Hospital Cadillac, MI

Munson Healthcare Cadillac

Munson Healthcare Cadillac in Cadillac, MI publishes cash prices for 434 common procedures listed here, from its own machine-readable price file updated Apr 17, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Michigan median for 269 of 434 procedures and below it for 156. By typical cash price it ranks #69 of 98 Michigan hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.

400 Hobart St, Cadillac, MI 49601 Collected Sep 23, 2026 Source price file Check a bill from this hospital (231) 876-7400

Acute care hospital Nonprofit hospital Emergency department CMS star rating 4 of 5 CCN 230081 · CMS hospital register NPI 1841696754

Financial assistance

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

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

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

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

CMS price transparency record

The federal Centers for Medicare & Medicaid Services (CMS) enforces the rule that makes hospitals publish their prices. Its public enforcement list shows 3 actions for a hospital named Munson Healthcare Cadillac in Cadillac, MI:

Apr 25, 2025 Warning notice
May 8, 2025 Case closed
Jun 25, 2026 Met requirements

Warning notice: CMS reviewed the hospital and told it that it had found possible violations of the price transparency rules. Case closed: CMS closed the case after the hospital addressed the problems. Met requirements: CMS reviewed the hospital and found it met the requirements, so no further action was taken.

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

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Michigan	Off list
Abdominal CT scan without and with contrast CPT 74170 CT ABDOMEN W/ + W/O LIVER TRIPLE PHASE	$2,573.80	$3,028.00	$91.40–$2,573.80	64% above	15%
Abdominal CT scan without and with contrast CPT 74170 CT Exams	$2,573.80	$3,028.00	$91.40–$2,573.80	64% above	15%
Abdominal CT scan without and with contrast CPT 74170 CT ABDOMEN W/ + W/O ADRENAL PROTOCOL	$2,573.80	$3,028.00	$91.40–$2,573.80	64% above	15%
Abdominal CT scan without and with contrast CPT 74170 4601 CT ESOPH ABD W+W/O	$2,573.80	$3,028.00	$91.40–$2,573.80	64% above	15%
Abdominal CT scan without and with contrast CPT 74170 CT ESOPH ABD W + W/O	$2,573.80	$3,028.00	$91.40–$2,573.80	64% above	15%
Abdominal CT scan without and with contrast CPT 74170 CT ABDOMEN W+W/O RENAL PROTOCOL	$2,573.80	$3,028.00	$91.40–$2,573.80	64% above	15%
Abdominal CT scan without and with contrast CPT 74170 CT ABDOMEN W/ + W/O CONTRAST (ORAL + IV)	$2,573.80	$3,028.00	$91.40–$2,573.80	64% above	15%
Abdominal CT scan without and with contrast inpatient CPT 74170 CT ABDOMEN W+W/O RENAL PROTOCOL	$2,573.80	$3,028.00	$852.12–$2,573.80	—	15%
Abdominal CT scan without and with contrast inpatient CPT 74170 CT ABDOMEN W/ + W/O ADRENAL PROTOCOL	$2,573.80	$3,028.00	$852.12–$2,573.80	—	15%
Abdominal CT scan without and with contrast inpatient CPT 74170 CT ESOPH ABD W + W/O	$2,573.80	$3,028.00	$852.12–$2,573.80	—	15%
Abdominal CT scan without and with contrast inpatient CPT 74170 4601 CT ESOPH ABD W+W/O	$2,573.80	$3,028.00	$852.12–$2,573.80	—	15%
Abdominal CT scan without and with contrast inpatient CPT 74170 CT Exams	$2,573.80	$3,028.00	$852.12–$2,573.80	—	15%
Abdominal CT scan without and with contrast inpatient CPT 74170 CT ABDOMEN W/ + W/O LIVER TRIPLE PHASE	$2,573.80	$3,028.00	$852.12–$2,573.80	—	15%
Abdominal CT scan without and with contrast inpatient CPT 74170 CT ABDOMEN W/ + W/O CONTRAST (ORAL + IV)	$2,573.80	$3,028.00	$852.12–$2,573.80	—	15%
Abdominal X-ray, 2 views CPT 74019 GD Exams	$294.95	$347.00	$54.48–$294.95	41% above	15%
Abdominal X-ray, 2 views CPT 74019 ABDOMEN COMPLETE 2 V	$294.95	$347.00	$54.48–$294.95	41% above	15%
Abdominal X-ray, 2 views inpatient CPT 74019 GD Exams	$294.95	$347.00	$208.20–$852.12	—	15%
Abdominal X-ray, 2 views inpatient CPT 74019 ABDOMEN COMPLETE 2 V	$294.95	$347.00	$208.20–$852.12	—	15%
Ankle X-ray, complete, 3 or more views both sides CPT 73610 ANKLES COMPLETE MIN 3 V EA BILAT 73610	$83.30	$98.00	$37.01–$147.41	—	15%
Ankle X-ray, complete, 3 or more views both sides CPT 73610 ANKLES MIN 3 V EA BILAT	$351.90	$414.00	$45.35–$351.90	—	15%
Ankle X-ray, complete, 3 or more views CPT 73610 GD Exams	$351.90	$414.00	$45.35–$351.90	65% above	15%
Ankle X-ray, complete, 3 or more views one side CPT 73610 ANKLE COMPLETE MIN 3 V RT 73610	$73.95	$87.00	$32.86–$147.41	65% below	15%
Ankle X-ray, complete, 3 or more views one side CPT 73610 ANKLE COMPLETE MIN 3 V LT 73610	$73.95	$87.00	$32.86–$147.41	65% below	15%
Ankle X-ray, complete, 3 or more views one side CPT 73610 ANKLE COMPLETE MIN 3 V RT	$351.90	$414.00	$45.35–$351.90	65% above	15%
Ankle X-ray, complete, 3 or more views one side CPT 73610 ANKLE COMPLETE MIN 3 V LT	$351.90	$414.00	$45.35–$351.90	65% above	15%
Ankle X-ray, complete, 3 or more views inpatient both sides CPT 73610 ANKLES COMPLETE MIN 3 V EA BILAT 73610	$83.30	$98.00	$58.80–$852.12	—	15%
Ankle X-ray, complete, 3 or more views inpatient both sides CPT 73610 ANKLES MIN 3 V EA BILAT	$351.90	$414.00	$248.40–$852.12	—	15%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 GD Exams	$351.90	$414.00	$248.40–$852.12	—	15%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 ANKLE COMPLETE MIN 3 V LT 73610	$73.95	$87.00	$52.20–$852.12	—	15%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 ANKLE COMPLETE MIN 3 V RT 73610	$73.95	$87.00	$52.20–$852.12	—	15%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 ANKLE COMPLETE MIN 3 V RT	$351.90	$414.00	$248.40–$852.12	—	15%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 ANKLE COMPLETE MIN 3 V LT	$351.90	$414.00	$248.40–$852.12	—	15%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 UPR/L XTREMITY ART 2 LEVELS	$412.25	$485.00	$69.33–$412.25	28% above	15%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 Lower or Upper Single 93922	$412.25	$485.00	$69.33–$412.25	28% above	15%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 USV Exams	$412.25	$485.00	$69.33–$412.25	28% above	15%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 USV LOWER ART NON EXERCISE UNI	$412.25	$485.00	$69.33–$412.25	28% above	15%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 USV LOWER ARTERIAL ABI ONLY	$412.25	$485.00	$69.33–$412.25	28% above	15%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 USV LOWER ARTERIAL EXERCISE UNI	$412.25	$485.00	$69.33–$412.25	28% above	15%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 UPR/L XTREMITY ART 2 LEVELS RDC	$412.25	$485.00	$69.33–$412.25	28% above	15%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 USV LOWER ARTERIAL EXERCISE UNI	$412.25	$485.00	$291.00–$852.12	—	15%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 Lower or Upper Single 93922	$412.25	$485.00	$291.00–$852.12	—	15%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 USV Exams	$412.25	$485.00	$291.00–$852.12	—	15%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 UPR/L XTREMITY ART 2 LEVELS RDC	$412.25	$485.00	$291.00–$852.12	—	15%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 UPR/L XTREMITY ART 2 LEVELS	$412.25	$485.00	$291.00–$852.12	—	15%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 USV LOWER ART NON EXERCISE UNI	$412.25	$485.00	$291.00–$852.12	—	15%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 USV LOWER ARTERIAL ABI ONLY	$412.25	$485.00	$291.00–$852.12	—	15%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 CT Exams	$1,513.00	$1,780.00	$54.48–$1,513.00	51% above	15%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT UPPER EXTREM W/O CONTRAST RT	$1,513.00	$1,780.00	$54.48–$1,513.00	51% above	15%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT UPPER EXTREM W/O CONTRAST LT	$1,513.00	$1,780.00	$54.48–$1,513.00	51% above	15%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 CT Exams	$1,513.00	$1,780.00	$852.12–$1,513.00	—	15%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT UPPER EXTREM W/O CONTRAST RT	$1,513.00	$1,780.00	$852.12–$1,513.00	—	15%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT UPPER EXTREM W/O CONTRAST LT	$1,513.00	$1,780.00	$852.12–$1,513.00	—	15%
Barium swallow (esophagus X-ray with contrast) CPT 74220 ESOPHAGRAM	$742.90	$874.00	$91.40–$742.90	157% above	15%
Barium swallow (esophagus X-ray with contrast) CPT 74220 GD Exams	$742.90	$874.00	$91.40–$742.90	157% above	15%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 GD Exams	$742.90	$874.00	$524.40–$852.12	—	15%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 ESOPHAGRAM	$742.90	$874.00	$524.40–$852.12	—	15%
Bone scan, whole body (nuclear medicine) CPT 78306 NM BONE WHOLE BODY	$1,371.90	$1,614.00	$208.33–$1,789.94	38% above	15%
Bone scan, whole body (nuclear medicine) CPT 78306 BONE SCAN WH BODY	$1,591.20	$1,872.00	$208.33–$1,789.94	60% above	15%
Bone scan, whole body (nuclear medicine) CPT 78306 Nuclear Med Exams	$1,591.20	$1,872.00	$208.33–$1,789.94	60% above	15%
Bone scan, whole body (nuclear medicine) CPT 78306 1479 BONE SCAN WHOLE BODY	$1,591.20	$1,872.00	$208.33–$1,789.94	60% above	15%
Bone scan, whole body (nuclear medicine) CPT 78306 NM BONE WHOLE BODY W/SPECT CT	$2,603.55	$3,063.00	$208.33–$2,603.55	162% above	15%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM BONE WHOLE BODY	$1,371.90	$1,614.00	$852.12–$1,371.90	—	15%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 Nuclear Med Exams	$1,591.20	$1,872.00	$852.12–$1,591.20	—	15%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 BONE SCAN WH BODY	$1,591.20	$1,872.00	$852.12–$1,591.20	—	15%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 1479 BONE SCAN WHOLE BODY	$1,591.20	$1,872.00	$852.12–$1,591.20	—	15%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM BONE WHOLE BODY W/SPECT CT	$2,603.55	$3,063.00	$852.12–$2,603.55	—	15%
Breast ultrasound, complete, one breast CPT 76641 Breast Ultrasound, Complete 76641	$232.05	$273.00	$54.48–$288.12	25% below	15%
Breast ultrasound, complete, one breast CPT 76641 US BREAST WHOLE BIL	$630.70	$742.00	$54.48–$630.70	103% above	15%
Breast ultrasound, complete, one breast CPT 76641 US Exams	$630.70	$742.00	$54.48–$630.70	103% above	15%
Breast ultrasound, complete, one breast one side CPT 76641 US BREAST WHOLE RT	$631.55	$743.00	$54.48–$631.55	103% above	15%
Breast ultrasound, complete, one breast one side CPT 76641 US BREAST WHOLE LT	$631.55	$743.00	$54.48–$631.55	103% above	15%
Breast ultrasound, complete, one breast inpatient CPT 76641 Breast Ultrasound, Complete 76641	$232.05	$273.00	$163.80–$852.12	—	15%
Breast ultrasound, complete, one breast inpatient CPT 76641 US Exams	$630.70	$742.00	$445.20–$852.12	—	15%
Breast ultrasound, complete, one breast inpatient CPT 76641 US BREAST WHOLE BIL	$630.70	$742.00	$445.20–$852.12	—	15%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US BREAST WHOLE RT	$631.55	$743.00	$445.80–$852.12	—	15%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US BREAST WHOLE LT	$631.55	$743.00	$445.80–$852.12	—	15%
Breast ultrasound, limited (one breast or one area) CPT 76642 Breast Ultrasound, Limited 76642	$191.25	$225.00	$45.35–$288.12	29% below	15%
Breast ultrasound, limited (one breast or one area) CPT 76642 US BREAST LIMITED BIL	$424.15	$499.00	$45.35–$424.15	57% above	15%
Breast ultrasound, limited (one breast or one area) CPT 76642 US Exams	$424.15	$499.00	$45.35–$424.15	57% above	15%
Breast ultrasound, limited (one breast or one area) CPT 76642 US BREAST LIMITED POST MRI BIL	$425.00	$500.00	$45.35–$425.00	57% above	15%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST LIMITED POST MRI LT	$425.00	$500.00	$45.35–$425.00	57% above	15%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST LIMITED LT	$425.00	$500.00	$45.35–$425.00	57% above	15%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST LIMITED RT	$425.00	$500.00	$45.35–$425.00	57% above	15%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST LIMITED POST MRI RT	$425.00	$500.00	$45.35–$425.00	57% above	15%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 Breast Ultrasound, Limited 76642	$191.25	$225.00	$135.00–$852.12	—	15%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 US Exams	$424.15	$499.00	$299.40–$852.12	—	15%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 US BREAST LIMITED BIL	$424.15	$499.00	$299.40–$852.12	—	15%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 US BREAST LIMITED POST MRI BIL	$425.00	$500.00	$300.00–$852.12	—	15%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US BREAST LIMITED LT	$425.00	$500.00	$300.00–$852.12	—	15%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US BREAST LIMITED POST MRI LT	$425.00	$500.00	$300.00–$852.12	—	15%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US BREAST LIMITED POST MRI RT	$425.00	$500.00	$300.00–$852.12	—	15%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US BREAST LIMITED RT	$425.00	$500.00	$300.00–$852.12	—	15%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CT Exams	$3,427.20	$4,032.00	$181.80–$3,427.20	38% above	15%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CTA MESENTERIC	$3,427.20	$4,032.00	$181.80–$3,427.20	38% above	15%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CTA ABDOMEN + PELVIS W/ IMAGE POST PROC	$3,427.20	$4,032.00	$181.80–$3,427.20	38% above	15%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 4272 CTA ABD + PELV TAVI W/ CONTRA	$3,468.00	$4,080.00	$181.80–$3,468.00	40% above	15%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 2432 CTA ABD + PELV TAVI W/O CONT	$3,468.00	$4,080.00	$181.80–$3,468.00	40% above	15%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 2430 CTA ABD + PELV TAVI W/ CONT	$3,468.00	$4,080.00	$181.80–$3,468.00	40% above	15%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CT Exams	$3,427.20	$4,032.00	$852.12–$3,427.20	—	15%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CTA ABDOMEN + PELVIS W/ IMAGE POST PROC	$3,427.20	$4,032.00	$852.12–$3,427.20	—	15%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CTA MESENTERIC	$3,427.20	$4,032.00	$852.12–$3,427.20	—	15%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 4272 CTA ABD + PELV TAVI W/ CONTRA	$3,468.00	$4,080.00	$852.12–$3,468.00	—	15%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 2430 CTA ABD + PELV TAVI W/ CONT	$3,468.00	$4,080.00	$852.12–$3,468.00	—	15%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 2432 CTA ABD + PELV TAVI W/O CONT	$3,468.00	$4,080.00	$852.12–$3,468.00	—	15%
CT angiography (CTA) of the head CPT 70496 CT Exams	$2,803.30	$3,298.00	$91.40–$2,803.30	81% above	15%
CT angiography (CTA) of the head CPT 70496 CTA HEAD W/ IMAGE POST PROCESSING	$2,803.30	$3,298.00	$91.40–$2,803.30	81% above	15%
CT angiography (CTA) of the head inpatient CPT 70496 CT Exams	$2,803.30	$3,298.00	$852.12–$2,803.30	—	15%
CT angiography (CTA) of the head inpatient CPT 70496 CTA HEAD W/ IMAGE POST PROCESSING	$2,803.30	$3,298.00	$852.12–$2,803.30	—	15%
CT angiography (CTA) of the neck CPT 70498 CTA NECK W/ IMAGE POST PROCESSING	$2,938.45	$3,457.00	$91.40–$2,938.45	95% above	15%
CT angiography (CTA) of the neck CPT 70498 CT Exams	$2,938.45	$3,457.00	$91.40–$2,938.45	95% above	15%
CT angiography (CTA) of the neck CPT 70498 CTA NECK W/ &/OR W/O CONTR	$2,938.45	$3,457.00	$91.40–$2,938.45	95% above	15%
CT angiography (CTA) of the neck inpatient CPT 70498 CTA NECK W/ &/OR W/O CONTR	$2,938.45	$3,457.00	$852.12–$2,938.45	—	15%
CT angiography (CTA) of the neck inpatient CPT 70498 CTA NECK W/ IMAGE POST PROCESSING	$2,938.45	$3,457.00	$852.12–$2,938.45	—	15%
CT angiography (CTA) of the neck inpatient CPT 70498 CT Exams	$2,938.45	$3,457.00	$852.12–$2,938.45	—	15%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA CHEST ABD PELVIS TAVI W/O CONTRAST	$2,580.60	$3,036.00	$91.40–$2,580.60	54% above	15%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA CARDIAC TAVI W/ + CTA C/A/P TAVI W/	$2,580.60	$3,036.00	$91.40–$2,580.60	54% above	15%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA CHEST ABD PELVIS TAVI W/ CONTRAST	$2,580.60	$3,036.00	$91.40–$2,580.60	54% above	15%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT Exams	$2,589.10	$3,046.00	$91.40–$2,589.10	54% above	15%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA CHEST THORACIC AORTA	$2,589.10	$3,046.00	$91.40–$2,589.10	54% above	15%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA CHEST PE PROTOCOL	$2,589.10	$3,046.00	$91.40–$2,589.10	54% above	15%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA CHEST/ABD DISSECTION PROTOCOL	$2,589.10	$3,046.00	$91.40–$2,589.10	54% above	15%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA CARDIAC TAVI W/ + CTA C/A/P TAVI W/	$2,580.60	$3,036.00	$852.12–$2,580.60	—	15%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA CHEST ABD PELVIS TAVI W/ CONTRAST	$2,580.60	$3,036.00	$852.12–$2,580.60	—	15%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA CHEST ABD PELVIS TAVI W/O CONTRAST	$2,580.60	$3,036.00	$852.12–$2,580.60	—	15%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT Exams	$2,589.10	$3,046.00	$852.12–$2,589.10	—	15%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA CHEST THORACIC AORTA	$2,589.10	$3,046.00	$852.12–$2,589.10	—	15%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA CHEST/ABD DISSECTION PROTOCOL	$2,589.10	$3,046.00	$852.12–$2,589.10	—	15%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA CHEST PE PROTOCOL	$2,589.10	$3,046.00	$852.12–$2,589.10	—	15%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CTA CORONARY ARTERIES W/ CALCIUM SCORING	$2,536.40	$2,984.00	$181.80–$2,536.40	90% above	15%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CT Exams	$2,536.40	$2,984.00	$181.80–$2,536.40	90% above	15%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CTA CORONARY ARTERIES	$2,536.40	$2,984.00	$181.80–$2,536.40	90% above	15%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 CT Exams	$2,536.40	$2,984.00	$852.12–$2,536.40	—	15%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 CTA CORONARY ARTERIES W/ CALCIUM SCORING	$2,536.40	$2,984.00	$852.12–$2,536.40	—	15%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 CTA CORONARY ARTERIES	$2,536.40	$2,984.00	$852.12–$2,536.40	—	15%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT Exams	$473.45	$557.00	$45.35–$531.58	216% above	15%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT CALCIUM SCORING	$473.45	$557.00	$45.35–$531.58	216% above	15%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT CALCIUM SCORING	$473.45	$557.00	$334.20–$852.12	—	15%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT Exams	$473.45	$557.00	$334.20–$852.12	—	15%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Exams	$2,278.00	$2,680.00	$124.34–$2,278.00	28% above	15%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD + PELVIS W/O IV CONT (ORAL ONLY)	$2,278.00	$2,680.00	$124.34–$2,278.00	28% above	15%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD + PELVIS KIDNEY STONE W/O	$2,278.00	$2,680.00	$124.34–$2,278.00	28% above	15%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD+PELV ORAL ONLY	$2,278.00	$2,680.00	$124.34–$2,278.00	28% above	15%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD + PELVIS W/O CONT (NO ORAL-NO IV)	$2,278.00	$2,680.00	$124.34–$2,278.00	28% above	15%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD+PELV W/O NO O/IV	$2,278.00	$2,680.00	$124.34–$2,278.00	28% above	15%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 3074 CT ABD + PEL W/O NO ORAL IV	$2,306.05	$2,713.00	$124.34–$2,306.05	29% above	15%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 3076 CT ABD + PEL W/O IV ORAL ONLY	$2,306.05	$2,713.00	$124.34–$2,306.05	29% above	15%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT Exams	$2,278.00	$2,680.00	$852.12–$2,278.00	—	15%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD + PELVIS W/O CONT (NO ORAL-NO IV)	$2,278.00	$2,680.00	$852.12–$2,278.00	—	15%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD + PELVIS KIDNEY STONE W/O	$2,278.00	$2,680.00	$852.12–$2,278.00	—	15%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD+PELV W/O NO O/IV	$2,278.00	$2,680.00	$852.12–$2,278.00	—	15%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD+PELV ORAL ONLY	$2,278.00	$2,680.00	$852.12–$2,278.00	—	15%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD + PELVIS W/O IV CONT (ORAL ONLY)	$2,278.00	$2,680.00	$852.12–$2,278.00	—	15%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 3076 CT ABD + PEL W/O IV ORAL ONLY	$2,306.05	$2,713.00	$852.12–$2,306.05	—	15%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 3074 CT ABD + PEL W/O NO ORAL IV	$2,306.05	$2,713.00	$852.12–$2,306.05	—	15%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT VENOGRAM ABD + PEL W/ CONTRAST	$3,390.65	$3,989.00	$181.80–$3,390.65	20% above	15%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 93077 CT ABD PELV W/ IV CONT	$3,390.65	$3,989.00	$181.80–$3,390.65	20% above	15%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 93079 CT ABD PELV W/ IV+ORAL CONT	$3,390.65	$3,989.00	$181.80–$3,390.65	20% above	15%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD + PELVIS W/IV CONT (NO ORAL)	$3,390.65	$3,989.00	$181.80–$3,390.65	20% above	15%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABDOMEN + PELVIS W/CONTRAST (ORAL+IV)	$3,390.65	$3,989.00	$181.80–$3,390.65	20% above	15%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT CHEST ABD PELVIS W/IV CONT (NO ORAL)	$3,390.65	$3,989.00	$181.80–$3,390.65	20% above	15%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT CHEST ABDOMEN PELVIS W/CONT (ORAL+IV)	$3,390.65	$3,989.00	$181.80–$3,390.65	20% above	15%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ENTEROGRAPHY	$3,390.65	$3,989.00	$181.80–$3,390.65	20% above	15%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Exams	$3,390.65	$3,989.00	$181.80–$3,390.65	20% above	15%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ENTEROGRAPHY	$3,390.65	$3,989.00	$852.12–$3,390.65	—	15%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT CHEST ABD PELVIS W/IV CONT (NO ORAL)	$3,390.65	$3,989.00	$852.12–$3,390.65	—	15%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT VENOGRAM ABD + PEL W/ CONTRAST	$3,390.65	$3,989.00	$852.12–$3,390.65	—	15%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABDOMEN + PELVIS W/CONTRAST (ORAL+IV)	$3,390.65	$3,989.00	$852.12–$3,390.65	—	15%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD + PELVIS W/IV CONT (NO ORAL)	$3,390.65	$3,989.00	$852.12–$3,390.65	—	15%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 93079 CT ABD PELV W/ IV+ORAL CONT	$3,390.65	$3,989.00	$852.12–$3,390.65	—	15%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 93077 CT ABD PELV W/ IV CONT	$3,390.65	$3,989.00	$852.12–$3,390.65	—	15%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT CHEST ABDOMEN PELVIS W/CONT (ORAL+IV)	$3,390.65	$3,989.00	$852.12–$3,390.65	—	15%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Exams	$3,390.65	$3,989.00	$852.12–$3,390.65	—	15%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT Exams	$4,027.30	$4,738.00	$181.80–$4,027.30	54% above	15%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD + PELVIS W/+W/O CONTR (ORAL+IV)	$4,027.30	$4,738.00	$181.80–$4,027.30	54% above	15%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT HEMATURIA PROTOCOL	$4,027.30	$4,738.00	$181.80–$4,027.30	54% above	15%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT HEMATURIA PROTOCOL	$4,027.30	$4,738.00	$852.12–$4,027.30	—	15%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD + PELVIS W/+W/O CONTR (ORAL+IV)	$4,027.30	$4,738.00	$852.12–$4,027.30	—	15%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT Exams	$4,027.30	$4,738.00	$852.12–$4,027.30	—	15%
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W/IV CONTRAST (NO ORAL CONT)	$1,958.40	$2,304.00	$91.40–$1,958.40	33% above	15%
CT scan of the abdomen with contrast CPT 74160 CT ABD W/ CONT ORAL+IV	$1,958.40	$2,304.00	$91.40–$1,958.40	33% above	15%
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W/ CONTRAST (ORAL + IV)	$1,958.40	$2,304.00	$91.40–$1,958.40	33% above	15%
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W/ CONTRAST PANCREAS PROTOCOL	$1,958.40	$2,304.00	$91.40–$1,958.40	33% above	15%
CT scan of the abdomen with contrast CPT 74160 CT Exams	$1,958.40	$2,304.00	$91.40–$1,958.40	33% above	15%
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W/CON LIVER DUAL PHASE	$1,958.40	$2,304.00	$91.40–$1,958.40	33% above	15%
CT scan of the abdomen with contrast CPT 74160 3070 CT ABDOMEN W/ CONT ORAL+IV	$1,981.35	$2,331.00	$91.40–$1,981.35	35% above	15%
CT scan of the abdomen with contrast CPT 74160 3072 CT ABDOMEN W/ IV CONTRAST ONL	$1,981.35	$2,331.00	$91.40–$1,981.35	35% above	15%
CT scan of the abdomen with contrast inpatient CPT 74160 CT Exams	$1,958.40	$2,304.00	$852.12–$1,958.40	—	15%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN W/IV CONTRAST (NO ORAL CONT)	$1,958.40	$2,304.00	$852.12–$1,958.40	—	15%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN W/CON LIVER DUAL PHASE	$1,958.40	$2,304.00	$852.12–$1,958.40	—	15%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN W/ CONTRAST PANCREAS PROTOCOL	$1,958.40	$2,304.00	$852.12–$1,958.40	—	15%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN W/ CONTRAST (ORAL + IV)	$1,958.40	$2,304.00	$852.12–$1,958.40	—	15%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABD W/ CONT ORAL+IV	$1,958.40	$2,304.00	$852.12–$1,958.40	—	15%
CT scan of the abdomen with contrast inpatient CPT 74160 3070 CT ABDOMEN W/ CONT ORAL+IV	$1,981.35	$2,331.00	$852.12–$1,981.35	—	15%
CT scan of the abdomen with contrast inpatient CPT 74160 3072 CT ABDOMEN W/ IV CONTRAST ONL	$1,981.35	$2,331.00	$852.12–$1,981.35	—	15%
CT scan of the abdomen without contrast CPT 74150 CT ESOPH ABD W/O	$1,278.40	$1,504.00	$54.48–$1,278.40	38% above	15%
CT scan of the abdomen without contrast CPT 74150 CT Exams	$1,278.40	$1,504.00	$54.48–$1,278.40	38% above	15%
CT scan of the abdomen without contrast CPT 74150 3066 CT ABD W/O IV CON NO ORAL	$1,278.40	$1,504.00	$54.48–$1,278.40	38% above	15%
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/O IV CONTRAST (ORAL ONLY)	$1,278.40	$1,504.00	$54.48–$1,278.40	38% above	15%
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/O CONTRAST (NO ORAL-NO IV)	$1,278.40	$1,504.00	$54.48–$1,278.40	38% above	15%
CT scan of the abdomen without contrast CPT 74150 4603 74150 CT ESOPH ABD W/O	$1,278.40	$1,504.00	$54.48–$1,278.40	38% above	15%
CT scan of the abdomen without contrast CPT 74150 CT ABD W/O IV ORAL ONLY	$1,278.40	$1,504.00	$54.48–$1,278.40	38% above	15%
CT scan of the abdomen without contrast CPT 74150 3068 CT ABD W/O IV CON ORAL ONLY	$1,294.55	$1,523.00	$54.48–$1,294.55	40% above	15%
CT scan of the abdomen without contrast inpatient CPT 74150 CT Exams	$1,278.40	$1,504.00	$852.12–$1,278.40	—	15%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN W/O IV CONTRAST (ORAL ONLY)	$1,278.40	$1,504.00	$852.12–$1,278.40	—	15%
CT scan of the abdomen without contrast inpatient CPT 74150 3066 CT ABD W/O IV CON NO ORAL	$1,278.40	$1,504.00	$852.12–$1,278.40	—	15%
CT scan of the abdomen without contrast inpatient CPT 74150 4603 74150 CT ESOPH ABD W/O	$1,278.40	$1,504.00	$852.12–$1,278.40	—	15%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABD W/O IV ORAL ONLY	$1,278.40	$1,504.00	$852.12–$1,278.40	—	15%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ESOPH ABD W/O	$1,278.40	$1,504.00	$852.12–$1,278.40	—	15%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN W/O CONTRAST (NO ORAL-NO IV)	$1,278.40	$1,504.00	$852.12–$1,278.40	—	15%
CT scan of the abdomen without contrast inpatient CPT 74150 3068 CT ABD W/O IV CON ORAL ONLY	$1,294.55	$1,523.00	$852.12–$1,294.55	—	15%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT SINUSES W/O CONTRAST	$1,433.10	$1,686.00	$54.48–$1,433.10	41% above	15%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT FACIAL BONES W/O CONTRAST	$1,433.10	$1,686.00	$54.48–$1,433.10	41% above	15%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT Exams	$1,433.10	$1,686.00	$54.48–$1,433.10	41% above	15%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT FACIAL BONES W/O CONTRAST	$1,433.10	$1,686.00	$852.12–$1,433.10	—	15%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT SINUSES W/O CONTRAST	$1,433.10	$1,686.00	$852.12–$1,433.10	—	15%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT Exams	$1,433.10	$1,686.00	$852.12–$1,433.10	—	15%
CT scan of the head or brain, no contrast dye CPT 70450 CT Exams	$1,334.50	$1,570.00	$54.48–$1,334.50	50% above	15%
CT scan of the head or brain, no contrast dye CPT 70450 CT STEALTH HEAD W/O CONTRAST	$1,334.50	$1,570.00	$54.48–$1,334.50	50% above	15%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD W/O CONTRAST	$1,334.50	$1,570.00	$54.48–$1,334.50	50% above	15%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Exams	$1,334.50	$1,570.00	$852.12–$1,334.50	—	15%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD W/O CONTRAST	$1,334.50	$1,570.00	$852.12–$1,334.50	—	15%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT STEALTH HEAD W/O CONTRAST	$1,334.50	$1,570.00	$852.12–$1,334.50	—	15%
CT scan of the head with contrast CPT 70460 CT VENOGRAM/HEAD W/ CONTRAST	$2,072.30	$2,438.00	$91.40–$2,072.30	67% above	15%
CT scan of the head with contrast CPT 70460 CT Exams	$2,078.25	$2,445.00	$91.40–$2,078.25	68% above	15%
CT scan of the head with contrast CPT 70460 CT HEAD W/ CONTRAST	$2,078.25	$2,445.00	$91.40–$2,078.25	68% above	15%
CT scan of the head with contrast inpatient CPT 70460 CT VENOGRAM/HEAD W/ CONTRAST	$2,072.30	$2,438.00	$852.12–$2,072.30	—	15%
CT scan of the head with contrast inpatient CPT 70460 CT HEAD W/ CONTRAST	$2,078.25	$2,445.00	$852.12–$2,078.25	—	15%
CT scan of the head with contrast inpatient CPT 70460 CT Exams	$2,078.25	$2,445.00	$852.12–$2,078.25	—	15%
CT scan of the head without and with contrast CPT 70470 CT Exams	$2,415.70	$2,842.00	$91.40–$2,415.70	54% above	15%
CT scan of the head without and with contrast CPT 70470 CT VENOGRAM/HEAD W/ + W/O CONTRAST	$2,415.70	$2,842.00	$91.40–$2,415.70	54% above	15%
CT scan of the head without and with contrast CPT 70470 CT HEAD W/ + W/O CONTRAST	$2,415.70	$2,842.00	$91.40–$2,415.70	54% above	15%
CT scan of the head without and with contrast inpatient CPT 70470 CT Exams	$2,415.70	$2,842.00	$852.12–$2,415.70	—	15%
CT scan of the head without and with contrast inpatient CPT 70470 CT VENOGRAM/HEAD W/ + W/O CONTRAST	$2,415.70	$2,842.00	$852.12–$2,415.70	—	15%
CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD W/ + W/O CONTRAST	$2,415.70	$2,842.00	$852.12–$2,415.70	—	15%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT Exams	$1,586.95	$1,867.00	$54.48–$1,586.95	46% above	15%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMBAR SPINE W/O CONTRAST	$1,586.95	$1,867.00	$54.48–$1,586.95	46% above	15%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT LUMBAR SPINE W/O CONTRAST	$1,586.95	$1,867.00	$852.12–$1,586.95	—	15%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT Exams	$1,586.95	$1,867.00	$852.12–$1,586.95	—	15%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT CERVICAL SPINE W/O CONTRAST	$1,554.65	$1,829.00	$54.48–$1,554.65	40% above	15%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT Exams	$1,554.65	$1,829.00	$54.48–$1,554.65	40% above	15%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT Exams	$1,554.65	$1,829.00	$852.12–$1,554.65	—	15%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT CERVICAL SPINE W/O CONTRAST	$1,554.65	$1,829.00	$852.12–$1,554.65	—	15%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/ IV CONTRAST (NO ORAL CONT)	$2,017.05	$2,373.00	$91.40–$2,017.05	49% above	15%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/ CONTRAST (ORAL + IV)	$2,017.05	$2,373.00	$91.40–$2,017.05	49% above	15%
CT scan of the pelvis, with contrast dye CPT 72193 CT Exams	$2,017.05	$2,373.00	$91.40–$2,017.05	49% above	15%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/ CONTRAST (ORAL + IV)	$2,017.05	$2,373.00	$852.12–$2,017.05	—	15%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/ IV CONTRAST (NO ORAL CONT)	$2,017.05	$2,373.00	$852.12–$2,017.05	—	15%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Exams	$2,017.05	$2,373.00	$852.12–$2,017.05	—	15%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 Duplex scan of extracranial arteries complete bilateral study 93880	$891.65	$1,049.00	$124.34–$891.65	—	15%
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 USV Exams	$891.65	$1,049.00	$124.34–$891.65	3% above	15%
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 USV CAROTID	$891.65	$1,049.00	$124.34–$891.65	3% above	15%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 Duplex scan of extracranial arteries complete bilateral study 93880	$891.65	$1,049.00	$629.40–$891.65	—	15%
Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 USV CAROTID	$891.65	$1,049.00	$629.40–$891.65	—	15%
Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 USV Exams	$891.65	$1,049.00	$629.40–$891.65	—	15%
