XRAY EXAM OF ELBOW MIN 3 VIEWS	$442.80	$442.80	$172.69–$445.28	102% above	—
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 HC XRAY EXAM OF ELBOW MIN 3 VIEWS	$442.80	$442.80	$394.05–$416.72	—	—
Eye socket (orbit) CT scan without contrast CPT 70480 HC CT ORBIT/EAR/FOSSA W/O CONTRAST	$2,150.40	$2,150.40	$534.92–$2,023.74	119% above	—
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 HC CT ORBIT/EAR/FOSSA W/O CONTRAST	$2,150.40	$2,150.40	$1,913.64–$2,023.74	—	—
Facial bones X-ray, complete, 3 or more views CPT 70150 HC XRAY EXAM OF FACIAL BONES MIN 3 VIEWS	$552.30	$552.30	$215.40–$534.92	142% above	—
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 HC XRAY EXAM OF FACIAL BONES MIN 3 VIEWS	$552.30	$552.30	$491.49–$519.77	—	—
Forearm X-ray (radius and ulna), 2 views CPT 73090 HC XRAY EXAM OF FOREARM 2 VIEWS	$364.30	$364.30	$142.08–$445.28	72% above	—
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 HC XRAY EXAM OF FOREARM 2 VIEWS	$364.30	$364.30	$324.19–$342.84	—	—
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HC HEPATOBILIARY SYSTEM IMAGING	$1,572.85	$1,572.85	$613.41–$2,045.49	57% above	—
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HC HEPATOBILIARY SYSTEM IMAGING	$1,572.85	$1,572.85	$1,399.68–$1,480.21	—	—
Hand X-ray, 2 views CPT 73120 HC XRAY HAND 2 VIEWS	$364.30	$364.30	$142.08–$534.92	72% above	—
Hand X-ray, 2 views inpatient CPT 73120 HC XRAY HAND 2 VIEWS	$364.30	$364.30	$324.19–$342.84	—	—
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 HC XRAY EXAM OF HEEL MIN 2 VIEWS	$429.45	$429.45	$167.49–$445.28	106% above	—
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 HC XRAY EXAM OF HEEL MIN 2 VIEWS	$429.45	$429.45	$382.17–$404.16	—	—
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 HC POLYSOMNOGRAPHY CPAP	$4,645.75	$4,645.75	$1,811.84–$4,393.84	166% above	—
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 HC POLYSOMNOGRAPHY CPAP	$4,645.75	$4,645.75	$4,134.25–$4,372.12	—	—
Knee X-ray, 3 views CPT 73562 HC XRAY EXAM OF KNEE 3 VIEWS	$518.35	$518.35	$202.16–$487.82	128% above	—
Knee X-ray, 3 views inpatient CPT 73562 HC XRAY EXAM OF KNEE 3 VIEWS	$518.35	$518.35	$461.28–$487.82	—	—
Knee X-ray, complete, 4 or more views CPT 73564 HC XRAY EXAM KNEE 4 OR MORE	$564.30	$564.30	$220.08–$534.92	123% above	—
Knee X-ray, complete, 4 or more views inpatient CPT 73564 HC XRAY EXAM KNEE 4 OR MORE	$564.30	$564.30	$502.17–$531.06	—	—
Leg CT scan without contrast (hip to foot, any part) CPT 73700 HC CT LOWER EXTREMITY W/O CONTRAST	$2,012.65	$2,012.65	$534.92–$1,894.10	90% above	—
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 HC CT LOWER EXTREMITY W/O CONTRAST	$2,012.65	$2,012.65	$1,791.06–$1,894.10	—	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US ABDOMINAL LIMITED REAL TIME	$824.95	$824.95	$321.73–$776.36	239% above	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC US ABDOMINAL LIMITED REAL TIME	$824.95	$824.95	$734.12–$776.36	—	—
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 HC US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/ IMG	$485.80	$485.80	$189.46–$534.92	191% above	—
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	$485.80	$485.80	$432.31–$457.19	—	—
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 HC COMPUTED TOMOGRAPHY THORAX LW DOSE LNG CA SCR C-	$472.35	$472.35	$184.22–$534.92	109% above	—
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 HC COMPUTED TOMOGRAPHY THORAX LW DOSE LNG CA SCR C-	$472.35	$472.35	$420.34–$444.53	—	—
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 HC XRAY EXAM OF LOWER LEG 2 VIEWS	$364.30	$364.30	$142.08–$445.28	70% above	—
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 HC XRAY EXAM OF LOWER LEG 2 VIEWS	$364.30	$364.30	$324.19–$342.84	—	—
MR angiography (MRA) of the head without contrast CPT 70544 HC MR ANGIOGRAPHY HEAD W/O CONTRAST	$2,314.70	$2,314.70	$902.73–$2,178.36	32% above	—
MR angiography (MRA) of the head without contrast inpatient CPT 70544 HC MR ANGIOGRAPHY HEAD W/O CONTRAST	$2,314.70	$2,314.70	$2,059.85–$2,178.36	—	—
MRI of both breasts, without and then with contrast dye CPT 77049 HC MRI BREAST BIL W/O & W/ CONTRAST	$5,285.45	$5,285.45	$730.34–$4,974.14	109% above	—
MRI of both breasts, without and then with contrast dye inpatient CPT 77049 HC MRI BREAST BIL W/O & W/ CONTRAST	$5,285.45	$5,285.45	$4,703.52–$4,974.14	—	—
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI JOINT LOWER EXTREM W/O CONTRAST	$2,581.25	$2,581.25	$1,006.69–$2,429.21	72% above	—
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MRI JOINT LOWER EXTREM W/O CONTRAST	$2,581.25	$2,581.25	$2,297.05–$2,429.21	—	—
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI JOINT LOWER EXTREM W/O & W/CONTRAST	$4,013.40	$4,013.40	$1,565.23–$3,777.01	54% above	—
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HC MRI JOINT LOWER EXTREM W/O & W/CONTRAST	$4,013.40	$4,013.40	$3,571.52–$3,777.01	—	—
MRI of the abdomen without contrast CPT 74181 HC MRI ABDOMEN W/O CONTRAST	$2,958.95	$2,958.95	$1,153.99–$2,784.67	71% above	—
MRI of the abdomen without contrast inpatient CPT 74181 HC MRI ABDOMEN W/O CONTRAST	$2,958.95	$2,958.95	$2,633.17–$2,784.67	—	—
MRI of the abdomen, without and then with contrast dye CPT 74183 HC MRI ABDOMEN W/O & W/ CONTRAST	$3,591.40	$3,591.40	$1,400.65–$3,379.87	65% above	—
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 HC MRI ABDOMEN W/O & W/ CONTRAST	$3,591.40	$3,591.40	$3,195.99–$3,379.87	—	—
MRI of the brain, no contrast dye CPT 70551 HC MRI BRAIN STEM W/O CONTRAST	$2,590.20	$2,590.20	$1,010.18–$2,437.64	80% above	—
MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI BRAIN STEM W/O CONTRAST	$2,590.20	$2,590.20	$2,305.02–$2,437.64	—	—
MRI of the brain, with and without contrast dye CPT 70553 HC MRI BRAIN STEM W/O & W/ CONTRAST	$3,388.35	$3,388.35	$1,321.46–$3,188.78	54% above	—
MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI BRAIN STEM W/O & W/ CONTRAST	$3,388.35	$3,388.35	$3,015.29–$3,188.78	—	—
MRI of the lower back, no contrast dye CPT 72148 HC MRI LUMBAR SPINE W/O CONTRAST	$2,677.60	$2,677.60	$1,044.26–$2,519.89	89% above	—
MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI LUMBAR SPINE W/O CONTRAST	$2,677.60	$2,677.60	$2,382.80–$2,519.89	—	—
MRI of the lower back, without and then with contrast dye CPT 72158 HC MRI LUMBAR SPINE W/O & W/ CONTRAST	$3,711.25	$3,711.25	$1,447.39–$3,492.66	60% above	—
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 HC MRI LUMBAR SPINE W/O & W/ CONTRAST	$3,711.25	$3,711.25	$3,302.64–$3,492.66	—	—
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 HC MRI CHEST SPINE THORACIC W/O CONTRAST	$2,676.10	$2,676.10	$1,043.68–$2,518.48	88% above	—
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 HC MRI CHEST SPINE THORACIC W/O CONTRAST	$2,676.10	$2,676.10	$2,381.46–$2,518.48	—	—
MRI of the neck (cervical spine) without and with contrast CPT 72156 HC MRI NECK SPINE CERVICAL W/O & W/ CONTRAST	$2,929.35	$2,929.35	$1,142.45–$2,756.81	43% above	—
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 HC MRI NECK SPINE CERVICAL W/O & W/ CONTRAST	$2,929.35	$2,929.35	$2,606.83–$2,756.81	—	—
MRI of the neck (cervical spine), no contrast dye CPT 72141 HC MRI NECK SPINE CERVICAL W/O CONTRAST	$2,525.05	$2,525.05	$984.77–$2,376.32	78% above	—
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 HC MRI NECK SPINE CERVICAL W/O CONTRAST	$2,525.05	$2,525.05	$2,247.04–$2,376.32	—	—
MRI of the pelvis without and with contrast CPT 72197 HC MRI PELVIS W/O & W/ CONTRAST	$3,720.10	$3,720.10	$1,450.84–$3,500.99	60% above	—
MRI of the pelvis without and with contrast inpatient CPT 72197 HC MRI PELVIS W/O & W/ CONTRAST	$3,720.10	$3,720.10	$3,310.52–$3,500.99	—	—
MRI of the pelvis, no contrast dye CPT 72195 HC MRI PELVIS W/O CONTRAST	$2,699.75	$2,699.75	$1,052.90–$2,540.73	73% above	—
MRI of the pelvis, no contrast dye inpatient CPT 72195 HC MRI PELVIS W/O CONTRAST	$2,699.75	$2,699.75	$2,402.51–$2,540.73	—	—
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 HC MRI JOINT UPPER EXTREM W/O CONTRAST	$2,591.65	$2,591.65	$1,010.74–$2,439.00	73% above	—
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 HC MRI JOINT UPPER EXTREM W/O CONTRAST	$2,591.65	$2,591.65	$2,306.31–$2,439.00	—	—
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 HC XRAY EXAM NECK SPINE, CERV 4-5 VIEWS	$518.35	$518.35	$202.16–$534.92	76% above	—
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 HC XRAY EXAM NECK SPINE, CERV 4-5 VIEWS	$518.35	$518.35	$461.28–$487.82	—	—
Neck soft tissue CT scan with contrast CPT 70491 HC CT SOFT TISSUE NECK W/ CONTRAST	$2,419.85	$2,419.85	$897.46–$2,277.32	89% above	—
Neck soft tissue CT scan with contrast inpatient CPT 70491 HC CT SOFT TISSUE NECK W/ CONTRAST	$2,419.85	$2,419.85	$2,153.42–$2,277.32	—	—
Neck soft tissue CT scan without contrast CPT 70490 HC CT SOFT TISSUE NECK W/O CONTRAST	$2,018.55	$2,018.55	$534.92–$1,899.66	101% above	—
Neck soft tissue CT scan without contrast inpatient CPT 70490 HC CT SOFT TISSUE NECK W/O CONTRAST	$2,018.55	$2,018.55	$1,796.31–$1,899.66	—	—
Neck soft tissue X-ray CPT 70360 HC XRAY EXAM OF NECK SOFT TISSUE	$358.40	$358.40	$139.78–$445.28	71% above	—
Neck soft tissue X-ray inpatient CPT 70360 HC XRAY EXAM OF NECK SOFT TISSUE	$358.40	$358.40	$318.94–$337.29	—	—
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC HT MUSCLE IMAGE SPECT MULTIPLE STUDY	$3,542.40	$3,542.40	$1,381.54–$6,624.24	72% above	—
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HC HT MUSCLE IMAGE SPECT MULTIPLE STUDY	$3,542.40	$3,542.40	$3,152.38–$3,333.75	—	—
PET/CT scan from the base of the skull to mid-thigh CPT 78815 HC PET IMAGE W/CT ATTENUATION SKULL BASE-THIGH	$3,271.10	$3,271.10	$1,275.73–$7,316.51	at median	—
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 HC PET IMAGE W/CT ATTENUATION SKULL BASE-THIGH	$3,271.10	$3,271.10	$2,910.95–$3,078.43	—	—
Pelvic CT scan without contrast CPT 72192 HC CT PELVIS W/O CONTRAST	$1,901.50	$1,901.50	$534.92–$1,789.50	101% above	—
Pelvic CT scan without contrast inpatient CPT 72192 HC CT PELVIS W/O CONTRAST	$1,901.50	$1,901.50	$1,692.14–$1,789.50	—	—
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC US PELVIC LIMITED OR F/U REAL TIME	$478.35	$478.35	$186.56–$534.92	174% above	—
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC US PELVIC LIMITED OR F/U REAL TIME	$478.35	$478.35	$425.68–$450.18	—	—
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HC US PELVIC COMPLETE REAL TIME	$878.15	$878.15	$342.48–$826.43	123% above	—
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 HC US PELVIC COMPLETE REAL TIME	$878.15	$878.15	$781.47–$826.43	—	—
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US SINGLE FETUS >/= 14 WKS REAL TIME	$613.10	$613.10	$239.11–$576.99	39% above	—
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC US SINGLE FETUS >/= 14 WKS REAL TIME	$613.10	$613.10	$545.60–$576.99	—	—
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 HC US SINGLE FETUS < 14 WKS REAL TIME	$408.75	$408.75	$159.41–$534.92	31% above	—
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 HC US SINGLE FETUS < 14 WKS REAL TIME	$408.75	$408.75	$363.75–$384.67	—	—
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC US PREGNANT UTERUS LIMITED 1/> FETUSES REAL TIME	$659.10	$659.10	$257.05–$620.28	242% above	—
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC US PREGNANT UTERUS LIMITED 1/> FETUSES REAL TIME	$659.10	$659.10	$586.53–$620.28	—	—
Rib X-ray, one side, 2 views CPT 71100 HC XRAY EXAM RIBS UNI 2 VIEWS	$485.80	$485.80	$189.46–$457.19	112% above	—
Rib X-ray, one side, 2 views inpatient CPT 71100 HC XRAY EXAM RIBS UNI 2 VIEWS	$485.80	$485.80	$432.31–$457.19	—	—
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 HC XRAY EXAM UNILAT RIBS/CHEST MIN 3 VIEWS	$685.70	$685.70	$267.42–$645.31	109% above	—
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 HC XRAY EXAM UNILAT RIBS/CHEST MIN 3 VIEWS	$685.70	$685.70	$610.20–$645.31	—	—
Screening mammogram, both breasts both sides CPT 77067 HC SCR MAMMO BI INCL CAD	$420.60	$420.60	$164.03–$395.83	—	—
Screening mammogram, both breasts inpatient both sides CPT 77067 HC SCR MAMMO BI INCL CAD	$420.60	$420.60	$374.29–$395.83	—	—
Shoulder X-ray, complete, 2 or more views CPT 73030 HC XRAY EXAM OF SHOULDER MIN 2 VIEWS	$466.55	$466.55	$181.95–$445.28	104% above	—
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 HC XRAY EXAM OF SHOULDER MIN 2 VIEWS	$466.55	$466.55	$415.18–$439.07	—	—
Sinus X-ray, complete, 3 or more views CPT 70220 HC XRAY EXAM OF SINUSES MIN 3 VIEWS	$472.35	$472.35	$184.22–$445.28	108% above	—
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 HC XRAY EXAM OF SINUSES MIN 3 VIEWS	$472.35	$472.35	$420.34–$444.53	—	—
Skull X-ray, fewer than 4 views CPT 70250 HC XRAY EXAM OF SKULL < 4 VIEWS	$472.35	$472.35	$184.22–$534.92	118% above	—
Skull X-ray, fewer than 4 views inpatient CPT 70250 HC XRAY EXAM OF SKULL < 4 VIEWS	$472.35	$472.35	$420.34–$444.53	—	—
Sleep study in a lab (polysomnography) CPT 95810 HC POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND	$4,201.40	$4,201.40	$1,638.55–$4,393.84	158% above	—
Sleep study in a lab (polysomnography) inpatient CPT 95810 HC POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND	$4,201.40	$4,201.40	$3,738.83–$3,953.94	—	—
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 HC STRESS TTE COMPLETE	$2,083.70	$2,083.70	$812.64–$2,795.82	85% above	—
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 HC STRESS TTE COMPLETE	$2,083.70	$2,083.70	$1,854.28–$1,960.97	—	—
Swallow study (modified barium swallow, video X-ray) CPT 74230 HC SWALLOWING FCN,W/CINE &/OR VIDEO	$890.10	$890.10	$347.14–$897.46	101% above	—
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 HC SWALLOWING FCN,W/CINE &/OR VIDEO	$890.10	$890.10	$792.10–$837.67	—	—
Thigh bone (femur) X-ray, 2 or more views CPT 73552 HC X-RAY EXAM OF FEMUR 2/>	$364.30	$364.30	$142.08–$445.28	72% above	—
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 HC X-RAY EXAM OF FEMUR 2/>	$364.30	$364.30	$324.19–$342.84	—	—
Thoracic spine (mid back) CT scan without contrast CPT 72128 HC CT NECK THORACIC SPINE W/O CONTRAST	$2,046.65	$2,046.65	$534.92–$1,926.10	93% above	—
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 HC CT NECK THORACIC SPINE W/O CONTRAST	$2,046.65	$2,046.65	$1,821.31–$1,926.10	—	—
Toe X-ray, 2 or more views CPT 73660 HC XRAY EXAM OF TOE(S) MIN 2 VIEWS	$337.65	$337.65	$131.68–$445.28	88% above	—
Toe X-ray, 2 or more views inpatient CPT 73660 HC XRAY EXAM OF TOE(S) MIN 2 VIEWS	$337.65	$337.65	$300.47–$317.76	—	—
Transvaginal pelvic ultrasound CPT 76830 HC US TRANSVAGINAL NON OB	$804.15	$804.15	$313.62–$756.79	114% above	—
Transvaginal pelvic ultrasound inpatient CPT 76830 HC US TRANSVAGINAL NON OB	$804.15	$804.15	$715.61–$756.79	—	—
Transvaginal ultrasound during pregnancy CPT 76817 HC OB US UTERUS TRANSVAGINAL	$522.75	$522.75	$203.87–$534.92	69% above	—
Transvaginal ultrasound during pregnancy inpatient CPT 76817 HC OB US UTERUS TRANSVAGINAL	$522.75	$522.75	$465.20–$491.96	—	—
Ultrasound of the abdomen, complete CPT 76700 HC US ABDOMINAL COMPLETE REAL TIME	$1,272.25	$1,272.25	$496.18–$1,197.31	170% above	—
Ultrasound of the abdomen, complete inpatient CPT 76700 HC US ABDOMINAL COMPLETE REAL TIME	$1,272.25	$1,272.25	$1,132.18–$1,197.31	—	—
Ultrasound of the scrotum and testicles CPT 76870 HC US SCROTUM & CONTENTS	$857.50	$857.50	$334.43–$806.99	86% above	—
Ultrasound of the scrotum and testicles inpatient CPT 76870 HC US SCROTUM & CONTENTS	$857.50	$857.50	$763.09–$806.99	—	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC US HEAD & NECK SOFT TISSUES REAL TIME	$798.25	$798.25	$311.32–$751.23	97% above	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HC US HEAD & NECK SOFT TISSUES REAL TIME	$798.25	$798.25	$710.36–$751.23	—	—
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 HC XRAY UPPER GI TRACT DELAY W/ W/O KUB	$1,134.35	$1,134.35	$442.40–$1,067.54	159% above	—
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 HC XRAY UPPER GI TRACT DELAY W/ W/O KUB	$1,134.35	$1,134.35	$1,009.46–$1,067.54	—	—
Upper arm X-ray (humerus), 2 views CPT 73060 HC XRAY EXAM OF HUMERUS MIN 2 VIEWS	$420.60	$420.60	$164.03–$445.28	103% above	—
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 HC XRAY EXAM OF HUMERUS MIN 2 VIEWS	$420.60	$420.60	$374.29–$395.83	—	—
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 HC STUDY EXTREMITY COMPLETE UNILATERAL OR LMTD	$810.10	$810.10	$315.94–$762.39	64% above	—
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 HC STUDY EXTREMITY COMPLETE UNILATERAL OR LMTD	$810.10	$810.10	$720.91–$762.39	—	—
Wrist X-ray, 2 views CPT 73100 HC XRAY EXAM OF WRIST 2 VIEWS	$364.30	$364.30	$142.08–$445.28	60% above	—
Wrist X-ray, 2 views inpatient CPT 73100 HC XRAY EXAM OF WRIST 2 VIEWS	$364.30	$364.30	$324.19–$342.84	—	—
Wrist X-ray, complete, 3 or more views CPT 73110 HC XRAY EXAM OF WRIST MIN 3 VIEWS	$445.75	$445.75	$173.84–$445.28	103% above	—
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 HC XRAY EXAM OF WRIST MIN 3 VIEWS	$445.75	$445.75	$396.67–$419.50	—	—
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 HC X-RAY EXAM HIP UNI 2-3 VIEWS	$543.60	$543.60	$212.00–$511.58	168% above	—
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 HC X-RAY EXAM HIP UNI 2-3 VIEWS	$543.60	$543.60	$483.75–$511.58	—	—
X-ray of the abdomen, 1 view CPT 74018 HC X-RAY EXAM ABDOMEN 1 VIEW	$364.30	$364.30	$142.08–$445.28	72% above	—
X-ray of the abdomen, 1 view inpatient CPT 74018 HC X-RAY EXAM ABDOMEN 1 VIEW	$364.30	$364.30	$324.19–$342.84	—	—
X-ray of the ankle, 2 views CPT 73600 HC XRAY EXAM OF ANKLE 2 VIEWS	$364.30	$364.30	$142.08–$445.28	76% above	—
X-ray of the ankle, 2 views inpatient CPT 73600 HC XRAY EXAM OF ANKLE 2 VIEWS	$364.30	$364.30	$324.19–$342.84	—	—
X-ray of the finger(s), 2 or more views CPT 73140 HC XRAY EXAM OF FINGER(S) MIN 2 VIEWS	$333.25	$333.25	$129.97–$445.28	69% above	—
X-ray of the finger(s), 2 or more views inpatient CPT 73140 HC XRAY EXAM OF FINGER(S) MIN 2 VIEWS	$333.25	$333.25	$296.56–$313.62	—	—
X-ray of the foot, 2 views CPT 73620 HC XRAY EXAM OF FOOT 2 VIEWS	$364.30	$364.30	$142.08–$445.28	79% above	—
X-ray of the foot, 2 views inpatient CPT 73620 HC XRAY EXAM OF FOOT 2 VIEWS	$364.30	$364.30	$324.19–$342.84	—	—
X-ray of the foot, complete, 3 or more views CPT 73630 HC XRAY EXAM OF FOOT MIN 3 VIEWS	$442.80	$442.80	$172.69–$445.28	108% above	—
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 HC XRAY EXAM OF FOOT MIN 3 VIEWS	$442.80	$442.80	$394.05–$416.72	—	—
X-ray of the hand, 3 or more views CPT 73130 HC XRAY HAND MIN 3 VIEWS	$439.85	$439.85	$171.54–$445.28	100% above	—
X-ray of the hand, 3 or more views inpatient CPT 73130 HC XRAY HAND MIN 3 VIEWS	$439.85	$439.85	$391.42–$413.94	—	—
X-ray of the knee, 1 or 2 views CPT 73560 HC XRAY EXAM OF KNEE 1 OR 2 VIEWS	$364.30	$364.30	$142.08–$445.28	66% above	—
X-ray of the knee, 1 or 2 views inpatient CPT 73560 HC XRAY EXAM OF KNEE 1 OR 2 VIEWS	$364.30	$364.30	$324.19–$342.84	—	—
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HC XRAY EXAM SPINE LUMBOSACRAL 2-3 VIEWS	$564.30	$564.30	$220.08–$534.92	130% above	—
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 HC XRAY EXAM SPINE LUMBOSACRAL 2-3 VIEWS	$564.30	$564.30	$502.17–$531.06	—	—
X-ray of the lower back, 4 or more views CPT 72110 HC XRAY EXAM L-2 SPINE 4/> VIEWS	$633.80	$633.80	$247.18–$596.47	97% above	—
X-ray of the lower back, 4 or more views inpatient CPT 72110 HC XRAY EXAM L-2 SPINE 4/> VIEWS	$633.80	$633.80	$564.02–$596.47	—	—
X-ray of the mid back (thoracic spine), 2 views CPT 72070 HC XRAY EXAM THORACIC SPINE 2 VIEWS	$439.85	$439.85	$171.54–$534.92	94% above	—
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 HC XRAY EXAM THORACIC SPINE 2 VIEWS	$439.85	$439.85	$391.42–$413.94	—	—
X-ray of the nasal bones, 3 or more views CPT 70160 HC XRAY EXAM OF NASAL BONES MIN 3 VIEWS	$417.65	$417.65	$162.88–$445.28	84% above	—
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 HC XRAY EXAM OF NASAL BONES MIN 3 VIEWS	$417.65	$417.65	$371.67–$393.05	—	—
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 HC XRAY EXAM NECK SPINE, CERV 2-3 VIEWS	$422.05	$422.05	$164.60–$445.28	99% above	—
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 HC XRAY EXAM NECK SPINE, CERV 2-3 VIEWS	$422.05	$422.05	$375.58–$397.19	—	—
X-ray of the pelvis, 1 or 2 views CPT 72170 HC XRAY EXAM OF PELVIS 1-2 VIEWS	$393.90	$393.90	$153.62–$534.92	86% above	—
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 HC XRAY EXAM OF PELVIS 1-2 VIEWS	$393.90	$393.90	$350.53–$370.70	—	—
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 HC XRAY EXAM SACRUM & COCCYX MIN 2 VIEWS	$515.35	$515.35	$200.99–$485.00	127% above	—
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 HC XRAY EXAM SACRUM & COCCYX MIN 2 VIEWS	$515.35	$515.35	$458.61–$485.00	—	—

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Maine	Off list
ACTH blood test CPT 82024 B* HC ADRENOCORTICOTROPIC HORMONE ACTH	$404.25	$404.25	$157.66–$380.44	152% above	—
ACTH blood test inpatient CPT 82024 B* HC ADRENOCORTICOTROPIC HORMONE ACTH	$404.25	$404.25	$359.74–$380.44	—	—
ALT (alanine aminotransferase) liver enzyme test CPT 84460 B* HC TRANSFERASE ALANINE AMINO ALT SGPT	$34.15	$34.15	$13.32–$32.14	1% above	—
ALT (alanine aminotransferase) liver enzyme test CPT 84460 CHG TRANSFERASE ALANINE AMINO ALT SGPT	$34.15	$34.15	$13.32–$32.14	1% above	—
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 CHG TRANSFERASE ALANINE AMINO ALT SGPT	$34.15	$34.15	$30.39–$32.14	—	—
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 B* HC TRANSFERASE ALANINE AMINO ALT SGPT	$34.15	$34.15	$30.39–$32.14	—	—
AST (aspartate aminotransferase) enzyme test CPT 84450 B* HC TRANSFERASE ASPARTATE AMINO AST SGOT	$32.60	$32.60	$12.71–$30.68	6% above	—
AST (aspartate aminotransferase) enzyme test CPT 84450 CHG TRANSFERASE ASPARTATE AMINO AST SGOT	$32.60	$32.60	$12.71–$30.68	6% above	—
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 CHG TRANSFERASE ASPARTATE AMINO AST SGOT	$32.60	$32.60	$29.01–$30.68	—	—
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 B* HC TRANSFERASE ASPARTATE AMINO AST SGOT	$32.60	$32.60	$29.01–$30.68	—	—
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 B* HC ACUTE HEPATITIS PANEL	$534.65	$534.65	$208.51–$503.16	233% above	—
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 B* HC ACUTE HEPATITIS PANEL	$534.65	$534.65	$475.79–$503.16	—	—
Albumin blood test CPT 82040 B* HC ALBUMIN SERUM PLASMA/WHOLE BLOOD	$17.75	$17.75	$6.92–$28.52	23% below	—
Albumin blood test inpatient CPT 82040 B* HC ALBUMIN SERUM PLASMA/WHOLE BLOOD	$17.75	$17.75	$15.80–$16.70	—	—
Aldosterone blood test CPT 82088 B* HC ASSAY OF ALDOSTERONE	$190.30	$190.30	$74.22–$234.79	22% above	—
Aldosterone blood test inpatient CPT 82088 B* HC ASSAY OF ALDOSTERONE	$190.30	$190.30	$169.35–$179.09	—	—