Chest CT scan without and with contrast CPT 71270 CT CHEST W/ + W/O CONTRAST	$2,249.95	$2,647.00	$91.40–$2,249.95	29% above	15%
Chest CT scan without and with contrast CPT 71270 CT Exams	$2,249.95	$2,647.00	$91.40–$2,249.95	29% above	15%
Chest CT scan without and with contrast inpatient CPT 71270 CT CHEST W/ + W/O CONTRAST	$2,249.95	$2,647.00	$852.12–$2,249.95	—	15%
Chest CT scan without and with contrast inpatient CPT 71270 CT Exams	$2,249.95	$2,647.00	$852.12–$2,249.95	—	15%
Chest X-ray, 2 views CPT 71046 SNIFF TEST	$334.90	$394.00	$45.35–$334.90	88% above	15%
Chest X-ray, 2 views CPT 71046 GD Exams	$334.90	$394.00	$45.35–$334.90	88% above	15%
Chest X-ray, 2 views CPT 71046 CHEST 2 V W/ABDOMEN (INFANT ONLY)	$334.90	$394.00	$45.35–$334.90	88% above	15%
Chest X-ray, 2 views CPT 71046 CHEST 2 V	$334.90	$394.00	$45.35–$334.90	88% above	15%
Chest X-ray, 2 views inpatient CPT 71046 CHEST 2 V W/ABDOMEN (INFANT ONLY)	$334.90	$394.00	$236.40–$852.12	—	15%
Chest X-ray, 2 views inpatient CPT 71046 CHEST 2 V	$334.90	$394.00	$236.40–$852.12	—	15%
Chest X-ray, 2 views inpatient CPT 71046 GD Exams	$334.90	$394.00	$236.40–$852.12	—	15%
Chest X-ray, 2 views inpatient CPT 71046 SNIFF TEST	$334.90	$394.00	$236.40–$852.12	—	15%
Chest X-ray, single view CPT 71045 GD Exams	$217.60	$256.00	$43.28–$217.60	42% above	15%
Chest X-ray, single view CPT 71045 CHEST 1 V W/ABDOMEN (NICU LINE SERIES)	$217.60	$256.00	$43.28–$217.60	42% above	15%
Chest X-ray, single view CPT 71045 CHEST 1 V W/ABDOMEN (INFANT ONLY)	$217.60	$256.00	$43.28–$217.60	42% above	15%
Chest X-ray, single view CPT 71045 CHEST 1 V	$217.60	$256.00	$43.28–$217.60	42% above	15%
Chest X-ray, single view CPT 71045 CHEST 1 V (NICU LINE SERIES)	$217.60	$256.00	$43.28–$217.60	42% above	15%
Chest X-ray, single view one side CPT 71045 CHEST DECUBITUS RT	$217.60	$256.00	$43.28–$217.60	42% above	15%
Chest X-ray, single view one side CPT 71045 CHEST DECUBITUS LT	$217.60	$256.00	$43.28–$217.60	42% above	15%
Chest X-ray, single view inpatient CPT 71045 CHEST 1 V W/ABDOMEN (INFANT ONLY)	$217.60	$256.00	$153.60–$852.12	—	15%
Chest X-ray, single view inpatient CPT 71045 CHEST 1 V	$217.60	$256.00	$153.60–$852.12	—	15%
Chest X-ray, single view inpatient CPT 71045 CHEST 1 V (NICU LINE SERIES)	$217.60	$256.00	$153.60–$852.12	—	15%
Chest X-ray, single view inpatient CPT 71045 CHEST 1 V W/ABDOMEN (NICU LINE SERIES)	$217.60	$256.00	$153.60–$852.12	—	15%
Chest X-ray, single view inpatient CPT 71045 GD Exams	$217.60	$256.00	$153.60–$852.12	—	15%
Chest X-ray, single view inpatient one side CPT 71045 CHEST DECUBITUS RT	$217.60	$256.00	$153.60–$852.12	—	15%
Chest X-ray, single view inpatient one side CPT 71045 CHEST DECUBITUS LT	$217.60	$256.00	$153.60–$852.12	—	15%
Collarbone (clavicle) X-ray, complete CPT 73000 GD Exams	$304.30	$358.00	$45.35–$304.30	74% above	15%
Collarbone (clavicle) X-ray, complete one side CPT 73000 CLAVICLE COMPLETE LT 73000	$67.15	$79.00	$29.84–$147.41	62% below	15%
Collarbone (clavicle) X-ray, complete one side CPT 73000 CLAVICLE COMPLETE RT 73000	$67.15	$79.00	$29.84–$147.41	62% below	15%
Collarbone (clavicle) X-ray, complete one side CPT 73000 CLAVICLE COMPLETE LT	$304.30	$358.00	$45.35–$304.30	74% above	15%
Collarbone (clavicle) X-ray, complete one side CPT 73000 CLAVICLE COMPLETE RT	$304.30	$358.00	$45.35–$304.30	74% above	15%
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 GD Exams	$304.30	$358.00	$214.80–$852.12	—	15%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 CLAVICLE COMPLETE RT 73000	$67.15	$79.00	$47.40–$852.12	—	15%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 CLAVICLE COMPLETE LT 73000	$67.15	$79.00	$47.40–$852.12	—	15%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 CLAVICLE COMPLETE LT	$304.30	$358.00	$214.80–$852.12	—	15%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 CLAVICLE COMPLETE RT	$304.30	$358.00	$214.80–$852.12	—	15%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US AORTA/RENAL COMPLETE	$776.90	$914.00	$54.48–$776.90	29% above	15%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US Exams	$776.90	$914.00	$54.48–$776.90	29% above	15%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RENAL/BLADDER	$776.90	$914.00	$54.48–$776.90	29% above	15%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 Renal Ultrasound 76770	$813.45	$957.00	$54.48–$813.45	35% above	15%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US Exams	$776.90	$914.00	$548.40–$852.12	—	15%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US AORTA/RENAL COMPLETE	$776.90	$914.00	$548.40–$852.12	—	15%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RENAL/BLADDER	$776.90	$914.00	$548.40–$852.12	—	15%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 Renal Ultrasound 76770	$813.45	$957.00	$574.20–$852.12	—	15%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 BONE DENSITY AXIAL + PERIPHERAL SKELETON	$585.65	$689.00	$54.48–$585.65	89% above	15%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 BONE DENSITY AXIAL SKELETON	$585.65	$689.00	$54.48–$585.65	89% above	15%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 Bone Density Exam	$585.65	$689.00	$54.48–$585.65	89% above	15%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 Bone Density Exam	$585.65	$689.00	$413.40–$852.12	—	15%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 BONE DENSITY AXIAL + PERIPHERAL SKELETON	$585.65	$689.00	$413.40–$852.12	—	15%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 BONE DENSITY AXIAL SKELETON	$585.65	$689.00	$413.40–$852.12	—	15%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 BONE DENSITY PERIPHERAL	$162.35	$191.00	$45.35–$162.35	27% above	15%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 Bone Density Exam	$162.35	$191.00	$45.35–$162.35	27% above	15%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 4557 BONE DENSITY PERIPHERAL SKELE	$162.35	$191.00	$45.35–$162.35	27% above	15%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 BONE DENSITY PERIPHERAL SKELETON	$162.35	$191.00	$45.35–$162.35	27% above	15%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 4557 BONE DENSITY PERIPHERAL SKELE	$162.35	$191.00	$114.60–$852.12	—	15%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 BONE DENSITY PERIPHERAL	$162.35	$191.00	$114.60–$852.12	—	15%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 BONE DENSITY PERIPHERAL SKELETON	$162.35	$191.00	$114.60–$852.12	—	15%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 Bone Density Exam	$162.35	$191.00	$114.60–$852.12	—	15%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US OB Detailed Single Fetus 76811	$391.85	$461.00	$124.34–$580.99	46% below	15%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US OB COMPLETE QUADS	$846.60	$996.00	$124.34–$846.60	17% above	15%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US OB COMPLETE - HIGH RISK	$846.60	$996.00	$124.34–$846.60	17% above	15%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US OB HIGH RISK TRIPLETS-	$846.60	$996.00	$124.34–$846.60	17% above	15%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US OB HIGH RISK TWINS	$846.60	$996.00	$124.34–$846.60	17% above	15%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US OB HIGH RISK TWINS-	$846.60	$996.00	$124.34–$846.60	17% above	15%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US Exams	$846.60	$996.00	$124.34–$846.60	17% above	15%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US OB COMPLETE TRIPLETS-	$846.60	$996.00	$124.34–$846.60	17% above	15%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US OB COMPLETE TWINS	$846.60	$996.00	$124.34–$846.60	17% above	15%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US OB COMPLETE TWINS-	$846.60	$996.00	$124.34–$846.60	17% above	15%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US OB HIGH RISK TRIPLETS	$846.60	$996.00	$124.34–$846.60	17% above	15%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US OB COMPLETE TRIPLETS	$846.60	$996.00	$124.34–$846.60	17% above	15%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US OB COMPLETE QUADS-	$846.60	$996.00	$124.34–$846.60	17% above	15%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US OB COMPLETE - HIGH RISK-	$846.60	$996.00	$124.34–$846.60	17% above	15%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US OB Detailed Single Fetus 76811	$391.85	$461.00	$276.60–$852.12	—	15%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US OB HIGH RISK TWINS	$846.60	$996.00	$597.60–$852.12	—	15%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US OB HIGH RISK TRIPLETS-	$846.60	$996.00	$597.60–$852.12	—	15%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US OB HIGH RISK TRIPLETS	$846.60	$996.00	$597.60–$852.12	—	15%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US Exams	$846.60	$996.00	$597.60–$852.12	—	15%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US OB COMPLETE TWINS-	$846.60	$996.00	$597.60–$852.12	—	15%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US OB COMPLETE TWINS	$846.60	$996.00	$597.60–$852.12	—	15%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US OB HIGH RISK TWINS-	$846.60	$996.00	$597.60–$852.12	—	15%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US OB COMPLETE TRIPLETS	$846.60	$996.00	$597.60–$852.12	—	15%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US OB COMPLETE QUADS-	$846.60	$996.00	$597.60–$852.12	—	15%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US OB COMPLETE QUADS	$846.60	$996.00	$597.60–$852.12	—	15%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US OB COMPLETE - HIGH RISK-	$846.60	$996.00	$597.60–$852.12	—	15%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US OB COMPLETE - HIGH RISK	$846.60	$996.00	$597.60–$852.12	—	15%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US OB COMPLETE TRIPLETS-	$846.60	$996.00	$597.60–$852.12	—	15%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST + ABDOMEN W/O IV (ORAL ONLY)	$1,363.40	$1,604.00	$54.48–$1,363.40	36% above	15%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 93073 CT CHEST W/O NO ORAL+IV	$1,363.40	$1,604.00	$54.48–$1,363.40	36% above	15%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 93075 CT CHEST W/O IV ORAL ONLY	$1,363.40	$1,604.00	$54.48–$1,363.40	36% above	15%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST + ABD W/O CONT (NO ORAL-NO IV)	$1,363.40	$1,604.00	$54.48–$1,363.40	36% above	15%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT LUNG CANCER SCREENING INTERVAL F/U	$1,363.40	$1,604.00	$54.48–$1,363.40	36% above	15%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Exams	$1,363.40	$1,604.00	$54.48–$1,363.40	36% above	15%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST ABD PELVIS W/O (NO ORAL-NO IV)	$1,363.40	$1,604.00	$54.48–$1,363.40	36% above	15%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST ABD PELVIS W/O IV (ORAL ONLY)	$1,363.40	$1,604.00	$54.48–$1,363.40	36% above	15%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST W/O CONTRAST	$1,363.40	$1,604.00	$54.48–$1,363.40	36% above	15%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST W/O CONTRAST ION PROTOCOL	$1,363.40	$1,604.00	$54.48–$1,363.40	36% above	15%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT ESOPHAGRAM CHEST/ABD W/O (ORAL ONLY)	$1,363.40	$1,604.00	$54.48–$1,363.40	36% above	15%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT LUNGS HIGH RESOLUTION	$2,017.05	$2,373.00	$54.48–$2,017.05	101% above	15%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST + ABD W/O CONT (NO ORAL-NO IV)	$1,363.40	$1,604.00	$852.12–$1,363.40	—	15%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT LUNG CANCER SCREENING INTERVAL F/U	$1,363.40	$1,604.00	$852.12–$1,363.40	—	15%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Exams	$1,363.40	$1,604.00	$852.12–$1,363.40	—	15%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT ESOPHAGRAM CHEST/ABD W/O (ORAL ONLY)	$1,363.40	$1,604.00	$852.12–$1,363.40	—	15%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST W/O CONTRAST ION PROTOCOL	$1,363.40	$1,604.00	$852.12–$1,363.40	—	15%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST W/O CONTRAST	$1,363.40	$1,604.00	$852.12–$1,363.40	—	15%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST ABD PELVIS W/O IV (ORAL ONLY)	$1,363.40	$1,604.00	$852.12–$1,363.40	—	15%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST ABD PELVIS W/O (NO ORAL-NO IV)	$1,363.40	$1,604.00	$852.12–$1,363.40	—	15%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 93075 CT CHEST W/O IV ORAL ONLY	$1,363.40	$1,604.00	$852.12–$1,363.40	—	15%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 93073 CT CHEST W/O NO ORAL+IV	$1,363.40	$1,604.00	$852.12–$1,363.40	—	15%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST + ABDOMEN W/O IV (ORAL ONLY)	$1,363.40	$1,604.00	$852.12–$1,363.40	—	15%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT LUNGS HIGH RESOLUTION	$2,017.05	$2,373.00	$852.12–$2,017.05	—	15%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT THORAX W	$2,017.05	$2,373.00	$91.40–$2,017.05	54% above	15%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT VENOGRAM CHEST W/ CONTRAST	$2,017.05	$2,373.00	$91.40–$2,017.05	54% above	15%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST + ABDOMEN W/ CONT (ORAL + IV)	$2,017.05	$2,373.00	$91.40–$2,017.05	54% above	15%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Exams	$2,017.05	$2,373.00	$91.40–$2,017.05	54% above	15%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST W/ CONTRAST	$2,017.05	$2,373.00	$91.40–$2,017.05	54% above	15%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST W/CONTR--	$2,017.05	$2,373.00	$91.40–$2,017.05	54% above	15%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 3080 CT CHEST W CONTR	$2,040.00	$2,400.00	$91.40–$2,040.00	55% above	15%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 3078 CT CHEST W/ CONTRAST	$2,040.00	$2,400.00	$91.40–$2,040.00	55% above	15%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST + ABDOMEN W/ IV CONT (NO ORAL)	$2,040.00	$2,400.00	$91.40–$2,040.00	55% above	15%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT CHEST W/CONTR--	$2,017.05	$2,373.00	$852.12–$2,017.05	—	15%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT CHEST W/ CONTRAST	$2,017.05	$2,373.00	$852.12–$2,017.05	—	15%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT CHEST + ABDOMEN W/ CONT (ORAL + IV)	$2,017.05	$2,373.00	$852.12–$2,017.05	—	15%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Exams	$2,017.05	$2,373.00	$852.12–$2,017.05	—	15%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT THORAX W	$2,017.05	$2,373.00	$852.12–$2,017.05	—	15%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT VENOGRAM CHEST W/ CONTRAST	$2,017.05	$2,373.00	$852.12–$2,017.05	—	15%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 3078 CT CHEST W/ CONTRAST	$2,040.00	$2,400.00	$852.12–$2,040.00	—	15%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 3080 CT CHEST W CONTR	$2,040.00	$2,400.00	$852.12–$2,040.00	—	15%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT CHEST + ABDOMEN W/ IV CONT (NO ORAL)	$2,040.00	$2,400.00	$852.12–$2,040.00	—	15%
Diagnostic mammogram, both breasts both sides CPT 77066 MA FFD MAMM DIAGNOSTIC BILAT	$414.80	$488.00	$76.75–$414.80	—	15%
Diagnostic mammogram, both breasts CPT 77066 MA FFD MAMM DIAGNOSTIC W/ CONT BIL	$395.25	$465.00	$76.75–$395.25	27% above	15%
Diagnostic mammogram, both breasts CPT 77066 MA MAMM 3D DIAGNOSTIC W/ CONT BIL	$395.25	$465.00	$76.75–$395.25	27% above	15%
Diagnostic mammogram, both breasts CPT 77066 MA MAMM 3D DIAGNOSTIC BIL	$414.80	$488.00	$76.75–$414.80	33% above	15%
Diagnostic mammogram, both breasts CPT 77066 MA MAMM 3D DX FOLL PROCEDURE BIL	$414.80	$488.00	$76.75–$414.80	33% above	15%
Diagnostic mammogram, both breasts CPT 77066 MA Exams	$414.80	$488.00	$76.75–$414.80	33% above	15%
Diagnostic mammogram, both breasts CPT 77066 MA FFD DX FOLLOW PROCEDURE BIL	$414.80	$488.00	$76.75–$414.80	33% above	15%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MA FFD MAMM DIAGNOSTIC BILAT	$414.80	$488.00	$292.80–$852.12	—	15%
Diagnostic mammogram, both breasts inpatient CPT 77066 MA FFD MAMM DIAGNOSTIC W/ CONT BIL	$395.25	$465.00	$279.00–$852.12	—	15%
Diagnostic mammogram, both breasts inpatient CPT 77066 MA MAMM 3D DIAGNOSTIC W/ CONT BIL	$395.25	$465.00	$279.00–$852.12	—	15%
Diagnostic mammogram, both breasts inpatient CPT 77066 MA MAMM 3D DX FOLL PROCEDURE BIL	$414.80	$488.00	$292.80–$852.12	—	15%
Diagnostic mammogram, both breasts inpatient CPT 77066 MA FFD DX FOLLOW PROCEDURE BIL	$414.80	$488.00	$292.80–$852.12	—	15%
Diagnostic mammogram, both breasts inpatient CPT 77066 MA MAMM 3D DIAGNOSTIC BIL	$414.80	$488.00	$292.80–$852.12	—	15%
Diagnostic mammogram, both breasts inpatient CPT 77066 MA Exams	$414.80	$488.00	$292.80–$852.12	—	15%
Diagnostic mammogram, one breast CPT 77065 MA Exams	$322.15	$379.00	$60.60–$322.15	4% above	15%
Diagnostic mammogram, one breast one side CPT 77065 MA FFD MAMM DIAGNOSTIC W/ CONT LT	$306.85	$361.00	$60.60–$306.85	1% below	15%
Diagnostic mammogram, one breast one side CPT 77065 MA MAMM 3D DIAGNOSTIC W/ CONT LT	$306.85	$361.00	$60.60–$306.85	1% below	15%
Diagnostic mammogram, one breast one side CPT 77065 MA MAMM 3D DIAGNOSTIC W/ CONT RT	$306.85	$361.00	$60.60–$306.85	1% below	15%
Diagnostic mammogram, one breast one side CPT 77065 MA FFD MAMM DIAGNOSTIC W/ CONT RT	$306.85	$361.00	$60.60–$306.85	1% below	15%
Diagnostic mammogram, one breast one side CPT 77065 MA FFD DX FOLLOW PROCEDURE LT	$322.15	$379.00	$60.60–$322.15	4% above	15%
Diagnostic mammogram, one breast one side CPT 77065 MA MAMM 3D DX FOLL PROCEDURE RT	$322.15	$379.00	$60.60–$322.15	4% above	15%
Diagnostic mammogram, one breast one side CPT 77065 MA MAMM 3D DIAGNOSTIC RT	$322.15	$379.00	$60.60–$322.15	4% above	15%
Diagnostic mammogram, one breast one side CPT 77065 MA MAMM 3D DIAGNOSTIC LT	$322.15	$379.00	$60.60–$322.15	4% above	15%
Diagnostic mammogram, one breast one side CPT 77065 MA MAMM 3D DX FOLL PROCEDURE LT	$322.15	$379.00	$60.60–$322.15	4% above	15%
Diagnostic mammogram, one breast one side CPT 77065 MA FFD MAMM DIAGNOSTIC UNI RT	$322.15	$379.00	$60.60–$322.15	4% above	15%
Diagnostic mammogram, one breast one side CPT 77065 MA FFD MAMM DIAGNOSTIC UNI LT	$322.15	$379.00	$60.60–$322.15	4% above	15%
Diagnostic mammogram, one breast one side CPT 77065 MA FFD MAMM DIAGNOSTIC FOLLOW SCRN RT	$322.15	$379.00	$60.60–$322.15	4% above	15%
Diagnostic mammogram, one breast one side CPT 77065 MA FFD MAMM DIAGNOSTIC FOLLOW SCRN LT	$322.15	$379.00	$60.60–$322.15	4% above	15%
Diagnostic mammogram, one breast one side CPT 77065 MA FFD DX FOLLOW PROCEDURE RT	$322.15	$379.00	$60.60–$322.15	4% above	15%
Diagnostic mammogram, one breast inpatient CPT 77065 MA Exams	$322.15	$379.00	$227.40–$852.12	—	15%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA MAMM 3D DIAGNOSTIC W/ CONT RT	$306.85	$361.00	$216.60–$852.12	—	15%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA FFD MAMM DIAGNOSTIC W/ CONT RT	$306.85	$361.00	$216.60–$852.12	—	15%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA FFD MAMM DIAGNOSTIC W/ CONT LT	$306.85	$361.00	$216.60–$852.12	—	15%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA MAMM 3D DIAGNOSTIC W/ CONT LT	$306.85	$361.00	$216.60–$852.12	—	15%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA MAMM 3D DX FOLL PROCEDURE LT	$322.15	$379.00	$227.40–$852.12	—	15%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA FFD MAMM DIAGNOSTIC FOLLOW SCRN RT	$322.15	$379.00	$227.40–$852.12	—	15%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA MAMM 3D DX FOLL PROCEDURE RT	$322.15	$379.00	$227.40–$852.12	—	15%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA MAMM 3D DIAGNOSTIC RT	$322.15	$379.00	$227.40–$852.12	—	15%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA MAMM 3D DIAGNOSTIC LT	$322.15	$379.00	$227.40–$852.12	—	15%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA FFD DX FOLLOW PROCEDURE LT	$322.15	$379.00	$227.40–$852.12	—	15%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA FFD MAMM DIAGNOSTIC FOLLOW SCRN LT	$322.15	$379.00	$227.40–$852.12	—	15%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA FFD MAMM DIAGNOSTIC UNI LT	$322.15	$379.00	$227.40–$852.12	—	15%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA FFD MAMM DIAGNOSTIC UNI RT	$322.15	$379.00	$227.40–$852.12	—	15%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA FFD DX FOLLOW PROCEDURE RT	$322.15	$379.00	$227.40–$852.12	—	15%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 Duplex Scan Lower Extremity Art Complete Bilateral 93925	$725.05	$853.00	$124.34–$787.88	—	15%
Duplex ultrasound of the leg arteries, both legs CPT 93925 USV Exams	$725.05	$853.00	$124.34–$787.88	2% above	15%
Duplex ultrasound of the leg arteries, both legs CPT 93925 USV GROIN BIL/PSEUDO 93925	$725.05	$853.00	$124.34–$787.88	2% above	15%
Duplex ultrasound of the leg arteries, both legs CPT 93925 USV LOWER BIL PSEUDO	$725.05	$853.00	$124.34–$787.88	2% above	15%
Duplex ultrasound of the leg arteries, both legs CPT 93925 USV LOWER EXT ARTERY BIL	$1,126.25	$1,325.00	$124.34–$1,126.25	58% above	15%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 Duplex Scan Lower Extremity Art Complete Bilateral 93925	$725.05	$853.00	$511.80–$852.12	—	15%
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 USV Exams	$725.05	$853.00	$511.80–$852.12	—	15%
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 USV LOWER BIL PSEUDO	$725.05	$853.00	$511.80–$852.12	—	15%
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 USV GROIN BIL/PSEUDO 93925	$725.05	$853.00	$511.80–$852.12	—	15%
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 USV LOWER EXT ARTERY BIL	$1,126.25	$1,325.00	$795.00–$1,126.25	—	15%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 USV VEIN MAPPING BILAT ARMS	$1,076.95	$1,267.00	$124.34–$1,076.95	—	15%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 USV LOWER EXT VEIN BILAT	$1,076.95	$1,267.00	$124.34–$1,076.95	—	15%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 USV CALF REFLUX STUDY BILAT	$1,076.95	$1,267.00	$124.34–$1,076.95	—	15%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 USV UPPER EXT VEIN BILAT	$1,076.95	$1,267.00	$124.34–$1,076.95	—	15%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 Dup-Scan Xtr Veins Complete Bilateral Study 93970	$1,076.95	$1,267.00	$124.34–$1,076.95	—	15%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 USV VEIN MAPPING BILAT LEGS	$1,076.95	$1,267.00	$124.34–$1,076.95	—	15%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 USV UPPER EXT VEIN BILAT 93970	$1,076.95	$1,267.00	$124.34–$1,076.95	—	15%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 USV CALF REFLUX STUDY BILAT 93970	$1,076.95	$1,267.00	$124.34–$1,076.95	—	15%
Duplex ultrasound of the leg veins, both legs CPT 93970 EXTREMITY STUDY	$1,076.95	$1,267.00	$124.34–$1,076.95	75% above	15%
Duplex ultrasound of the leg veins, both legs CPT 93970 USV Exams	$1,076.95	$1,267.00	$124.34–$1,076.95	75% above	15%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 USV VEIN MAPPING BILAT LEGS	$1,076.95	$1,267.00	$760.20–$1,076.95	—	15%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 USV UPPER EXT VEIN BILAT 93970	$1,076.95	$1,267.00	$760.20–$1,076.95	—	15%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 USV CALF REFLUX STUDY BILAT	$1,076.95	$1,267.00	$760.20–$1,076.95	—	15%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 USV LOWER EXT VEIN BILAT	$1,076.95	$1,267.00	$760.20–$1,076.95	—	15%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 USV UPPER EXT VEIN BILAT	$1,076.95	$1,267.00	$760.20–$1,076.95	—	15%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 USV VEIN MAPPING BILAT ARMS	$1,076.95	$1,267.00	$760.20–$1,076.95	—	15%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 USV CALF REFLUX STUDY BILAT 93970	$1,076.95	$1,267.00	$760.20–$1,076.95	—	15%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 Dup-Scan Xtr Veins Complete Bilateral Study 93970	$1,076.95	$1,267.00	$760.20–$1,076.95	—	15%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 EXTREMITY STUDY	$1,076.95	$1,267.00	$760.20–$1,076.95	—	15%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 USV Exams	$1,076.95	$1,267.00	$760.20–$1,076.95	—	15%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Echo Complete 2D/M/D/CF	$1,725.50	$2,030.00	$284.75–$1,725.50	25% above	15%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Echo 2D & M W SPCT & Color (C/G)	$1,725.50	$2,030.00	$284.75–$1,725.50	25% above	15%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Transthoracic Echo (TTE) Complete w/2D Doppler & Color (GLOBAL) 93306	$1,784.15	$2,099.00	$284.75–$1,784.15	29% above	15%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 Echo Complete 2D/M/D/CF	$1,725.50	$2,030.00	$852.12–$1,725.50	—	15%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 Echo 2D & M W SPCT & Color (C/G)	$1,725.50	$2,030.00	$852.12–$1,725.50	—	15%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 Transthoracic Echo (TTE) Complete w/2D Doppler & Color (GLOBAL) 93306	$1,784.15	$2,099.00	$852.12–$1,784.15	—	15%
Elbow X-ray, 2 views both sides CPT 73070 ELBOW 2 V EA BILAT 73070	$66.30	$78.00	$29.46–$147.41	—	15%
Elbow X-ray, 2 views CPT 73070 GD Exams	$278.80	$328.00	$45.35–$278.80	108% above	15%
Elbow X-ray, 2 views one side CPT 73070 ELBOW 2 V RT 73070	$60.35	$71.00	$26.82–$147.41	55% below	15%
Elbow X-ray, 2 views one side CPT 73070 ELBOW 2 V LT 73070	$60.35	$71.00	$26.82–$147.41	55% below	15%
Elbow X-ray, 2 views one side CPT 73070 ELBOW 2 V LT	$278.80	$328.00	$45.35–$278.80	108% above	15%
Elbow X-ray, 2 views one side CPT 73070 ELBOW 2 V RT	$278.80	$328.00	$45.35–$278.80	108% above	15%
Elbow X-ray, 2 views inpatient both sides CPT 73070 ELBOW 2 V EA BILAT 73070	$66.30	$78.00	$46.80–$852.12	—	15%
Elbow X-ray, 2 views inpatient CPT 73070 GD Exams	$278.80	$328.00	$196.80–$852.12	—	15%
Elbow X-ray, 2 views inpatient one side CPT 73070 ELBOW 2 V LT 73070	$60.35	$71.00	$42.60–$852.12	—	15%
Elbow X-ray, 2 views inpatient one side CPT 73070 ELBOW 2 V RT 73070	$60.35	$71.00	$42.60–$852.12	—	15%
Elbow X-ray, 2 views inpatient one side CPT 73070 ELBOW 2 V LT	$278.80	$328.00	$196.80–$852.12	—	15%
Elbow X-ray, 2 views inpatient one side CPT 73070 ELBOW 2 V RT	$278.80	$328.00	$196.80–$852.12	—	15%
Elbow X-ray, complete, 3 or more views both sides CPT 73080 ELBOW COMP MIN 3 V EA BILAT 73080	$73.10	$86.00	$32.48–$147.41	—	15%
Elbow X-ray, complete, 3 or more views CPT 73080 GD Exams	$351.90	$414.00	$45.35–$351.90	85% above	15%
Elbow X-ray, complete, 3 or more views one side CPT 73080 ELBOW COMP MIN 3 V RT 73080	$66.30	$78.00	$29.46–$147.41	65% below	15%
Elbow X-ray, complete, 3 or more views one side CPT 73080 ELBOW COMP MIN 3 V LT 73080	$66.30	$78.00	$29.46–$147.41	65% below	15%
Elbow X-ray, complete, 3 or more views one side CPT 73080 ELBOW COMP MIN 3 V LT	$351.90	$414.00	$45.35–$351.90	85% above	15%
Elbow X-ray, complete, 3 or more views one side CPT 73080 ELBOW COMP MIN 3 V RT	$351.90	$414.00	$45.35–$351.90	85% above	15%
Elbow X-ray, complete, 3 or more views inpatient both sides CPT 73080 ELBOW COMP MIN 3 V EA BILAT 73080	$73.10	$86.00	$51.60–$852.12	—	15%
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 GD Exams	$351.90	$414.00	$248.40–$852.12	—	15%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 ELBOW COMP MIN 3 V LT 73080	$66.30	$78.00	$46.80–$852.12	—	15%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 ELBOW COMP MIN 3 V RT 73080	$66.30	$78.00	$46.80–$852.12	—	15%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 ELBOW COMP MIN 3 V RT	$351.90	$414.00	$248.40–$852.12	—	15%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 ELBOW COMP MIN 3 V LT	$351.90	$414.00	$248.40–$852.12	—	15%
Eye socket (orbit) CT scan without contrast CPT 70480 CT Exams	$1,833.45	$2,157.00	$54.48–$1,833.45	81% above	15%
Eye socket (orbit) CT scan without contrast CPT 70480 CT TEMPORAL BONES W/O CONTRAST	$1,833.45	$2,157.00	$54.48–$1,833.45	81% above	15%
Eye socket (orbit) CT scan without contrast CPT 70480 CT PITUITARY W/O CONTRAST	$1,833.45	$2,157.00	$54.48–$1,833.45	81% above	15%
Eye socket (orbit) CT scan without contrast CPT 70480 CT ORBITS W/O CONTRAST	$1,833.45	$2,157.00	$54.48–$1,833.45	81% above	15%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT TEMPORAL BONES W/O CONTRAST	$1,833.45	$2,157.00	$852.12–$1,833.45	—	15%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT ORBITS W/O CONTRAST	$1,833.45	$2,157.00	$852.12–$1,833.45	—	15%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT PITUITARY W/O CONTRAST	$1,833.45	$2,157.00	$852.12–$1,833.45	—	15%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT Exams	$1,833.45	$2,157.00	$852.12–$1,833.45	—	15%
Facial bones X-ray, complete, 3 or more views CPT 70150 FACIAL BONES COMPLETE MIN 3 V	$429.25	$505.00	$54.48–$429.25	66% above	15%
Facial bones X-ray, complete, 3 or more views CPT 70150 GD Exams	$429.25	$505.00	$54.48–$429.25	66% above	15%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 FACIAL BONES COMPLETE MIN 3 V	$429.25	$505.00	$303.00–$852.12	—	15%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 GD Exams	$429.25	$505.00	$303.00–$852.12	—	15%
Forearm X-ray (radius and ulna), 2 views both sides CPT 73090 FOREARM 2 V BILAT 73090	$66.30	$78.00	$29.46–$147.41	—	15%
Forearm X-ray (radius and ulna), 2 views CPT 73090 GD Exams	$304.30	$358.00	$45.35–$304.30	71% above	15%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 FOREARM 2 V LT 73090	$61.20	$72.00	$27.19–$147.41	66% below	15%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 FOREARM 2 V RT 73090	$61.20	$72.00	$27.19–$147.41	66% below	15%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 FOREARM 2 V RT	$304.30	$358.00	$45.35–$304.30	71% above	15%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 FOREARM 2 V LT	$304.30	$358.00	$45.35–$304.30	71% above	15%
Forearm X-ray (radius and ulna), 2 views inpatient both sides CPT 73090 FOREARM 2 V BILAT 73090	$66.30	$78.00	$46.80–$852.12	—	15%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 GD Exams	$304.30	$358.00	$214.80–$852.12	—	15%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 FOREARM 2 V RT 73090	$61.20	$72.00	$43.20–$852.12	—	15%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 FOREARM 2 V LT 73090	$61.20	$72.00	$43.20–$852.12	—	15%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 FOREARM 2 V RT	$304.30	$358.00	$214.80–$852.12	—	15%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 FOREARM 2 V LT	$304.30	$358.00	$214.80–$852.12	—	15%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 Nuclear Med Exams	$1,798.60	$2,116.00	$208.33–$2,022.81	92% above	15%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM GALLBLADDER IMAGING	$1,798.60	$2,116.00	$208.33–$2,022.81	92% above	15%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM GALLBLADDER IMAGING	$1,798.60	$2,116.00	$852.12–$1,798.60	—	15%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 Nuclear Med Exams	$1,798.60	$2,116.00	$852.12–$1,798.60	—	15%
Hand X-ray, 2 views CPT 73120 GD Exams	$194.65	$229.00	$54.48–$194.65	33% above	15%
Hand X-ray, 2 views one side CPT 73120 HAND 2 V RT 73120	$64.60	$76.00	$28.71–$177.09	56% below	15%
Hand X-ray, 2 views one side CPT 73120 HAND 2 V LT 73120	$64.60	$76.00	$28.71–$177.09	56% below	15%
Hand X-ray, 2 views one side CPT 73120 HAND 2 V RT	$194.65	$229.00	$54.48–$194.65	33% above	15%
Hand X-ray, 2 views one side CPT 73120 HAND 2 V LT	$194.65	$229.00	$54.48–$194.65	33% above	15%
Hand X-ray, 2 views inpatient CPT 73120 GD Exams	$194.65	$229.00	$137.40–$852.12	—	15%
Hand X-ray, 2 views inpatient one side CPT 73120 HAND 2 V LT 73120	$64.60	$76.00	$45.60–$852.12	—	15%
Hand X-ray, 2 views inpatient one side CPT 73120 HAND 2 V RT 73120	$64.60	$76.00	$45.60–$852.12	—	15%
Hand X-ray, 2 views inpatient one side CPT 73120 HAND 2 V RT	$194.65	$229.00	$137.40–$852.12	—	15%