Alkaline phosphatase (ALP) blood test CPT 84075 B* HC ASSAY OF PHOSPHATASE ALKALINE	$84.20	$84.20	$29.85–$79.24	207% above	—
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 B* HC ASSAY OF PHOSPHATASE ALKALINE	$84.20	$84.20	$74.93–$79.24	—	—
Allergy blood test, specific IgE, per allergen CPT 86003 B* HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH	$42.90	$42.90	$16.73–$40.37	87% above	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 B* HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH	$42.90	$42.90	$38.18–$40.37	—	—
Alpha-fetoprotein (AFP) blood test CPT 82105 B* HC ALPHA-FETOPROTEIN SERUM	$194.90	$194.90	$76.01–$183.42	195% above	—
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 B* HC ALPHA-FETOPROTEIN SERUM	$194.90	$194.90	$173.44–$183.42	—	—
Ammonia blood test CPT 82140 B* HC ASSAY OF AMMONIA	$300.70	$300.70	$83.95–$282.99	230% above	—
Ammonia blood test inpatient CPT 82140 B* HC ASSAY OF AMMONIA	$300.70	$300.70	$267.59–$282.99	—	—
Amylase blood test CPT 82150 B* HC ASSAY OF AMYLASE	$88.85	$88.85	$34.65–$83.62	114% above	—
Amylase blood test inpatient CPT 82150 B* HC ASSAY OF AMYLASE	$88.85	$88.85	$79.07–$83.62	—	—
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 B* HC CYCLIC CITRULLINATED PEPTIDE ANTIBODY	$278.40	$278.40	$74.61–$262.00	290% above	—
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 B* HC CYCLIC CITRULLINATED PEPTIDE ANTIBODY	$278.40	$278.40	$247.75–$262.00	—	—
Antinuclear antibody (ANA) blood test, screen CPT 86038 B* HC ANTINUCLEAR ANTIBODIES ANA	$51.85	$51.85	$20.22–$69.66	6% below	—
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 B* HC ANTINUCLEAR ANTIBODIES ANA	$51.85	$51.85	$46.14–$48.80	—	—
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 B* HC NATRIURETIC PEPTIDE	$388.05	$388.05	$151.34–$365.19	147% above	—
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 B* HC NATRIURETIC PEPTIDE	$388.05	$388.05	$345.33–$365.19	—	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 B* HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL	$199.25	$199.25	$49.67–$187.51	269% above	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 B* HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL	$199.25	$199.25	$177.31–$187.51	—	—
Basic metabolic panel (blood test) CPT 80048 B* HC BASIC METABOLIC PANEL CALCIUM TOTAL	$149.65	$149.65	$48.74–$140.84	92% above	—
Basic metabolic panel (blood test) inpatient CPT 80048 B* HC BASIC METABOLIC PANEL CALCIUM TOTAL	$149.65	$149.65	$133.17–$140.84	—	—
Bilirubin blood test, total CPT 82247 B* HC BILIRUBIN TOTAL	$32.60	$32.60	$12.71–$30.68	5% above	—
Bilirubin blood test, total inpatient CPT 82247 B* HC BILIRUBIN TOTAL	$32.60	$32.60	$29.01–$30.68	—	—
Biopsy tissue exam by a pathologist (level IV) CPT 88305 B* HC LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM - PROSTATE BX	$300.60	$300.60	$117.23–$282.89	117% above	—
Biopsy tissue exam by a pathologist (level IV) CPT 88305 B* HC LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM	$300.60	$300.60	$117.23–$282.89	117% above	—
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 B* HC LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM - PROSTATE BX	$300.60	$300.60	$267.50–$282.89	—	—
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 B* HC LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM	$300.60	$300.60	$267.50–$282.89	—	—
Blood culture for bacteria CPT 87040 B* HC CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES	$300.70	$300.70	$59.46–$282.99	254% above	—
Blood culture for bacteria inpatient CPT 87040 B* HC CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES	$300.70	$300.70	$267.59–$282.99	—	—
Blood draw from a vein (venipuncture), collection fee only CPT 36415 B* HC COLLECTION BLOOD, VENIPUNCTURE	$22.25	$22.25	$8.68–$53.81	58% above	—
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 B* HC COLLECTION BLOOD, VENIPUNCTURE	$22.25	$22.25	$19.80–$20.94	—	—
Blood glucose (sugar) test CPT 82947 B* HC GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP	$23.15	$23.15	$9.03–$22.64	at median	—
Blood glucose (sugar) test inpatient CPT 82947 B* HC GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP	$23.15	$23.15	$20.60–$21.79	—	—
Blood lead test CPT 83655 B* HC ASSAY OF LEAD	$82.65	$82.65	$32.23–$77.78	84% above	—
Blood lead test inpatient CPT 83655 B* HC ASSAY OF LEAD	$82.65	$82.65	$73.55–$77.78	—	—
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 B* HC GONADOTROPIN CHORIONIC QUALITATIVE	$114.05	$114.05	$43.33–$107.33	164% above	—
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 B* HC GONADOTROPIN CHORIONIC QUALITATIVE	$114.05	$114.05	$101.49–$107.33	—	—
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 B* HC BLOOD TYPING SEROLOGIC ABO	$60.75	$60.75	$23.69–$680.78	23% above	—
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 B* HC (ARC) BLOOD TYPING SEROLOGIC ABO	$60.75	$60.75	$23.69–$680.78	23% above	—
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HC BLOOD TYPING SEROLOGIC ABO	$60.75	$60.75	$23.69–$680.78	23% above	—
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 B* HC (ARC) BLOOD TYPING SEROLOGIC ABO	$60.75	$60.75	$54.06–$57.17	—	—
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 B* HC BLOOD TYPING SEROLOGIC ABO	$60.75	$60.75	$54.06–$57.17	—	—
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HC BLOOD TYPING SEROLOGIC ABO	$60.75	$60.75	$54.06–$57.17	—	—
Blood urea nitrogen (BUN) test CPT 84520 CHG ASSAY OF UREA NITROGEN QUANTITATIVE	$25.20	$25.20	$9.83–$23.72	at median	—
Blood urea nitrogen (BUN) test CPT 84520 B* HC ASSAY OF UREA NITROGEN QUANTITATIVE	$25.20	$25.20	$9.83–$23.72	at median	—
Blood urea nitrogen (BUN) test inpatient CPT 84520 CHG ASSAY OF UREA NITROGEN QUANTITATIVE	$25.20	$25.20	$22.43–$23.72	—	—
Blood urea nitrogen (BUN) test inpatient CPT 84520 B* HC ASSAY OF UREA NITROGEN QUANTITATIVE	$25.20	$25.20	$22.43–$23.72	—	—
C-peptide blood test CPT 84681 B* HC ASSAY OF C-PEPTIDE	$201.40	$201.40	$78.55–$189.54	186% above	—
C-peptide blood test inpatient CPT 84681 B* HC ASSAY OF C-PEPTIDE	$201.40	$201.40	$179.23–$189.54	—	—
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 B* HC C-REACTIVE PROTEIN	$179.20	$179.20	$29.85–$168.65	383% above	—
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 B* HC C-REACTIVE PROTEIN	$179.20	$179.20	$159.47–$168.65	—	—
C. difficile toxin gene test (stool PCR) CPT 87493 B* HC INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE	$229.50	$229.50	$89.51–$215.98	124% above	—
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 B* HC INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE	$229.50	$229.50	$204.23–$215.98	—	—
CA 19-9 blood test (tumor marker) CPT 86301 B* HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9	$191.05	$191.05	$74.51–$179.80	196% above	—
CA 19-9 blood test (tumor marker) inpatient CPT 86301 B* HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9	$191.05	$191.05	$170.02–$179.80	—	—
CA-125 blood test (ovarian cancer marker) CPT 86304 B* HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125	$226.65	$226.65	$88.39–$213.30	164% above	—
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 B* HC IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125	$226.65	$226.65	$201.70–$213.30	—	—
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 B* HC SARS-COV-2 AB-ID NOW (COVID 19)	$92.85	$92.85	$36.21–$295.63	6% above	—
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 B* HC DETECT AGENT NOS DNA AMP PRB (COVID 19)	$92.85	$92.85	$36.21–$295.63	6% above	—
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 B* HC DETECT AGENT NOS DNA AMP PRB (COVID 19)	$92.85	$92.85	$82.63–$87.38	—	—
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 B* HC SARS-COV-2 AB-ID NOW (COVID 19)	$92.85	$92.85	$82.63–$87.38	—	—
Calcium blood test, total CPT 82310 B* HC CALCIUM TOTAL	$32.60	$32.60	$12.71–$30.68	16% above	—
Calcium blood test, total CPT 82310 CHG CALCIUM TOTAL	$32.60	$32.60	$12.71–$30.68	16% above	—
Calcium blood test, total inpatient CPT 82310 B* HC CALCIUM TOTAL	$32.60	$32.60	$29.01–$30.68	—	—
Calcium blood test, total inpatient CPT 82310 CHG CALCIUM TOTAL	$32.60	$32.60	$29.01–$30.68	—	—
Carcinoembryonic antigen (CEA) test CPT 82378 B* HC CARCINOEMBRYONIC ANTIGEN CEA	$136.30	$136.30	$53.16–$128.27	55% above	—
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 B* HC CARCINOEMBRYONIC ANTIGEN CEA	$136.30	$136.30	$121.29–$128.27	—	—
Chickenpox (varicella) immunity blood test CPT 86787 B* HC ANTIBODY VARICELLA-ZOSTER	$155.70	$155.70	$60.72–$146.53	220% above	—
Chickenpox (varicella) immunity blood test inpatient CPT 86787 B* HC ANTIBODY VARICELLA-ZOSTER	$155.70	$155.70	$138.56–$146.53	—	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 B* HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ	$192.55	$192.55	$75.09–$202.18	166% above	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 B* HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ	$192.55	$192.55	$171.35–$181.21	—	—
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 B* HC LIPID PANEL	$151.30	$151.30	$59.01–$142.39	104% above	—
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 B* HC LIPID PANEL	$151.30	$151.30	$134.64–$142.39	—	—
Complete blood count (CBC) with differential CPT 85025 B* HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC	$84.40	$84.40	$32.92–$79.43	80% above	—
Complete blood count (CBC) with differential inpatient CPT 85025 B* HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC	$84.40	$84.40	$75.11–$79.43	—	—
Complete blood count (CBC), no differential CPT 85027 B* HC BLOOD COUNT COMPLETE AUTOMATED	$56.25	$56.25	$21.94–$52.94	81% above	—
Complete blood count (CBC), no differential inpatient CPT 85027 B* HC BLOOD COUNT COMPLETE AUTOMATED	$56.25	$56.25	$50.06–$52.94	—	—
Comprehensive metabolic panel (blood test) CPT 80053 B* HC COMPREHENSIVE METABOLIC PANEL	$174.85	$174.85	$60.84–$164.55	66% above	—
Comprehensive metabolic panel (blood test) inpatient CPT 80053 B* HC COMPREHENSIVE METABOLIC PANEL	$174.85	$174.85	$155.60–$164.55	—	—
Cortisol blood test, total CPT 82533 B* HC CORTISOL TOTAL	$213.70	$213.70	$83.34–$201.11	204% above	—
Cortisol blood test, total inpatient CPT 82533 B* HC CORTISOL TOTAL	$213.70	$213.70	$190.17–$201.11	—	—
Creatine kinase (CK) blood test, total CPT 82550 B* HC CREATINE KINASE TOTAL	$97.75	$97.75	$37.51–$91.99	115% above	—
Creatine kinase (CK) blood test, total inpatient CPT 82550 B* HC CREATINE KINASE TOTAL	$97.75	$97.75	$86.99–$91.99	—	—
Creatinine blood test CPT 82565 B* HC CREATININE BLOOD	$32.60	$32.60	$12.71–$30.68	13% above	—
Creatinine blood test inpatient CPT 82565 B* HC CREATININE BLOOD	$32.60	$32.60	$29.01–$30.68	—	—
Cytomegalovirus (CMV) antibody test CPT 86644 HC CMV-BLOOD BANK-BLOOD PROD	$454.65	$454.65	$82.91–$427.87	622% above	—
Cytomegalovirus (CMV) antibody test CPT 86644 B* HC ANTIBODY CYTOMEGALOVIRUS CMV	$454.65	$454.65	$82.91–$427.87	622% above	—
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 B* HC ANTIBODY CYTOMEGALOVIRUS CMV	$454.65	$454.65	$404.59–$427.87	—	—
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 HC CMV-BLOOD BANK-BLOOD PROD	$454.65	$454.65	$404.59–$427.87	—	—
D-dimer blood test (blood clot marker) CPT 85379 B* HC FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE	$131.70	$131.70	$51.36–$123.94	82% above	—
D-dimer blood test (blood clot marker) inpatient CPT 85379 B* HC FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE	$131.70	$131.70	$117.20–$123.94	—	—