Hand X-ray, 2 views inpatient one side CPT 73120 HAND 2 V LT	$194.65	$229.00	$137.40–$852.12	—	15%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 GD Exams	$257.55	$303.00	$45.35–$257.55	67% above	15%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 HEEL MIN 2 V RT 73650	$60.35	$71.00	$26.82–$147.41	61% below	15%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 HEEL MIN 2 V LT 73650	$60.35	$71.00	$26.82–$147.41	61% below	15%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 HEEL MIN 2 V RT	$257.55	$303.00	$45.35–$257.55	67% above	15%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 HEEL MIN 2 V LT	$257.55	$303.00	$45.35–$257.55	67% above	15%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 GD Exams	$257.55	$303.00	$181.80–$852.12	—	15%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 HEEL MIN 2 V LT 73650	$60.35	$71.00	$42.60–$852.12	—	15%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 HEEL MIN 2 V RT 73650	$60.35	$71.00	$42.60–$852.12	—	15%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 HEEL MIN 2 V LT	$257.55	$303.00	$181.80–$852.12	—	15%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 HEEL MIN 2 V RT	$257.55	$303.00	$181.80–$852.12	—	15%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 SLEEP STUDY UNATT&RESP EFF	$419.90	$494.00	$112.52–$419.90	24% below	15%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 SLEEP STUDY UNATT&RESP EFFT	$420.75	$495.00	$112.52–$420.75	23% below	15%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 SLEEP STUDY, UNATTENDED 95806	$420.75	$495.00	$112.52–$420.75	23% below	15%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 SLEEP STUDY, UNATTENDED Home Sleep Apnea	$420.75	$495.00	$112.52–$420.75	23% below	15%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 Sleep Study Unatt&Resp RDC 95806	$420.75	$495.00	$112.52–$420.75	23% below	15%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 SLEEP STUDY UNATT&RESP EFFT RDC	$420.75	$495.00	$112.52–$420.75	23% below	15%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 SLEEP STUDY UNATT&RESP EFF	$419.90	$494.00	$296.40–$852.12	—	15%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 SLEEP STUDY, UNATTENDED Home Sleep Apnea	$420.75	$495.00	$297.00–$852.12	—	15%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 Sleep Study Unatt&Resp RDC 95806	$420.75	$495.00	$297.00–$852.12	—	15%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 SLEEP STUDY UNATT&RESP EFFT RDC	$420.75	$495.00	$297.00–$852.12	—	15%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 SLEEP STUDY UNATT&RESP EFFT	$420.75	$495.00	$297.00–$852.12	—	15%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 SLEEP STUDY, UNATTENDED 95806	$420.75	$495.00	$297.00–$852.12	—	15%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 POLYSOMNOGRAPHY W/CPAP - NCPAP 95811	$4,030.70	$4,742.00	$447.51–$4,030.70	16% above	15%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 CPAP Bilevels ST 95811	$4,030.70	$4,742.00	$447.51–$4,030.70	16% above	15%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 CPAP Bilevels S 95811	$4,030.70	$4,742.00	$447.51–$4,030.70	16% above	15%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 NCPAP Study (C)	$4,030.70	$4,742.00	$447.51–$4,030.70	16% above	15%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 Polysom 6/> Yrs CPSP 4/ RDC 95811	$4,030.70	$4,742.00	$447.51–$4,030.70	16% above	15%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 POLYSOMNOGRAPHY W/CPAP Split Night 95811	$4,030.70	$4,742.00	$447.51–$4,030.70	16% above	15%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 NCPAP Study (C)	$4,030.70	$4,742.00	$852.12–$4,030.70	—	15%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 CPAP Bilevels S 95811	$4,030.70	$4,742.00	$852.12–$4,030.70	—	15%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 CPAP Bilevels ST 95811	$4,030.70	$4,742.00	$852.12–$4,030.70	—	15%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 POLYSOMNOGRAPHY W/CPAP - NCPAP 95811	$4,030.70	$4,742.00	$852.12–$4,030.70	—	15%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 POLYSOMNOGRAPHY W/CPAP Split Night 95811	$4,030.70	$4,742.00	$852.12–$4,030.70	—	15%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 Polysom 6/> Yrs CPSP 4/ RDC 95811	$4,030.70	$4,742.00	$852.12–$4,030.70	—	15%
Knee X-ray, 3 views both sides CPT 73562 KNEES BILATERAL 3 V EA 73562	$90.95	$107.00	$40.41–$147.41	—	15%
Knee X-ray, 3 views both sides CPT 73562 KNEES BILATERAL 3 V EACH	$351.90	$414.00	$45.35–$351.90	—	15%
Knee X-ray, 3 views CPT 73562 GD Exams	$351.90	$414.00	$45.35–$351.90	82% above	15%
Knee X-ray, 3 views one side CPT 73562 KNEE 3 V RT 73562	$83.30	$98.00	$37.01–$147.41	57% below	15%
Knee X-ray, 3 views one side CPT 73562 KNEE 3 V LT 73562	$83.30	$98.00	$37.01–$147.41	57% below	15%
Knee X-ray, 3 views one side CPT 73562 6228 KNEE 3 V LT	$351.90	$414.00	$45.35–$351.90	82% above	15%
Knee X-ray, 3 views one side CPT 73562 KNEE 3 V RT	$351.90	$414.00	$45.35–$351.90	82% above	15%
Knee X-ray, 3 views one side CPT 73562 KNEE 3 V LT	$351.90	$414.00	$45.35–$351.90	82% above	15%
Knee X-ray, 3 views inpatient both sides CPT 73562 KNEES BILATERAL 3 V EA 73562	$90.95	$107.00	$64.20–$852.12	—	15%
Knee X-ray, 3 views inpatient both sides CPT 73562 KNEES BILATERAL 3 V EACH	$351.90	$414.00	$248.40–$852.12	—	15%
Knee X-ray, 3 views inpatient CPT 73562 GD Exams	$351.90	$414.00	$248.40–$852.12	—	15%
Knee X-ray, 3 views inpatient one side CPT 73562 KNEE 3 V RT 73562	$83.30	$98.00	$58.80–$852.12	—	15%
Knee X-ray, 3 views inpatient one side CPT 73562 KNEE 3 V LT 73562	$83.30	$98.00	$58.80–$852.12	—	15%
Knee X-ray, 3 views inpatient one side CPT 73562 6228 KNEE 3 V LT	$351.90	$414.00	$248.40–$852.12	—	15%
Knee X-ray, 3 views inpatient one side CPT 73562 KNEE 3 V LT	$351.90	$414.00	$248.40–$852.12	—	15%
Knee X-ray, 3 views inpatient one side CPT 73562 KNEE 3 V RT	$351.90	$414.00	$248.40–$852.12	—	15%
Knee X-ray, complete, 4 or more views both sides CPT 73564 KNEES BILATERAL 4 V EA 73564	$185.30	$218.00	$54.48–$185.30	—	15%
Knee X-ray, complete, 4 or more views both sides CPT 73564 KNEES BILATERAL 4 V EA	$341.70	$402.00	$54.48–$341.70	—	15%
Knee X-ray, complete, 4 or more views CPT 73564 GD Exams	$341.70	$402.00	$54.48–$341.70	60% above	15%
Knee X-ray, complete, 4 or more views one side CPT 73564 KNEE COMPLETE MIN 4 V RT 73564	$92.65	$109.00	$41.17–$177.09	57% below	15%
Knee X-ray, complete, 4 or more views one side CPT 73564 KNEE COMPLETE MIN 4 V LT 73564	$92.65	$109.00	$41.17–$177.09	57% below	15%
Knee X-ray, complete, 4 or more views one side CPT 73564 KNEE COMPLETE MIN 4 V LT	$341.70	$402.00	$54.48–$341.70	60% above	15%
Knee X-ray, complete, 4 or more views one side CPT 73564 KNEE COMPLETE MIN 4 V RT	$341.70	$402.00	$54.48–$341.70	60% above	15%
Knee X-ray, complete, 4 or more views inpatient both sides CPT 73564 KNEES BILATERAL 4 V EA 73564	$185.30	$218.00	$130.80–$852.12	—	15%
Knee X-ray, complete, 4 or more views inpatient both sides CPT 73564 KNEES BILATERAL 4 V EA	$341.70	$402.00	$241.20–$852.12	—	15%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 GD Exams	$341.70	$402.00	$241.20–$852.12	—	15%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 KNEE COMPLETE MIN 4 V LT 73564	$92.65	$109.00	$65.40–$852.12	—	15%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 KNEE COMPLETE MIN 4 V RT 73564	$92.65	$109.00	$65.40–$852.12	—	15%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 KNEE COMPLETE MIN 4 V RT	$341.70	$402.00	$241.20–$852.12	—	15%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 KNEE COMPLETE MIN 4 V LT	$341.70	$402.00	$241.20–$852.12	—	15%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT ROTATION STUDY LOW EXT W/O	$1,106.70	$1,302.00	$54.48–$1,106.70	1% above	15%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT Exams	$1,523.20	$1,792.00	$54.48–$1,523.20	39% above	15%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT LOW EXT W/O LT LIMITED	$1,106.70	$1,302.00	$54.48–$1,106.70	1% above	15%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 4874 CT LOW EXT W/O LT LIMIT	$1,161.95	$1,367.00	$54.48–$1,161.95	6% above	15%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT LOWER EXTREM W/O CONTRAST RT	$1,523.20	$1,792.00	$54.48–$1,523.20	39% above	15%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT LOWER EXTREM W/O CONTRAST LT	$1,523.20	$1,792.00	$54.48–$1,523.20	39% above	15%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 CT ROTATION STUDY LOW EXT W/O	$1,106.70	$1,302.00	$781.20–$1,106.70	—	15%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 CT Exams	$1,523.20	$1,792.00	$852.12–$1,523.20	—	15%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT LOW EXT W/O LT LIMITED	$1,106.70	$1,302.00	$781.20–$1,106.70	—	15%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 4874 CT LOW EXT W/O LT LIMIT	$1,161.95	$1,367.00	$820.20–$1,161.95	—	15%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT LOWER EXTREM W/O CONTRAST RT	$1,523.20	$1,792.00	$852.12–$1,523.20	—	15%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT LOWER EXTREM W/O CONTRAST LT	$1,523.20	$1,792.00	$852.12–$1,523.20	—	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMEN	$731.85	$861.00	$54.48–$731.85	57% above	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US TRUNK/ABDOMEN SOFT TISSUE	$731.85	$861.00	$54.48–$731.85	57% above	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Exams	$731.85	$861.00	$54.48–$731.85	57% above	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMEN RUQ	$731.85	$861.00	$54.48–$731.85	57% above	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMEN PYLORIC STENOSIS	$731.85	$861.00	$54.48–$731.85	57% above	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMEN LUQ	$731.85	$861.00	$54.48–$731.85	57% above	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMEN INTUSSUSCEPTION	$731.85	$861.00	$54.48–$731.85	57% above	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMEN HERNIA	$731.85	$861.00	$54.48–$731.85	57% above	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMEN ASCITES	$731.85	$861.00	$54.48–$731.85	57% above	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMEN APPENDIX	$731.85	$861.00	$54.48–$731.85	57% above	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Echography abdominal Bscan andor real time w image documentation limited	$731.85	$861.00	$54.48–$731.85	57% above	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ECHO EXAM OF ABDOMEN BCE	$734.40	$864.00	$54.48–$734.40	58% above	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMEN LUQ	$731.85	$861.00	$516.60–$852.12	—	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMEN PYLORIC STENOSIS	$731.85	$861.00	$516.60–$852.12	—	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMEN RUQ	$731.85	$861.00	$516.60–$852.12	—	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Exams	$731.85	$861.00	$516.60–$852.12	—	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US TRUNK/ABDOMEN SOFT TISSUE	$731.85	$861.00	$516.60–$852.12	—	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMEN	$731.85	$861.00	$516.60–$852.12	—	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMEN ASCITES	$731.85	$861.00	$516.60–$852.12	—	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMEN HERNIA	$731.85	$861.00	$516.60–$852.12	—	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMEN INTUSSUSCEPTION	$731.85	$861.00	$516.60–$852.12	—	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMEN APPENDIX	$731.85	$861.00	$516.60–$852.12	—	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 Echography abdominal Bscan andor real time w image documentation limited	$731.85	$861.00	$516.60–$852.12	—	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 ECHO EXAM OF ABDOMEN BCE	$734.40	$864.00	$518.40–$852.12	—	15%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US LMTD JT/FCL EVL NVASC XTR	$517.65	$609.00	$54.48–$517.65	43% above	15%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US LMTD JT/FCL EVL NVASC XTR BCE	$538.05	$633.00	$54.48–$538.05	48% above	15%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US BREAST AXILLA BIL	$667.25	$785.00	$54.48–$667.25	84% above	15%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US EXT NON VASCULAR TENDON/MUSCLE BIL	$667.25	$785.00	$54.48–$667.25	84% above	15%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US Exams	$668.10	$786.00	$54.48–$668.10	84% above	15%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US EXT NON VASCULAR TENDON/MUSCLE RT	$668.10	$786.00	$54.48–$668.10	84% above	15%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US BREAST AXILLA LT	$668.10	$786.00	$54.48–$668.10	84% above	15%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US INGUINAL HERNIA RT	$668.10	$786.00	$54.48–$668.10	84% above	15%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US INGUINAL HERNIA LT	$668.10	$786.00	$54.48–$668.10	84% above	15%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US EXT NON VASCULAR TENDON/MUSCLE LT	$668.10	$786.00	$54.48–$668.10	84% above	15%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US EXT NON VASC RT	$668.10	$786.00	$54.48–$668.10	84% above	15%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US EXT NON VASC LT	$668.10	$786.00	$54.48–$668.10	84% above	15%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US BREAST AXILLA RT	$668.10	$786.00	$54.48–$668.10	84% above	15%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US LMTD JT/FCL EVL NVASC XTR	$517.65	$609.00	$365.40–$852.12	—	15%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US LMTD JT/FCL EVL NVASC XTR BCE	$538.05	$633.00	$379.80–$852.12	—	15%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US BREAST AXILLA BIL	$667.25	$785.00	$471.00–$852.12	—	15%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US EXT NON VASCULAR TENDON/MUSCLE BIL	$667.25	$785.00	$471.00–$852.12	—	15%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US Exams	$668.10	$786.00	$471.60–$852.12	—	15%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US BREAST AXILLA LT	$668.10	$786.00	$471.60–$852.12	—	15%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US EXT NON VASCULAR TENDON/MUSCLE LT	$668.10	$786.00	$471.60–$852.12	—	15%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US BREAST AXILLA RT	$668.10	$786.00	$471.60–$852.12	—	15%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US EXT NON VASC LT	$668.10	$786.00	$471.60–$852.12	—	15%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US EXT NON VASC RT	$668.10	$786.00	$471.60–$852.12	—	15%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US INGUINAL HERNIA LT	$668.10	$786.00	$471.60–$852.12	—	15%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US EXT NON VASCULAR TENDON/MUSCLE RT	$668.10	$786.00	$471.60–$852.12	—	15%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US INGUINAL HERNIA RT	$668.10	$786.00	$471.60–$852.12	—	15%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT Exams	$585.65	$689.00	$54.48–$658.59	68% above	15%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT LUNG CANCER SCREENING ANNUAL EXAM	$585.65	$689.00	$54.48–$658.59	68% above	15%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT Exams	$585.65	$689.00	$413.40–$852.12	—	15%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT LUNG CANCER SCREENING ANNUAL EXAM	$585.65	$689.00	$413.40–$852.12	—	15%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 GD Exams	$304.30	$358.00	$45.35–$304.30	65% above	15%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 TIBIA/FIBULA 2 V LT 73590	$65.45	$77.00	$29.08–$147.41	65% below	15%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 TIBIA/FIBULA 2 V RT 73590	$65.45	$77.00	$29.08–$147.41	65% below	15%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 TIBIA/FIBULA 2 V LT	$304.30	$358.00	$45.35–$304.30	65% above	15%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 TIBIA/FIBULA 2 V RT	$304.30	$358.00	$45.35–$304.30	65% above	15%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 GD Exams	$304.30	$358.00	$214.80–$852.12	—	15%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 TIBIA/FIBULA 2 V LT 73590	$65.45	$77.00	$46.20–$852.12	—	15%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 TIBIA/FIBULA 2 V RT 73590	$65.45	$77.00	$46.20–$852.12	—	15%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 TIBIA/FIBULA 2 V RT	$304.30	$358.00	$214.80–$852.12	—	15%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 TIBIA/FIBULA 2 V LT	$304.30	$358.00	$214.80–$852.12	—	15%
MR angiography (MRA) of the head without contrast CPT 70544 MRV HEAD W/O CONTRAST	$2,690.25	$3,165.00	$124.34–$2,690.25	73% above	15%
MR angiography (MRA) of the head without contrast CPT 70544 MR Exams	$2,690.25	$3,165.00	$124.34–$2,690.25	73% above	15%
MR angiography (MRA) of the head without contrast CPT 70544 MRA HEAD W/O CONTRAST	$2,690.25	$3,165.00	$124.34–$2,690.25	73% above	15%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRA HEAD W/O CONTRAST	$2,690.25	$3,165.00	$852.12–$2,690.25	—	15%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRV HEAD W/O CONTRAST	$2,690.25	$3,165.00	$852.12–$2,690.25	—	15%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 MR Exams	$2,690.25	$3,165.00	$852.12–$2,690.25	—	15%
MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 MRI HIPS BILATERAL W/O CONTRAST	$2,590.80	$3,048.00	$124.34–$2,590.80	—	15%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MR Exams	$2,593.35	$3,051.00	$124.34–$2,593.35	61% above	15%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI INCOMPLETE JOINT LOWER EXTREM	$2,593.35	$3,051.00	$124.34–$2,593.35	61% above	15%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP LIMITED W/O CONTRAST RT	$2,593.35	$3,051.00	$124.34–$2,593.35	61% above	15%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE W/O CONTRAST RT	$2,593.35	$3,051.00	$124.34–$2,593.35	61% above	15%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE W/O CONTRAST LT	$2,593.35	$3,051.00	$124.34–$2,593.35	61% above	15%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI ANKLE W/O CONTRAST LT	$2,593.35	$3,051.00	$124.34–$2,593.35	61% above	15%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI ANKLE W/O CONTRAST RT	$2,593.35	$3,051.00	$124.34–$2,593.35	61% above	15%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP W/O CONTRAST RT	$2,593.35	$3,051.00	$124.34–$2,593.35	61% above	15%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP W/O CONTRAST LT	$2,593.35	$3,051.00	$124.34–$2,593.35	61% above	15%
MRI of knee or other lower-limb joint, no contrast dye inpatient both sides CPT 73721 MRI HIPS BILATERAL W/O CONTRAST	$2,590.80	$3,048.00	$852.12–$2,590.80	—	15%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MR Exams	$2,593.35	$3,051.00	$852.12–$2,593.35	—	15%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI INCOMPLETE JOINT LOWER EXTREM	$2,593.35	$3,051.00	$852.12–$2,593.35	—	15%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI HIP W/O CONTRAST LT	$2,593.35	$3,051.00	$852.12–$2,593.35	—	15%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI ANKLE W/O CONTRAST LT	$2,593.35	$3,051.00	$852.12–$2,593.35	—	15%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI HIP W/O CONTRAST RT	$2,593.35	$3,051.00	$852.12–$2,593.35	—	15%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI HIP LIMITED W/O CONTRAST RT	$2,593.35	$3,051.00	$852.12–$2,593.35	—	15%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI KNEE W/O CONTRAST RT	$2,593.35	$3,051.00	$852.12–$2,593.35	—	15%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI ANKLE W/O CONTRAST RT	$2,593.35	$3,051.00	$852.12–$2,593.35	—	15%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI KNEE W/O CONTRAST LT	$2,593.35	$3,051.00	$852.12–$2,593.35	—	15%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI HIPS BIL W/ + W/O CONTRAST	$3,740.00	$4,400.00	$181.80–$3,740.00	49% above	15%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MR Exams	$3,744.25	$4,405.00	$181.80–$3,744.25	50% above	15%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI ANKLE W/ + W/O CONTRAST LT	$3,744.25	$4,405.00	$181.80–$3,744.25	50% above	15%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI KNEE W/ + W/O CONTRAST LT	$3,744.25	$4,405.00	$181.80–$3,744.25	50% above	15%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI KNEE W/ + W/O CONTRAST RT	$3,744.25	$4,405.00	$181.80–$3,744.25	50% above	15%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI HIP W/ + W/O CONTRAST LT	$3,744.25	$4,405.00	$181.80–$3,744.25	50% above	15%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI ANKLE W/ + W/O CONTRAST RT	$3,744.25	$4,405.00	$181.80–$3,744.25	50% above	15%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI HIP W/ + W/O CONTRAST RT	$3,744.25	$4,405.00	$181.80–$3,744.25	50% above	15%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI HIPS BIL W/ + W/O CONTRAST	$3,740.00	$4,400.00	$852.12–$3,740.00	—	15%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MR Exams	$3,744.25	$4,405.00	$852.12–$3,744.25	—	15%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI ANKLE W/ + W/O CONTRAST RT	$3,744.25	$4,405.00	$852.12–$3,744.25	—	15%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI ANKLE W/ + W/O CONTRAST LT	$3,744.25	$4,405.00	$852.12–$3,744.25	—	15%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI HIP W/ + W/O CONTRAST LT	$3,744.25	$4,405.00	$852.12–$3,744.25	—	15%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI HIP W/ + W/O CONTRAST RT	$3,744.25	$4,405.00	$852.12–$3,744.25	—	15%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI KNEE W/ + W/O CONTRAST LT	$3,744.25	$4,405.00	$852.12–$3,744.25	—	15%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI KNEE W/ + W/O CONTRAST RT	$3,744.25	$4,405.00	$852.12–$3,744.25	—	15%
MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN W/O CONTRAST	$2,455.65	$2,889.00	$124.34–$2,455.65	43% above	15%
MRI of the abdomen without contrast CPT 74181 MRI ENTEROGRAPHY ABD/PEL WO W/GLUCAGON	$2,455.65	$2,889.00	$124.34–$2,455.65	43% above	15%
MRI of the abdomen without contrast CPT 74181 MRI UROGRAPHY ABD/PEL W/O CONT	$2,455.65	$2,889.00	$124.34–$2,455.65	43% above	15%
MRI of the abdomen without contrast CPT 74181 MRI INCOMPLETE ABDOMEN	$2,455.65	$2,889.00	$124.34–$2,455.65	43% above	15%
MRI of the abdomen without contrast CPT 74181 MR Exams	$2,455.65	$2,889.00	$124.34–$2,455.65	43% above	15%
MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN (MRCP) W/O CONTRAST	$2,455.65	$2,889.00	$124.34–$2,455.65	43% above	15%
MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN (MRCP) W/O CONTRAST	$2,455.65	$2,889.00	$852.12–$2,455.65	—	15%
MRI of the abdomen without contrast inpatient CPT 74181 MRI ENTEROGRAPHY ABD/PEL WO W/GLUCAGON	$2,455.65	$2,889.00	$852.12–$2,455.65	—	15%
MRI of the abdomen without contrast inpatient CPT 74181 MRI UROGRAPHY ABD/PEL W/O CONT	$2,455.65	$2,889.00	$852.12–$2,455.65	—	15%
MRI of the abdomen without contrast inpatient CPT 74181 MRI INCOMPLETE ABDOMEN	$2,455.65	$2,889.00	$852.12–$2,455.65	—	15%
MRI of the abdomen without contrast inpatient CPT 74181 MR Exams	$2,455.65	$2,889.00	$852.12–$2,455.65	—	15%
MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN W/O CONTRAST	$2,455.65	$2,889.00	$852.12–$2,455.65	—	15%
MRI of the abdomen, without and then with contrast dye CPT 74183 MR Exams	$3,887.05	$4,573.00	$181.80–$3,887.05	24% above	15%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI UROGRAPHY ABD/PEL W/+W/O CONTRAST	$3,887.05	$4,573.00	$181.80–$3,887.05	24% above	15%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ENTEROGRAPHY ABD/PEL W+WO W/GLUCAGON	$3,887.05	$4,573.00	$181.80–$3,887.05	24% above	15%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN W/ + W/O CONTRAST	$3,887.05	$4,573.00	$181.80–$3,887.05	24% above	15%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN (MRCP) W/ + W/O CONTRAST	$3,887.05	$4,573.00	$181.80–$3,887.05	24% above	15%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MR Exams	$3,887.05	$4,573.00	$852.12–$3,887.05	—	15%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ENTEROGRAPHY ABD/PEL W+WO W/GLUCAGON	$3,887.05	$4,573.00	$852.12–$3,887.05	—	15%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI UROGRAPHY ABD/PEL W/+W/O CONTRAST	$3,887.05	$4,573.00	$852.12–$3,887.05	—	15%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABDOMEN W/ + W/O CONTRAST	$3,887.05	$4,573.00	$852.12–$3,887.05	—	15%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABDOMEN (MRCP) W/ + W/O CONTRAST	$3,887.05	$4,573.00	$852.12–$3,887.05	—	15%
MRI of the brain, no contrast dye CPT 70551 MR Exams	$2,494.75	$2,935.00	$124.34–$2,494.75	47% above	15%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O CONTRAST	$2,494.75	$2,935.00	$124.34–$2,494.75	47% above	15%
MRI of the brain, no contrast dye CPT 70551 MRI INCOMPLETE BRAIN	$2,494.75	$2,935.00	$124.34–$2,494.75	47% above	15%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI INCOMPLETE BRAIN	$2,494.75	$2,935.00	$852.12–$2,494.75	—	15%
MRI of the brain, no contrast dye inpatient CPT 70551 MR Exams	$2,494.75	$2,935.00	$852.12–$2,494.75	—	15%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN W/O CONTRAST	$2,494.75	$2,935.00	$852.12–$2,494.75	—	15%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W/ + W/O CONTRAST	$3,730.65	$4,389.00	$181.80–$3,730.65	32% above	15%
MRI of the brain, with and without contrast dye CPT 70553 MR Exams	$3,730.65	$4,389.00	$181.80–$3,730.65	32% above	15%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN W/ + W/O CONTRAST	$3,730.65	$4,389.00	$852.12–$3,730.65	—	15%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MR Exams	$3,730.65	$4,389.00	$852.12–$3,730.65	—	15%
MRI of the lower back, no contrast dye CPT 72148 MR Exams	$2,462.45	$2,897.00	$124.34–$2,462.45	36% above	15%
MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR SPINE W/O CONTRAST	$2,462.45	$2,897.00	$124.34–$2,462.45	36% above	15%
MRI of the lower back, no contrast dye CPT 72148 MRI INCOMPLETE LUMBAR SPINE	$2,462.45	$2,897.00	$124.34–$2,462.45	36% above	15%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI LUMBAR SPINE W/O CONTRAST	$2,462.45	$2,897.00	$852.12–$2,462.45	—	15%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI INCOMPLETE LUMBAR SPINE	$2,462.45	$2,897.00	$852.12–$2,462.45	—	15%
MRI of the lower back, no contrast dye inpatient CPT 72148 MR Exams	$2,462.45	$2,897.00	$852.12–$2,462.45	—	15%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI LUMBAR SPINE W/ + W/O CONTRAST	$3,730.65	$4,389.00	$181.80–$3,730.65	37% above	15%
MRI of the lower back, without and then with contrast dye CPT 72158 MR Exams	$3,730.65	$4,389.00	$181.80–$3,730.65	37% above	15%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MR Exams	$3,730.65	$4,389.00	$852.12–$3,730.65	—	15%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI LUMBAR SPINE W/ + W/O CONTRAST	$3,730.65	$4,389.00	$852.12–$3,730.65	—	15%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI INCOMPLETE THORACIC SPINE	$2,464.15	$2,899.00	$124.34–$2,464.15	45% above	15%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI THORACIC SPINE W/O CONTRAST	$2,464.15	$2,899.00	$124.34–$2,464.15	45% above	15%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MR Exams	$2,464.15	$2,899.00	$124.34–$2,464.15	45% above	15%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI THORACIC SPINE W/O CONTRAST	$2,464.15	$2,899.00	$852.12–$2,464.15	—	15%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI INCOMPLETE THORACIC SPINE	$2,464.15	$2,899.00	$852.12–$2,464.15	—	15%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MR Exams	$2,464.15	$2,899.00	$852.12–$2,464.15	—	15%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI CERVICAL SPINE W/ + W/O CONTRAST	$3,730.65	$4,389.00	$181.80–$3,730.65	32% above	15%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MR Exams	$3,730.65	$4,389.00	$181.80–$3,730.65	32% above	15%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MR Exams	$3,730.65	$4,389.00	$852.12–$3,730.65	—	15%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI CERVICAL SPINE W/ + W/O CONTRAST	$3,730.65	$4,389.00	$852.12–$3,730.65	—	15%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI INCOMPLETE CERVICAL SPINE	$2,331.55	$2,743.00	$124.34–$2,331.55	32% above	15%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI CERVICAL SPINE W/O CONTRAST	$2,331.55	$2,743.00	$124.34–$2,331.55	32% above	15%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MR Exams	$2,331.55	$2,743.00	$124.34–$2,331.55	32% above	15%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MR Exams	$2,331.55	$2,743.00	$852.12–$2,331.55	—	15%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI CERVICAL SPINE W/O CONTRAST	$2,331.55	$2,743.00	$852.12–$2,331.55	—	15%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI INCOMPLETE CERVICAL SPINE	$2,331.55	$2,743.00	$852.12–$2,331.55	—	15%
MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS W/ & W/O CONTRA	$3,817.35	$4,491.00	$181.80–$3,817.35	37% above	15%
MRI of the pelvis without and with contrast CPT 72197 MR Exams	$3,874.30	$4,558.00	$181.80–$3,874.30	39% above	15%
MRI of the pelvis without and with contrast CPT 72197 MRI PROSTATE W/ + W/O CONTRAST	$3,874.30	$4,558.00	$181.80–$3,874.30	39% above	15%
MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS W/ + W/O CONTRAST	$3,874.30	$4,558.00	$181.80–$3,874.30	39% above	15%
MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS - FIBROID PROTOCOL	$3,874.30	$4,558.00	$181.80–$3,874.30	39% above	15%
MRI of the pelvis without and with contrast CPT 72197 2390 MRI PELVIS W/ & W/O CONTRAST	$3,922.75	$4,615.00	$181.80–$3,922.75	40% above	15%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS W/ & W/O CONTRA	$3,817.35	$4,491.00	$852.12–$3,817.35	—	15%
MRI of the pelvis without and with contrast inpatient CPT 72197 MR Exams	$3,874.30	$4,558.00	$852.12–$3,874.30	—	15%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS - FIBROID PROTOCOL	$3,874.30	$4,558.00	$852.12–$3,874.30	—	15%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS W/ + W/O CONTRAST	$3,874.30	$4,558.00	$852.12–$3,874.30	—	15%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PROSTATE W/ + W/O CONTRAST	$3,874.30	$4,558.00	$852.12–$3,874.30	—	15%
MRI of the pelvis without and with contrast inpatient CPT 72197 2390 MRI PELVIS W/ & W/O CONTRAST	$3,922.75	$4,615.00	$852.12–$3,922.75	—	15%
MRI of the pelvis, no contrast dye CPT 72195 MR Exams	$2,582.30	$3,038.00	$124.34–$2,582.30	52% above	15%
MRI of the pelvis, no contrast dye CPT 72195 4817 MRI URO PELVIS W/O CONTRAST	$2,582.30	$3,038.00	$124.34–$2,582.30	52% above	15%
MRI of the pelvis, no contrast dye CPT 72195 MRI INCOMPLETE PELVIS	$2,582.30	$3,038.00	$124.34–$2,582.30	52% above	15%
MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS W/O CONTRAST	$2,582.30	$3,038.00	$124.34–$2,582.30	52% above	15%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MR Exams	$2,582.30	$3,038.00	$852.12–$2,582.30	—	15%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS W/O CONTRAST	$2,582.30	$3,038.00	$852.12–$2,582.30	—	15%
MRI of the pelvis, no contrast dye inpatient CPT 72195 4817 MRI URO PELVIS W/O CONTRAST	$2,582.30	$3,038.00	$852.12–$2,582.30	—	15%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI INCOMPLETE PELVIS	$2,582.30	$3,038.00	$852.12–$2,582.30	—	15%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MR Exams	$2,555.10	$3,006.00	$124.34–$2,555.10	36% above	15%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI INCOMPLETE JOINT UPPER EXTREM	$2,555.10	$3,006.00	$124.34–$2,555.10	36% above	15%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI WRIST W/O CONTRAST LT	$2,555.10	$3,006.00	$124.34–$2,555.10	36% above	15%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI SHOULDER W/O CONTRAST LT	$2,555.10	$3,006.00	$124.34–$2,555.10	36% above	15%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI ELBOW W/O CONTRAST RT	$2,555.10	$3,006.00	$124.34–$2,555.10	36% above	15%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI ELBOW W/O CONTRAST LT	$2,555.10	$3,006.00	$124.34–$2,555.10	36% above	15%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI SHOULDER W/O CONTRAST RT	$2,555.10	$3,006.00	$124.34–$2,555.10	36% above	15%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI WRIST W/O CONTRAST RT	$2,555.10	$3,006.00	$124.34–$2,555.10	36% above	15%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MR Exams	$2,555.10	$3,006.00	$852.12–$2,555.10	—	15%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MRI INCOMPLETE JOINT UPPER EXTREM	$2,555.10	$3,006.00	$852.12–$2,555.10	—	15%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI ELBOW W/O CONTRAST LT	$2,555.10	$3,006.00	$852.12–$2,555.10	—	15%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI ELBOW W/O CONTRAST RT	$2,555.10	$3,006.00	$852.12–$2,555.10	—	15%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI SHOULDER W/O CONTRAST LT	$2,555.10	$3,006.00	$852.12–$2,555.10	—	15%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI SHOULDER W/O CONTRAST RT	$2,555.10	$3,006.00	$852.12–$2,555.10	—	15%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI WRIST W/O CONTRAST LT	$2,555.10	$3,006.00	$852.12–$2,555.10	—	15%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI WRIST W/O CONTRAST RT	$2,555.10	$3,006.00	$852.12–$2,555.10	—	15%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 SPINE CERVICAL 4 OR 5 V 72050	$107.10	$126.00	$47.59–$177.09	62% below	15%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 SPINE CERVICAL 4 OR 5 V	$485.35	$571.00	$54.48–$485.35	71% above	15%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 SPINE CERVICAL 2 V W/ FLEX + EXT	$485.35	$571.00	$54.48–$485.35	71% above	15%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 GD Exams	$485.35	$571.00	$54.48–$485.35	71% above	15%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 SPINE CERVICAL 4 OR 5 V 72050	$107.10	$126.00	$75.60–$852.12	—	15%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 GD Exams	$485.35	$571.00	$342.60–$852.12	—	15%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 SPINE CERVICAL 4 OR 5 V	$485.35	$571.00	$342.60–$852.12	—	15%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 SPINE CERVICAL 2 V W/ FLEX + EXT	$485.35	$571.00	$342.60–$852.12	—	15%