DHEA sulfate (DHEA-S) blood test CPT 82627 B* HC DEHYDROEPIANDROSTERONE-SULFATE	$38.35	$38.35	$14.96–$128.08	58% below	—
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 B* HC DEHYDROEPIANDROSTERONE-SULFATE	$38.35	$38.35	$34.13–$36.09	—	—
Drug screen by lab instrument (any number of drug classes) CPT 80307 B* HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE	$323.95	$323.95	$126.34–$358.03	234% above	—
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 B* HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE	$323.95	$323.95	$288.28–$304.87	—	—
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 B* HC ELECTROLYTE PANEL	$151.05	$151.05	$40.39–$142.15	201% above	—
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 B* HC ELECTROLYTE PANEL POC	$151.05	$151.05	$40.39–$142.15	201% above	—
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 B* HC ELECTROLYTE PANEL POC	$151.05	$151.05	$134.42–$142.15	—	—
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 B* HC ELECTROLYTE PANEL	$151.05	$151.05	$134.42–$142.15	—	—
Epstein-Barr virus (EBV) antibody test CPT 86665 B* HC ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA	$146.65	$146.65	$57.19–$138.01	140% above	—
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 B* HC ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA	$146.65	$146.65	$130.50–$138.01	—	—
Estradiol blood test CPT 82670 B* HC ASSAY OF TOTAL ESTRADIOL	$458.05	$458.05	$160.98–$431.07	349% above	—
Estradiol blood test inpatient CPT 82670 B* HC ASSAY OF TOTAL ESTRADIOL	$458.05	$458.05	$407.62–$431.07	—	—
FSH (follicle-stimulating hormone) test CPT 83001 B* HC GONADOTROPIN FOLLICLE STIMULATING HORMONE	$188.05	$188.05	$73.34–$176.97	137% above	—
FSH (follicle-stimulating hormone) test inpatient CPT 83001 B* HC GONADOTROPIN FOLLICLE STIMULATING HORMONE	$188.05	$188.05	$167.35–$176.97	—	—
Fecal calprotectin (stool inflammation test) CPT 83993 B* HC ASSAY OF CALPROTECTIN FECAL	$444.20	$444.20	$113.10–$418.04	189% above	—
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 B* HC ASSAY OF CALPROTECTIN FECAL	$444.20	$444.20	$395.29–$418.04	—	—
Ferritin blood test (iron stores) CPT 82728 B* HC ASSAY OF FERRITIN	$194.05	$194.05	$75.68–$182.62	160% above	—
Ferritin blood test (iron stores) inpatient CPT 82728 B* HC ASSAY OF FERRITIN	$194.05	$194.05	$172.69–$182.62	—	—
Fibrinogen blood test CPT 85384 B* HC FIBRINOGEN ACTIVITY	$121.40	$121.40	$47.35–$114.25	101% above	—
Fibrinogen blood test inpatient CPT 85384 B* HC FIBRINOGEN ACTIVITY	$121.40	$121.40	$108.03–$114.25	—	—
Folate (folic acid) blood test CPT 82746 B* HC ASSAY OF FOLIC ACID SERUM	$210.25	$210.25	$82.00–$197.87	180% above	—
Folate (folic acid) blood test inpatient CPT 82746 B* HC ASSAY OF FOLIC ACID SERUM	$210.25	$210.25	$187.10–$197.87	—	—
Free T3 thyroid hormone test CPT 84481 B* HC ASSAY OF TRIIODOTHYRONINE T3 FREE	$219.25	$219.25	$85.51–$206.34	155% above	—
Free T3 thyroid hormone test inpatient CPT 84481 B* HC ASSAY OF TRIIODOTHYRONINE T3 FREE	$219.25	$219.25	$195.11–$206.34	—	—
Free T4 (free thyroxine) thyroid blood test CPT 84439 B* HC ASSAY OF FREE THYROXINE	$171.55	$171.55	$51.97–$161.45	187% above	—
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 B* HC ASSAY OF FREE THYROXINE	$171.55	$171.55	$152.66–$161.45	—	—
Free testosterone test CPT 84402 B* HC ASSAY OF TESTOSTERONE FREE	$41.50	$41.50	$16.19–$146.75	59% below	—
Free testosterone test inpatient CPT 84402 B* HC ASSAY OF TESTOSTERONE FREE	$41.50	$41.50	$36.93–$39.06	—	—
Gamma-glutamyl transferase (GGT) blood test CPT 82977 B* HC ASSAY OF GLUTAMYLTRASE GAMMA	$88.85	$88.85	$34.65–$83.62	100% above	—
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 B* HC ASSAY OF GLUTAMYLTRASE GAMMA	$88.85	$88.85	$79.07–$83.62	—	—
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 B* HC GENERAL HEALTH PANEL	$439.45	$439.45	$171.39–$413.57	3% above	—
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 B* HC GENERAL HEALTH PANEL	$439.45	$439.45	$391.07–$413.57	—	—
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 B* HC GLUCOSE POST GLUCOSE DOSE	$40.05	$40.05	$15.62–$37.69	8% above	—
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 B* HC GLUCOSE POST GLUCOSE DOSE	$40.05	$40.05	$35.64–$37.69	—	—
Glucose tolerance test, 3 samples CPT 82951 B* HC GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS	$189.45	$189.45	$73.89–$178.29	196% above	—
Glucose tolerance test, 3 samples inpatient CPT 82951 B* HC GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS	$189.45	$189.45	$168.59–$178.29	—	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 B* HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ	$85.90	$85.90	$33.50–$202.18	30% above	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 B* HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ	$85.90	$85.90	$76.44–$80.84	—	—
H. pylori antibody blood test CPT 86677 B* HC ANTIBODY HELICOBACTER PYLORI	$279.95	$279.95	$97.08–$263.46	265% above	—
H. pylori antibody blood test inpatient CPT 86677 B* HC ANTIBODY HELICOBACTER PYLORI	$279.95	$279.95	$249.13–$263.46	—	—
H. pylori stool antigen test CPT 87338 B* HC IAAD IA HPYLORI STOOL	$336.40	$336.40	$82.85–$316.59	192% above	—
H. pylori stool antigen test inpatient CPT 87338 B* HC IAAD IA HPYLORI STOOL	$336.40	$336.40	$299.36–$316.59	—	—
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 B* HC IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION	$598.30	$598.30	$233.34–$563.06	161% above	—
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 B* HC IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION	$598.30	$598.30	$532.43–$563.06	—	—
HIV-1 and HIV-2 antibody test CPT 86703 B* HC ANTIBODY HIV-1&HIV-2 SINGLE RESULT	$105.15	$105.15	$41.01–$98.96	131% above	—
HIV-1 and HIV-2 antibody test inpatient CPT 86703 B* HC ANTIBODY HIV-1&HIV-2 SINGLE RESULT	$105.15	$105.15	$93.57–$98.96	—	—
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 B* HC IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE	$68.10	$68.10	$26.56–$138.74	44% above	—
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 B* HC IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE	$68.10	$68.10	$60.60–$64.09	—	—
HPV test for high-risk types, one combined (pooled) result CPT 87624 B* HC IADNA HUMAN PAPILLOMAVIRUS HI-RSK TYP POOLD RSLT	$151.05	$151.05	$58.91–$202.18	111% above	—
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 B* HC IADNA HUMAN PAPILLOMAVIRUS HI-RSK TYP POOLD RSLT	$151.05	$151.05	$134.42–$142.15	—	—
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 B* HC HEMOGLOBIN GLYCOSYLATED A1C	$85.25	$85.25	$33.25–$80.23	62% above	—
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 B* HC HEMOGLOBIN GLYCOSYLATED A1C	$85.25	$85.25	$75.86–$80.23	—	—
Hemoglobin blood test CPT 85018 B* HC BLOOD COUNT HEMOGLOBIN	$27.65	$27.65	$10.78–$26.02	82% above	—
Hemoglobin blood test inpatient CPT 85018 B* HC BLOOD COUNT HEMOGLOBIN	$27.65	$27.65	$24.61–$26.02	—	—
Hepatitis B core antibody test (total) CPT 86704 B* HC HEPATITIS B CORE ANTIBODY HBCAB TOTAL	$188.10	$188.10	$69.43–$177.02	209% above	—
Hepatitis B core antibody test (total) inpatient CPT 86704 B* HC HEPATITIS B CORE ANTIBODY HBCAB TOTAL	$188.10	$188.10	$167.39–$177.02	—	—
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 B* HC HEPATITIS B SURF ANTIBODY HBSAB	$146.65	$146.65	$57.19–$138.01	191% above	—
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 B* HC HEPATITIS B SURF ANTIBODY HBSAB	$146.65	$146.65	$130.50–$138.01	—	—
Hepatitis B surface antigen (HBsAg) test CPT 87340 B* HC IAAD IA HEPATITIS B SURFACE ANTIGEN	$108.15	$108.15	$42.18–$101.78	122% above	—
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 B* HC IAAD IA HEPATITIS B SURFACE ANTIGEN	$108.15	$108.15	$96.24–$101.78	—	—
Hepatitis C antibody blood test (screening) CPT 86803 B* HC HEPATITIS C ANTIBODY	$225.15	$225.15	$82.22–$211.89	206% above	—
Hepatitis C antibody blood test (screening) inpatient CPT 86803 B* HC HEPATITIS C ANTIBODY	$225.15	$225.15	$200.36–$211.89	—	—
Hepatitis C viral load (HCV RNA) test CPT 87522 B* HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION	$556.80	$556.80	$217.15–$524.00	223% above	—
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 B* HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION	$556.80	$556.80	$495.50–$524.00	—	—
Herpes blood test, HSV-1 antibody CPT 86695 B* HC ANTIBODY HERPES SMPLX TYPE 1	$151.25	$151.25	$58.99–$142.34	187% above	—
Herpes blood test, HSV-1 antibody inpatient CPT 86695 B* HC ANTIBODY HERPES SMPLX TYPE 1	$151.25	$151.25	$134.60–$142.34	—	—
Herpes blood test, HSV-2 antibody CPT 86696 B* HC ANTIBODY HERPES SMPLX TYPE 2	$151.25	$151.25	$58.99–$142.34	113% above	—
Herpes blood test, HSV-2 antibody inpatient CPT 86696 B* HC ANTIBODY HERPES SMPLX TYPE 2	$151.25	$151.25	$134.60–$142.34	—	—
High-sensitivity CRP (hs-CRP) test CPT 86141 B* HC C-REACTIVE PROTEIN HIGH SENSITIVITY	$104.90	$104.90	$40.91–$98.72	103% above	—
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 B* HC C-REACTIVE PROTEIN HIGH SENSITIVITY	$104.90	$104.90	$93.35–$98.72	—	—
Homocysteine blood test CPT 83090 B* HC ASSAY OF HOMOCYSTEINE	$174.85	$174.85	$68.19–$164.55	141% above	—
Homocysteine blood test inpatient CPT 83090 B* HC ASSAY OF HOMOCYSTEINE	$174.85	$174.85	$155.60–$164.55	—	—
Insulin blood test CPT 83525 B* HC ASSAY OF INSULIN TOTAL	$171.80	$171.80	$65.86–$161.68	165% above	—
Insulin blood test inpatient CPT 83525 B* HC ASSAY OF INSULIN TOTAL	$171.80	$171.80	$152.88–$161.68	—	—
Iron blood test (serum iron) CPT 83540 B* HC ASSAY OF IRON	$122.90	$122.90	$37.28–$115.66	227% above	—
Iron blood test (serum iron) inpatient CPT 83540 B* HC ASSAY OF IRON	$122.90	$122.90	$109.37–$115.66	—	—
Iron-binding capacity (TIBC) test CPT 83550 B* HC IRON BINDING CAPACITY	$146.65	$146.65	$50.36–$138.01	264% above	—
Iron-binding capacity (TIBC) test inpatient CPT 83550 B* HC IRON BINDING CAPACITY	$146.65	$146.65	$130.50–$138.01	—	—
Kidney function blood test panel CPT 80069 B* HC RENAL FUNCTION PANEL	$122.90	$122.90	$47.93–$115.66	83% above	—
Kidney function blood test panel inpatient CPT 80069 B* HC RENAL FUNCTION PANEL	$122.90	$122.90	$109.37–$115.66	—	—
LH (luteinizing hormone) test CPT 83002 B* HC GONADOTROPIN LUTEINIZING HORMONE	$350.75	$350.75	$106.71–$330.09	313% above	—
LH (luteinizing hormone) test inpatient CPT 83002 B* HC GONADOTROPIN LUTEINIZING HORMONE	$350.75	$350.75	$312.13–$330.09	—	—
Lactate (lactic acid) blood test CPT 83605 B* HC ASSAY OF LACTATE	$133.25	$133.25	$51.97–$125.40	129% above	—
Lactate (lactic acid) blood test CPT 83605 B* HC ASSAY OF LACTATE POC	$133.25	$133.25	$51.97–$125.40	129% above	—
Lactate (lactic acid) blood test inpatient CPT 83605 B* HC ASSAY OF LACTATE	$133.25	$133.25	$118.58–$125.40	—	—
Lactate (lactic acid) blood test inpatient CPT 83605 B* HC ASSAY OF LACTATE POC	$133.25	$133.25	$118.58–$125.40	—	—
Lactate dehydrogenase (LDH) blood test CPT 83615 B* HC LACTATE DEHYDROGENASE LDH	$37.00	$37.00	$14.43–$34.82	3% above	—
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 B* HC LACTATE DEHYDROGENASE LDH	$37.00	$37.00	$32.93–$34.82	—	—
Lipase blood test (pancreas enzyme) CPT 83690 B* HC ASSAY OF LIPASE	$109.60	$109.60	$39.70–$103.14	138% above	—
Lipase blood test (pancreas enzyme) inpatient CPT 83690 B* HC ASSAY OF LIPASE	$109.60	$109.60	$97.53–$103.14	—	—
Liver function blood test panel CPT 80076 B* HC HEPATIC FUNCTION PANEL	$174.85	$174.85	$47.07–$164.55	110% above	—