Neck soft tissue CT scan with contrast CPT 70491 CT NECK CHEST ABD PEL W/ CONT (ORAL+IV)	$1,936.30	$2,278.00	$91.40–$1,936.30	47% above	15%
Neck soft tissue CT scan with contrast CPT 70491 CT NECK CHEST ABD PEL W/ CONT (NO ORAL)	$1,936.30	$2,278.00	$91.40–$1,936.30	47% above	15%
Neck soft tissue CT scan with contrast CPT 70491 CT Exams	$2,033.20	$2,392.00	$91.40–$2,033.20	54% above	15%
Neck soft tissue CT scan with contrast CPT 70491 CT NECK SOFT TISSUE W/ CONTRAST	$2,033.20	$2,392.00	$91.40–$2,033.20	54% above	15%
Neck soft tissue CT scan with contrast inpatient CPT 70491 CT NECK CHEST ABD PEL W/ CONT (ORAL+IV)	$1,936.30	$2,278.00	$852.12–$1,936.30	—	15%
Neck soft tissue CT scan with contrast inpatient CPT 70491 CT NECK CHEST ABD PEL W/ CONT (NO ORAL)	$1,936.30	$2,278.00	$852.12–$1,936.30	—	15%
Neck soft tissue CT scan with contrast inpatient CPT 70491 CT Exams	$2,033.20	$2,392.00	$852.12–$2,033.20	—	15%
Neck soft tissue CT scan with contrast inpatient CPT 70491 CT NECK SOFT TISSUE W/ CONTRAST	$2,033.20	$2,392.00	$852.12–$2,033.20	—	15%
Neck soft tissue CT scan without contrast CPT 70490 CT NECK CHEST ABD PEL W/O (NO ORAL+IV)	$1,271.60	$1,496.00	$54.48–$1,271.60	25% above	15%
Neck soft tissue CT scan without contrast CPT 70490 CT NECK CHEST ABD PEL W/O IV (ORAL ONLY)	$1,271.60	$1,496.00	$54.48–$1,271.60	25% above	15%
Neck soft tissue CT scan without contrast CPT 70490 CT NECK SOFT TISSUE W/O CONTRAST	$1,335.35	$1,571.00	$54.48–$1,335.35	32% above	15%
Neck soft tissue CT scan without contrast CPT 70490 CT Exams	$1,335.35	$1,571.00	$54.48–$1,335.35	32% above	15%
Neck soft tissue CT scan without contrast inpatient CPT 70490 CT NECK CHEST ABD PEL W/O IV (ORAL ONLY)	$1,271.60	$1,496.00	$852.12–$1,271.60	—	15%
Neck soft tissue CT scan without contrast inpatient CPT 70490 CT NECK CHEST ABD PEL W/O (NO ORAL+IV)	$1,271.60	$1,496.00	$852.12–$1,271.60	—	15%
Neck soft tissue CT scan without contrast inpatient CPT 70490 CT NECK SOFT TISSUE W/O CONTRAST	$1,335.35	$1,571.00	$852.12–$1,335.35	—	15%
Neck soft tissue CT scan without contrast inpatient CPT 70490 CT Exams	$1,335.35	$1,571.00	$852.12–$1,335.35	—	15%
Neck soft tissue X-ray CPT 70360 NECK SOFT TISSUE	$257.55	$303.00	$45.35–$257.55	46% above	15%
Neck soft tissue X-ray CPT 70360 GD Exams	$257.55	$303.00	$45.35–$257.55	46% above	15%
Neck soft tissue X-ray inpatient CPT 70360 NECK SOFT TISSUE	$257.55	$303.00	$181.80–$852.12	—	15%
Neck soft tissue X-ray inpatient CPT 70360 GD Exams	$257.55	$303.00	$181.80–$852.12	—	15%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM MYO MULTI SPECT W/ STRESS 78452	$3,292.05	$3,873.00	$674.67–$3,292.05	14% above	15%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM MYO MULTI SPECT PERF W/ PHARMACOLOGIC 78452	$3,292.05	$3,873.00	$674.67–$3,292.05	14% above	15%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM MYOC MLT SP THALLIUM STR/PHARMCOLOGIC	$3,385.55	$3,983.00	$674.67–$3,385.55	18% above	15%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM MYO MULTI SPECT W/ STRESS	$3,385.55	$3,983.00	$674.67–$3,385.55	18% above	15%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM MYO MULTI SPECT PERF W /PHARMACOLOGIC	$3,385.55	$3,983.00	$674.67–$3,385.55	18% above	15%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Nuclear Med Exams	$3,385.55	$3,983.00	$674.67–$3,385.55	18% above	15%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM MYO MULTI SPECT W/ STRESS 78452	$3,292.05	$3,873.00	$852.12–$3,292.05	—	15%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM MYO MULTI SPECT PERF W/ PHARMACOLOGIC 78452	$3,292.05	$3,873.00	$852.12–$3,292.05	—	15%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM MYO MULTI SPECT W/ STRESS	$3,385.55	$3,983.00	$852.12–$3,385.55	—	15%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM MYOC MLT SP THALLIUM STR/PHARMCOLOGIC	$3,385.55	$3,983.00	$852.12–$3,385.55	—	15%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 Nuclear Med Exams	$3,385.55	$3,983.00	$852.12–$3,385.55	—	15%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM MYO MULTI SPECT PERF W /PHARMACOLOGIC	$3,385.55	$3,983.00	$852.12–$3,385.55	—	15%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 NM PET/CT SKULL TO MID THIGH PI DOTA	$5,138.25	$6,045.00	$745.17–$5,779.02	7% below	15%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 Nuclear Med Exams	$5,138.25	$6,045.00	$745.17–$5,779.02	7% below	15%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 NM PET/CT SKULL TO MID THIGH PS ZR89	$5,138.25	$6,045.00	$745.17–$5,779.02	7% below	15%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 NM PET/CT SKULL TO MID THIGH PI ZR89	$5,138.25	$6,045.00	$745.17–$5,779.02	7% below	15%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 NM PET/CT SKULL TO MID THIGH PS PSMA	$5,138.25	$6,045.00	$745.17–$5,779.02	7% below	15%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 NM PET/CT SKULL TO MID THIGH PI PSMA	$5,138.25	$6,045.00	$745.17–$5,779.02	7% below	15%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 NM PET/CT SKULL TO MID THIGH PS FDG	$5,138.25	$6,045.00	$745.17–$5,779.02	7% below	15%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 NM PET/CT SKULL TO MID THIGH PI FDG	$5,138.25	$6,045.00	$745.17–$5,779.02	7% below	15%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 NM PET/CT SKULL TO MID THIGH PS DOTA	$5,138.25	$6,045.00	$745.17–$5,779.02	7% below	15%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 NM PET/CT SKULL TO MID THIGH PS	$5,138.25	$6,045.00	$745.17–$5,779.02	7% below	15%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 NM PET/CT SKULL TO MID THIGH PI	$5,138.25	$6,045.00	$745.17–$5,779.02	7% below	15%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 NM PET/CT SKULL TO MID THIGH PI DOTA	$5,138.25	$6,045.00	$852.12–$5,138.25	—	15%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 NM PET/CT SKULL TO MID THIGH PS	$5,138.25	$6,045.00	$852.12–$5,138.25	—	15%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 Nuclear Med Exams	$5,138.25	$6,045.00	$852.12–$5,138.25	—	15%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 NM PET/CT SKULL TO MID THIGH PS ZR89	$5,138.25	$6,045.00	$852.12–$5,138.25	—	15%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 NM PET/CT SKULL TO MID THIGH PI ZR89	$5,138.25	$6,045.00	$852.12–$5,138.25	—	15%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 NM PET/CT SKULL TO MID THIGH PS PSMA	$5,138.25	$6,045.00	$852.12–$5,138.25	—	15%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 NM PET/CT SKULL TO MID THIGH PI PSMA	$5,138.25	$6,045.00	$852.12–$5,138.25	—	15%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 NM PET/CT SKULL TO MID THIGH PI	$5,138.25	$6,045.00	$852.12–$5,138.25	—	15%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 NM PET/CT SKULL TO MID THIGH PS FDG	$5,138.25	$6,045.00	$852.12–$5,138.25	—	15%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 NM PET/CT SKULL TO MID THIGH PI FDG	$5,138.25	$6,045.00	$852.12–$5,138.25	—	15%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 NM PET/CT SKULL TO MID THIGH PS DOTA	$5,138.25	$6,045.00	$852.12–$5,138.25	—	15%
Pelvic CT scan without contrast CPT 72192 CT CYSTOGRAM	$1,278.40	$1,504.00	$54.48–$1,278.40	30% above	15%
Pelvic CT scan without contrast CPT 72192 CT PELVIS W/O IV CONTRAST (ORAL ONLY)	$1,366.80	$1,608.00	$54.48–$1,366.80	39% above	15%
Pelvic CT scan without contrast CPT 72192 CT Exams	$1,366.80	$1,608.00	$54.48–$1,366.80	39% above	15%
Pelvic CT scan without contrast CPT 72192 CT PELVIS W/O CONTRAST (NO ORAL-NO IV)	$1,366.80	$1,608.00	$54.48–$1,366.80	39% above	15%
Pelvic CT scan without contrast inpatient CPT 72192 CT CYSTOGRAM	$1,278.40	$1,504.00	$852.12–$1,278.40	—	15%
Pelvic CT scan without contrast inpatient CPT 72192 CT PELVIS W/O CONTRAST (NO ORAL-NO IV)	$1,366.80	$1,608.00	$852.12–$1,366.80	—	15%
Pelvic CT scan without contrast inpatient CPT 72192 CT Exams	$1,366.80	$1,608.00	$852.12–$1,366.80	—	15%
Pelvic CT scan without contrast inpatient CPT 72192 CT PELVIS W/O IV CONTRAST (ORAL ONLY)	$1,366.80	$1,608.00	$852.12–$1,366.80	—	15%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US Exams	$414.80	$488.00	$54.48–$414.80	23% above	15%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US FOLLICULAR	$414.80	$488.00	$54.48–$414.80	23% above	15%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIS SOFT TISSUE	$414.80	$488.00	$54.48–$414.80	23% above	15%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 Echography pelvic nonobstetric Bscan real time w image documentation limited or fu eg for follicles	$414.80	$488.00	$54.48–$414.80	23% above	15%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US BLADDER	$414.80	$488.00	$54.48–$414.80	23% above	15%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US Exams	$414.80	$488.00	$292.80–$852.12	—	15%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US FOLLICULAR	$414.80	$488.00	$292.80–$852.12	—	15%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIS SOFT TISSUE	$414.80	$488.00	$292.80–$852.12	—	15%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 Echography pelvic nonobstetric Bscan real time w image documentation limited or fu eg for follicles	$414.80	$488.00	$292.80–$852.12	—	15%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US BLADDER	$414.80	$488.00	$292.80–$852.12	—	15%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US Pelvis Complete 76856	$236.30	$278.00	$54.48–$247.98	58% below	15%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US Exams	$756.50	$890.00	$54.48–$756.50	36% above	15%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 94608 US PELVIS	$756.50	$890.00	$54.48–$756.50	36% above	15%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIS	$756.50	$890.00	$54.48–$756.50	36% above	15%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US Pelvis Complete 76856	$236.30	$278.00	$166.80–$852.12	—	15%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 94608 US PELVIS	$756.50	$890.00	$534.00–$852.12	—	15%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US Exams	$756.50	$890.00	$534.00–$852.12	—	15%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIS	$756.50	$890.00	$534.00–$852.12	—	15%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB >=14 weeks Single Fetus 76805	$304.30	$358.00	$54.48–$304.30	46% below	15%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US Exams	$717.40	$844.00	$54.48–$717.40	28% above	15%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB COMPLETE	$717.40	$844.00	$54.48–$717.40	28% above	15%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB COMPLETE-	$717.40	$844.00	$54.48–$717.40	28% above	15%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB >=14 weeks Single Fetus 76805	$304.30	$358.00	$214.80–$852.12	—	15%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US Exams	$717.40	$844.00	$506.40–$852.12	—	15%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB COMPLETE	$717.40	$844.00	$506.40–$852.12	—	15%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB COMPLETE-	$717.40	$844.00	$506.40–$852.12	—	15%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB 1ST TRIMESTER	$665.55	$783.00	$54.48–$665.55	20% above	15%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US Exams	$665.55	$783.00	$54.48–$665.55	20% above	15%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB <14 weeks Single Fetus 76801	$665.55	$783.00	$54.48–$665.55	20% above	15%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB 1ST TRIMESTER TWINS-	$665.55	$783.00	$54.48–$665.55	20% above	15%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB 1ST TRIMESTER-	$665.55	$783.00	$54.48–$665.55	20% above	15%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB 1ST TRIMESTER QUADS-	$665.55	$783.00	$54.48–$665.55	20% above	15%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB 1ST TRIMESTER TRIPLETS	$665.55	$783.00	$54.48–$665.55	20% above	15%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB 1ST TRIMESTER TWINS	$665.55	$783.00	$54.48–$665.55	20% above	15%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB 1ST TRIMESTER QUADS	$665.55	$783.00	$54.48–$665.55	20% above	15%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OB 1ST TRIMESTER TWINS	$665.55	$783.00	$469.80–$852.12	—	15%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US Exams	$665.55	$783.00	$469.80–$852.12	—	15%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OB <14 weeks Single Fetus 76801	$665.55	$783.00	$469.80–$852.12	—	15%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OB 1ST TRIMESTER	$665.55	$783.00	$469.80–$852.12	—	15%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OB 1ST TRIMESTER QUADS	$665.55	$783.00	$469.80–$852.12	—	15%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OB 1ST TRIMESTER QUADS-	$665.55	$783.00	$469.80–$852.12	—	15%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OB 1ST TRIMESTER TRIPLETS	$665.55	$783.00	$469.80–$852.12	—	15%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OB 1ST TRIMESTER TWINS-	$665.55	$783.00	$469.80–$852.12	—	15%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OB 1ST TRIMESTER-	$665.55	$783.00	$469.80–$852.12	—	15%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB Limited 1+ Fetus 76815	$182.75	$215.00	$54.48–$182.75	43% below	15%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Echography pregnant uterus Bscan andor real time w image documentation limited fetal size heart bea	$583.95	$687.00	$54.48–$583.95	82% above	15%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB LIMITED-	$583.95	$687.00	$54.48–$583.95	82% above	15%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB LIMITED W/ BIOMETRY	$583.95	$687.00	$54.48–$583.95	82% above	15%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB LIMITED	$583.95	$687.00	$54.48–$583.95	82% above	15%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US Exams	$583.95	$687.00	$54.48–$583.95	82% above	15%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB Limited 1+ Fetus 76815	$182.75	$215.00	$129.00–$852.12	—	15%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB LIMITED W/ BIOMETRY	$583.95	$687.00	$412.20–$852.12	—	15%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 Echography pregnant uterus Bscan andor real time w image documentation limited fetal size heart bea	$583.95	$687.00	$412.20–$852.12	—	15%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB LIMITED-	$583.95	$687.00	$412.20–$852.12	—	15%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US Exams	$583.95	$687.00	$412.20–$852.12	—	15%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB LIMITED	$583.95	$687.00	$412.20–$852.12	—	15%
Rib X-ray, one side, 2 views CPT 71100 GD Exams	$311.10	$366.00	$45.35–$311.10	57% above	15%
Rib X-ray, one side, 2 views one side CPT 71100 RIBS 2 V UNI RT	$311.10	$366.00	$45.35–$311.10	57% above	15%
Rib X-ray, one side, 2 views one side CPT 71100 RIBS 2 V UNI LT	$311.10	$366.00	$45.35–$311.10	57% above	15%
Rib X-ray, one side, 2 views inpatient CPT 71100 GD Exams	$311.10	$366.00	$219.60–$852.12	—	15%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 RIBS 2 V UNI RT	$311.10	$366.00	$219.60–$852.12	—	15%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 RIBS 2 V UNI LT	$311.10	$366.00	$219.60–$852.12	—	15%
Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 GD Exams	$455.60	$536.00	$54.48–$455.60	94% above	15%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 RIBS MIN 2V LT W/1V CHEST	$455.60	$536.00	$54.48–$455.60	94% above	15%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 RIBS MIN 2V RT W/1V CHEST	$455.60	$536.00	$54.48–$455.60	94% above	15%
Rib X-ray, one side, with a chest view, 3 or more views inpatient CPT 71101 GD Exams	$455.60	$536.00	$321.60–$852.12	—	15%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 RIBS MIN 2V RT W/1V CHEST	$455.60	$536.00	$321.60–$852.12	—	15%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 RIBS MIN 2V LT W/1V CHEST	$455.60	$536.00	$321.60–$852.12	—	15%
Screening mammogram, both breasts both sides CPT 77067 MA FFD MAMM SCREEN BILATERAL	$320.45	$377.00	$61.60–$320.45	—	15%
Screening mammogram, both breasts CPT 77067 MA Exams	$320.45	$377.00	$61.60–$320.45	12% above	15%
Screening mammogram, both breasts CPT 77067 MA MAMM 3D SCREENING BIL	$320.45	$377.00	$61.60–$320.45	12% above	15%
Screening mammogram, both breasts one side CPT 77067 MA FFD MAMM SCREEN LT UNI	$320.45	$377.00	$61.60–$320.45	12% above	15%
Screening mammogram, both breasts one side CPT 77067 MA MAMM 3D SCREENING RT	$320.45	$377.00	$61.60–$320.45	12% above	15%
Screening mammogram, both breasts one side CPT 77067 MA MAMM 3D SCREENING LT	$320.45	$377.00	$61.60–$320.45	12% above	15%
Screening mammogram, both breasts one side CPT 77067 MA FFD MAMM SCREEN RT UNI	$320.45	$377.00	$61.60–$320.45	12% above	15%
Screening mammogram, both breasts inpatient both sides CPT 77067 MA FFD MAMM SCREEN BILATERAL	$320.45	$377.00	$226.20–$852.12	—	15%
Screening mammogram, both breasts inpatient CPT 77067 MA Exams	$320.45	$377.00	$226.20–$852.12	—	15%
Screening mammogram, both breasts inpatient CPT 77067 MA MAMM 3D SCREENING BIL	$320.45	$377.00	$226.20–$852.12	—	15%
Screening mammogram, both breasts inpatient one side CPT 77067 MA FFD MAMM SCREEN LT UNI	$320.45	$377.00	$226.20–$852.12	—	15%
Screening mammogram, both breasts inpatient one side CPT 77067 MA MAMM 3D SCREENING LT	$320.45	$377.00	$226.20–$852.12	—	15%
Screening mammogram, both breasts inpatient one side CPT 77067 MA MAMM 3D SCREENING RT	$320.45	$377.00	$226.20–$852.12	—	15%
Screening mammogram, both breasts inpatient one side CPT 77067 MA FFD MAMM SCREEN RT UNI	$320.45	$377.00	$226.20–$852.12	—	15%
Shoulder X-ray, complete, 2 or more views both sides CPT 73030 SHOULDER COMP MIN 2 V EA BILAT 73030	$78.20	$92.00	$34.75–$147.41	—	15%
Shoulder X-ray, complete, 2 or more views both sides CPT 73030 SHOULDER COMP MIN 2 V BILATERAL	$351.90	$414.00	$45.35–$351.90	—	15%
Shoulder X-ray, complete, 2 or more views CPT 73030 GD Exams	$351.90	$414.00	$45.35–$351.90	74% above	15%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER COMPLETE MIN 2 V RT 73030	$70.55	$83.00	$31.35–$147.41	65% below	15%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER COMPLETE MIN 2 V LT 73030	$70.55	$83.00	$31.35–$147.41	65% below	15%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER COMPLETE MIN 2 V RT	$351.90	$414.00	$45.35–$351.90	74% above	15%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER COMPLETE MIN 2 V LT	$351.90	$414.00	$45.35–$351.90	74% above	15%
Shoulder X-ray, complete, 2 or more views inpatient both sides CPT 73030 SHOULDER COMP MIN 2 V EA BILAT 73030	$78.20	$92.00	$55.20–$852.12	—	15%
Shoulder X-ray, complete, 2 or more views inpatient both sides CPT 73030 SHOULDER COMP MIN 2 V BILATERAL	$351.90	$414.00	$248.40–$852.12	—	15%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 GD Exams	$351.90	$414.00	$248.40–$852.12	—	15%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 SHOULDER COMPLETE MIN 2 V RT 73030	$70.55	$83.00	$49.80–$852.12	—	15%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 SHOULDER COMPLETE MIN 2 V LT 73030	$70.55	$83.00	$49.80–$852.12	—	15%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 SHOULDER COMPLETE MIN 2 V LT	$351.90	$414.00	$248.40–$852.12	—	15%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 SHOULDER COMPLETE MIN 2 V RT	$351.90	$414.00	$248.40–$852.12	—	15%
Sinus X-ray, complete, 3 or more views CPT 70220 SINUSES COMPLETE MIN 3 V	$368.90	$434.00	$45.35–$368.90	61% above	15%
Sinus X-ray, complete, 3 or more views CPT 70220 GD Exams	$368.90	$434.00	$45.35–$368.90	61% above	15%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 SINUSES COMPLETE MIN 3 V	$368.90	$434.00	$260.40–$852.12	—	15%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 GD Exams	$368.90	$434.00	$260.40–$852.12	—	15%
Skull X-ray, fewer than 4 views CPT 70250 GD Exams	$328.95	$387.00	$54.48–$328.95	59% above	15%
Skull X-ray, fewer than 4 views CPT 70250 SKULL < 4 V	$328.95	$387.00	$54.48–$328.95	59% above	15%
Skull X-ray, fewer than 4 views inpatient CPT 70250 SKULL < 4 V	$328.95	$387.00	$232.20–$852.12	—	15%
Skull X-ray, fewer than 4 views inpatient CPT 70250 GD Exams	$328.95	$387.00	$232.20–$852.12	—	15%
Sleep study in a lab (polysomnography) CPT 95810 POLYSOM 6/> YRS 4/> PARAM 95810	$3,589.55	$4,223.00	$447.51–$3,589.55	11% above	15%
Sleep study in a lab (polysomnography) CPT 95810 PSG Study Reduced Serv (C)	$3,589.55	$4,223.00	$447.51–$3,589.55	11% above	15%
Sleep study in a lab (polysomnography) CPT 95810 PSG Study (C)	$3,589.55	$4,223.00	$447.51–$3,589.55	11% above	15%
Sleep study in a lab (polysomnography) CPT 95810 Polysom 6/> Yrs 4/> par RDC 95810	$3,589.55	$4,223.00	$447.51–$3,589.55	11% above	15%
Sleep study in a lab (polysomnography) inpatient CPT 95810 PSG Study Reduced Serv (C)	$3,589.55	$4,223.00	$852.12–$3,589.55	—	15%
Sleep study in a lab (polysomnography) inpatient CPT 95810 PSG Study (C)	$3,589.55	$4,223.00	$852.12–$3,589.55	—	15%
Sleep study in a lab (polysomnography) inpatient CPT 95810 Polysom 6/> Yrs 4/> par RDC 95810	$3,589.55	$4,223.00	$852.12–$3,589.55	—	15%
Sleep study in a lab (polysomnography) inpatient CPT 95810 POLYSOM 6/> YRS 4/> PARAM 95810	$3,589.55	$4,223.00	$852.12–$3,589.55	—	15%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 303 ECHO FOR STRESS ABORT	$1,513.00	$1,780.00	$284.75–$1,513.00	28% above	15%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 Stress TTE Complete Rdc	$1,513.00	$1,780.00	$284.75–$1,513.00	28% above	15%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 Stress Echo (Rest - Stress & Cont EKG) 93351	$1,604.80	$1,888.00	$284.75–$1,604.80	36% above	15%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 zzCardiac Echocardiogram w/Stress	$1,828.35	$2,151.00	$284.75–$1,828.35	55% above	15%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 zzDobut Stress Panel Aborted (chg)	$1,828.35	$2,151.00	$284.75–$1,828.35	55% above	15%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 zzExercise Stress Echo Panel (chg)	$1,828.35	$2,151.00	$284.75–$1,828.35	55% above	15%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 zzExer Stress Panel Aborted (chg)	$1,828.35	$2,151.00	$284.75–$1,828.35	55% above	15%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 Stress TTE Complete	$1,828.35	$2,151.00	$284.75–$1,828.35	55% above	15%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 304 ECHO FOR STRESS	$1,915.05	$2,253.00	$284.75–$1,915.05	62% above	15%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 303 ECHO FOR STRESS ABORT	$1,513.00	$1,780.00	$852.12–$1,513.00	—	15%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 Stress TTE Complete Rdc	$1,513.00	$1,780.00	$852.12–$1,513.00	—	15%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 Stress Echo (Rest - Stress & Cont EKG) 93351	$1,604.80	$1,888.00	$852.12–$1,604.80	—	15%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 zzCardiac Echocardiogram w/Stress	$1,828.35	$2,151.00	$852.12–$1,828.35	—	15%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 Stress TTE Complete	$1,828.35	$2,151.00	$852.12–$1,828.35	—	15%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 zzDobut Stress Panel Aborted (chg)	$1,828.35	$2,151.00	$852.12–$1,828.35	—	15%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 zzExer Stress Panel Aborted (chg)	$1,828.35	$2,151.00	$852.12–$1,828.35	—	15%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 zzExercise Stress Echo Panel (chg)	$1,828.35	$2,151.00	$852.12–$1,828.35	—	15%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 304 ECHO FOR STRESS	$1,915.05	$2,253.00	$852.12–$1,915.05	—	15%
Swallow study (modified barium swallow, video X-ray) CPT 74230 GD Exams	$658.75	$775.00	$91.40–$740.88	75% above	15%
Swallow study (modified barium swallow, video X-ray) CPT 74230 VIDEO FLUOROSCOPY W/ SPEECH PATH	$658.75	$775.00	$91.40–$740.88	75% above	15%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 VIDEO FLUOROSCOPY W/ SPEECH PATH	$658.75	$775.00	$465.00–$852.12	—	15%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 GD Exams	$658.75	$775.00	$465.00–$852.12	—	15%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 GD Exams	$312.80	$368.00	$45.35–$312.80	46% above	15%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 FEMUR 2 V LT 73552	$73.10	$86.00	$32.48–$147.41	66% below	15%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 FEMUR 2 V RT 73552	$73.10	$86.00	$32.48–$147.41	66% below	15%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 FEMUR 2 V LT	$312.80	$368.00	$45.35–$312.80	46% above	15%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 FEMUR 2 V RT	$312.80	$368.00	$45.35–$312.80	46% above	15%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 GD Exams	$312.80	$368.00	$220.80–$852.12	—	15%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 FEMUR 2 V LT 73552	$73.10	$86.00	$51.60–$852.12	—	15%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 FEMUR 2 V RT 73552	$73.10	$86.00	$51.60–$852.12	—	15%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 FEMUR 2 V RT	$312.80	$368.00	$220.80–$852.12	—	15%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 FEMUR 2 V LT	$312.80	$368.00	$220.80–$852.12	—	15%
Thoracic spine (mid back) CT scan without contrast CPT 72128 Reduced Svc CT Thor Spine w/o	$1,554.65	$1,829.00	$54.48–$1,554.65	53% above	15%
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT Exams	$1,554.65	$1,829.00	$54.48–$1,554.65	53% above	15%
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT THORACIC SPINE W/O CONTRAST	$1,554.65	$1,829.00	$54.48–$1,554.65	53% above	15%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT Exams	$1,554.65	$1,829.00	$852.12–$1,554.65	—	15%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT THORACIC SPINE W/O CONTRAST	$1,554.65	$1,829.00	$852.12–$1,554.65	—	15%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 Reduced Svc CT Thor Spine w/o	$1,554.65	$1,829.00	$852.12–$1,554.65	—	15%
Toe X-ray, 2 or more views CPT 73660 GD Exams	$296.65	$349.00	$45.35–$296.65	136% above	15%
Toe X-ray, 2 or more views one side CPT 73660 TOE MIN 2 V RT 73660	$60.35	$71.00	$26.82–$147.41	52% below	15%
Toe X-ray, 2 or more views one side CPT 73660 TOE MIN 2 V LT 73660	$60.35	$71.00	$26.82–$147.41	52% below	15%
Toe X-ray, 2 or more views one side CPT 73660 TOE MIN 2 V LT	$296.65	$349.00	$45.35–$296.65	136% above	15%
Toe X-ray, 2 or more views one side CPT 73660 TOE MIN 2 V RT	$296.65	$349.00	$45.35–$296.65	136% above	15%
Toe X-ray, 2 or more views inpatient CPT 73660 GD Exams	$296.65	$349.00	$209.40–$852.12	—	15%
Toe X-ray, 2 or more views inpatient one side CPT 73660 TOE MIN 2 V LT 73660	$60.35	$71.00	$42.60–$852.12	—	15%
Toe X-ray, 2 or more views inpatient one side CPT 73660 TOE MIN 2 V RT 73660	$60.35	$71.00	$42.60–$852.12	—	15%
Toe X-ray, 2 or more views inpatient one side CPT 73660 TOE MIN 2 V RT	$296.65	$349.00	$209.40–$852.12	—	15%
Toe X-ray, 2 or more views inpatient one side CPT 73660 TOE MIN 2 V LT	$296.65	$349.00	$209.40–$852.12	—	15%
Transvaginal pelvic ultrasound CPT 76830 US Pelvis Non-OB 76830	$269.45	$317.00	$54.48–$295.20	50% below	15%
Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL NON OB W/ DOPPLER	$691.90	$814.00	$54.48–$691.90	29% above	15%
Transvaginal pelvic ultrasound CPT 76830 US Exams	$691.90	$814.00	$54.48–$691.90	29% above	15%
Transvaginal pelvic ultrasound CPT 76830 4611 US TRANSVAGINAL NON OB	$703.80	$828.00	$54.48–$703.80	31% above	15%
Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL NON OB	$893.35	$1,051.00	$54.48–$893.35	66% above	15%
Transvaginal pelvic ultrasound inpatient CPT 76830 US Pelvis Non-OB 76830	$269.45	$317.00	$190.20–$852.12	—	15%
Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL NON OB W/ DOPPLER	$691.90	$814.00	$488.40–$852.12	—	15%
Transvaginal pelvic ultrasound inpatient CPT 76830 US Exams	$691.90	$814.00	$488.40–$852.12	—	15%
Transvaginal pelvic ultrasound inpatient CPT 76830 4611 US TRANSVAGINAL NON OB	$703.80	$828.00	$496.80–$852.12	—	15%
Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL NON OB	$893.35	$1,051.00	$630.60–$893.35	—	15%
Transvaginal ultrasound during pregnancy CPT 76817 US OB Transvaginal Pro 76817	$209.10	$246.00	$54.48–$209.10	52% below	15%
Transvaginal ultrasound during pregnancy CPT 76817 US OB Transvaginal 76817	$209.10	$246.00	$54.48–$209.10	52% below	15%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US OB Transvaginal Pro 76817	$209.10	$246.00	$147.60–$852.12	—	15%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US OB Transvaginal 76817	$209.10	$246.00	$147.60–$852.12	—	15%
Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN COMPLETE	$903.55	$1,063.00	$54.48–$903.55	36% above	15%
Ultrasound of the abdomen, complete CPT 76700 US Exams	$903.55	$1,063.00	$54.48–$903.55	36% above	15%
Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMEN COMPLETE	$903.55	$1,063.00	$637.80–$903.55	—	15%
Ultrasound of the abdomen, complete inpatient CPT 76700 US Exams	$903.55	$1,063.00	$637.80–$903.55	—	15%
Ultrasound of the scrotum and testicles CPT 76870 US Exams	$742.90	$874.00	$54.48–$742.90	42% above	15%
Ultrasound of the scrotum and testicles CPT 76870 US TESTICULAR/SCROTUM W/ DOPPLER	$742.90	$874.00	$54.48–$742.90	42% above	15%
Ultrasound of the scrotum and testicles CPT 76870 4612 US TESTICULAR/SCROTUM	$751.40	$884.00	$54.48–$751.40	43% above	15%
Ultrasound of the scrotum and testicles CPT 76870 US TESTICULAR/SCROTUM	$893.35	$1,051.00	$54.48–$893.35	70% above	15%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US Exams	$742.90	$874.00	$524.40–$852.12	—	15%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US TESTICULAR/SCROTUM W/ DOPPLER	$742.90	$874.00	$524.40–$852.12	—	15%
Ultrasound of the scrotum and testicles inpatient CPT 76870 4612 US TESTICULAR/SCROTUM	$751.40	$884.00	$530.40–$852.12	—	15%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US TESTICULAR/SCROTUM	$893.35	$1,051.00	$630.60–$893.35	—	15%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US THYROID	$695.30	$818.00	$54.48–$695.30	46% above	15%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US HEAD SOFT TISSUE	$695.30	$818.00	$54.48–$695.30	46% above	15%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Exams	$695.30	$818.00	$54.48–$695.30	46% above	15%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US NECK SOFT TISSUE	$695.30	$818.00	$54.48–$695.30	46% above	15%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US HEAD SOFT TISSUE	$695.30	$818.00	$490.80–$852.12	—	15%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US THYROID	$695.30	$818.00	$490.80–$852.12	—	15%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US Exams	$695.30	$818.00	$490.80–$852.12	—	15%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US NECK SOFT TISSUE	$695.30	$818.00	$490.80–$852.12	—	15%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 UPPER GI WITH SM BOWEL	$531.25	$625.00	$91.40–$597.43	32% above	15%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 UPPER GI/ESOPHAGRAM W/ SMALL BOWEL	$659.60	$776.00	$91.40–$659.60	64% above	15%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 UPPER GI W/ ESOPHAGRAM	$659.60	$776.00	$91.40–$659.60	64% above	15%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 1448 UPPER GI/ESOPHAGRAM	$659.60	$776.00	$91.40–$659.60	64% above	15%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 UPPER GI	$659.60	$776.00	$91.40–$659.60	64% above	15%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 GD Exams	$659.60	$776.00	$91.40–$659.60	64% above	15%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 UPPER GI WITH SM BOWEL	$531.25	$625.00	$375.00–$852.12	—	15%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 UPPER GI/ESOPHAGRAM W/ SMALL BOWEL	$659.60	$776.00	$465.60–$852.12	—	15%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 UPPER GI W/ ESOPHAGRAM	$659.60	$776.00	$465.60–$852.12	—	15%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 UPPER GI	$659.60	$776.00	$465.60–$852.12	—	15%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 GD Exams	$659.60	$776.00	$465.60–$852.12	—	15%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 1448 UPPER GI/ESOPHAGRAM	$659.60	$776.00	$465.60–$852.12	—	15%
Upper arm X-ray (humerus), 2 views CPT 73060 GD Exams	$278.80	$328.00	$45.35–$278.80	52% above	15%
Upper arm X-ray (humerus), 2 views one side CPT 73060 HUMERUS MIN 2 V RT 73060	$67.15	$79.00	$29.84–$147.41	63% below	15%
Upper arm X-ray (humerus), 2 views one side CPT 73060 HUMERUS MIN 2 V LT 73060	$67.15	$79.00	$29.84–$147.41	63% below	15%
Upper arm X-ray (humerus), 2 views one side CPT 73060 HUMERUS MIN 2 V LT	$278.80	$328.00	$45.35–$278.80	52% above	15%
Upper arm X-ray (humerus), 2 views one side CPT 73060 HUMERUS MIN 2 V RT	$278.80	$328.00	$45.35–$278.80	52% above	15%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 GD Exams	$278.80	$328.00	$196.80–$852.12	—	15%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 HUMERUS MIN 2 V LT 73060	$67.15	$79.00	$47.40–$852.12	—	15%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 HUMERUS MIN 2 V RT 73060	$67.15	$79.00	$47.40–$852.12	—	15%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 HUMERUS MIN 2 V LT	$278.80	$328.00	$196.80–$852.12	—	15%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 HUMERUS MIN 2 V RT	$278.80	$328.00	$196.80–$852.12	—	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 USV Exams	$492.15	$579.00	$54.48–$492.15	7% below	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 Duplex scan of extremity veins including responses to compression and other maneuvers	$843.20	$992.00	$54.48–$843.20	59% above	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 USV CALF REFLUX STUDY RT	$492.15	$579.00	$54.48–$492.15	7% below	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 USV CALF REFLUX STUDY LT	$492.15	$579.00	$54.48–$492.15	7% below	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 USV LOWER EXT VEIN RT 93971	$843.20	$992.00	$54.48–$843.20	59% above	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 USV UPPER EXT VEIN LT 93971	$843.20	$992.00	$54.48–$843.20	59% above	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 USV UPPER EXT VEIN RT 93971	$843.20	$992.00	$54.48–$843.20	59% above	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 USV VEIN MAPPING RT LEG	$843.20	$992.00	$54.48–$843.20	59% above	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 USV VEIN MAPPING RT ARM	$843.20	$992.00	$54.48–$843.20	59% above	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Dup-Scan Xtr Veins Unilateral/Limited Study 93971	$843.20	$992.00	$54.48–$843.20	59% above	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 USV VEIN MAPPING LT LEG	$843.20	$992.00	$54.48–$843.20	59% above	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 USV VEIN MAPPING LT ARM	$843.20	$992.00	$54.48–$843.20	59% above	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 USV UPPER EXT VEIN LT	$843.20	$992.00	$54.48–$843.20	59% above	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 USV CALF REFLUX STUDY LT 93971	$843.20	$992.00	$54.48–$843.20	59% above	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 USV CALF REFLUX STUDY RT 93971	$843.20	$992.00	$54.48–$843.20	59% above	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 USV LOWER EXT VEIN LT 93971	$843.20	$992.00	$54.48–$843.20	59% above	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 USV LOWER EXT VEIN RT	$843.20	$992.00	$54.48–$843.20	59% above	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 USV UPPER EXT VEIN RT	$843.20	$992.00	$54.48–$843.20	59% above	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 USV LOWER EXT VEIN LT	$843.20	$992.00	$54.48–$843.20	59% above	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 USV Exams	$492.15	$579.00	$347.40–$852.12	—	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 Duplex scan of extremity veins including responses to compression and other maneuvers	$843.20	$992.00	$595.20–$852.12	—	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 USV CALF REFLUX STUDY RT	$492.15	$579.00	$347.40–$852.12	—	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 USV CALF REFLUX STUDY LT	$492.15	$579.00	$347.40–$852.12	—	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 USV UPPER EXT VEIN LT 93971	$843.20	$992.00	$595.20–$852.12	—	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 USV LOWER EXT VEIN RT 93971	$843.20	$992.00	$595.20–$852.12	—	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 USV LOWER EXT VEIN LT 93971	$843.20	$992.00	$595.20–$852.12	—	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 USV CALF REFLUX STUDY RT 93971	$843.20	$992.00	$595.20–$852.12	—	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 USV CALF REFLUX STUDY LT 93971	$843.20	$992.00	$595.20–$852.12	—	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 USV VEIN MAPPING RT LEG	$843.20	$992.00	$595.20–$852.12	—	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 Dup-Scan Xtr Veins Unilateral/Limited Study 93971	$843.20	$992.00	$595.20–$852.12	—	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 USV LOWER EXT VEIN LT	$843.20	$992.00	$595.20–$852.12	—	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 USV LOWER EXT VEIN RT	$843.20	$992.00	$595.20–$852.12	—	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 USV UPPER EXT VEIN LT	$843.20	$992.00	$595.20–$852.12	—	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 USV UPPER EXT VEIN RT	$843.20	$992.00	$595.20–$852.12	—	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 USV VEIN MAPPING LT ARM	$843.20	$992.00	$595.20–$852.12	—	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 USV VEIN MAPPING LT LEG	$843.20	$992.00	$595.20–$852.12	—	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 USV VEIN MAPPING RT ARM	$843.20	$992.00	$595.20–$852.12	—	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 USV UPPER EXT VEIN RT 93971	$843.20	$992.00	$595.20–$852.12	—	15%
Wrist X-ray, 2 views CPT 73100 GD Exams	$278.80	$328.00	$45.35–$278.80	99% above	15%
Wrist X-ray, 2 views one side CPT 73100 WRIST 2 V LT 73100	$69.70	$82.00	$30.97–$176.42	50% below	15%
Wrist X-ray, 2 views one side CPT 73100 WRIST 2 V RT 73100	$69.70	$82.00	$30.97–$176.42	50% below	15%
Wrist X-ray, 2 views one side CPT 73100 WRIST 2 V LT	$278.80	$328.00	$45.35–$278.80	99% above	15%
Wrist X-ray, 2 views one side CPT 73100 WRIST 2 V RT	$278.80	$328.00	$45.35–$278.80	99% above	15%
Wrist X-ray, 2 views inpatient CPT 73100 GD Exams	$278.80	$328.00	$196.80–$852.12	—	15%
Wrist X-ray, 2 views inpatient one side CPT 73100 WRIST 2 V LT 73100	$69.70	$82.00	$49.20–$852.12	—	15%
Wrist X-ray, 2 views inpatient one side CPT 73100 WRIST 2 V RT 73100	$69.70	$82.00	$49.20–$852.12	—	15%
Wrist X-ray, 2 views inpatient one side CPT 73100 WRIST 2 V LT	$278.80	$328.00	$196.80–$852.12	—	15%
Wrist X-ray, 2 views inpatient one side CPT 73100 WRIST 2 V RT	$278.80	$328.00	$196.80–$852.12	—	15%
Wrist X-ray, complete, 3 or more views both sides CPT 73110 WRIST COMP MIN 3 V BILAT 73110	$164.90	$194.00	$45.35–$164.90	—	15%
Wrist X-ray, complete, 3 or more views both sides CPT 73110 WRIST COMP MIN 3 V BILAT	$351.90	$414.00	$45.35–$351.90	—	15%
Wrist X-ray, complete, 3 or more views CPT 73110 GD Exams	$351.90	$414.00	$45.35–$351.90	83% above	15%
Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST COMP MIN 3 V LT 73110	$83.30	$98.00	$37.01–$147.41	57% below	15%
Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST COMP MIN 3 V RT 73110	$83.30	$98.00	$37.01–$147.41	57% below	15%
Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST COMP MIN 3 V LT	$351.90	$414.00	$45.35–$351.90	83% above	15%
Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST COMP MIN 3 V RT	$351.90	$414.00	$45.35–$351.90	83% above	15%
Wrist X-ray, complete, 3 or more views inpatient both sides CPT 73110 WRIST COMP MIN 3 V BILAT 73110	$164.90	$194.00	$116.40–$852.12	—	15%
Wrist X-ray, complete, 3 or more views inpatient both sides CPT 73110 WRIST COMP MIN 3 V BILAT	$351.90	$414.00	$248.40–$852.12	—	15%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 GD Exams	$351.90	$414.00	$248.40–$852.12	—	15%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 WRIST COMP MIN 3 V RT 73110	$83.30	$98.00	$58.80–$852.12	—	15%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 WRIST COMP MIN 3 V LT 73110	$83.30	$98.00	$58.80–$852.12	—	15%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 WRIST COMP MIN 3 V LT	$351.90	$414.00	$248.40–$852.12	—	15%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 WRIST COMP MIN 3 V RT	$351.90	$414.00	$248.40–$852.12	—	15%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 GD Exams	$332.35	$391.00	$45.35–$332.35	63% above	15%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP COMPLETE MIN 2 V RT 73502	$96.05	$113.00	$42.68–$147.41	53% below	15%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP COMPLETE MIN 2 V LT 73502	$96.05	$113.00	$42.68–$147.41	53% below	15%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP 1V RT W/PELVIS 1 V	$238.85	$281.00	$45.35–$238.85	17% above	15%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP 1V LT W/PELVIS 1 V	$238.85	$281.00	$45.35–$238.85	17% above	15%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP COMPLETE MIN 2 V LT	$332.35	$391.00	$45.35–$332.35	63% above	15%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP COMPLETE MIN 2 V RT	$332.35	$391.00	$45.35–$332.35	63% above	15%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 GD Exams	$332.35	$391.00	$234.60–$852.12	—	15%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP COMPLETE MIN 2 V LT 73502	$96.05	$113.00	$67.80–$852.12	—	15%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP COMPLETE MIN 2 V RT 73502	$96.05	$113.00	$67.80–$852.12	—	15%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP 1V RT W/PELVIS 1 V	$238.85	$281.00	$168.60–$852.12	—	15%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP 1V LT W/PELVIS 1 V	$238.85	$281.00	$168.60–$852.12	—	15%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP COMPLETE MIN 2 V RT	$332.35	$391.00	$234.60–$852.12	—	15%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP COMPLETE MIN 2 V LT	$332.35	$391.00	$234.60–$852.12	—	15%
X-ray of the abdomen, 1 view CPT 74018 GD Exams	$279.65	$329.00	$45.35–$279.65	77% above	15%
X-ray of the abdomen, 1 view CPT 74018 ABDOMEN 1 V	$279.65	$329.00	$45.35–$279.65	77% above	15%
X-ray of the abdomen, 1 view inpatient CPT 74018 GD Exams	$279.65	$329.00	$197.40–$852.12	—	15%
X-ray of the abdomen, 1 view inpatient CPT 74018 ABDOMEN 1 V	$279.65	$329.00	$197.40–$852.12	—	15%
X-ray of the ankle, 2 views CPT 73600 GD Exams	$249.05	$293.00	$45.35–$249.05	42% above	15%
X-ray of the ankle, 2 views one side CPT 73600 ANKLE 2 V LT 73600	$68.00	$80.00	$30.22–$147.41	61% below	15%
X-ray of the ankle, 2 views one side CPT 73600 ANKLE 2 V RT 73600	$68.00	$80.00	$30.22–$147.41	61% below	15%
X-ray of the ankle, 2 views one side CPT 73600 ANKLE 2 V RT	$249.05	$293.00	$45.35–$249.05	42% above	15%
X-ray of the ankle, 2 views one side CPT 73600 ANKLE 2 V LT	$249.05	$293.00	$45.35–$249.05	42% above	15%
X-ray of the ankle, 2 views inpatient CPT 73600 GD Exams	$249.05	$293.00	$175.80–$852.12	—	15%
X-ray of the ankle, 2 views inpatient one side CPT 73600 ANKLE 2 V RT 73600	$68.00	$80.00	$48.00–$852.12	—	15%
X-ray of the ankle, 2 views inpatient one side CPT 73600 ANKLE 2 V LT 73600	$68.00	$80.00	$48.00–$852.12	—	15%
X-ray of the ankle, 2 views inpatient one side CPT 73600 ANKLE 2 V RT	$249.05	$293.00	$175.80–$852.12	—	15%
X-ray of the ankle, 2 views inpatient one side CPT 73600 ANKLE 2 V LT	$249.05	$293.00	$175.80–$852.12	—	15%
X-ray of the finger(s), 2 or more views CPT 73140 GD Exams	$277.95	$327.00	$45.35–$277.95	111% above	15%
X-ray of the finger(s), 2 or more views one side CPT 73140 FINGER MIN 2 V RT 73140	$74.80	$88.00	$33.24–$147.41	43% below	15%
X-ray of the finger(s), 2 or more views one side CPT 73140 FINGER MIN 2 V LT 73140	$74.80	$88.00	$33.24–$147.41	43% below	15%
X-ray of the finger(s), 2 or more views one side CPT 73140 FINGER MIN 2 V LT	$277.95	$327.00	$45.35–$277.95	111% above	15%
X-ray of the finger(s), 2 or more views one side CPT 73140 FINGER MIN 2 V RT	$277.95	$327.00	$45.35–$277.95	111% above	15%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 GD Exams	$277.95	$327.00	$196.20–$852.12	—	15%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 FINGER MIN 2 V LT 73140	$74.80	$88.00	$52.80–$852.12	—	15%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 FINGER MIN 2 V RT 73140	$74.80	$88.00	$52.80–$852.12	—	15%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 FINGER MIN 2 V LT	$277.95	$327.00	$196.20–$852.12	—	15%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 FINGER MIN 2 V RT	$277.95	$327.00	$196.20–$852.12	—	15%
X-ray of the foot, 2 views CPT 73620 GD Exams	$278.80	$328.00	$45.35–$278.80	76% above	15%
X-ray of the foot, 2 views one side CPT 73620 FOOT 2 V LT 73620	$59.50	$70.00	$26.44–$147.41	62% below	15%
X-ray of the foot, 2 views one side CPT 73620 FOOT 2 V RT 73620	$59.50	$70.00	$26.44–$147.41	62% below	15%
X-ray of the foot, 2 views one side CPT 73620 FOOT 2 V LT	$278.80	$328.00	$45.35–$278.80	76% above	15%
X-ray of the foot, 2 views one side CPT 73620 FOOT 2 V RT	$278.80	$328.00	$45.35–$278.80	76% above	15%
X-ray of the foot, 2 views inpatient CPT 73620 GD Exams	$278.80	$328.00	$196.80–$852.12	—	15%
X-ray of the foot, 2 views inpatient one side CPT 73620 FOOT 2 V LT 73620	$59.50	$70.00	$42.00–$852.12	—	15%
X-ray of the foot, 2 views inpatient one side CPT 73620 FOOT 2 V RT 73620	$59.50	$70.00	$42.00–$852.12	—	15%
X-ray of the foot, 2 views inpatient one side CPT 73620 FOOT 2 V LT	$278.80	$328.00	$196.80–$852.12	—	15%
X-ray of the foot, 2 views inpatient one side CPT 73620 FOOT 2 V RT	$278.80	$328.00	$196.80–$852.12	—	15%
X-ray of the foot, complete, 3 or more views both sides CPT 73630 FOOT COMPLETE MIN 3 V EA BILAT 73630	$77.35	$91.00	$34.37–$147.41	—	15%
X-ray of the foot, complete, 3 or more views both sides CPT 73630 FOOT COMPLETE MIN 3 V EA BILAT	$351.90	$414.00	$45.35–$351.90	—	15%
X-ray of the foot, complete, 3 or more views CPT 73630 GD Exams	$351.90	$414.00	$45.35–$351.90	96% above	15%
X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT COMPLETE MIN 3 V RT 73630	$69.70	$82.00	$30.97–$147.41	61% below	15%
X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT COMPLETE MIN 3 V LT 73630	$69.70	$82.00	$30.97–$147.41	61% below	15%
X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT COMPLETE MIN 3 V LT	$351.90	$414.00	$45.35–$351.90	96% above	15%
X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT COMPLETE MIN 3 V RT	$351.90	$414.00	$45.35–$351.90	96% above	15%
X-ray of the foot, complete, 3 or more views inpatient both sides CPT 73630 FOOT COMPLETE MIN 3 V EA BILAT 73630	$77.35	$91.00	$54.60–$852.12	—	15%
X-ray of the foot, complete, 3 or more views inpatient both sides CPT 73630 FOOT COMPLETE MIN 3 V EA BILAT	$351.90	$414.00	$248.40–$852.12	—	15%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 GD Exams	$351.90	$414.00	$248.40–$852.12	—	15%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 FOOT COMPLETE MIN 3 V LT 73630	$69.70	$82.00	$49.20–$852.12	—	15%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 FOOT COMPLETE MIN 3 V RT 73630	$69.70	$82.00	$49.20–$852.12	—	15%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 FOOT COMPLETE MIN 3 V LT	$351.90	$414.00	$248.40–$852.12	—	15%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 FOOT COMPLETE MIN 3 V RT	$351.90	$414.00	$248.40–$852.12	—	15%
X-ray of the hand, 3 or more views both sides CPT 73130 HAND MIN 3 V EA BILAT 73130	$83.30	$98.00	$37.01–$147.41	—	15%
X-ray of the hand, 3 or more views both sides CPT 73130 HAND MIN 3 V BILAT	$304.30	$358.00	$45.35–$304.30	—	15%
X-ray of the hand, 3 or more views CPT 73130 GD Exams	$304.30	$358.00	$45.35–$304.30	66% above	15%
X-ray of the hand, 3 or more views one side CPT 73130 HAND MIN 3 V RT 73130	$73.95	$87.00	$32.86–$147.41	60% below	15%
X-ray of the hand, 3 or more views one side CPT 73130 HAND MIN 3 V LT 73130	$73.95	$87.00	$32.86–$147.41	60% below	15%
X-ray of the hand, 3 or more views one side CPT 73130 HAND MIN 3 V LT	$304.30	$358.00	$45.35–$304.30	66% above	15%
X-ray of the hand, 3 or more views one side CPT 73130 HAND MIN 3 V RT	$304.30	$358.00	$45.35–$304.30	66% above	15%
X-ray of the hand, 3 or more views inpatient both sides CPT 73130 HAND MIN 3 V EA BILAT 73130	$83.30	$98.00	$58.80–$852.12	—	15%
X-ray of the hand, 3 or more views inpatient both sides CPT 73130 HAND MIN 3 V BILAT	$304.30	$358.00	$214.80–$852.12	—	15%
X-ray of the hand, 3 or more views inpatient CPT 73130 GD Exams	$304.30	$358.00	$214.80–$852.12	—	15%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 HAND MIN 3 V LT 73130	$73.95	$87.00	$52.20–$852.12	—	15%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 HAND MIN 3 V RT 73130	$73.95	$87.00	$52.20–$852.12	—	15%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 HAND MIN 3 V LT	$304.30	$358.00	$214.80–$852.12	—	15%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 HAND MIN 3 V RT	$304.30	$358.00	$214.80–$852.12	—	15%
X-ray of the knee, 1 or 2 views both sides CPT 73560 KNEES BILATERAL 2 V EACH	$249.05	$293.00	$45.35–$249.05	—	15%
X-ray of the knee, 1 or 2 views CPT 73560 GD Exams	$249.05	$293.00	$45.35–$249.05	60% above	15%
X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE 1 - 2 V RT 73560	$71.40	$84.00	$31.73–$147.41	54% below	15%
X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE 1 - 2 V LT 73560	$71.40	$84.00	$31.73–$147.41	54% below	15%
X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE 1 - 2 V RT	$249.05	$293.00	$45.35–$249.05	60% above	15%
X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE 1 - 2 V LT	$249.05	$293.00	$45.35–$249.05	60% above	15%
X-ray of the knee, 1 or 2 views inpatient both sides CPT 73560 KNEES BILATERAL 2 V EACH	$249.05	$293.00	$175.80–$852.12	—	15%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 GD Exams	$249.05	$293.00	$175.80–$852.12	—	15%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 KNEE 1 - 2 V RT 73560	$71.40	$84.00	$50.40–$852.12	—	15%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 KNEE 1 - 2 V LT 73560	$71.40	$84.00	$50.40–$852.12	—	15%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 KNEE 1 - 2 V RT	$249.05	$293.00	$175.80–$852.12	—	15%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 KNEE 1 - 2 V LT	$249.05	$293.00	$175.80–$852.12	—	15%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 SPINE LUMBAR 2 V 72100	$81.60	$96.00	$36.26–$177.09	62% below	15%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 GD Exams	$371.45	$437.00	$54.48–$371.45	74% above	15%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 POSTURAL STUDY	$371.45	$437.00	$54.48–$371.45	74% above	15%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 SPINE LUMBAR 2 V	$371.45	$437.00	$54.48–$371.45	74% above	15%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 SPINE LUMBAR 2 V 72100	$81.60	$96.00	$57.60–$852.12	—	15%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 GD Exams	$371.45	$437.00	$262.20–$852.12	—	15%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 POSTURAL STUDY	$371.45	$437.00	$262.20–$852.12	—	15%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 SPINE LUMBAR 2 V	$371.45	$437.00	$262.20–$852.12	—	15%
X-ray of the lower back, 4 or more views CPT 72110 SPINE LUMBAR MIN 4 V 72110	$102.85	$121.00	$45.70–$177.09	67% below	15%
X-ray of the lower back, 4 or more views CPT 72110 SPINE LUMBAR MIN 4 V	$516.80	$608.00	$54.48–$516.80	68% above	15%
X-ray of the lower back, 4 or more views CPT 72110 SPINE LUMBAR AP + LAT W/ FLEX + EXT	$516.80	$608.00	$54.48–$516.80	68% above	15%
X-ray of the lower back, 4 or more views CPT 72110 GD Exams	$516.80	$608.00	$54.48–$516.80	68% above	15%
X-ray of the lower back, 4 or more views inpatient CPT 72110 SPINE LUMBAR MIN 4 V 72110	$102.85	$121.00	$72.60–$852.12	—	15%
X-ray of the lower back, 4 or more views inpatient CPT 72110 GD Exams	$516.80	$608.00	$364.80–$852.12	—	15%
X-ray of the lower back, 4 or more views inpatient CPT 72110 SPINE LUMBAR AP + LAT W/ FLEX + EXT	$516.80	$608.00	$364.80–$852.12	—	15%
X-ray of the lower back, 4 or more views inpatient CPT 72110 SPINE LUMBAR MIN 4 V	$516.80	$608.00	$364.80–$852.12	—	15%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 SPINE THORACIC 2 V 72070	$68.00	$80.00	$30.22–$177.09	63% below	15%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 SPINE THORACIC 2 V	$295.80	$348.00	$54.48–$295.80	61% above	15%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 GD Exams	$295.80	$348.00	$54.48–$295.80	61% above	15%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 SPINE THORACIC 2 V 72070	$68.00	$80.00	$48.00–$852.12	—	15%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 GD Exams	$295.80	$348.00	$208.80–$852.12	—	15%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 SPINE THORACIC 2 V	$295.80	$348.00	$208.80–$852.12	—	15%
X-ray of the nasal bones, 3 or more views CPT 70160 NASAL BONES COMPLETE MIN 3 V	$294.95	$347.00	$45.35–$294.95	71% above	15%
X-ray of the nasal bones, 3 or more views CPT 70160 GD Exams	$294.95	$347.00	$45.35–$294.95	71% above	15%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 NASAL BONES COMPLETE MIN 3 V	$294.95	$347.00	$208.20–$852.12	—	15%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 GD Exams	$294.95	$347.00	$208.20–$852.12	—	15%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 SPINE CERVICAL 2 OR 3 V 72040	$81.60	$96.00	$36.26–$147.41	65% below	15%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 SPINE CERVICAL 2 OR 3 V	$373.15	$439.00	$45.35–$373.15	62% above	15%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 GD Exams	$373.15	$439.00	$45.35–$373.15	62% above	15%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 SPINE CERVICAL LAT W/ FLEX + EXT	$373.15	$439.00	$45.35–$373.15	62% above	15%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 SPINE CERVICAL 2 OR 3 V 72040	$81.60	$96.00	$57.60–$852.12	—	15%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 GD Exams	$373.15	$439.00	$263.40–$852.12	—	15%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 SPINE CERVICAL LAT W/ FLEX + EXT	$373.15	$439.00	$263.40–$852.12	—	15%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 SPINE CERVICAL 2 OR 3 V	$373.15	$439.00	$263.40–$852.12	—	15%
X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS 1 - 2 V 72170	$60.35	$71.00	$26.82–$177.09	63% below	15%
X-ray of the pelvis, 1 or 2 views CPT 72170 GD Exams	$287.30	$338.00	$49.09–$287.30	75% above	15%
X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS 1 - 2 V	$287.30	$338.00	$49.09–$287.30	75% above	15%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PELVIS 1 - 2 V 72170	$60.35	$71.00	$42.60–$852.12	—	15%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 GD Exams	$287.30	$338.00	$202.80–$852.12	—	15%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PELVIS 1 - 2 V	$287.30	$338.00	$202.80–$852.12	—	15%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 SACRUM/COCCYX MIN 2 V 72220	$67.15	$79.00	$29.84–$147.41	61% below	15%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 GD Exams	$355.30	$418.00	$45.35–$355.30	106% above	15%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 SACRUM/COCCYX MIN 2 V	$355.30	$418.00	$45.35–$355.30	106% above	15%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 SACRUM/COCCYX MIN 2 V 72220	$67.15	$79.00	$47.40–$852.12	—	15%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 SACRUM/COCCYX MIN 2 V	$355.30	$418.00	$250.80–$852.12	—	15%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 GD Exams	$355.30	$418.00	$250.80–$852.12	—	15%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Michigan	Off list
ACTH blood test CPT 82024 Adrenocorticotropic Hormone, Plasma	$18.70	$22.00	$8.31–$166.68	80% below	15%
ACTH blood test inpatient CPT 82024 Adrenocorticotropic Hormone, Plasma	$18.70	$22.00	$13.20–$852.12	—	15%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 Alanine aminotransferase	$41.65	$49.00	$1.40–$41.65	74% above	15%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 Alanine aminotransferase	$41.65	$49.00	$29.40–$852.12	—	15%
AST (aspartate aminotransferase) enzyme test CPT 84450 Aspartate aminotransferase	$39.10	$46.00	$1.40–$39.10	78% above	15%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 Aspartate aminotransferase	$39.10	$46.00	$27.60–$852.12	—	15%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Acute Hepatitis Panel	$298.35	$351.00	$24.91–$298.35	76% above	15%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 Acute Hepatitis Panel	$298.35	$351.00	$210.60–$852.12	—	15%
Albumin blood test CPT 82040 Albumin Level	$32.30	$38.00	$1.40–$32.30	62% above	15%
Albumin blood test inpatient CPT 82040 Albumin Level	$32.30	$38.00	$22.80–$852.12	—	15%
Aldosterone blood test CPT 82088 Aldosterone	$17.00	$20.00	$7.55–$175.87	69% below	15%
Aldosterone blood test CPT 82088 Aldosterone, 24 Hour, Urine	$46.75	$55.00	$20.77–$175.87	15% below	15%
Aldosterone blood test CPT 82088 Aldosterone Level	$170.00	$200.00	$21.31–$175.87	209% above	15%
Aldosterone blood test CPT 82088 Aldosterone with Sodium, 24 Hour, Urine	$393.78	$463.27	$21.31–$393.78	616% above	15%
Aldosterone blood test inpatient CPT 82088 Aldosterone	$17.00	$20.00	$12.00–$852.12	—	15%
Aldosterone blood test inpatient CPT 82088 Aldosterone, 24 Hour, Urine	$46.75	$55.00	$33.00–$852.12	—	15%
Aldosterone blood test inpatient CPT 82088 Aldosterone Level	$170.00	$200.00	$120.00–$852.12	—	15%
Aldosterone blood test inpatient CPT 82088 Aldosterone with Sodium, 24 Hour, Urine	$393.78	$463.27	$277.96–$852.12	—	15%
Alkaline phosphatase (ALP) blood test CPT 84075 Alkaline Phosphatase, Total and Isoenzymes, Serum	$6.72	$7.90	$1.40–$22.35	68% below	15%
Alkaline phosphatase (ALP) blood test CPT 84075 Alkaline Phosphatase	$41.65	$49.00	$1.40–$41.65	98% above	15%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 Alkaline Phosphatase, Total and Isoenzymes, Serum	$6.72	$7.90	$4.74–$852.12	—	15%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 Alkaline Phosphatase	$41.65	$49.00	$29.40–$852.12	—	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Watermelon, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Wasp Venom, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Walnut-Food, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Walnut Tree, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Venom Bumble Bee (Bombus terrestrus) IgE	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Vanilla, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Ulocladium chartarum, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Turkey, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Tuna, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Trout, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Trichoderma viride, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Tomato, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Timothy Grass, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Thyme, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Tea, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Tarragon, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Mustard, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Mushroom, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Mugwort, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Mucor, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Mouse Urine Protein, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Mouse Serum Protein, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Swordfish, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Sweet Potato, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Sunflower, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Mouse Epithelium, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Mountain Cedar, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Mosquito Species, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Milk, Processed, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Milk, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Mesquite, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Melons, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Megrim, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Meadow Fescue, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Marjoram, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Mare's Milk, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Mango, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Mandarin, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Malt, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Mahi Mahi IgE	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Mackerel, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Mace, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Macadamia Nut, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Lupin, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Lobster, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Linseed, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Lime, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Lettuce, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Lentil, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Lemon, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Latex, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Langust (Lobster), IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Lamb, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Lamb's Quarter, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Kiwi Fruit, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Kidney Bean (Red), IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Juniper Western (Juniperus occidentalis) IgE	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 June Grass, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Johnson Grass, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Jalapeno/Chipotle (Capsicum annuum) IgE	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Jack Mackerel, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 House Dust/H-S Lab, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 House Dust/Greer Lab, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 House Dust Mites/Dermatophagoides pteronyssinus, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 House Dust Mites/Dermatophagoides farinae, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Horse Dander, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Honeybee Venom, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Hickory Shagbark (Carya ovata) IgE	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Herring, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Helminthosporium sativum/Drechslera IgE	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Helminthosporium halodes, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Hazelnut-Tree, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Hazelnut-Food, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Hamster Epithelium, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Sunflower Seed, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Sugarbeet Seed, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Halibut, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Hake, Fish, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Gum Xanthan IgE	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Gum Arabic, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Guinea Pig Epithelium, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Guar Gum, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Grey Alder, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Green String Bean, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Green Pepper, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Green Pea, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Greek Fennel, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Grapefruit, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Grape, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Goose Feathers, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Goat's Milk, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Goat Epithelium, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Gluten, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Ginger, IgE	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Giant Ragweed, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Gerbil Epithelium, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Gelatin, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Garlic, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Fusarium moniliforme, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Foxtail Millet, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Firebush (Kochia), IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Fire Ant, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 European Hornet, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Epicoccum purpurascens, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 English Plantain, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Elm, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Elder, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Eggplant, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Egg Yolk, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Egg White, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Eastern Sycamore, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Duck Feathers, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Dog Dander, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Strawberry, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Stinging Insects Allergen