Liver function blood test panel inpatient CPT 80076 B* HC HEPATIC FUNCTION PANEL	$174.85	$174.85	$155.60–$164.55	—	—
Lyme disease antibody test CPT 86618 B* HC ANTIBODY BORRELIA BURGDORFERI LYME DISEASE	$50.40	$50.40	$19.66–$98.12	35% below	—
Lyme disease antibody test CPT 86618 CHG ANTIBODY BORRELIA BURGDORFERI LYME DISEASE	$50.40	$50.40	$19.66–$98.12	35% below	—
Lyme disease antibody test inpatient CPT 86618 B* HC ANTIBODY BORRELIA BURGDORFERI LYME DISEASE	$50.40	$50.40	$44.85–$47.43	—	—
Lyme disease antibody test inpatient CPT 86618 CHG ANTIBODY BORRELIA BURGDORFERI LYME DISEASE	$50.40	$50.40	$44.85–$47.43	—	—
Magnesium blood test CPT 83735 B* HC ASSAY OF MAGNESIUM	$125.80	$125.80	$38.60–$118.39	214% above	—
Magnesium blood test inpatient CPT 83735 B* HC ASSAY OF MAGNESIUM	$125.80	$125.80	$111.95–$118.39	—	—
Measles (rubeola) antibody test CPT 86765 B* HC ANTIBODY RUBEOLA	$102.20	$102.20	$39.86–$96.18	191% above	—
Measles (rubeola) antibody test inpatient CPT 86765 B* HC ANTIBODY RUBEOLA	$102.20	$102.20	$90.95–$96.18	—	—
Mono test (heterophile antibody, Monospot) CPT 86308 B* HC HETEROPHILE ANTIBODIES SCREEN	$102.20	$102.20	$29.85–$96.18	184% above	—
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 B* HC HETEROPHILE ANTIBODIES SCREEN	$102.20	$102.20	$90.95–$96.18	—	—
Mumps immunity blood test CPT 86735 B* HC ANTIBODY MUMPS	$94.75	$94.75	$36.95–$89.17	156% above	—
Mumps immunity blood test inpatient CPT 86735 B* HC ANTIBODY MUMPS	$94.75	$94.75	$84.32–$89.17	—	—
PSA (prostate-specific antigen) blood test, free CPT 84154 B* HC ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE	$167.35	$167.35	$65.27–$157.49	80% above	—
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 B* HC ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE	$167.35	$167.35	$148.92–$157.49	—	—
PSA (prostate-specific antigen) blood test, total CPT 84153 B* HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL	$167.35	$167.35	$65.27–$157.49	133% above	—
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 B* HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL	$167.35	$167.35	$148.92–$157.49	—	—
Pap test (liquid-based, automated screening with review) CPT 88175 B* HC CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS	$64.20	$64.20	$25.04–$153.32	at median	—
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 B* HC CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS	$64.20	$64.20	$57.13–$60.42	—	—
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 B* HC CYTOPATH CERV/VAG AUTO THIN LAYER PREP MNL SCREEN	$78.50	$78.50	$30.62–$116.73	12% above	—
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 B* HC CYTOPATH CERV/VAG AUTO THIN LAYER PREP MNL SCREEN	$78.50	$78.50	$69.86–$73.88	—	—
Parathyroid hormone (PTH) blood test CPT 83970 B* HC ASSAY OF PARATHORMONE	$279.95	$279.95	$109.18–$263.46	185% above	—
Parathyroid hormone (PTH) blood test inpatient CPT 83970 B* HC ASSAY OF PARATHORMONE	$279.95	$279.95	$249.13–$263.46	—	—
Partial thromboplastin time (PTT) clotting test CPT 85730 B* HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD	$186.60	$186.60	$34.63–$175.61	329% above	—
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 B* HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD	$186.60	$186.60	$166.06–$175.61	—	—
Phosphorus (phosphate) blood test CPT 84100 B* HC ASSAY OF PHOSPHORUS INORGANIC	$28.15	$28.15	$10.98–$27.31	1% above	—
Phosphorus (phosphate) blood test inpatient CPT 84100 B* HC ASSAY OF PHOSPHORUS INORGANIC	$28.15	$28.15	$25.05–$26.49	—	—
Potassium blood test CPT 84132 B* HC POTASSIUM SERUM PLASMA/WHOLE BLOOD	$45.45	$45.45	$17.73–$42.77	87% above	—
Potassium blood test inpatient CPT 84132 B* HC POTASSIUM SERUM PLASMA/WHOLE BLOOD	$45.45	$45.45	$40.45–$42.77	—	—
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 B* HC FETAL CHROMOSOMAL ANEUPLOIDY GENOMIC SEQ ANALYS	$1,043.25	$1,043.25	$406.87–$4,373.42	1% below	—
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 B* HC FETAL CHROMOSOMAL ANEUPLOIDY GENOMIC SEQ ANALYS	$1,043.25	$1,043.25	$928.39–$981.80	—	—
Progesterone blood test CPT 84144 B* HC ASSAY OF PROGESTERONE	$265.05	$265.05	$103.37–$249.44	198% above	—
Progesterone blood test inpatient CPT 84144 B* HC ASSAY OF PROGESTERONE	$265.05	$265.05	$235.87–$249.44	—	—
Prolactin blood test CPT 84146 B* HC ASSAY OF PROLACTIN	$208.25	$208.25	$81.22–$195.98	178% above	—
Prolactin blood test inpatient CPT 84146 B* HC ASSAY OF PROLACTIN	$208.25	$208.25	$185.32–$195.98	—	—
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME	$81.55	$81.55	$24.72–$76.75	177% above	—
Prothrombin time (PT/INR) clotting test CPT 85610 B* HC PROTHROMBIN TIME	$81.55	$81.55	$24.72–$76.75	177% above	—
Prothrombin time (PT/INR) clotting test CPT 85610 CHG PROTHROMBIN TIME	$81.55	$81.55	$24.72–$76.75	177% above	—
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 B* HC PROTHROMBIN TIME	$81.55	$81.55	$72.57–$76.75	—	—
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME	$81.55	$81.55	$72.57–$76.75	—	—
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 CHG PROTHROMBIN TIME	$81.55	$81.55	$72.57–$76.75	—	—
Rapid strep A antigen test from a throat swab, read visually CPT 87880 B* HC IAADIADOO STREPTOCOCCUS GROUP A	$105.55	$105.55	$41.16–$99.33	169% above	—
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 B* HC IAADIADOO STREPTOCOCCUS GROUP A	$105.55	$105.55	$93.93–$99.33	—	—
Renin blood test CPT 84244 B* HC ASSAY OF RENIN	$346.80	$346.80	$126.70–$326.37	371% above	—
Renin blood test inpatient CPT 84244 B* HC ASSAY OF RENIN	$346.80	$346.80	$308.62–$326.37	—	—
Rh blood typing CPT 86901 B* HC (ARC) BLOOD TYPING SEROLOGIC RH (D)	$60.75	$60.75	$23.69–$191.09	67% above	—
Rh blood typing CPT 86901 B* HC BLOOD TYPING SEROLOGIC RH (D)	$60.75	$60.75	$23.69–$191.09	67% above	—
Rh blood typing CPT 86901 HC BLOOD TYPE RH	$60.75	$60.75	$23.69–$191.09	67% above	—
Rh blood typing inpatient CPT 86901 B* HC (ARC) BLOOD TYPING SEROLOGIC RH (D)	$60.75	$60.75	$54.06–$57.17	—	—
Rh blood typing inpatient CPT 86901 HC BLOOD TYPE RH	$60.75	$60.75	$54.06–$57.17	—	—
Rh blood typing inpatient CPT 86901 B* HC BLOOD TYPING SEROLOGIC RH (D)	$60.75	$60.75	$54.06–$57.17	—	—
Rheumatoid factor (RF) test CPT 86431 B* HC RHEUMATOID FACTOR QUANTITATIVE	$74.05	$74.05	$28.88–$69.69	120% above	—
Rheumatoid factor (RF) test inpatient CPT 86431 B* HC RHEUMATOID FACTOR QUANTITATIVE	$74.05	$74.05	$65.90–$69.69	—	—
Rubella antibody test (immunity check) CPT 86762 B* HC ANTIBODY RUBELLA	$73.50	$73.50	$28.67–$82.91	47% above	—
Rubella antibody test (immunity check) inpatient CPT 86762 B* HC ANTIBODY RUBELLA	$73.50	$73.50	$65.41–$69.17	—	—
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 B* HC SEDIMENTATION RATE RBC AUTOMATED	$71.05	$71.05	$15.56–$66.87	139% above	—
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 B* HC SEDIMENTATION RATE RBC AUTOMATED	$71.05	$71.05	$63.23–$66.87	—	—
Semen analysis: volume, sperm count, motility and morphology CPT 89320 B* HC SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT	$413.25	$413.25	$70.93–$388.91	399% above	—
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 B* HC SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT	$413.25	$413.25	$367.75–$388.91	—	—
Sodium blood test CPT 84295 B* HC SODIUM SERUM PLASMA OR WHOLE BLOOD	$45.90	$45.90	$17.90–$43.20	93% above	—
Sodium blood test inpatient CPT 84295 B* HC SODIUM SERUM PLASMA OR WHOLE BLOOD	$45.90	$45.90	$40.85–$43.20	—	—
Stool ova and parasites exam CPT 87177 B* HC OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID	$75.50	$75.50	$29.45–$71.05	105% above	—
Stool ova and parasites exam inpatient CPT 87177 B* HC OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID	$75.50	$75.50	$67.19–$71.05	—	—
Stool test for hidden blood (guaiac FOBT) CPT 82270 B* HC BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER	$37.00	$37.00	$14.43–$34.82	79% above	—
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 B* HC BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER	$37.00	$37.00	$32.93–$34.82	—	—
Stool test for hidden blood by immunoassay (FIT) CPT 82274 B* HC DX BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3	$100.70	$100.70	$39.27–$94.77	147% above	—
Stool test for hidden blood by immunoassay (FIT) CPT 82274 B* HC SCREEN BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3	$100.70	$100.70	$39.27–$94.77	147% above	—
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 B* HC SCREEN BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3	$100.70	$100.70	$89.61–$94.77	—	—
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 B* HC DX BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3	$100.70	$100.70	$89.61–$94.77	—	—
Syphilis antibody test (Treponema pallidum) CPT 86780 B* HC ANTIBODY TREPONEMA PALLIDUM	$133.00	$133.00	$51.87–$125.17	149% above	—
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 B* HC ANTIBODY TREPONEMA PALLIDUM	$133.00	$133.00	$118.36–$125.17	—	—
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 B* HC SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL	$65.10	$65.10	$24.60–$61.27	108% above	—
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 B* HC SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL	$65.10	$65.10	$57.93–$61.27	—	—
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 B* HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON	$70.50	$70.50	$27.50–$357.11	40% below	—
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 B* HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON	$70.50	$70.50	$62.74–$66.35	—	—
Testosterone blood test, total (not free testosterone) CPT 84403 B* HC ASSAY OF TESTOSTERONE TOTAL	$185.10	$185.10	$72.19–$174.20	103% above	—
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 B* HC ASSAY OF TESTOSTERONE TOTAL	$185.10	$185.10	$164.72–$174.20	—	—
Thyroid peroxidase (TPO) antibody test CPT 86376 B* HC MICROSOMAL ANTIBODIES EACH	$211.05	$211.05	$82.31–$198.62	146% above	—
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 B* HC MICROSOMAL ANTIBODIES EACH	$211.05	$211.05	$187.81–$198.62	—	—
Thyroid-stimulating hormone (TSH) blood test CPT 84443 B* HC ASSAY OF THYROID STIMULATING HORMONE TSH	$210.25	$210.25	$82.00–$197.87	170% above	—
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 B* HC ASSAY OF THYROID STIMULATING HORMONE TSH	$210.25	$210.25	$187.10–$197.87	—	—
Total IgE blood test CPT 82785 B* HC ASSAY OF GAMMAGLOBULIN IGE	$94.75	$94.75	$36.95–$94.84	49% above	—
Total IgE blood test inpatient CPT 82785 B* HC ASSAY OF GAMMAGLOBULIN IGE	$94.75	$94.75	$84.32–$89.17	—	—
Total cholesterol blood test CPT 82465 B* HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL	$28.15	$28.15	$10.98–$26.49	15% above	—
Total cholesterol blood test inpatient CPT 82465 B* HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL	$28.15	$28.15	$25.05–$26.49	—	—
Total thyroxine (T4) blood test CPT 84436 B* HC ASSAY OF THYROXINE TOTAL	$162.90	$162.90	$39.58–$153.31	235% above	—
Total thyroxine (T4) blood test inpatient CPT 84436 B* HC ASSAY OF THYROXINE TOTAL	$162.90	$162.90	$144.96–$153.31	—	—
Total triiodothyronine (T3) blood test CPT 84480 B* HC ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3	$154.00	$154.00	$60.06–$144.93	83% above	—
Total triiodothyronine (T3) blood test inpatient CPT 84480 B* HC ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3	$154.00	$154.00	$137.04–$144.93	—	—
Transferrin blood test CPT 84466 B* HC ASSAY OF L7383TRANSFERRIN	$68.10	$68.10	$26.56–$73.52	17% above	—