Profile, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Stemphyllium, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Squid, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Dock Yellow (Rumex crispus) IgE	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Dill, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Dermatophagoides microceras, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Date, Fruit, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Dairy and Grain Allergen Profile, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Curvularia spicifera/Bipolaris IgE	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Squash, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Spinach, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Soybean, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Curvularia lunata, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Cultivated Rye, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Cucumber, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Crayfish, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Sole, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Snail, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Silver Birch, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Shrimp, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Short Ragweed, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Sheep Wool, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Sesame Seed, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Cranberry, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Crab, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Cow Epithelium, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Cottonwood, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Corn-Food, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Coriander, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Common Reed, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Common Millet, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Codfish, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Coconut, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Cockroach, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Seasonal Inhalants Allergen Profile, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Seafood Allergen Profile, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Scallop, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Sardine (Pilchard), IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Cocklebur, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Clove, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Clam, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Cladosporium, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Cinnamon, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Chub Mackerel, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Chicken, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Chicken Feathers, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Salmon, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Rye, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Rye Grass, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Russian Thistle, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Rough Pigweed, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Rough Marsh Elder, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Chick Pea, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Chestnut, Sweet, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Chestnut Tree, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Cherry, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Cheese, Mold, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Cheese, Cheddar, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Chaetomium globosum, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Cephalosporium acremonium, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Celery, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Pig Epithelium, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Perch Ocean	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Penicillium chrysogenum, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Penicillin V, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Penicillin G, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Pediatric Allergy Screen <3 Years, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Pecan-Food, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Pear, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Peanut, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Peanut, IgE with Reflex to Peanut Components, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Peach, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Passion Fruit, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Parsley, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Paprika, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Papaya, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Pacific Squid, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Oyster, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Oregano, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Orchard Grass, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Orange, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Onion, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Olive-Food, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Olive Tree, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Octopus, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Oat, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Oak, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Yellow Jacket Venom, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Yellow Faced Hornet Venom, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Wormwood, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Nuts Allergen Profile, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Nutmeg, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Northeast Regional Allergen Profile, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Non-Seasonal Inhalant Allergen Profile, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Willow, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Whole Egg, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Whitefish IgE	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 White Potato, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 White Pine, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 White Hickory, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 White Faced Hornet Venom, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 White Bean, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 White Ash, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Whey, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Wheat, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Rape Seed, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Rabbit Urine Proteins, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Rabbit Serum Proteins, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Rabbit Meat, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Pineapple, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Rabbit Epithelium, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Quinoa (Chenopodium quinoa) IgE	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Pistachio, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Pollock White (Pollachius virens) IgE	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Plaice, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Plum, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Pumpkin Seed, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Pork, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Poppy Seed, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Poplar White (Populus alba) IgE	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Apple, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Anise, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Anchovy, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Amoxicillin, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Alternaria tenuis, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Almond, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Pine Nut, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Phoma betae, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Rice, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Rhizopus nigricans, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Red Top, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Cedar, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Cedar Red (Juniperus virginiana) IgE	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Cauliflower, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Catfish (Siluriformes spp) IgE	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Cat Epithelium, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Carrot, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Carob, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Carmine Dye/Red Dye Cochineal (Dactylopius coccus) IgE (Red # 4)	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Caraway, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Candida albicans (Monilia), IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Cacao/Cocoa, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Cabbage, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Buckwheat, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Brussels Sprouts, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Broccoli, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Brazil Nut, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Box Elder/Maple, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Botrytis cinerea, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Blueberry, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Blue Mussel, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Blackberry, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Black/White Pepper, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Bermuda Grass, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Beets (Beetroot), IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Beef, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Beech, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Bean Navy/White (Phaseolus vulgaris) IgE	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Bean Black (Phaseolus spp) IgE	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Bay Leaf, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Bass Black (Sea Bass) (Centropristis striata) IgE	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Basil, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Barley, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Banana, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Bamboo Shoot, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Bald Cypress, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Baker's Yeast, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Avocado, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Aureobasidium pullulans, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Aspergillus niger, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Aspergillus fumigatus, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Asparagus, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Ascaris, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Apricot, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Red Snapper (Lutjanus spp) IgE	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Rat Urine Protein, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Rat Serum Protein, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Rat Epithelium, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Raspberry, IgE, Serum	$4.25	$5.00	$1.89–$22.53	33% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Tree Panel #3, Serum	$23.21	$27.30	$2.73–$23.21	264% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Epithelia Panel # 2, Serum	$23.21	$27.30	$2.73–$23.21	264% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Mold Panel, Serum	$23.21	$27.30	$2.73–$23.21	264% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Tree Panel #1, Serum	$23.21	$27.30	$2.73–$23.21	264% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Epithelia Panel # 1, Serum	$23.21	$27.30	$2.73–$23.21	264% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Food Panel, Serum	$23.21	$27.30	$2.73–$23.21	264% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Food-Fruit Panel, Serum	$23.21	$27.30	$2.73–$23.21	264% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Food-Grain Panel, Serum	$23.21	$27.30	$2.73–$23.21	264% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Tree Panel #4, Serum	$23.21	$27.30	$2.73–$23.21	264% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Weed Panel # 2, Serum	$23.21	$27.30	$2.73–$23.21	264% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Food-Nut Panel # 1, Serum	$23.21	$27.30	$2.73–$23.21	264% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Weed Panel # 3, Serum	$23.21	$27.30	$2.73–$23.21	264% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Weed Panel # 4, Serum	$23.21	$27.30	$2.73–$23.21	264% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Weed Panel # 1, Serum	$23.21	$27.30	$2.73–$23.21	264% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Food-Nut Panel # 2, Serum	$23.21	$27.30	$2.73–$23.21	264% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Food-Seafood Panel, Serum	$23.21	$27.30	$2.73–$23.21	264% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Grass Panel # 1, Serum	$23.21	$27.30	$2.73–$23.21	264% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Grass Panel # 2, Serum	$23.21	$27.30	$2.73–$23.21	264% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Grass Panel # 3, Serum	$23.21	$27.30	$2.73–$23.21	264% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 House Dust Panel, Serum	$23.21	$27.30	$2.73–$23.21	264% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Food Panel #2, Serum	$28.15	$33.11	$2.73–$28.14	342% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Annatto Seed (Bixa orellana) IgE	$47.66	$56.06	$2.73–$47.65	648% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 Cashew, IgE, Serum	$73.70	$86.70	$2.73–$73.70	1057% above	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Botrytis cinerea, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Yellow Jacket Venom, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Yellow Faced Hornet Venom, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Wormwood, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Willow, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Whole Egg, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Whitefish IgE	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 White Potato, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 White Pine, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 White Hickory, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 White Faced Hornet Venom, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 White Bean, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 White Ash, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Whey, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Wheat, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Watermelon, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Wasp Venom, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Walnut-Food, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Walnut Tree, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Venom Bumble Bee (Bombus terrestrus) IgE	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Vanilla, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Ulocladium chartarum, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Turkey, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Tuna, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Trout, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Trichoderma viride, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Tomato, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Timothy Grass, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Thyme, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Tea, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Tarragon, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Swordfish, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Sweet Potato, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Sunflower, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Sunflower Seed, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Sugarbeet Seed, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Strawberry, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Stinging Insects Allergen Profile, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Stemphyllium, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Squid, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Squash, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Spinach, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Soybean, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Sole, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Snail, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Silver Birch, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Shrimp, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Short Ragweed, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Sheep Wool, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Sesame Seed, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Seasonal Inhalants Allergen Profile, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Seafood Allergen Profile, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Scallop, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Sardine (Pilchard), IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Salmon, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Rye, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Rye Grass, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Russian Thistle, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Rough Pigweed, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Rough Marsh Elder, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Rice, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Rhizopus nigricans, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Red Top, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Red Snapper (Lutjanus spp) IgE	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Rat Urine Protein, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Rat Serum Protein, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Rat Epithelium, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Raspberry, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Rape Seed, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Rabbit Urine Proteins, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Rabbit Serum Proteins, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Rabbit Meat, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Rabbit Epithelium, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Quinoa (Chenopodium quinoa) IgE	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Pumpkin Seed, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Pork, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Poppy Seed, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Poplar White (Populus alba) IgE	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Pollock White (Pollachius virens) IgE	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Plum, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Plaice, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Pistachio, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Pineapple, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Pine Nut, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Pig Epithelium, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Phoma betae, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Perch Ocean	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Penicillium chrysogenum, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Penicillin V, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Penicillin G, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Pediatric Allergy Screen <3 Years, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Pecan-Food, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Pear, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Peanut, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Peanut, IgE with Reflex to Peanut Components, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Peach, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Passion Fruit, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Parsley, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Paprika, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Papaya, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Pacific Squid, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Oyster, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Oregano, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Orchard Grass, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Orange, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Onion, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Olive-Food, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Olive Tree, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Octopus, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Oat, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Oak, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Nuts Allergen Profile, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Nutmeg, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Northeast Regional Allergen Profile, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Non-Seasonal Inhalant Allergen Profile, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Mustard, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Mushroom, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Mugwort, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Mucor, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Mouse Urine Protein, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Mouse Serum Protein, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Mouse Epithelium, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Mountain Cedar, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Mosquito Species, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Milk, Processed, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Milk, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Mesquite, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Melons, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Megrim, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Meadow Fescue, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Marjoram, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Mare's Milk, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Mango, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Mandarin, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Malt, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Mahi Mahi IgE	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Mackerel, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Mace, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Macadamia Nut, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Lupin, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Lobster, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Linseed, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Lime, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Lettuce, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Lentil, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Lemon, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Latex, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Langust (Lobster), IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Lamb, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Lamb's Quarter, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Kiwi Fruit, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Kidney Bean (Red), IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Juniper Western (Juniperus occidentalis) IgE	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 June Grass, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Johnson Grass, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Jalapeno/Chipotle (Capsicum annuum) IgE	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Jack Mackerel, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 House Dust/H-S Lab, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 House Dust/Greer Lab, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 House Dust Mites/Dermatophagoides pteronyssinus, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 House Dust Mites/Dermatophagoides farinae, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Horse Dander, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Honeybee Venom, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Hickory Shagbark (Carya ovata) IgE	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Herring, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Helminthosporium sativum/Drechslera IgE	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Helminthosporium halodes, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Hazelnut-Tree, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Hazelnut-Food, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Hamster Epithelium, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Halibut, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Hake, Fish, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Gum Xanthan IgE	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Gum Arabic, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Guinea Pig Epithelium, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Guar Gum, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Grey Alder, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Green String Bean, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Green Pepper, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Green Pea, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Greek Fennel, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Grapefruit, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Grape, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Goose Feathers, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Goat's Milk, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Goat Epithelium, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Gluten, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Ginger, IgE	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Giant Ragweed, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Gerbil Epithelium, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Gelatin, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Garlic, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Fusarium moniliforme, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Foxtail Millet, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Firebush (Kochia), IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Fire Ant, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 European Hornet, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Epicoccum purpurascens, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 English Plantain, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Elm, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Elder, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Eggplant, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Egg Yolk, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Egg White, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Eastern Sycamore, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Duck Feathers, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Dog Dander, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Dock Yellow (Rumex crispus) IgE	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Dill, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Dermatophagoides microceras, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Date, Fruit, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Dairy and Grain Allergen Profile, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Curvularia spicifera/Bipolaris IgE	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Curvularia lunata, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cultivated Rye, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cucumber, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Crayfish, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cranberry, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Crab, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cow Epithelium, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cottonwood, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Corn-Food, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Coriander, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Common Reed, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Common Millet, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Codfish, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Coconut, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cockroach, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cocklebur, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Clove, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Clam, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cladosporium, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cinnamon, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Chub Mackerel, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Chicken, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Chicken Feathers, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Chick Pea, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Chestnut, Sweet, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Chestnut Tree, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cherry, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cheese, Mold, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cheese, Cheddar, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Chaetomium globosum, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cephalosporium acremonium, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Celery, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cedar, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cedar Red (Juniperus virginiana) IgE	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cauliflower, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Catfish (Siluriformes spp) IgE	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cat Epithelium, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Carrot, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Carob, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Carmine Dye/Red Dye Cochineal (Dactylopius coccus) IgE (Red # 4)	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Caraway, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Candida albicans (Monilia), IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cacao/Cocoa, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cabbage, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Buckwheat, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Brussels Sprouts, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Broccoli, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Brazil Nut, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Box Elder/Maple, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Blueberry, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Blue Mussel, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Blackberry, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Black/White Pepper, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Bermuda Grass, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Beets (Beetroot), IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Beef, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Beech, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Bean Navy/White (Phaseolus vulgaris) IgE	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Bean Black (Phaseolus spp) IgE	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Bay Leaf, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Bass Black (Sea Bass) (Centropristis striata) IgE	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Basil, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Barley, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Banana, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Bamboo Shoot, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Bald Cypress, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Baker's Yeast, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Avocado, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Aureobasidium pullulans, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Aspergillus niger, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Aspergillus fumigatus, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Asparagus, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Ascaris, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Apricot, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Apple, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Anise, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Anchovy, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Amoxicillin, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Alternaria tenuis, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Almond, IgE, Serum	$4.25	$5.00	$3.00–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Grass Panel # 1, Serum	$23.21	$27.30	$16.38–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Epithelia Panel # 1, Serum	$23.21	$27.30	$16.38–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Epithelia Panel # 2, Serum	$23.21	$27.30	$16.38–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Food Panel, Serum	$23.21	$27.30	$16.38–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Food-Fruit Panel, Serum	$23.21	$27.30	$16.38–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Food-Grain Panel, Serum	$23.21	$27.30	$16.38–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Food-Nut Panel # 1, Serum	$23.21	$27.30	$16.38–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Food-Nut Panel # 2, Serum	$23.21	$27.30	$16.38–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Food-Seafood Panel, Serum	$23.21	$27.30	$16.38–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Grass Panel # 2, Serum	$23.21	$27.30	$16.38–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Grass Panel # 3, Serum	$23.21	$27.30	$16.38–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 House Dust Panel, Serum	$23.21	$27.30	$16.38–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Tree Panel #1, Serum	$23.21	$27.30	$16.38–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Tree Panel #3, Serum	$23.21	$27.30	$16.38–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Tree Panel #4, Serum	$23.21	$27.30	$16.38–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Weed Panel # 1, Serum	$23.21	$27.30	$16.38–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Weed Panel # 2, Serum	$23.21	$27.30	$16.38–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Weed Panel # 3, Serum	$23.21	$27.30	$16.38–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Weed Panel # 4, Serum	$23.21	$27.30	$16.38–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Mold Panel, Serum	$23.21	$27.30	$16.38–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Food Panel #2, Serum	$28.15	$33.11	$19.87–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Annatto Seed (Bixa orellana) IgE	$47.66	$56.06	$33.64–$852.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cashew, IgE, Serum	$73.70	$86.70	$52.02–$852.12	—	15%
Alpha-fetoprotein (AFP) blood test CPT 82105 Alpha-Fetoprotein (AFP), Single Marker Screen, Maternal, Serum	$15.64	$18.40	$6.95–$72.37	69% below	15%
Alpha-fetoprotein (AFP) blood test CPT 82105 Alpha Fetoprotein Tumor Marker	$75.65	$89.00	$8.77–$75.65	48% above	15%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 Alpha-Fetoprotein (AFP), Single Marker Screen, Maternal, Serum	$15.64	$18.40	$11.04–$852.12	—	15%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 Alpha Fetoprotein Tumor Marker	$75.65	$89.00	$53.40–$852.12	—	15%
Ammonia blood test CPT 82140 Ammonia Level	$104.55	$123.00	$7.62–$104.55	61% above	15%
Ammonia blood test inpatient CPT 82140 Ammonia Level	$104.55	$123.00	$73.80–$852.12	—	15%
Amylase blood test CPT 82150 Amylase, Isoenzymes, Serum	$12.94	$15.22	$3.39–$14.16	40% below	15%
Amylase blood test CPT 82150 Amylase, Body Fluid	$36.98	$43.50	$3.39–$36.98	72% above	15%
Amylase blood test CPT 82150 Amylase Level	$49.30	$58.00	$3.39–$49.30	129% above	15%
Amylase blood test CPT 82150 Amylase Level Body Fluid	$49.30	$58.00	$3.39–$49.30	129% above	15%
Amylase blood test CPT 82150 Amylase, Pancreatic Cyst Fluid	$156.66	$184.30	$3.39–$156.66	628% above	15%
Amylase blood test inpatient CPT 82150 Amylase, Isoenzymes, Serum	$12.94	$15.22	$9.13–$852.12	—	15%
Amylase blood test inpatient CPT 82150 Amylase, Body Fluid	$36.98	$43.50	$26.10–$852.12	—	15%
Amylase blood test inpatient CPT 82150 Amylase Level Body Fluid	$49.30	$58.00	$34.80–$852.12	—	15%
Amylase blood test inpatient CPT 82150 Amylase Level	$49.30	$58.00	$34.80–$852.12	—	15%
Amylase blood test inpatient CPT 82150 Amylase, Pancreatic Cyst Fluid	$156.66	$184.30	$110.58–$852.12	—	15%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Connective Tissue Disease Cascade	$68.85	$81.00	$6.77–$68.85	24% above	15%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Cyclic Citrullinated Peptide IgG	$68.85	$81.00	$6.77–$68.85	24% above	15%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 Cyclic Citrullinated Peptide IgG	$68.85	$81.00	$48.60–$852.12	—	15%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 Connective Tissue Disease Cascade	$68.85	$81.00	$48.60–$852.12	—	15%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Connective Tissue Diseases Cascade, Serum	$10.20	$12.00	$4.53–$52.17	82% below	15%
Antinuclear antibody (ANA) blood test, screen CPT 86038 86038 3864	$90.95	$107.00	$6.32–$90.95	63% above	15%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Antinuclear Antibody	$90.95	$107.00	$6.32–$90.95	63% above	15%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Connective Tissue Diseases Cascade, Serum	$10.20	$12.00	$7.20–$852.12	—	15%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 86038 3864	$90.95	$107.00	$64.20–$852.12	—	15%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Antinuclear Antibody	$90.95	$107.00	$64.20–$852.12	—	15%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NT-Pro BNP, Serum	$46.75	$55.00	$20.53–$169.43	40% below	15%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 B-Type Natriuretic Peptide	$214.20	$252.00	$20.53–$214.20	173% above	15%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NT-Pro BNP, Serum	$46.75	$55.00	$33.00–$852.12	—	15%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 B-Type Natriuretic Peptide	$214.20	$252.00	$151.20–$852.12	—	15%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Bone Marrow Culture	$87.55	$103.00	$4.51–$87.55	65% above	15%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CSF Culture	$87.55	$103.00	$4.51–$87.55	65% above	15%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Body Fluid Culture	$87.55	$103.00	$4.51–$87.55	65% above	15%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Catheter Tip Culture	$87.55	$103.00	$4.51–$87.55	65% above	15%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Cystic Fibrosis Culture	$87.55	$103.00	$4.51–$87.55	65% above	15%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Ear Culture	$87.55	$103.00	$4.51–$87.55	65% above	15%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Eye Culture	$87.55	$103.00	$4.51–$87.55	65% above	15%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Genital Culture	$87.55	$103.00	$4.51–$87.55	65% above	15%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Medical Device Culture	$87.55	$103.00	$4.51–$87.55	65% above	15%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Oral Culture	$87.55	$103.00	$4.51–$87.55	65% above	15%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Wound Culture	$87.55	$103.00	$4.51–$87.55	65% above	15%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Respiratory Culture	$87.55	$103.00	$4.51–$87.55	65% above	15%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Tissue Culture	$87.55	$103.00	$4.51–$87.55	65% above	15%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Wound Culture	$87.55	$103.00	$61.80–$852.12	—	15%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Respiratory Culture	$87.55	$103.00	$61.80–$852.12	—	15%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Oral Culture	$87.55	$103.00	$61.80–$852.12	—	15%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Cystic Fibrosis Culture	$87.55	$103.00	$61.80–$852.12	—	15%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CSF Culture	$87.55	$103.00	$61.80–$852.12	—	15%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Catheter Tip Culture	$87.55	$103.00	$61.80–$852.12	—	15%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Medical Device Culture	$87.55	$103.00	$61.80–$852.12	—	15%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Genital Culture	$87.55	$103.00	$61.80–$852.12	—	15%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Eye Culture	$87.55	$103.00	$61.80–$852.12	—	15%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Ear Culture	$87.55	$103.00	$61.80–$852.12	—	15%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Tissue Culture	$87.55	$103.00	$61.80–$852.12	—	15%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Bone Marrow Culture	$87.55	$103.00	$61.80–$852.12	—	15%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Body Fluid Culture	$87.55	$103.00	$61.80–$852.12	—	15%
Basic metabolic panel (blood test) CPT 80048 Basic Metabolic Panel	$82.45	$97.00	$4.42–$82.45	53% above	15%
Basic metabolic panel (blood test) inpatient CPT 80048 Basic Metabolic Panel	$82.45	$97.00	$58.20–$852.12	—	15%
Bilirubin blood test, total CPT 82247 Bilirubin Total/Direct	$31.45	$37.00	$1.40–$31.45	38% above	15%
Bilirubin blood test, total CPT 82247 Bilirubin Total	$31.45	$37.00	$1.40–$31.45	38% above	15%
Bilirubin blood test, total CPT 82247 Bilirubin Body Fluid	$90.02	$105.90	$1.40–$90.02	296% above	15%
Bilirubin blood test, total inpatient CPT 82247 Bilirubin Total/Direct	$31.45	$37.00	$22.20–$852.12	—	15%
Bilirubin blood test, total inpatient CPT 82247 Bilirubin Total	$31.45	$37.00	$22.20–$852.12	—	15%
Bilirubin blood test, total inpatient CPT 82247 Bilirubin Body Fluid	$90.02	$105.90	$63.54–$852.12	—	15%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 RL University of Michigan 88305 Gross/micro tissue exam lvl IV	$89.25	$105.00	$27.16–$101.48	18% below	15%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 88305 AP Bill Cell Block	$171.70	$202.00	$27.16–$171.70	57% above	15%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 88305 AP Bill Surgical Pathology Level IV Complexity	$171.70	$202.00	$27.16–$171.70	57% above	15%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 88305 AP Bill Bone Marrow Biopsy	$171.70	$202.00	$27.16–$171.70	57% above	15%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Level 4 Gross and Microscopic, RB (Bill Only)	$255.00	$300.00	$27.16–$255.00	134% above	15%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 RL University of Michigan 88305 Gross/micro tissue exam lvl IV	$89.25	$105.00	$63.00–$852.12	—	15%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 88305 AP Bill Bone Marrow Biopsy	$171.70	$202.00	$121.20–$852.12	—	15%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 88305 AP Bill Surgical Pathology Level IV Complexity	$171.70	$202.00	$121.20–$852.12	—	15%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 88305 AP Bill Cell Block	$171.70	$202.00	$121.20–$852.12	—	15%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 Level 4 Gross and Microscopic, RB (Bill Only)	$255.00	$300.00	$180.00–$852.12	—	15%
Blood culture for bacteria CPT 87040 Blood Culture	$55.25	$65.00	$5.40–$55.25	12% below	15%
Blood culture for bacteria CPT 87040 Blood Culture, Line Draw	$55.25	$65.00	$5.40–$55.25	12% below	15%
Blood culture for bacteria inpatient CPT 87040 Blood Culture	$55.25	$65.00	$39.00–$852.12	—	15%
Blood culture for bacteria inpatient CPT 87040 Blood Culture, Line Draw	$55.25	$65.00	$39.00–$852.12	—	15%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Blood hdl fee 36415	$5.10	$6.00	$2.27–$15.88	60% below	15%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Venipuncture (N)	$33.15	$39.00	$4.88–$33.15	157% above	15%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLLECTION: Venous Draw	$34.00	$40.00	$4.88–$34.00	164% above	15%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Routine venipuncture or finger/heel/ear stick for collection of specimen(s)	$34.00	$40.00	$4.88–$34.00	164% above	15%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Routine Venipuncture (C/G)	$34.00	$40.00	$4.88–$34.00	164% above	15%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Routine Venipuncture	$34.00	$40.00	$4.88–$34.00	164% above	15%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Blood hdl fee 36415	$5.10	$6.00	$3.60–$852.12	—	15%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Venipuncture (N)	$33.15	$39.00	$23.40–$852.12	—	15%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Routine Venipuncture	$34.00	$40.00	$24.00–$852.12	—	15%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Routine Venipuncture (C/G)	$34.00	$40.00	$24.00–$852.12	—	15%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 COLLECTION: Venous Draw	$34.00	$40.00	$24.00–$852.12	—	15%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Routine venipuncture or finger/heel/ear stick for collection of specimen(s)	$34.00	$40.00	$24.00–$852.12	—	15%
Blood glucose (sugar) test CPT 82947 Glucose Fasting	$32.30	$38.00	$1.40–$32.30	35% above	15%
Blood glucose (sugar) test CPT 82947 Glucose Whole Blood	$32.30	$38.00	$1.40–$32.30	35% above	15%
Blood glucose (sugar) test CPT 82947 82947 5611	$32.30	$38.00	$1.40–$32.30	35% above	15%
Blood glucose (sugar) test CPT 82947 POC Fingerstick Blood Sugar (nsg) Task - UC Only	$32.30	$38.00	$1.40–$32.30	35% above	15%
Blood glucose (sugar) test CPT 82947 Glucose Level	$32.30	$38.00	$1.40–$32.30	35% above	15%
Blood glucose (sugar) test CPT 82947 Glucose 2 Hour Postprandial	$32.30	$38.00	$1.40–$32.30	35% above	15%
Blood glucose (sugar) test inpatient CPT 82947 Glucose Level	$32.30	$38.00	$22.80–$852.12	—	15%
Blood glucose (sugar) test inpatient CPT 82947 82947 5611	$32.30	$38.00	$22.80–$852.12	—	15%
Blood glucose (sugar) test inpatient CPT 82947 Glucose 2 Hour Postprandial	$32.30	$38.00	$22.80–$852.12	—	15%
Blood glucose (sugar) test inpatient CPT 82947 Glucose Fasting	$32.30	$38.00	$22.80–$852.12	—	15%
Blood glucose (sugar) test inpatient CPT 82947 Glucose Whole Blood	$32.30	$38.00	$22.80–$852.12	—	15%
Blood glucose (sugar) test inpatient CPT 82947 POC Fingerstick Blood Sugar (nsg) Task - UC Only	$32.30	$38.00	$22.80–$852.12	—	15%
Blood lead test CPT 83655 83655 2117	$7.65	$9.00	$3.40–$52.27	at median	15%
Blood lead test CPT 83655 Lead, Venous, with Demographics, Blood	$8.50	$10.00	$3.78–$52.27	11% above	15%
Blood lead test CPT 83655 Lead Testing POC	$9.35	$11.00	$4.15–$52.27	22% above	15%
Blood lead test CPT 83655 Lead, 24 Hour, Urine	$136.51	$160.60	$6.33–$136.51	1684% above	15%
Blood lead test inpatient CPT 83655 83655 2117	$7.65	$9.00	$5.40–$852.12	—	15%
Blood lead test inpatient CPT 83655 Lead, Venous, with Demographics, Blood	$8.50	$10.00	$6.00–$852.12	—	15%
Blood lead test inpatient CPT 83655 Lead Testing POC	$9.35	$11.00	$6.60–$852.12	—	15%
Blood lead test inpatient CPT 83655 Lead, 24 Hour, Urine	$136.51	$160.60	$96.36–$852.12	—	15%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Pregnancy Test, Serum (Auto)	$53.55	$63.00	$3.93–$53.55	45% above	15%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Pregnancy Test Serum	$53.55	$63.00	$3.93–$53.55	45% above	15%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 Pregnancy Test, Serum (Auto)	$53.55	$63.00	$37.80–$852.12	—	15%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 Pregnancy Test Serum	$53.55	$63.00	$37.80–$852.12	—	15%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Cord ABO/Rh	$119.85	$141.00	$3.50–$225.37	473% above	15%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO/Rh New	$119.85	$141.00	$3.50–$225.37	473% above	15%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Neonate ABO/Rh	$119.85	$141.00	$3.50–$225.37	473% above	15%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Ref Lab ABO/Rh	$119.85	$141.00	$3.50–$225.37	473% above	15%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPING SEROLOGIC ABO	$119.85	$141.00	$3.50–$225.37	473% above	15%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Cord ABO/Rh	$119.85	$141.00	$84.60–$852.12	—	15%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO/Rh New	$119.85	$141.00	$84.60–$852.12	—	15%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Neonate ABO/Rh	$119.85	$141.00	$84.60–$852.12	—	15%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Ref Lab ABO/Rh	$119.85	$141.00	$84.60–$852.12	—	15%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BLOOD TYPING SEROLOGIC ABO	$119.85	$141.00	$84.60–$852.12	—	15%
Blood urea nitrogen (BUN) test CPT 84520 Blood Urea Nitrogen	$30.60	$36.00	$1.40–$30.60	71% above	15%
Blood urea nitrogen (BUN) test CPT 84520 Post Dialysis BUN	$30.60	$36.00	$1.40–$30.60	71% above	15%
Blood urea nitrogen (BUN) test CPT 84520 Pre Dialysis BUN	$30.60	$36.00	$1.40–$30.60	71% above	15%
Blood urea nitrogen (BUN) test CPT 84520 Urea Nitrogen Dialysate	$30.60	$36.00	$1.40–$30.60	71% above	15%
Blood urea nitrogen (BUN) test CPT 84520 Urea Nitrogen, Body Fluid	$48.79	$57.40	$1.40–$48.79	172% above	15%
Blood urea nitrogen (BUN) test inpatient CPT 84520 Blood Urea Nitrogen	$30.60	$36.00	$21.60–$852.12	—	15%
Blood urea nitrogen (BUN) test inpatient CPT 84520 Post Dialysis BUN	$30.60	$36.00	$21.60–$852.12	—	15%
Blood urea nitrogen (BUN) test inpatient CPT 84520 Pre Dialysis BUN	$30.60	$36.00	$21.60–$852.12	—	15%
Blood urea nitrogen (BUN) test inpatient CPT 84520 Urea Nitrogen Dialysate	$30.60	$36.00	$21.60–$852.12	—	15%
Blood urea nitrogen (BUN) test inpatient CPT 84520 Urea Nitrogen, Body Fluid	$48.79	$57.40	$34.44–$852.12	—	15%
C-peptide blood test CPT 84681 C-Peptide	$129.20	$152.00	$10.88–$129.20	83% above	15%
C-peptide blood test CPT 84681 C Peptide	$129.20	$152.00	$10.88–$129.20	83% above	15%
C-peptide blood test inpatient CPT 84681 C-Peptide	$129.20	$152.00	$91.20–$852.12	—	15%
C-peptide blood test inpatient CPT 84681 C Peptide	$129.20	$152.00	$91.20–$852.12	—	15%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-Reactive Protein	$41.65	$49.00	$2.71–$41.65	22% above	15%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-Reactive Protein	$41.65	$49.00	$29.40–$852.12	—	15%
C. difficile toxin gene test (stool PCR) CPT 87493 .Clostridium difficile PCR	$198.05	$233.00	$19.49–$198.05	71% above	15%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 .Clostridium difficile PCR	$198.05	$233.00	$139.80–$852.12	—	15%
CA 19-9 blood test (tumor marker) CPT 86301 Carbohydrate Antigen 19-9	$92.65	$109.00	$10.88–$92.65	1% below	15%
CA 19-9 blood test (tumor marker) CPT 86301 Carbohydrate Antigen 19-9 (CA 19-9), Pleural Fluid	$290.36	$341.60	$10.88–$290.36	211% above	15%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 Carbohydrate Antigen 19-9	$92.65	$109.00	$65.40–$852.12	—	15%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 Carbohydrate Antigen 19-9 (CA 19-9), Pleural Fluid	$290.36	$341.60	$204.96–$852.12	—	15%
CA-125 blood test (ovarian cancer marker) CPT 86304 Cancer Antigen 125	$113.05	$133.00	$10.88–$113.05	12% above	15%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 Cancer Antigen 125	$113.05	$133.00	$79.80–$852.12	—	15%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) RNA Detection, PCR, Varies	$63.75	$75.00	$26.84–$221.44	41% below	15%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 POC SARS CoV2 RNA by NAAT (Abbott) - UC	$197.20	$232.00	$26.84–$221.44	82% above	15%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 POC SARS CoV2 RNA by NAAT Task - UC Only (Abbott)	$197.20	$232.00	$26.84–$221.44	82% above	15%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS CoV2 RNA by NAAT POC (Abbott)	$197.20	$232.00	$26.84–$221.44	82% above	15%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) RNA Detection, PCR, Varies	$63.75	$75.00	$45.00–$852.12	—	15%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 POC SARS CoV2 RNA by NAAT (Abbott) - UC	$197.20	$232.00	$139.20–$852.12	—	15%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS CoV2 RNA by NAAT POC (Abbott)	$197.20	$232.00	$139.20–$852.12	—	15%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 POC SARS CoV2 RNA by NAAT Task - UC Only (Abbott)	$197.20	$232.00	$139.20–$852.12	—	15%
Calcium blood test, total CPT 82310 Calcium/Creatinine Ratio, Random, Urine	$9.34	$10.98	$1.40–$22.27	54% below	15%
Calcium blood test, total CPT 82310 Calcium Level	$40.80	$48.00	$1.40–$40.80	101% above	15%
Calcium blood test, total CPT 82310 Calcium Level Total	$40.80	$48.00	$1.40–$40.80	101% above	15%
Calcium blood test, total inpatient CPT 82310 Calcium/Creatinine Ratio, Random, Urine	$9.34	$10.98	$6.59–$852.12	—	15%
Calcium blood test, total inpatient CPT 82310 Calcium Level Total	$40.80	$48.00	$28.80–$852.12	—	15%
Calcium blood test, total inpatient CPT 82310 Calcium Level	$40.80	$48.00	$28.80–$852.12	—	15%
Carcinoembryonic antigen (CEA) test CPT 82378 Carcinoembryonic Antigen	$136.00	$160.00	$9.92–$136.00	64% above	15%
Carcinoembryonic antigen (CEA) test CPT 82378 Carcinoembryonic Antigen (CEA), Pancreatic Cyst Fluid	$150.20	$176.70	$9.92–$150.20	81% above	15%
Carcinoembryonic antigen (CEA) test CPT 82378 Carcinoembryonic Antigen (CEA), Pleural Fluid	$284.58	$334.80	$9.92–$284.58	243% above	15%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 Carcinoembryonic Antigen	$136.00	$160.00	$96.00–$852.12	—	15%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 Carcinoembryonic Antigen (CEA), Pancreatic Cyst Fluid	$150.20	$176.70	$106.02–$852.12	—	15%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 Carcinoembryonic Antigen (CEA), Pleural Fluid	$284.58	$334.80	$200.88–$852.12	—	15%
Chickenpox (varicella) immunity blood test CPT 86787 Varicella-Zoster Antibody, IgM and IgG, Serum	$10.63	$12.50	$4.72–$55.57	74% below	15%
Chickenpox (varicella) immunity blood test CPT 86787 86787 3237	$12.75	$15.00	$5.67–$55.57	68% below	15%
Chickenpox (varicella) immunity blood test CPT 86787 Varicella-Zoster Antibody, IgG, Serum	$12.75	$15.00	$5.67–$55.57	68% below	15%
Chickenpox (varicella) immunity blood test CPT 86787 Varicella-Zoster Virus (VZV) Antibody, IgM, Serum	$25.42	$29.90	$6.74–$55.57	37% below	15%
Chickenpox (varicella) immunity blood test CPT 86787 Varicella-Zoster Virus Antibody, IgG, CSF	$55.04	$64.75	$6.74–$55.57	37% above	15%
Chickenpox (varicella) immunity blood test CPT 86787 Varicella Zoster Antibody IgG	$59.50	$70.00	$6.74–$59.50	48% above	15%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 Varicella-Zoster Antibody, IgM and IgG, Serum	$10.63	$12.50	$7.50–$852.12	—	15%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 Varicella-Zoster Antibody, IgG, Serum	$12.75	$15.00	$9.00–$852.12	—	15%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 86787 3237	$12.75	$15.00	$9.00–$852.12	—	15%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 Varicella-Zoster Virus (VZV) Antibody, IgM, Serum	$25.42	$29.90	$17.94–$852.12	—	15%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 Varicella-Zoster Virus Antibody, IgG, CSF	$55.04	$64.75	$38.85–$852.12	—	15%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 Varicella Zoster Antibody IgG	$59.50	$70.00	$42.00–$852.12	—	15%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia trachomatis/Neisseria gonorrhoeae	$135.15	$159.00	$18.35–$151.44	83% above	15%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia trachomatis	$135.15	$159.00	$18.35–$151.44	83% above	15%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia trachomatis/Neisseria gonorrhoeae	$135.15	$159.00	$95.40–$852.12	—	15%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia trachomatis	$135.15	$159.00	$95.40–$852.12	—	15%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel	$90.95	$107.00	$7.00–$90.95	79% above	15%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel	$90.95	$107.00	$64.20–$852.12	—	15%
Complete blood count (CBC) with differential CPT 85025 CBC w/ Differential	$70.55	$83.00	$4.06–$70.55	72% above	15%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC w/ Differential	$70.55	$83.00	$49.80–$852.12	—	15%
Complete blood count (CBC), no differential CPT 85027 CBC without Differential	$33.15	$39.00	$3.38–$33.15	14% above	15%
Complete blood count (CBC), no differential inpatient CPT 85027 CBC without Differential	$33.15	$39.00	$23.40–$852.12	—	15%
Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive Metabolic Panel	$145.35	$171.00	$5.52–$145.35	94% above	15%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 Comprehensive Metabolic Panel	$145.35	$171.00	$102.60–$852.12	—	15%
Cortisol blood test, total CPT 82533 Cortisol Saliva	$34.00	$40.00	$8.52–$70.34	at median	15%
Cortisol blood test, total CPT 82533 Dexamethasone (Cortisol Suppression)	$98.60	$116.00	$8.52–$98.60	190% above	15%
Cortisol blood test, total CPT 82533 Cortisol PM	$98.60	$116.00	$8.52–$98.60	190% above	15%
Cortisol blood test, total CPT 82533 Cortisol AM	$98.60	$116.00	$8.52–$98.60	190% above	15%
Cortisol blood test, total CPT 82533 Cortisol	$98.60	$116.00	$8.52–$98.60	190% above	15%
Cortisol blood test, total CPT 82533 .Cortisol Stimulation 60 Minutes	$98.60	$116.00	$8.52–$98.60	190% above	15%
Cortisol blood test, total CPT 82533 .Cortisol Stimulation 30 Minutes	$98.60	$116.00	$8.52–$98.60	190% above	15%
Cortisol blood test, total CPT 82533 .Cortisol Pre Injection	$98.60	$116.00	$8.52–$98.60	190% above	15%
Cortisol blood test, total CPT 82533 Cortisol, Free and Total, Serum	$128.20	$150.82	$8.52–$128.20	277% above	15%
Cortisol blood test, total inpatient CPT 82533 Cortisol Saliva	$34.00	$40.00	$24.00–$852.12	—	15%
Cortisol blood test, total inpatient CPT 82533 Cortisol AM	$98.60	$116.00	$69.60–$852.12	—	15%
Cortisol blood test, total inpatient CPT 82533 Cortisol PM	$98.60	$116.00	$69.60–$852.12	—	15%
Cortisol blood test, total inpatient CPT 82533 .Cortisol Stimulation 30 Minutes	$98.60	$116.00	$69.60–$852.12	—	15%
Cortisol blood test, total inpatient CPT 82533 .Cortisol Pre Injection	$98.60	$116.00	$69.60–$852.12	—	15%
Cortisol blood test, total inpatient CPT 82533 Dexamethasone (Cortisol Suppression)	$98.60	$116.00	$69.60–$852.12	—	15%
Cortisol blood test, total inpatient CPT 82533 Cortisol	$98.60	$116.00	$69.60–$852.12	—	15%
Cortisol blood test, total inpatient CPT 82533 .Cortisol Stimulation 60 Minutes	$98.60	$116.00	$69.60–$852.12	—	15%
Cortisol blood test, total inpatient CPT 82533 Cortisol, Free and Total, Serum	$128.20	$150.82	$90.49–$852.12	—	15%
Creatine kinase (CK) blood test, total CPT 82550 Creatine Kinase	$53.55	$63.00	$1.40–$53.55	78% above	15%
Creatine kinase (CK) blood test, total inpatient CPT 82550 Creatine Kinase	$53.55	$63.00	$37.80–$852.12	—	15%
Creatinine blood test CPT 82565 Creatinine	$34.00	$40.00	$1.40–$34.00	40% above	15%
Creatinine blood test CPT 82565 Creatinine (POCT)	$34.00	$40.00	$1.40–$34.00	40% above	15%
Creatinine blood test inpatient CPT 82565 Creatinine (POCT)	$34.00	$40.00	$24.00–$852.12	—	15%
Creatinine blood test inpatient CPT 82565 Creatinine	$34.00	$40.00	$24.00–$852.12	—	15%
Cytomegalovirus (CMV) antibody test CPT 86644 CMV Antibody IgG, to Spectrum	$15.30	$18.00	$6.80–$62.09	65% below	15%
Cytomegalovirus (CMV) antibody test CPT 86644 Cytomegalovirus (CMV) Antibodies, IgG, Serum	$17.00	$20.00	$7.53–$62.09	61% below	15%
Cytomegalovirus (CMV) antibody test CPT 86644 Cytomegalovirus Antibody Panel IgG and IgM	$61.20	$72.00	$7.53–$62.09	41% above	15%
Cytomegalovirus (CMV) antibody test CPT 86644 zzCytomegalovirus IgG	$61.20	$72.00	$7.53–$62.09	41% above	15%
Cytomegalovirus (CMV) antibody test CPT 86644 Cytomegalovirus IgG Avidity	$127.50	$150.00	$7.53–$127.50	193% above	15%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CMV Antibody IgG, to Spectrum	$15.30	$18.00	$10.80–$852.12	—	15%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 Cytomegalovirus (CMV) Antibodies, IgG, Serum	$17.00	$20.00	$12.00–$852.12	—	15%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 zzCytomegalovirus IgG	$61.20	$72.00	$43.20–$852.12	—	15%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 Cytomegalovirus Antibody Panel IgG and IgM	$61.20	$72.00	$43.20–$852.12	—	15%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 Cytomegalovirus IgG Avidity	$127.50	$150.00	$90.00–$852.12	—	15%
D-dimer blood test (blood clot marker) CPT 85379 85379 4836	$19.60	$23.05	$5.32–$43.93	54% below	15%
D-dimer blood test (blood clot marker) CPT 85379 D-Dimer	$86.70	$102.00	$5.32–$86.70	102% above	15%
D-dimer blood test (blood clot marker) CPT 85379 D-Dimer, Plasma	$180.78	$212.68	$5.32–$180.78	320% above	15%
D-dimer blood test (blood clot marker) inpatient CPT 85379 85379 4836	$19.60	$23.05	$13.83–$852.12	—	15%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-Dimer	$86.70	$102.00	$61.20–$852.12	—	15%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-Dimer, Plasma	$180.78	$212.68	$127.61–$852.12	—	15%
DHEA sulfate (DHEA-S) blood test CPT 82627 Dehydroepiandrosterone Sulfate, Serum	$15.30	$18.00	$6.80–$95.94	76% below	15%
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA Sulfate	$145.35	$171.00	$11.63–$145.35	126% above	15%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 Dehydroepiandrosterone Sulfate, Serum	$15.30	$18.00	$10.80–$852.12	—	15%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA Sulfate	$145.35	$171.00	$102.60–$852.12	—	15%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Abuse Survey with Confirmation, Panel 9, Chain of Custody, Random, Urine	$25.50	$30.00	$11.33–$268.18	56% below	15%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Abuse Survey with Confirmation, Panel 9, Random, Urine	$25.50	$30.00	$11.33–$268.18	56% below	15%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Buprenorphine Screen with Reflex, Random, Urine	$25.50	$30.00	$11.33–$268.18	56% below	15%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen Abuse Toxicology to Spectrum	$25.50	$30.00	$11.33–$268.18	56% below	15%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen, Prescription/Over the Counter, Serum	$39.95	$47.00	$17.75–$268.18	31% below	15%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Ethyl Glucuronide Screen with Reflex, Random, Urine	$46.75	$55.00	$20.77–$268.18	20% below	15%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Ethyl Glucuronide Screen, Random, Urine	$46.75	$55.00	$20.77–$268.18	20% below	15%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen, Prescription/Over the Counter, Random, Urine	$46.75	$55.00	$20.77–$268.18	20% below	15%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drugs of Abuse Scrn Meconium 5	$59.93	$70.50	$26.63–$268.18	3% above	15%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drugs of Abuse Screen 5, Chain of Custody, Meconium	$59.93	$70.50	$26.63–$268.18	3% above	15%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen Urine	$66.30	$78.00	$29.46–$268.18	14% above	15%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Gabapentin, Urine	$70.64	$83.10	$31.39–$268.18	21% above	15%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drugs of Abuse Screen, Serum	$75.65	$89.00	$32.50–$268.18	30% above	15%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drugs of Abuse (10 panel) and Alcohol Screen, Serum	$83.30	$98.00	$32.50–$268.18	43% above	15%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Fentanyl Screen with Reflex, Random, Urine	$86.21	$101.42	$32.50–$268.18	48% above	15%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen 11 w/conf Mec to MedTox	$93.50	$110.00	$32.50–$268.18	61% above	15%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Antidepressant Drug Screen, Ur, Quantitative	$121.38	$142.80	$32.50–$268.18	108% above	15%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen 12 w/conf Mec to MedTox	$122.40	$144.00	$32.50–$268.18	110% above	15%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Naloxone - Total (Conjugated/Unconjugated), Screen, Urine	$194.65	$229.00	$32.50–$268.18	234% above	15%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Oxycodone Screen, Random, Urine	$203.78	$239.73	$32.50–$268.18	250% above	15%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Sedative Hypnotic Panel, Urine	$224.71	$264.36	$32.50–$268.18	286% above	15%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen Urine with Confirmation - MedTox	$238.00	$280.00	$32.50–$268.18	309% above	15%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Fentanyl Urine Screen	$238.00	$280.00	$32.50–$268.18	309% above	15%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen Urine with Confirmation	$238.00	$280.00	$32.50–$268.18	309% above	15%