Transferrin blood test inpatient CPT 84466 B* HC ASSAY OF L7383TRANSFERRIN	$68.10	$68.10	$60.60–$64.09	—	—
Trichomonas test (NAAT) CPT 87661 B* HC IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH	$275.45	$275.45	$107.43–$259.23	208% above	—
Trichomonas test (NAAT) inpatient CPT 87661 B* HC IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH	$275.45	$275.45	$245.12–$259.23	—	—
Triglycerides blood test CPT 84478 B* HC ASSAY OF TRIGLYCERIDES	$117.10	$117.10	$33.07–$110.20	163% above	—
Triglycerides blood test inpatient CPT 84478 B* HC ASSAY OF TRIGLYCERIDES	$117.10	$117.10	$104.21–$110.20	—	—
Troponin test, quantitative CPT 84484 B* HC ASSAY OF TROPONIN QUANTITATIVE	$213.30	$213.30	$71.85–$200.74	167% above	—
Troponin test, quantitative inpatient CPT 84484 B* HC ASSAY OF TROPONIN QUANTITATIVE	$213.30	$213.30	$189.82–$200.74	—	—
Uric acid blood test CPT 84550 CHG ASSAY OF BLOOD/URIC ACID	$28.15	$28.15	$10.98–$26.49	9% below	—
Uric acid blood test CPT 84550 B* HC ASSAY OF BLOOD/URIC ACID	$28.15	$28.15	$10.98–$26.49	9% below	—
Uric acid blood test inpatient CPT 84550 B* HC ASSAY OF BLOOD/URIC ACID	$28.15	$28.15	$25.05–$26.49	—	—
Uric acid blood test inpatient CPT 84550 CHG ASSAY OF BLOOD/URIC ACID	$28.15	$28.15	$25.05–$26.49	—	—
Urinalysis with microscope exam, automated CPT 81001 B* HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY	$38.50	$38.50	$15.02–$36.23	13% above	—
Urinalysis with microscope exam, automated inpatient CPT 81001 B* HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY	$38.50	$38.50	$34.26–$36.23	—	—
Urinalysis with microscope exam, manual CPT 81000 CHG URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY	$60.10	$60.10	$23.16–$56.56	141% above	—
Urinalysis with microscope exam, manual CPT 81000 B* HC URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY	$60.10	$60.10	$23.16–$56.56	141% above	—
Urinalysis with microscope exam, manual inpatient CPT 81000 B* HC URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY	$60.10	$60.10	$53.48–$56.56	—	—
Urinalysis with microscope exam, manual inpatient CPT 81000 CHG URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY	$60.10	$60.10	$53.48–$56.56	—	—
Urinalysis without microscope exam, automated CPT 81003 B* HC URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY	$23.65	$23.65	$9.22–$22.26	9% above	—
Urinalysis without microscope exam, automated CPT 81003 CHG URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY	$23.65	$23.65	$9.22–$22.26	9% above	—
Urinalysis without microscope exam, automated inpatient CPT 81003 B* HC URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY	$23.65	$23.65	$21.05–$22.26	—	—
Urinalysis without microscope exam, automated inpatient CPT 81003 CHG URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY	$23.65	$23.65	$21.05–$22.26	—	—
Urinalysis without microscope exam, manual CPT 81002 CHG URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP	$23.10	$23.10	$9.01–$21.74	46% above	—
Urinalysis without microscope exam, manual CPT 81002 HC URINE DIP STICK	$23.10	$23.10	$9.01–$21.74	46% above	—
Urinalysis without microscope exam, manual CPT 81002 B* HC URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP	$23.10	$23.10	$9.01–$21.74	46% above	—
Urinalysis without microscope exam, manual inpatient CPT 81002 CHG URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP	$23.10	$23.10	$20.56–$21.74	—	—
Urinalysis without microscope exam, manual inpatient CPT 81002 HC URINE DIP STICK	$23.10	$23.10	$20.56–$21.74	—	—
Urinalysis without microscope exam, manual inpatient CPT 81002 B* HC URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP	$23.10	$23.10	$20.56–$21.74	—	—
Urine culture for bacteria, with colony count CPT 87086 B* HC CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE	$226.65	$226.65	$46.50–$213.30	253% above	—
Urine culture for bacteria, with colony count inpatient CPT 87086 B* HC CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE	$226.65	$226.65	$201.70–$213.30	—	—
Urine microalbumin (albumin) test CPT 82043 B* HC URINE ALBUMIN QUANTITATIVE	$216.20	$216.20	$33.30–$203.47	324% above	—
Urine microalbumin (albumin) test inpatient CPT 82043 B* HC URINE ALBUMIN QUANTITATIVE	$216.20	$216.20	$192.40–$203.47	—	—
Urine pregnancy test, read by color change CPT 81025 HC URINE PREGNANCY TEST	$46.60	$46.60	$18.17–$49.61	66% above	—
Urine pregnancy test, read by color change inpatient CPT 81025 HC URINE PREGNANCY TEST	$46.60	$46.60	$41.47–$43.86	—	—
Vitamin B12 (cobalamin) blood test CPT 82607 B* HC CYANOCOBALAMIN VITAMIN B-12	$152.50	$152.50	$59.48–$143.52	78% above	—
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 B* HC CYANOCOBALAMIN VITAMIN B-12	$152.50	$152.50	$135.71–$143.52	—	—
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 B* HC 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED	$226.55	$226.55	$88.35–$213.21	99% above	—
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 B* HC 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED	$226.55	$226.55	$201.61–$213.21	—	—
Vitamin D, 1,25-dihydroxy blood test CPT 82652 B* HC 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED	$125.20	$125.20	$48.83–$221.83	5% below	—
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 B* HC 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED	$125.20	$125.20	$111.42–$117.83	—	—
Zinc blood test CPT 84630 B* HC ASSAY OF ZINC	$133.95	$133.95	$52.24–$126.06	218% above	—
Zinc blood test inpatient CPT 84630 B* HC ASSAY OF ZINC	$133.95	$133.95	$119.20–$126.06	—	—
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 B* HC GONADOTROPIN CHORIONIC QUANTITATIVE	$171.15	$171.15	$66.75–$161.07	110% above	—
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 B* HC GONADOTROPIN CHORIONIC QUANTITATIVE	$171.15	$171.15	$152.31–$161.07	—	—

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Maine	Off list
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 HC BX BREAST 1ST LESION STRTCTC	$5,313.70	$5,313.70	$2,072.34–$8,450.62	185% above	—
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 HC BX BREAST 1ST LESION STRTCTC	$5,313.70	$5,313.70	$4,728.66–$5,000.72	—	—
Cardioversion, elective (restoring heart rhythm) CPT 92960 HC CARDIOVERSION ELECTRIC EXTERNAL	$1,362.50	$1,362.50	$531.38–$3,381.78	180% above	—
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC CARDIOVERSION ELECTRIC EXTERNAL	$1,362.50	$1,362.50	$1,212.49–$1,282.25	—	—
Cystoscopy with ureteral stent placement CPT 52332 HC CYSTO W/INSERT URETERAL STENT	$767.15	$767.15	$299.19–$18,036.00	81% below	—
Cystoscopy with ureteral stent placement inpatient CPT 52332 HC CYSTO W/INSERT URETERAL STENT	$767.15	$767.15	$682.69–$721.96	—	—
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 HC CYSTOURETHROSCOPY	$1,766.80	$1,766.80	$689.05–$3,567.79	220% above	—
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 HC CYSTOURETHROSCOPY	$1,766.80	$1,766.80	$1,572.28–$1,662.74	—	—
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 HC REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT	$53.35	$53.35	$20.81–$301.84	7% above	—
Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 HC REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT	$53.35	$53.35	$47.48–$50.21	—	—
Earwax removal with instruments, one ear one side CPT 69210 HC REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT	$117.10	$117.10	$45.67–$301.84	102% above	—
Earwax removal with instruments, one ear inpatient one side CPT 69210 HC REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT	$117.10	$117.10	$104.21–$110.20	—	—
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 HC INJ INTERLAMINAR CRV/THRC W/ IMG GUIDE	$564.70	$564.70	$220.23–$3,611.74	40% below	—
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 HC INJ INTERLAMINAR CRV/THRC W/ IMG GUIDE	$564.70	$564.70	$502.53–$531.44	—	—
Hemorrhoid banding (rubber band ligation) CPT 46221 HC LIGATION OF HEMORRHOID(S)	$484.15	$484.15	$188.82–$4,758.26	36% below	—
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 HC LIGATION OF HEMORRHOID(S)	$484.15	$484.15	$430.85–$455.63	—	—
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HC CATHETER FOR HYSTEROGRAPHY	$539.85	$539.85	$210.54–$508.05	60% above	—
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 HC CATHETER FOR HYSTEROGRAPHY	$539.85	$539.85	$480.41–$508.05	—	—
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC INJ SINGLE TENDON SHEATH/LIGAMENT	$125.80	$125.80	$49.06–$1,570.55	33% below	—
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 HC INJ SINGLE TENDON SHEATH/LIGAMENT	$125.80	$125.80	$111.95–$118.39	—	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC DRAIN/INJ MAJ JOINT/BURSA W/O US GUIDANCE	$647.20	$647.20	$252.41–$1,570.55	145% above	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC DRAIN/INJ MAJ JOINT/BURSA W/O US GUIDANCE	$647.20	$647.20	$575.94–$609.08	—	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC DRAIN/INJ JOINT/BURSA W/O US	$632.40	$632.40	$246.64–$1,570.55	249% above	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC DRAIN/INJ JOINT/BURSA W/O US	$632.40	$632.40	$562.77–$595.15	—	—
Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC DRAIN/INJ SM JOINT/BURSA W/O US GUIDANCE	$482.75	$482.75	$188.27–$1,570.55	140% above	—
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC DRAIN/INJ SM JOINT/BURSA W/O US GUIDANCE	$482.75	$482.75	$429.60–$454.32	—	—
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC LAYER RPR SCLP <2.5	$565.70	$565.70	$220.62–$2,079.97	96% above	—
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HC LAYER RPR SCLP <2.5	$565.70	$565.70	$503.42–$532.38	—	—
Lower-back epidural injection, with imaging guidance CPT 62323 HC INJ INTERLAMINAR LMBR/SAC W/ IMG GUIDE	$556.85	$556.85	$217.17–$3,611.74	40% below	—
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC INJ INTERLAMINAR LMBR/SAC W/ IMG GUIDE	$556.85	$556.85	$495.54–$524.05	—	—
Lower-back epidural injection, without imaging guidance CPT 62322 HC INJ INTERLAMINAR LMBR/SAC W/O IMG GUIDE	$761.20	$761.20	$296.87–$4,525.50	16% below	—
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 HC INJ INTERLAMINAR LMBR/SAC W/O IMG GUIDE	$761.20	$761.20	$677.39–$716.37	—	—
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC TRANSFORAM L/S SGL	$599.75	$599.75	$233.90–$4,525.50	38% below	—
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HC TRANSFORAM L/S SGL	$599.75	$599.75	$533.72–$564.42	—	—
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 HC EXC T/A/L EXT BENIGN MARG 0.5 < CM	$282.10	$282.10	$110.02–$3,623.23	65% above	—
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 HC EXC T/A/L EXT BENIGN MARG 0.5 < CM	$282.10	$282.10	$251.04–$265.48	—	—
Nail removal (partial or complete), one nail CPT 11730 HC REMOVAL OF NAIL PLATE SIMPLE SINGLE	$248.80	$248.80	$97.03–$1,026.57	91% above	—
Nail removal (partial or complete), one nail inpatient CPT 11730 HC REMOVAL OF NAIL PLATE SIMPLE SINGLE	$248.80	$248.80	$221.41–$234.15	—	—
Occipital nerve block (injection for headaches) CPT 64405 HC INJ ANES GREATER OCCIP NERVE	$190.30	$190.30	$74.22–$1,570.55	36% below	—
Occipital nerve block (injection for headaches) CPT 64405 PR INJECTION AA&/STRD GREATER OCCIPITAL NERVE	$204.35	$204.35	$79.70–$1,570.55	31% below	—
Occipital nerve block (injection for headaches) inpatient CPT 64405 HC INJ ANES GREATER OCCIP NERVE	$190.30	$190.30	$169.35–$179.09	—	—
Occipital nerve block (injection for headaches) inpatient CPT 64405 PR INJECTION AA&/STRD GREATER OCCIPITAL NERVE	$204.35	$204.35	$181.85–$192.31	—	—
Paracentesis with imaging guidance CPT 49083 HC ABD PARACENTESIS W/ IMAGING GUIDANCE	$3,345.45	$3,345.45	$1,304.73–$4,640.69	311% above	—
Paracentesis with imaging guidance inpatient CPT 49083 HC ABD PARACENTESIS W/ IMAGING GUIDANCE	$3,345.45	$3,345.45	$2,977.12–$3,148.40	—	—
Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC REMOVAL OF NAIL BED	$364.30	$364.30	$142.08–$2,079.97	11% above	—
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 HC REMOVAL OF NAIL BED	$364.30	$364.30	$324.19–$342.84	—	—
Removal of a foreign object under the skin, simple CPT 10120 HC REMOVE FOREIGN BODY SIMPLE	$334.80	$334.80	$130.57–$2,079.97	46% above	—
Removal of a foreign object under the skin, simple inpatient CPT 10120 HC REMOVE FOREIGN BODY SIMPLE	$334.80	$334.80	$297.94–$315.08	—	—
Short arm cast (elbow to hand) CPT 29075 HC APPL ELBOW FINGER SHT ARM	$213.30	$213.30	$83.19–$1,431.10	22% above	—
Short arm cast (elbow to hand) inpatient CPT 29075 HC APPL ELBOW FINGER SHT ARM	$213.30	$213.30	$189.82–$200.74	—	—
Short arm splint (forearm and hand) CPT 29125 HC APPLY FOREARM SPLINT STATIC	$343.55	$343.55	$133.98–$680.78	198% above	—
Short arm splint (forearm and hand) inpatient CPT 29125 HC APPLY FOREARM SPLINT STATIC	$343.55	$343.55	$305.73–$323.31	—	—
Short leg cast (below the knee) CPT 29405 HC APPLY SHORT LEG CAST	$201.40	$201.40	$78.55–$1,431.10	25% above	—
Short leg cast (below the knee) inpatient CPT 29405 HC APPLY SHORT LEG CAST	$201.40	$201.40	$179.23–$189.54	—	—
Short leg splint (calf to foot) CPT 29515 HC APPLY LOWER LEG SPLINT	$173.25	$173.25	$67.57–$831.45	37% above	—
Short leg splint (calf to foot) inpatient CPT 29515 HC APPLY LOWER LEG SPLINT	$173.25	$173.25	$154.18–$163.05	—	—
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC RPR S/N/AX/GEN/TRNK 2.5CM/<	$373.30	$373.30	$145.59–$1,026.57	151% above	—
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HC RPR S/N/AX/GEN/TRNK 2.5CM/<	$373.30	$373.30	$332.20–$351.31	—	—
Skin biopsy, punch, one lesion CPT 11104 HC PUNCH BX SKIN SINGLE LES	$296.25	$296.25	$115.54–$2,079.97	15% above	—
Skin biopsy, punch, one lesion inpatient CPT 11104 HC PUNCH BX SKIN SINGLE LES	$296.25	$296.25	$263.63–$278.80	—	—
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 HC EXC TR-EXT MAL+MARG 0.5 CM/<	$378.15	$378.15	$147.48–$3,623.23	16% above	—
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 HC EXC TR-EXT MAL+MARG 0.5 CM/<	$378.15	$378.15	$336.52–$355.88	—	—
Skin tag removal, up to 15 tags CPT 11200 HC REMOVAL OF SKIN TAGS ANY AREA <W/15	$199.95	$199.95	$77.98–$1,026.57	52% above	—
Skin tag removal, up to 15 tags inpatient CPT 11200 HC REMOVAL OF SKIN TAGS ANY AREA <W/15	$199.95	$199.95	$177.94–$188.17	—	—
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC LUMBAR PUNCTURE/DIAG W/O IMG	$860.40	$860.40	$335.56–$3,611.74	77% above	—
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC LUMBAR PUNCTURE/DIAG W/O IMG	$860.40	$860.40	$765.67–$809.72	—	—
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC RPR S/N/AX/GEN/TRNK2.6-7.5CM	$373.30	$373.30	$145.59–$1,026.57	100% above	—
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 RPR S/N/AX/GEN/TRNK2.6-7.5CM	$373.30	$373.30	$332.20–$351.31	—	—
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HC SMPL REPR FACE LAC TO 2.5	$373.30	$373.30	$145.59–$1,026.57	126% above	—
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 HC SMPL REPR FACE LAC TO 2.5	$373.30	$373.30	$332.20–$351.31	—	—
Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC TANGNTL BX SKIN SINGLE LES	$235.45	$235.45	$91.83–$2,079.97	20% above	—
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 HC TANGNTL BX SKIN SINGLE LES	$235.45	$235.45	$209.53–$221.58	—	—
Thoracentesis with imaging guidance CPT 32555 HC ASPIRATE PLEURA W/ IMAGING GUIDANCE	$3,345.45	$3,345.45	$1,304.73–$3,209.68	398% above	—
Thoracentesis with imaging guidance inpatient CPT 32555 HC ASPIRATE PLEURA W/ IMAGING GUIDANCE	$3,345.45	$3,345.45	$2,977.12–$3,148.40	—	—
Trigger finger release surgery CPT 26055 HC TENDON SHEATH INCISION	$2,742.70	$2,742.70	$1,069.65–$8,227.48	14% above	—
Trigger finger release surgery inpatient CPT 26055 HC TENDON SHEATH INCISION	$2,742.70	$2,742.70	$2,440.73–$2,581.15	—	—
Trigger point injections, 1 or 2 muscles CPT 20552 HC INJ SINGLE OR MULTI TRIGGER POINT 1 OR 2 MUSCLE(S)	$127.30	$127.30	$49.65–$1,570.55	34% below	—
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC INJ SINGLE OR MULTI TRIGGER POINT 1 OR 2 MUSCLE(S)	$127.30	$127.30	$113.28–$119.80	—	—
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 HC BX BREAST 1ST LESION US IMAG	$3,345.45	$3,345.45	$1,304.73–$8,450.62	142% above	—
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 HC BX BREAST 1ST LESION US IMAG	$3,345.45	$3,345.45	$2,977.12–$3,148.40	—	—
Wart removal, up to 14 warts CPT 17110 HC DESTRUCT BENIGN LESION 1-14	$248.40	$248.40	$96.88–$1,026.57	47% above	—
Wart removal, up to 14 warts inpatient CPT 17110 HC DESTRUCT BENIGN LESION 1-14	$248.40	$248.40	$221.05–$233.77	—	—
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC DEB SUBQ TISSUE 1ST 20 SQ CM/<	$176.25	$176.25	$68.74–$2,079.97	5% below	—
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 PR DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM/<	$235.45	$235.45	$91.83–$2,079.97	27% above	—
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HC DEB SUBQ TISSUE 1ST 20 SQ CM/<	$176.25	$176.25	$156.84–$165.87	—	—
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 PR DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM/<	$235.45	$235.45	$209.53–$221.58	—	—

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Maine	Off list
Blood transfusion (giving blood or blood components) CPT 36430 HC BLOOD TRANSFUSION SERVICE - BLOOD OR BLOOD COMPONENTS	$1,036.65	$1,036.65	$404.29–$2,257.33	111% above	—
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC BLOOD TRANSFUSION SERVICE - BLOOD OR BLOOD COMPONENTS	$1,036.65	$1,036.65	$922.51–$975.59	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC AIRWAY INHALATION TREATMENT W/DEVICE	$128.20	$128.20	$50.00–$1,120.42	30% below	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC AIRWAY INHALATION TREATMENT W/DEVICE	$128.20	$128.20	$114.09–$120.65	—	—
Chemotherapy IV infusion, first hour CPT 96413 HC CHEMO INFUSION UP TO 1 HR	$816.00	$816.00	$318.24–$1,690.04	108% above	—
Chemotherapy IV infusion, first hour inpatient CPT 96413 HC CHEMO INFUSION UP TO 1 HR	$816.00	$816.00	$726.16–$767.94	—	—
Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 HC COMPREHENSIVE AUDIO	$316.90	$316.90	$123.59–$658.39	153% above	—
Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 HC COMPREHENSIVE AUDIO	$316.90	$316.90	$282.01–$298.23	—	—
Critical care, first 30 to 74 minutes CPT 99291 HC CRITICAL CARE 30-74 MIN	$650.10	$650.10	$253.54–$4,226.50	37% below	—
Critical care, first 30 to 74 minutes inpatient CPT 99291 HC CRITICAL CARE 30-74 MIN	$650.10	$650.10	$578.52–$611.81	—	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC ECG TRACING	$168.80	$168.80	$65.83–$301.84	50% above	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 HC ECG TRACING	$168.80	$168.80	$150.22–$158.86	—	—
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 HC EMERGENCY FACILITY LEV 1	$219.25	$219.25	$85.51–$431.45	112% above	—
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 HC EMERGENCY FACILITY LEV 1	$219.25	$219.25	$195.11–$206.34	—	—
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 HC EMERGENCY FACILITY LEV 2	$272.55	$272.55	$106.29–$785.62	30% above	—
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 HC EMERGENCY FACILITY LEV 2	$272.55	$272.55	$242.54–$256.50	—	—
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 HC EMERGENCY FACILITY LEV 3	$518.35	$518.35	$202.16–$1,396.72	54% above	—
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 HC EMERGENCY FACILITY LEV 3	$518.35	$518.35	$461.28–$487.82	—	—
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC EMERGENCY FACILITY LEV 4	$1,007.05	$1,007.05	$392.75–$2,135.00	65% above	—
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HC EMERGENCY FACILITY LEV 4	$1,007.05	$1,007.05	$896.17–$947.73	—	—
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC EMERGENCY FACILITY LEV 5	$1,526.80	$1,526.80	$595.45–$3,047.11	55% above	—
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HC EMERGENCY FACILITY LEV 5	$1,526.80	$1,526.80	$1,358.70–$1,436.87	—	—
Exercise stress test, tracing only, the hospital charge CPT 93017 HC CARDIOVASCULAR STRESS TEST	$1,089.95	$1,089.95	$425.08–$1,104.81	88% above	—
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HC CARDIOVASCULAR STRESS TEST	$1,089.95	$1,089.95	$969.95–$1,025.75	—	—
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC HYDRATE IV INFUSION INITIAL, 31 MINS TO 1 HR	$359.90	$359.90	$140.36–$1,088.33	71% above	—
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC HYDRATE IV INFUSION INITIAL, 31 MINS TO 1 HR	$359.90	$359.90	$320.28–$338.70	—	—
IV infusion of a medicine, first hour CPT 96365 HC THER/PROPH/DIAG IV INF INIT TO 1 HR	$359.90	$359.90	$140.36–$1,088.33	10% above	—
IV infusion of a medicine, first hour inpatient CPT 96365 HC THER/PROPH/DIAG IV INF INIT TO 1 HR	$359.90	$359.90	$320.28–$338.70	—	—
IV push of a medicine, first drug CPT 96374 HC THER/PROPH/DIAG INJ IV PUSH SINGLE/INITIAL	$197.00	$197.00	$76.83–$1,088.33	at median	—
IV push of a medicine, first drug inpatient CPT 96374 HC THER/PROPH/DIAG INJ IV PUSH SINGLE/INITIAL	$197.00	$197.00	$175.31–$185.40	—	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC THER/PROPH/DIAG INJ SC/IM	$91.90	$91.90	$35.84–$368.41	33% above	—
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC THER/PROPH/DIAG INJ SC/IM	$91.90	$91.90	$81.78–$86.49	—	—
Neuromuscular re-education, 15 minutes CPT 97112 HC NEUROMUSCULAR REEDUCATION 1/> AREAS EA 15 MIN	$207.30	$207.30	$72.25–$195.09	109% above	—
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC NEUROMUSCULAR REEDUCATION 1/> AREAS EA 15 MIN	$207.30	$207.30	$184.48–$195.09	—	—
New patient office visit, about 30 minutes CPT 99203 HC OFFICE/OUTPT NEW LEV 3	$256.20	$256.20	$99.92–$255.46	78% above	—
New patient office visit, about 30 minutes inpatient CPT 99203 HC OFFICE/OUTPT NEW LEV 3	$256.20	$256.20	$227.99–$241.11	—	—
New patient office visit, about 45 minutes CPT 99204 HC OFFICE/OUTPT NEW LEV 4	$389.50	$389.50	$151.91–$386.55	86% above	—
New patient office visit, about 45 minutes inpatient CPT 99204 HC OFFICE/OUTPT NEW LEV 4	$389.50	$389.50	$346.62–$366.56	—	—
New patient office visit, about 60 minutes CPT 99205 HC OFFICE/OUTPT NEW LEV 5	$490.20	$490.20	$191.18–$515.39	48% above	—
New patient office visit, about 60 minutes inpatient CPT 99205 HC OFFICE/OUTPT NEW LEV 5	$490.20	$490.20	$436.23–$461.33	—	—
New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC OFFICE/OUTPT NEW LEV 2	$177.70	$177.70	$69.30–$167.23	101% above	—
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC OFFICE/OUTPT NEW LEV 2	$177.70	$177.70	$158.14–$167.23	—	—
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC MED NUTRITION INDIV INITIAL EA 15 MINS	$82.95	$82.95	$32.35–$80.93	81% above	—
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HC MED NUTRITION INDIV INITIAL EA 15 MINS	$82.95	$82.95	$73.82–$78.06	—	—
Occupational therapy evaluation, low complexity CPT 97165 HC OT EVAL LOW COMPLEX	$361.30	$361.30	$140.91–$340.02	62% above	—
Occupational therapy evaluation, low complexity inpatient CPT 97165 HC OT EVAL LOW COMPLEX	$361.30	$361.30	$321.52–$340.02	—	—
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC PT EVAL HIGH COMPLEX	$407.20	$407.20	$158.81–$383.22	47% above	—
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC PT EVAL HIGH COMPLEX	$407.20	$407.20	$362.37–$383.22	—	—
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC PT EVAL LOW COMPLEX	$377.65	$377.65	$147.28–$355.41	69% above	—
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HC PT EVAL LOW COMPLEX	$377.65	$377.65	$336.07–$355.41	—	—
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC PT EVAL MOD COMPLEX	$392.45	$392.45	$153.06–$369.33	45% above	—
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC PT EVAL MOD COMPLEX	$392.45	$392.45	$349.24–$369.33	—	—
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC MANUAL THERAPY 1/> REGIONS EA 15 MIN	$174.85	$174.85	$61.20–$164.55	78% above	—
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC MANUAL THERAPY 1/> REGIONS EA 15 MIN	$174.85	$174.85	$155.60–$164.55	—	—
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THERAPEUTIC EXERCISES 1/> AREAS EA 15 MIN	$175.00	$175.00	$64.15–$164.69	158% above	—
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THERAPEUTIC EXERCISES 1/> AREAS EA 15 MIN	$175.00	$175.00	$155.73–$164.69	—	—
Psychotherapy for crisis, first 60 minutes CPT 90839 HC CRISIS PSYCHOTHRPY 30-74 MIN	$309.10	$309.10	$120.55–$908.18	11% above	—
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 HC CRISIS PSYCHOTHRPY 30-74 MIN	$309.10	$309.10	$275.07–$290.89	—	—
Quit-smoking counseling, 3 to 10 minutes CPT 99406 HC BEHAV CHNG SMOKING 3-10 MIN	$60.75	$60.75	$23.69–$191.69	144% above	—
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 HC BEHAV CHNG SMOKING 3-10 MIN	$60.75	$60.75	$54.06–$57.17	—	—
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC OFFICE/OUTPT EST LEV 5	$342.10	$342.10	$133.42–$420.34	135% above	—
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC OFFICE/OUTPT EST LEV 5	$342.10	$342.10	$304.43–$321.95	—	—
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC OFFICE/OUTPT EST LEV 3	$173.25	$173.25	$67.57–$207.77	137% above	—
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC OFFICE/OUTPT EST LEV 3	$173.25	$173.25	$154.18–$163.05	—	—
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC OFFICE/OUTPT EST LEV 4	$254.75	$254.75	$99.35–$296.13	141% above	—
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC OFFICE/OUTPT EST LEV 4	$254.75	$254.75	$226.70–$239.75	—	—
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC OFFICE/OUTPT EST LEV 2	$103.70	$103.70	$40.44–$128.99	84% above	—
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC OFFICE/OUTPT EST LEV 2	$103.70	$103.70	$92.28–$97.59	—	—
Speech and language evaluation CPT 92523 HC EVAL OF SPEECH PROD W/EVAL LANG COMP & EXPRESSION	$752.35	$752.35	$293.42–$708.04	133% above	—
Speech and language evaluation inpatient CPT 92523 HC EVAL OF SPEECH PROD W/EVAL LANG COMP & EXPRESSION	$752.35	$752.35	$669.52–$708.04	—	—
Speech therapy session, individual CPT 92507 HC SPEECH/HEARING THERAPY INDIVIDUAL	$503.55	$503.55	$169.24–$473.89	208% above	—
Speech therapy session, individual CPT 92507 HC SPCH IND THY-120	$503.55	$503.55	$169.24–$473.89	208% above	—
Speech therapy session, individual CPT 92507 HC SPEECH/VOICE THER 60 MIN	$503.55	$503.55	$169.24–$473.89	208% above	—
Speech therapy session, individual CPT 92507 HC SPEECH/VOICE THER 30 MIN	$503.55	$503.55	$169.24–$473.89	208% above	—
Speech therapy session, individual CPT 92507 HC SPCH IND THY-90	$503.55	$503.55	$169.24–$473.89	208% above	—
Speech therapy session, individual CPT 92507 HC SPEECH TREATMENT PEDS UP TO 15 MIN	$503.55	$503.55	$169.24–$473.89	208% above	—
Speech therapy session, individual inpatient CPT 92507 HC SPEECH/VOICE THER 30 MIN	$503.55	$503.55	$448.11–$473.89	—	—
Speech therapy session, individual inpatient CPT 92507 HC SPEECH TREATMENT PEDS UP TO 15 MIN	$503.55	$503.55	$448.11–$473.89	—	—
Speech therapy session, individual inpatient CPT 92507 HC SPEECH/VOICE THER 60 MIN	$503.55	$503.55	$448.11–$473.89	—	—
Speech therapy session, individual inpatient CPT 92507 HC SPEECH/HEARING THERAPY INDIVIDUAL	$503.55	$503.55	$448.11–$473.89	—	—
Speech therapy session, individual inpatient CPT 92507 HC SPCH IND THY-120	$503.55	$503.55	$448.11–$473.89	—	—
Speech therapy session, individual inpatient CPT 92507 HC SPCH IND THY-90	$503.55	$503.55	$448.11–$473.89	—	—
Spirometry (breathing test) CPT 94010 HC BREATHING CAPACITY TEST	$245.85	$245.85	$95.88–$1,104.81	74% above	—
Spirometry (breathing test) inpatient CPT 94010 HC BREATHING CAPACITY TEST	$245.85	$245.85	$218.78–$231.37	—	—
Spirometry before and after a bronchodilator CPT 94060 HC EVALUATION OF WHEEZING	$530.20	$530.20	$206.78–$1,909.29	65% above	—
Spirometry before and after a bronchodilator inpatient CPT 94060 HC EVALUATION OF WHEEZING	$530.20	$530.20	$471.82–$498.97	—	—
Therapeutic activities (functional training), 15 minutes CPT 97530 HC THERAPEUTIC ACTIVITIES 1/1 CONTACT EA 15 MINS	$174.85	$174.85	$68.19–$164.55	53% above	—
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC THERAPEUTIC ACTIVITIES 1/1 CONTACT EA 15 MINS	$174.85	$174.85	$155.60–$164.55	—	—
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HC THERAPEUTIC PHLEBOTOMY	$379.15	$379.15	$147.87–$680.78	145% above	—
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 HC THERAPEUTIC PHLEBOTOMY	$379.15	$379.15	$337.41–$356.82	—	—

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Maine	Off list
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 COVID-19 MRNA VACCINE (SPIKEVAX) 12+ (SEASONAL)	$160.00	$160.00	$62.40–$462.42	at median	—
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 COVID-19 MRNA VACCINE (SPIKEVAX) 12+ (SEASONAL)	$160.00	$160.00	$142.38–$150.58	—	—
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VIRUS VACCINE LIVE 1350 PFU/0.5ML IJ SUSR	$1,405.31	$1,405.31	$548.07–$1,322.54	806% above	—
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA VIRUS VACCINE LIVE 1350 PFU/0.5ML IJ SUSR	$1,405.31	$1,405.31	$1,250.59–$1,322.54	—	—
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DIPHTH-ACELL PERTUSSIS-TETANUS 25-58-10 LF-MCG/0.5 IM SUSP	$248.13	$248.13	$96.77–$233.52	951% above	—
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DIPHTH-ACELL PERTUSSIS-TETANUS 25-58-10 LF-MCG/0.5 IM SUSP	$248.13	$248.13	$220.81–$233.52	—	—
Hepatitis A vaccine, adult dose CPT 90632 HC HEP A VAC	$124.45	$124.45	$48.54–$117.12	27% above	—
Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VACCINE 1440 EL U/ML IM (COMBINED)	$724.26	$724.26	$282.46–$681.60	639% above	—
Hepatitis A vaccine, adult dose inpatient CPT 90632 HC HEP A VAC	$124.45	$124.45	$110.75–$117.12	—	—
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITIS A VACCINE 1440 EL U/ML IM (COMBINED)	$724.26	$724.26	$644.52–$681.60	—	—
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPATITIS B VAC RECOMBINANT 10 MCG/0.5ML IJ SUSY	$243.46	$243.46	$94.95–$229.12	589% above	—
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPATITIS B VAC RECOMBINANT 5 MCG/0.5ML IJ SUSP	$257.40	$257.40	$97.51–$242.24	629% above	—
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPATITIS B VAC RECOMBINANT 20 MCG/ML IJ SUSP (COMBINED)	$607.28	$607.28	$97.51–$571.51	1620% above	—
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEPATITIS B VAC RECOMBINANT 10 MCG/0.5ML IJ SUSY	$243.46	$243.46	$216.66–$229.12	—	—
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEPATITIS B VAC RECOMBINANT 5 MCG/0.5ML IJ SUSP	$257.40	$257.40	$229.06–$242.24	—	—
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEPATITIS B VAC RECOMBINANT 20 MCG/ML IJ SUSP (COMBINED)	$607.28	$607.28	$540.42–$571.51	—	—
MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES, MUMPS & RUBELLA VAC IJ SOLR	$702.80	$702.80	$274.09–$661.41	444% above	—
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES, MUMPS & RUBELLA VAC IJ SOLR	$702.80	$702.80	$625.42–$661.41	—	—
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENINGOCOCCAL B RECOMB OMV ADJ IM SUSY	$1,459.26	$1,459.26	$569.11–$1,373.31	658% above	—
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENINGOCOCCAL B VAC (RECOMB) IM SUSY	$1,574.12	$1,574.12	$613.91–$1,481.40	718% above	—
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 MENINGOCOCCAL B RECOMB OMV ADJ IM SUSY	$1,459.26	$1,459.26	$1,298.60–$1,373.31	—	—
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 MENINGOCOCCAL B VAC (RECOMB) IM SUSY	$1,574.12	$1,574.12	$1,400.81–$1,481.40	—	—
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCOCCAL 20-VAL CONJ VACC 0.5 ML IM SUSY (PREVNAR-20)	$1,841.63	$1,841.63	$718.24–$1,733.16	377% above	—
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOCOCCAL 20-VAL CONJ VACC 0.5 ML IM SUSY (PREVNAR-20)	$1,841.63	$1,841.63	$1,638.87–$1,733.16	—	—
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL VAC POLYVALENT 25 MCG/0.5ML IJ INJ (COMBINED)	$815.81	$815.81	$318.17–$767.76	749% above	—
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL VAC POLYVALENT 25 MCG/0.5ML IJ INJ (COMBINED)	$815.81	$815.81	$725.99–$767.76	—	—
Polio vaccine, inactivated (IPV) CPT 90713 POLIOVIRUS VACCINE INACTIVATED IJ SUSP	$277.62	$277.62	$108.27–$261.27	543% above	—
Polio vaccine, inactivated (IPV) inpatient CPT 90713 POLIOVIRUS VACCINE INACTIVATED IJ SUSP	$277.62	$277.62	$247.05–$261.27	—	—
Rabies vaccine, one dose CPT 90675 RABIES VACCINE, PCEC IM SUSR	$2,624.53	$2,624.53	$1,023.57–$2,469.95	253% above	—
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE, PCEC IM SUSR	$2,624.53	$2,624.53	$2,335.57–$2,469.95	—	—
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS-DIPHTHERIA TOXOIDS TD 5-2 LF/0.5ML IM SUSP	$371.27	$371.27	$144.80–$349.40	805% above	—
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS-DIPHTHERIA TOXOIDS TD 5-2 LF/0.5ML IM SUSP	$371.27	$371.27	$330.39–$349.40	—	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2-15.5 LF-MCG/0.5 IM (COMBINED)	$413.03	$413.03	$161.08–$388.70	824% above	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2-15.5 LF-MCG/0.5 IM (COMBINED)	$413.03	$413.03	$367.56–$388.70	—	—
Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 TYPHOID VI POLYSACCHARIDE VACC 25 MCG/0.5ML IM SOLN (COMBINED)	$1,126.02	$1,126.02	$439.15–$1,059.70	665% above	—
Typhoid vaccine, injectable (Vi polysaccharide) inpatient CPT 90691 TYPHOID VI POLYSACCHARIDE VACC 25 MCG/0.5ML IM SOLN (COMBINED)	$1,126.02	$1,126.02	$1,002.05–$1,059.70	—	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 HC IM ADM HCQ ID SUBQ/IM NJXS EA VACCINE	$26.70	$26.70	$10.41–$34.69	51% above	—
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 HC IM ADM HCQ ID SUBQ/IM NJXS EA VACCINE	$26.70	$26.70	$23.76–$25.13	—	—

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

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

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

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

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

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

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

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

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

Source file: https://sthpiprd.blob.core.windows.net/machine-readable-files/7977/010238552-1841397932_mainehealth_standardcharges.csv