Drug screen by lab instrument (any number of drug classes) CPT 80307 USDTL Umb Cord Tissue Drug Pnl 14	$238.94	$281.10	$32.50–$268.18	310% above	15%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen, Prescription/Over the Counter, Chain of Custody, Random, Urine	$362.44	$426.39	$32.50–$362.43	522% above	15%
Drug screen by lab instrument (any number of drug classes) CPT 80307 USDTL Umb Cord Tissue Drug Pnl 17	$382.50	$450.00	$32.50–$382.50	557% above	15%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Abuse Survey with Confirmation, Panel 9, Random, Urine	$25.50	$30.00	$18.00–$852.12	—	15%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Abuse Survey with Confirmation, Panel 9, Chain of Custody, Random, Urine	$25.50	$30.00	$18.00–$852.12	—	15%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Screen Abuse Toxicology to Spectrum	$25.50	$30.00	$18.00–$852.12	—	15%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Buprenorphine Screen with Reflex, Random, Urine	$25.50	$30.00	$18.00–$852.12	—	15%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Screen, Prescription/Over the Counter, Serum	$39.95	$47.00	$28.20–$852.12	—	15%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Ethyl Glucuronide Screen, Random, Urine	$46.75	$55.00	$33.00–$852.12	—	15%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Ethyl Glucuronide Screen with Reflex, Random, Urine	$46.75	$55.00	$33.00–$852.12	—	15%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Screen, Prescription/Over the Counter, Random, Urine	$46.75	$55.00	$33.00–$852.12	—	15%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drugs of Abuse Scrn Meconium 5	$59.93	$70.50	$42.30–$852.12	—	15%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drugs of Abuse Screen 5, Chain of Custody, Meconium	$59.93	$70.50	$42.30–$852.12	—	15%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Screen Urine	$66.30	$78.00	$46.80–$852.12	—	15%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Gabapentin, Urine	$70.64	$83.10	$49.86–$852.12	—	15%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drugs of Abuse Screen, Serum	$75.65	$89.00	$53.40–$852.12	—	15%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drugs of Abuse (10 panel) and Alcohol Screen, Serum	$83.30	$98.00	$58.80–$852.12	—	15%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Fentanyl Screen with Reflex, Random, Urine	$86.21	$101.42	$60.85–$852.12	—	15%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Screen 11 w/conf Mec to MedTox	$93.50	$110.00	$66.00–$852.12	—	15%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Antidepressant Drug Screen, Ur, Quantitative	$121.38	$142.80	$85.68–$852.12	—	15%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Screen 12 w/conf Mec to MedTox	$122.40	$144.00	$86.40–$852.12	—	15%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Naloxone - Total (Conjugated/Unconjugated), Screen, Urine	$194.65	$229.00	$137.40–$852.12	—	15%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Oxycodone Screen, Random, Urine	$203.78	$239.73	$143.84–$852.12	—	15%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Sedative Hypnotic Panel, Urine	$224.71	$264.36	$158.62–$852.12	—	15%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Screen Urine with Confirmation - MedTox	$238.00	$280.00	$168.00–$852.12	—	15%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Fentanyl Urine Screen	$238.00	$280.00	$168.00–$852.12	—	15%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Screen Urine with Confirmation	$238.00	$280.00	$168.00–$852.12	—	15%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 USDTL Umb Cord Tissue Drug Pnl 14	$238.94	$281.10	$168.66–$852.12	—	15%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Screen, Prescription/Over the Counter, Chain of Custody, Random, Urine	$362.44	$426.39	$255.83–$852.12	—	15%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 USDTL Umb Cord Tissue Drug Pnl 17	$382.50	$450.00	$270.00–$852.12	—	15%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 Electrolyte Panel	$69.70	$82.00	$3.67–$69.70	118% above	15%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 Electrolyte Panel	$69.70	$82.00	$49.20–$852.12	—	15%
Epstein-Barr virus (EBV) antibody test CPT 86665 86665 5662	$78.20	$92.00	$9.49–$78.28	22% above	15%
Epstein-Barr virus (EBV) antibody test CPT 86665 86665 5661	$78.20	$92.00	$9.49–$78.28	22% above	15%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 86665 5662	$78.20	$92.00	$55.20–$852.12	—	15%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 86665 5661	$78.20	$92.00	$55.20–$852.12	—	15%
Estradiol blood test CPT 82670 Estradiol, Serum	$17.00	$20.00	$7.55–$50.77	78% below	15%
Estradiol blood test CPT 82670 Estradiol Free, Serum (includes Estradiol and SHBG)	$58.05	$68.29	$14.61–$58.05	26% below	15%
Estradiol blood test CPT 82670 Estradiol Level	$141.95	$167.00	$14.61–$141.95	82% above	15%
Estradiol blood test inpatient CPT 82670 Estradiol, Serum	$17.00	$20.00	$12.00–$852.12	—	15%
Estradiol blood test inpatient CPT 82670 Estradiol Free, Serum (includes Estradiol and SHBG)	$58.05	$68.29	$40.97–$852.12	—	15%
Estradiol blood test inpatient CPT 82670 Estradiol Level	$141.95	$167.00	$100.20–$852.12	—	15%
FSH (follicle-stimulating hormone) test CPT 83001 Follicle Stimulating Hormone Level	$128.35	$151.00	$9.72–$128.35	61% above	15%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 Follicle Stimulating Hormone Level	$128.35	$151.00	$90.60–$852.12	—	15%
Fecal calprotectin (stool inflammation test) CPT 83993 Calprotectin	$102.85	$121.00	$10.27–$102.85	62% above	15%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 Calprotectin	$102.85	$121.00	$72.60–$852.12	—	15%
Ferritin blood test (iron stores) CPT 82728 Ferritin	$96.90	$114.00	$7.13–$96.90	62% above	15%
Ferritin blood test (iron stores) CPT 82728 Thalassemia and Hemoglobinopathy Evaluation, Blood and Serum	$156.86	$184.54	$7.13–$156.86	161% above	15%
Ferritin blood test (iron stores) inpatient CPT 82728 Ferritin	$96.90	$114.00	$68.40–$852.12	—	15%
Ferritin blood test (iron stores) inpatient CPT 82728 Thalassemia and Hemoglobinopathy Evaluation, Blood and Serum	$156.86	$184.54	$110.72–$852.12	—	15%
Fibrinogen blood test CPT 85384 Fibrinogen, Clauss, Plasma	$17.70	$20.82	$5.08–$41.96	39% below	15%
Fibrinogen blood test CPT 85384 85384 4835	$18.71	$22.01	$5.08–$41.96	35% below	15%
Fibrinogen blood test CPT 85384 Fibrinogen Level	$62.90	$74.00	$5.08–$62.90	117% above	15%
Fibrinogen blood test inpatient CPT 85384 Fibrinogen, Clauss, Plasma	$17.70	$20.82	$12.49–$852.12	—	15%
Fibrinogen blood test inpatient CPT 85384 85384 4835	$18.71	$22.01	$13.21–$852.12	—	15%
Fibrinogen blood test inpatient CPT 85384 Fibrinogen Level	$62.90	$74.00	$44.40–$852.12	—	15%
Folate (folic acid) blood test CPT 82746 Folate Level	$105.40	$124.00	$7.69–$105.40	34% above	15%
Folate (folic acid) blood test inpatient CPT 82746 Folate Level	$105.40	$124.00	$74.40–$852.12	—	15%
Free T3 thyroid hormone test CPT 84481 T3 Free	$105.40	$124.00	$8.86–$105.40	58% above	15%
Free T3 thyroid hormone test inpatient CPT 84481 T3 Free	$105.40	$124.00	$74.40–$852.12	—	15%
Free T4 (free thyroxine) thyroid blood test CPT 84439 zzT4 (Thyroxine), Free, Dialysis, Serum	$24.29	$28.57	$4.72–$24.28	22% below	15%
Free T4 (free thyroxine) thyroid blood test CPT 84439 T4 Free Direct Dialysis	$24.29	$28.57	$4.72–$24.28	22% below	15%
Free T4 (free thyroxine) thyroid blood test CPT 84439 Free T4 Level	$75.65	$89.00	$4.72–$75.65	144% above	15%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 zzT4 (Thyroxine), Free, Dialysis, Serum	$24.29	$28.57	$17.14–$852.12	—	15%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4 Free Direct Dialysis	$24.29	$28.57	$17.14–$852.12	—	15%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 Free T4 Level	$75.65	$89.00	$53.40–$852.12	—	15%
Free testosterone test CPT 84402 Testosterone, Total and Free, Serum	$10.54	$12.40	$4.68–$109.92	71% below	15%
Free testosterone test inpatient CPT 84402 Testosterone, Total and Free, Serum	$10.54	$12.40	$7.44–$852.12	—	15%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 Gamma Glutamyl Transferase	$31.45	$37.00	$1.40–$31.45	2% above	15%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 Gamma Glutamyl Transferase	$31.45	$37.00	$22.20–$852.12	—	15%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Gestational Diabetes Screen (Glucose)	$27.20	$32.00	$2.48–$27.20	25% above	15%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Gestational Diabetes Screen (Glucose)	$27.20	$32.00	$19.20–$852.12	—	15%
Glucose tolerance test, 3 samples CPT 82951 .Glucose 2 Hour- Gestational	$90.95	$107.00	$6.73–$90.95	59% above	15%
Glucose tolerance test, 3 samples CPT 82951 .Glucose 2 Hour	$90.95	$107.00	$6.73–$90.95	59% above	15%
Glucose tolerance test, 3 samples inpatient CPT 82951 .Glucose 2 Hour- Gestational	$90.95	$107.00	$64.20–$852.12	—	15%
Glucose tolerance test, 3 samples inpatient CPT 82951 .Glucose 2 Hour	$90.95	$107.00	$64.20–$852.12	—	15%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 3415 Neisseria gonorrhoeae	$135.15	$159.00	$18.35–$151.44	42% above	15%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Neisseria gonorrhoeae	$135.15	$159.00	$18.35–$151.44	42% above	15%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 3415 Neisseria gonorrhoeae	$135.15	$159.00	$95.40–$852.12	—	15%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Neisseria gonorrhoeae	$135.15	$159.00	$95.40–$852.12	—	15%
H. pylori stool antigen test CPT 87338 H. pylori Antigen, Stool	$70.55	$83.00	$7.52–$70.55	11% above	15%
H. pylori stool antigen test inpatient CPT 87338 H. pylori Antigen, Stool	$70.55	$83.00	$49.80–$852.12	—	15%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 RNA Detection and Quantification, PRENATAL, Plasma	$74.44	$87.57	$33.08–$367.27	59% below	15%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 RNA Detection and Quantification, Plasma	$74.44	$87.57	$33.08–$367.27	59% below	15%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV 1 Quantitative	$326.40	$384.00	$44.51–$367.27	79% above	15%
HIV viral load test (HIV-1 RNA, quantitative) one side CPT 87536 HIV1 RNA Qt Rflx Geno DR, RT/Prot/Integ Inhibitors	$74.44	$87.57	$33.08–$367.27	59% below	15%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV-1 RNA Detection and Quantification, Plasma	$74.44	$87.57	$52.54–$852.12	—	15%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV-1 RNA Detection and Quantification, PRENATAL, Plasma	$74.44	$87.57	$52.54–$852.12	—	15%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV 1 Quantitative	$326.40	$384.00	$230.40–$852.12	—	15%
HIV viral load test (HIV-1 RNA, quantitative) inpatient one side CPT 87536 HIV1 RNA Qt Rflx Geno DR, RT/Prot/Integ Inhibitors	$74.44	$87.57	$52.54–$852.12	—	15%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 zzHIV-1 and HIV-2 Antigen and Antibody Diagnostic Evaluation, Plasma	$17.00	$20.00	$7.55–$103.93	65% below	15%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV-1 and HIV-2 Antigen and Antibody Routine Screen, Plasma	$17.00	$20.00	$7.55–$103.93	65% below	15%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV 1/2 Antigen and Antibody	$99.45	$117.00	$12.59–$103.93	103% above	15%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 zzHIV-1 and HIV-2 Antigen and Antibody Diagnostic Evaluation, Plasma	$17.00	$20.00	$12.00–$852.12	—	15%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV-1 and HIV-2 Antigen and Antibody Routine Screen, Plasma	$17.00	$20.00	$12.00–$852.12	—	15%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV 1/2 Antigen and Antibody	$99.45	$117.00	$70.20–$852.12	—	15%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV High Risk with Genotype	$135.15	$159.00	$18.35–$151.44	83% above	15%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV High Risk with Genotype Cytology	$135.15	$159.00	$18.35–$151.44	83% above	15%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV High Risk with Genotype	$135.15	$159.00	$95.40–$852.12	—	15%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV High Risk with Genotype Cytology	$135.15	$159.00	$95.40–$852.12	—	15%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HbA1C POC	$79.05	$93.00	$5.08–$79.05	96% above	15%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1c	$79.05	$93.00	$5.08–$79.05	96% above	15%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hemoglobin A1c	$79.05	$93.00	$55.80–$852.12	—	15%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HbA1C POC	$79.05	$93.00	$55.80–$852.12	—	15%
Hemoglobin blood test CPT 85018 ISTAT HEMOGLOBIN UC	$22.10	$26.00	$1.24–$22.10	38% above	15%
Hemoglobin blood test CPT 85018 Hemoglobin	$22.10	$26.00	$1.24–$22.10	38% above	15%
Hemoglobin blood test CPT 85018 Hemoglobin POC	$22.10	$26.00	$1.24–$22.10	38% above	15%
Hemoglobin blood test CPT 85018 85018 661	$22.10	$26.00	$1.24–$22.10	38% above	15%
Hemoglobin blood test inpatient CPT 85018 Hemoglobin POC	$22.10	$26.00	$15.60–$852.12	—	15%
Hemoglobin blood test inpatient CPT 85018 Hemoglobin	$22.10	$26.00	$15.60–$852.12	—	15%
Hemoglobin blood test inpatient CPT 85018 85018 661	$22.10	$26.00	$15.60–$852.12	—	15%
Hemoglobin blood test inpatient CPT 85018 ISTAT HEMOGLOBIN UC	$22.10	$26.00	$15.60–$852.12	—	15%
Hepatitis B core antibody test (total) CPT 86704 Hepatitis B Core Total Antibodies, with Reflex to Hepatitis B Core Antibody IgM, Serum	$44.20	$52.00	$6.30–$52.01	at median	15%
Hepatitis B core antibody test (total) CPT 86704 86704 4374	$46.75	$55.00	$6.30–$52.01	6% above	15%
Hepatitis B core antibody test (total) CPT 86704 Hepatitis B Core Antibody Total IgG and IgM	$46.75	$55.00	$6.30–$52.01	6% above	15%
Hepatitis B core antibody test (total) CPT 86704 Previous Viral Hepatitis (Unknown Type), Serum	$59.32	$69.78	$6.30–$59.31	34% above	15%
Hepatitis B core antibody test (total) inpatient CPT 86704 Hepatitis B Core Total Antibodies, with Reflex to Hepatitis B Core Antibody IgM, Serum	$44.20	$52.00	$31.20–$852.12	—	15%
Hepatitis B core antibody test (total) inpatient CPT 86704 86704 4374	$46.75	$55.00	$33.00–$852.12	—	15%
Hepatitis B core antibody test (total) inpatient CPT 86704 Hepatitis B Core Antibody Total IgG and IgM	$46.75	$55.00	$33.00–$852.12	—	15%
Hepatitis B core antibody test (total) inpatient CPT 86704 Previous Viral Hepatitis (Unknown Type), Serum	$59.32	$69.78	$41.87–$852.12	—	15%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B Surface Antibody, Qualitative/Quantitative, Serum	$12.75	$15.00	$5.62–$46.35	70% below	15%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B Surface Antibody Screen, Qualitative/Quantitative, Serum	$12.75	$15.00	$5.62–$46.35	70% below	15%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Chronic Hepatitis Panel	$52.70	$62.00	$5.62–$52.70	25% above	15%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B Surface Antibody	$52.70	$62.00	$5.62–$52.70	25% above	15%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hepatitis B Surface Antibody, Qualitative/Quantitative, Serum	$12.75	$15.00	$9.00–$852.12	—	15%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hepatitis B Surface Antibody Screen, Qualitative/Quantitative, Serum	$12.75	$15.00	$9.00–$852.12	—	15%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hepatitis B Surface Antibody	$52.70	$62.00	$37.20–$852.12	—	15%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Chronic Hepatitis Panel	$52.70	$62.00	$37.20–$852.12	—	15%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hepatitis B Surface Antigen, Serum	$8.38	$9.85	$3.72–$44.58	82% below	15%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hepatitis B Surface Antigen	$54.40	$64.00	$5.40–$54.40	17% above	15%
Hepatitis B surface antigen (HBsAg) test CPT 87340 87340 4372	$54.40	$64.00	$5.40–$54.40	17% above	15%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hepatitis B Surface Antigen, Serum	$8.38	$9.85	$5.91–$852.12	—	15%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 87340 4372	$54.40	$64.00	$38.40–$852.12	—	15%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hepatitis B Surface Antigen	$54.40	$64.00	$38.40–$852.12	—	15%
Hepatitis C antibody blood test (screening) CPT 86803 zzChronic Hepatitis (Unknown Type), Serum	$16.61	$19.53	$7.38–$25.97	65% below	15%
Hepatitis C antibody blood test (screening) CPT 86803 zzHepatitis C Virus (HCV) Antibody with Reflex to HCV RNA, PCR, Symptomatic, Serum	$21.25	$25.00	$7.46–$25.97	56% below	15%
Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C Antibody IgG	$111.35	$131.00	$7.46–$111.35	132% above	15%
Hepatitis C antibody blood test (screening) CPT 86803 86803 4373	$111.35	$131.00	$7.46–$111.35	132% above	15%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 zzChronic Hepatitis (Unknown Type), Serum	$16.61	$19.53	$11.72–$852.12	—	15%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 zzHepatitis C Virus (HCV) Antibody with Reflex to HCV RNA, PCR, Symptomatic, Serum	$21.25	$25.00	$15.00–$852.12	—	15%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 86803 4373	$111.35	$131.00	$78.60–$852.12	—	15%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 Hepatitis C Antibody IgG	$111.35	$131.00	$78.60–$852.12	—	15%
Hepatitis C viral load (HCV RNA) test CPT 87522 Hepatitis C Virus (HCV) RNA Detect and Quant, Real-Time Reverse Transcription-PCR, Prenatal, Serum	$85.00	$100.00	$22.41–$184.88	35% below	15%
Hepatitis C viral load (HCV RNA) test CPT 87522 Hepatitis C Quantitative	$111.35	$131.00	$22.41–$184.88	15% below	15%
Hepatitis C viral load (HCV RNA) test CPT 87522 HCV RNA Detect/Quant, S	$256.70	$302.00	$22.41–$256.70	95% above	15%
Hepatitis C viral load (HCV RNA) test one side CPT 87522 HCV RNA Detect/Quant RT Rev Trans-PCR, Serum	$85.00	$100.00	$22.41–$184.88	35% below	15%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Hepatitis C Virus (HCV) RNA Detect and Quant, Real-Time Reverse Transcription-PCR, Prenatal, Serum	$85.00	$100.00	$60.00–$852.12	—	15%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Hepatitis C Quantitative	$111.35	$131.00	$78.60–$852.12	—	15%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HCV RNA Detect/Quant, S	$256.70	$302.00	$181.20–$852.12	—	15%
Hepatitis C viral load (HCV RNA) test inpatient one side CPT 87522 HCV RNA Detect/Quant RT Rev Trans-PCR, Serum	$85.00	$100.00	$60.00–$852.12	—	15%
Herpes blood test, HSV-1 antibody CPT 86695 Herpes Simplex Antibody IgG	$56.95	$67.00	$6.90–$56.95	37% above	15%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 Herpes Simplex Antibody IgG	$56.95	$67.00	$40.20–$852.12	—	15%
Herpes blood test, HSV-2 antibody CPT 86696 86696 3225	$11.05	$13.00	$4.91–$83.51	78% below	15%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 86696 3225	$11.05	$13.00	$7.80–$852.12	—	15%
High-sensitivity CRP (hs-CRP) test CPT 86141 C-Reactive Protein High Sensitivity	$71.40	$84.00	$6.77–$71.40	24% above	15%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-Reactive Protein High Sensitivity	$71.40	$84.00	$50.40–$852.12	—	15%
Homocysteine blood test CPT 83090 Homocysteine, Total, Plasma	$17.43	$20.50	$7.74–$77.34	77% below	15%
Homocysteine blood test CPT 83090 Homocysteine Total	$153.85	$181.00	$9.37–$153.85	101% above	15%
Homocysteine blood test inpatient CPT 83090 Homocysteine, Total, Plasma	$17.43	$20.50	$12.30–$852.12	—	15%
Homocysteine blood test inpatient CPT 83090 Homocysteine Total	$153.85	$181.00	$108.60–$852.12	—	15%
Insulin blood test CPT 83525 Insulin Level Total	$82.45	$97.00	$5.98–$82.45	125% above	15%
Insulin blood test inpatient CPT 83525 Insulin Level Total	$82.45	$97.00	$58.20–$852.12	—	15%
Iron blood test (serum iron) CPT 83540 Iron Liver Tissue	$35.70	$42.00	$3.38–$35.70	22% above	15%
Iron blood test (serum iron) CPT 83540 83540 4498	$53.55	$63.00	$3.38–$53.55	83% above	15%
Iron blood test (serum iron) CPT 83540 Iron Level	$53.55	$63.00	$3.38–$53.55	83% above	15%
Iron blood test (serum iron) inpatient CPT 83540 Iron Liver Tissue	$35.70	$42.00	$25.20–$852.12	—	15%
Iron blood test (serum iron) inpatient CPT 83540 83540 4498	$53.55	$63.00	$37.80–$852.12	—	15%
Iron blood test (serum iron) inpatient CPT 83540 Iron Level	$53.55	$63.00	$37.80–$852.12	—	15%
Iron-binding capacity (TIBC) test CPT 83550 Iron Binding Capacity	$76.50	$90.00	$4.57–$76.50	92% above	15%
Iron-binding capacity (TIBC) test inpatient CPT 83550 Iron Binding Capacity	$76.50	$90.00	$54.00–$852.12	—	15%
Kidney function blood test panel CPT 80069 Renal Function Panel	$120.70	$142.00	$4.54–$120.70	95% above	15%
Kidney function blood test panel inpatient CPT 80069 Renal Function Panel	$120.70	$142.00	$85.20–$852.12	—	15%
LH (luteinizing hormone) test CPT 83002 Luteinizing Hormone	$113.05	$133.00	$9.69–$113.05	49% above	15%
LH (luteinizing hormone) test inpatient CPT 83002 Luteinizing Hormone	$113.05	$133.00	$79.80–$852.12	—	15%
Lactate (lactic acid) blood test CPT 83605 Lactic Acid CSF	$47.60	$56.00	$6.05–$49.94	6% above	15%
Lactate (lactic acid) blood test CPT 83605 Lactic Acid (Venous)	$47.60	$56.00	$6.05–$49.94	6% above	15%
Lactate (lactic acid) blood test inpatient CPT 83605 Lactic Acid CSF	$47.60	$56.00	$33.60–$852.12	—	15%
Lactate (lactic acid) blood test inpatient CPT 83605 Lactic Acid (Venous)	$47.60	$56.00	$33.60–$852.12	—	15%
Lactate dehydrogenase (LDH) blood test CPT 83615 Lactate Dehydrogenase (LDH), Body Fluid	$10.20	$12.00	$1.40–$26.08	58% below	15%
Lactate dehydrogenase (LDH) blood test CPT 83615 Lactate Dehydrogenase Body Fluid	$38.25	$45.00	$1.40–$38.25	59% above	15%
Lactate dehydrogenase (LDH) blood test CPT 83615 Lactate Dehydrogenase	$38.25	$45.00	$1.40–$38.25	59% above	15%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Lactate Dehydrogenase (LDH), Body Fluid	$10.20	$12.00	$7.20–$852.12	—	15%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Lactate Dehydrogenase Body Fluid	$38.25	$45.00	$27.00–$852.12	—	15%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Lactate Dehydrogenase	$38.25	$45.00	$27.00–$852.12	—	15%
Lipase blood test (pancreas enzyme) CPT 83690 Lipase Body Fluid	$21.62	$25.43	$3.60–$21.62	30% below	15%
Lipase blood test (pancreas enzyme) CPT 83690 Lipase Level	$56.10	$66.00	$3.60–$56.10	81% above	15%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase Body Fluid	$21.62	$25.43	$15.26–$852.12	—	15%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase Level	$56.10	$66.00	$39.60–$852.12	—	15%
Liver function blood test panel CPT 80076 Hepatic Function Panel	$104.55	$123.00	$4.27–$104.55	123% above	15%
Liver function blood test panel inpatient CPT 80076 Hepatic Function Panel	$104.55	$123.00	$73.80–$852.12	—	15%
Lyme disease antibody test CPT 86618 Lyme Disease Serology, Serum	$14.87	$17.49	$6.61–$73.49	43% below	15%
Lyme disease antibody test CPT 86618 Lyme AB IgM	$15.30	$18.00	$6.80–$73.49	41% below	15%
Lyme disease antibody test CPT 86618 Lyme AB Total	$15.30	$18.00	$6.80–$73.49	41% below	15%
Lyme disease antibody test CPT 86618 Lyme AB IgG	$15.30	$18.00	$6.80–$73.49	41% below	15%
Lyme disease antibody test CPT 86618 Tick-Borne Disease Antibodies Panel, Serum	$29.08	$34.21	$8.91–$73.49	12% above	15%
Lyme disease antibody test inpatient CPT 86618 Lyme Disease Serology, Serum	$14.87	$17.49	$10.49–$852.12	—	15%
Lyme disease antibody test inpatient CPT 86618 Lyme AB Total	$15.30	$18.00	$10.80–$852.12	—	15%
Lyme disease antibody test inpatient CPT 86618 Lyme AB IgM	$15.30	$18.00	$10.80–$852.12	—	15%
Lyme disease antibody test inpatient CPT 86618 Lyme AB IgG	$15.30	$18.00	$10.80–$852.12	—	15%
Lyme disease antibody test inpatient CPT 86618 Tick-Borne Disease Antibodies Panel, Serum	$29.08	$34.21	$20.53–$852.12	—	15%
Magnesium blood test CPT 83735 Magnesium, RBC to QST	$50.10	$58.93	$3.50–$50.09	150% above	15%
Magnesium blood test CPT 83735 Magnesium Level 24 Hour Urine	$52.70	$62.00	$3.50–$52.70	164% above	15%
Magnesium blood test CPT 83735 Magnesium Level	$52.70	$62.00	$3.50–$52.70	164% above	15%
Magnesium blood test CPT 83735 Magnesium, OB	$52.70	$62.00	$3.50–$52.70	164% above	15%
Magnesium blood test CPT 83735 Magnesium Level Urine	$52.70	$62.00	$3.50–$52.70	164% above	15%
Magnesium blood test inpatient CPT 83735 Magnesium, RBC to QST	$50.10	$58.93	$35.36–$852.12	—	15%
Magnesium blood test inpatient CPT 83735 Magnesium Level 24 Hour Urine	$52.70	$62.00	$37.20–$852.12	—	15%
Magnesium blood test inpatient CPT 83735 Magnesium Level	$52.70	$62.00	$37.20–$852.12	—	15%
Magnesium blood test inpatient CPT 83735 Magnesium Level Urine	$52.70	$62.00	$37.20–$852.12	—	15%
Magnesium blood test inpatient CPT 83735 Magnesium, OB	$52.70	$62.00	$37.20–$852.12	—	15%
Measles (rubeola) antibody test CPT 86765 Measles (Rubeola) Antibodies, IgG, Serum	$12.75	$15.00	$5.67–$55.57	48% below	15%
Measles (rubeola) antibody test CPT 86765 zzMeasles, Mumps, Rubella, and Varicella (MMRV) Immune Status Profile, Serum	$13.60	$16.00	$6.04–$55.57	45% below	15%
Measles (rubeola) antibody test CPT 86765 86765 3239	$17.00	$20.00	$6.74–$55.57	31% below	15%
Measles (rubeola) antibody test CPT 86765 Measles (Rubeola) Virus Antibody, IgM and IgG, Serum	$17.00	$20.00	$6.74–$55.57	31% below	15%
Measles (rubeola) antibody test CPT 86765 Measles (Rubeola) Antibodies, IgM, Serum	$21.25	$25.00	$6.74–$55.57	14% below	15%
Measles (rubeola) antibody test CPT 86765 Measles IgG	$74.80	$88.00	$6.74–$74.80	203% above	15%
Measles (rubeola) antibody test inpatient CPT 86765 Measles (Rubeola) Antibodies, IgG, Serum	$12.75	$15.00	$9.00–$852.12	—	15%
Measles (rubeola) antibody test inpatient CPT 86765 zzMeasles, Mumps, Rubella, and Varicella (MMRV) Immune Status Profile, Serum	$13.60	$16.00	$9.60–$852.12	—	15%
Measles (rubeola) antibody test inpatient CPT 86765 86765 3239	$17.00	$20.00	$12.00–$852.12	—	15%
Measles (rubeola) antibody test inpatient CPT 86765 Measles (Rubeola) Virus Antibody, IgM and IgG, Serum	$17.00	$20.00	$12.00–$852.12	—	15%
Measles (rubeola) antibody test inpatient CPT 86765 Measles (Rubeola) Antibodies, IgM, Serum	$21.25	$25.00	$15.00–$852.12	—	15%
Measles (rubeola) antibody test inpatient CPT 86765 Measles IgG	$74.80	$88.00	$52.80–$852.12	—	15%
Mono test (heterophile antibody, Monospot) CPT 86308 Mono Screen POC	$51.00	$60.00	$2.71–$51.00	26% above	15%
Mono test (heterophile antibody, Monospot) CPT 86308 Mononucleosis Screen	$51.00	$60.00	$2.71–$51.00	26% above	15%
Mono test (heterophile antibody, Monospot) CPT 86308 POC Mono Screen (nsg) Task - UC Only	$51.85	$61.00	$2.71–$51.85	28% above	15%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 Mono Screen POC	$51.00	$60.00	$36.00–$852.12	—	15%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 Mononucleosis Screen	$51.00	$60.00	$36.00–$852.12	—	15%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 POC Mono Screen (nsg) Task - UC Only	$51.85	$61.00	$36.60–$852.12	—	15%
Mumps immunity blood test CPT 86735 Mumps Virus Antibody, IgM and IgG, Serum	$11.90	$14.00	$5.29–$56.33	53% below	15%
Mumps immunity blood test CPT 86735 Mumps Virus Antibody, IgG	$12.75	$15.00	$5.67–$56.33	49% below	15%
Mumps immunity blood test CPT 86735 Mumps IgG	$50.15	$59.00	$6.83–$56.33	100% above	15%
Mumps immunity blood test CPT 86735 Mumps Virus Antibody, IgM, Serum	$123.76	$145.60	$6.83–$123.76	393% above	15%
Mumps immunity blood test inpatient CPT 86735 Mumps Virus Antibody, IgM and IgG, Serum	$11.90	$14.00	$8.40–$852.12	—	15%
Mumps immunity blood test inpatient CPT 86735 Mumps Virus Antibody, IgG	$12.75	$15.00	$9.00–$852.12	—	15%
Mumps immunity blood test inpatient CPT 86735 Mumps IgG	$50.15	$59.00	$35.40–$852.12	—	15%
Mumps immunity blood test inpatient CPT 86735 Mumps Virus Antibody, IgM, Serum	$123.76	$145.60	$87.36–$852.12	—	15%
PSA (prostate-specific antigen) blood test, free CPT 84154 Prostate Health Index Rflx, Serum	$57.35	$67.47	$9.62–$79.36	at median	15%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA Free	$70.55	$83.00	$9.62–$79.36	23% above	15%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA Free and Total	$70.55	$83.00	$9.62–$79.36	23% above	15%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 Prostate Health Index Rflx, Serum	$57.35	$67.47	$40.48–$852.12	—	15%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA Free	$70.55	$83.00	$49.80–$852.12	—	15%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA Free and Total	$70.55	$83.00	$49.80–$852.12	—	15%
PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate Health Index Reflex, Serum	$10.66	$12.53	$4.73–$35.43	79% below	15%
PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate-Specific Antigen (PSA) Ultrasensitive, Serum	$34.81	$40.95	$9.62–$35.43	32% below	15%
PSA (prostate-specific antigen) blood test, total CPT 84153 84153 4140	$56.10	$66.00	$9.62–$56.10	9% above	15%
PSA (prostate-specific antigen) blood test, total CPT 84153 84153 4727	$56.10	$66.00	$9.62–$56.10	9% above	15%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Diagnostic	$56.10	$66.00	$9.62–$56.10	9% above	15%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Prostate Health Index Reflex, Serum	$10.66	$12.53	$7.52–$852.12	—	15%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Prostate-Specific Antigen (PSA) Ultrasensitive, Serum	$34.81	$40.95	$24.57–$852.12	—	15%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 84153 4727	$56.10	$66.00	$39.60–$852.12	—	15%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA Diagnostic	$56.10	$66.00	$39.60–$852.12	—	15%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 84153 4140	$56.10	$66.00	$39.60–$852.12	—	15%
Pap test (liquid-based, automated screening with review) CPT 88175 88175 AP Bill Gyn Cytology CAS Rescreen	$123.25	$145.00	$13.92–$123.25	66% above	15%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 88175 AP Bill Gyn Cytology CAS Rescreen	$123.25	$145.00	$87.00–$852.12	—	15%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 88142 AP Bill Gyn Cytology Liquid Prep	$77.35	$91.00	$10.60–$87.44	1% below	15%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 88142 AP Bill Gyn Cytology Liquid Prep	$77.35	$91.00	$54.60–$852.12	—	15%
Parathyroid hormone (PTH) blood test CPT 83970 Parathyroid Hormone Intact Intraoperative/Pre Operative	$127.50	$150.00	$21.59–$127.50	5% below	15%
Parathyroid hormone (PTH) blood test CPT 83970 PTH - Intact	$127.50	$150.00	$21.59–$127.50	5% below	15%
Parathyroid hormone (PTH) blood test CPT 83970 Parathyroid Hormone, Fine-Needle Aspiration Biopsy (FNAB)-Needle Wash	$226.95	$267.00	$21.59–$226.95	69% above	15%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 Parathyroid Hormone Intact Intraoperative/Pre Operative	$127.50	$150.00	$90.00–$852.12	—	15%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH - Intact	$127.50	$150.00	$90.00–$852.12	—	15%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 Parathyroid Hormone, Fine-Needle Aspiration Biopsy (FNAB)-Needle Wash	$226.95	$267.00	$160.20–$852.12	—	15%
Partial thromboplastin time (PTT) clotting test CPT 85730 Partial Thromboplastin Time	$36.55	$43.00	$3.14–$36.55	18% above	15%
Partial thromboplastin time (PTT) clotting test CPT 85730 Partial Thromboplastin Time Heparin Protocol	$36.55	$43.00	$3.14–$36.55	18% above	15%
Partial thromboplastin time (PTT) clotting test CPT 85730 85730 6787	$39.24	$46.16	$3.14–$39.24	27% above	15%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Partial Thromboplastin Time Heparin Protocol	$36.55	$43.00	$25.80–$852.12	—	15%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Partial Thromboplastin Time	$36.55	$43.00	$25.80–$852.12	—	15%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 85730 6787	$39.24	$46.16	$27.70–$852.12	—	15%
Phosphorus (phosphate) blood test CPT 84100 Phosphorus Level	$28.05	$33.00	$1.40–$28.05	34% above	15%
Phosphorus (phosphate) blood test inpatient CPT 84100 Phosphorus Level	$28.05	$33.00	$19.80–$852.12	—	15%
Potassium blood test CPT 84132 Potassium Level	$28.05	$33.00	$1.40–$28.05	17% above	15%
Potassium blood test CPT 84132 84132 5609	$28.05	$33.00	$1.40–$28.05	17% above	15%
Potassium blood test CPT 84132 Potassium, RBC to QST	$71.91	$84.59	$1.40–$71.90	201% above	15%
Potassium blood test inpatient CPT 84132 84132 5609	$28.05	$33.00	$19.80–$852.12	—	15%
Potassium blood test inpatient CPT 84132 Potassium Level	$28.05	$33.00	$19.80–$852.12	—	15%
Potassium blood test inpatient CPT 84132 Potassium, RBC to QST	$71.91	$84.59	$50.75–$852.12	—	15%
Progesterone blood test CPT 84144 Progesterone Level	$65.45	$77.00	$10.91–$65.45	3% above	15%
Progesterone blood test inpatient CPT 84144 Progesterone Level	$65.45	$77.00	$46.20–$852.12	—	15%
Prolactin blood test CPT 84146 Prolactin, Pituitary Macroadenoma, Serum	$126.99	$149.40	$10.14–$126.99	73% above	15%
Prolactin blood test CPT 84146 Prolactin Level	$146.20	$172.00	$10.14–$146.20	99% above	15%
Prolactin blood test inpatient CPT 84146 Prolactin, Pituitary Macroadenoma, Serum	$126.99	$149.40	$89.64–$852.12	—	15%
Prolactin blood test inpatient CPT 84146 Prolactin Level	$146.20	$172.00	$103.20–$852.12	—	15%
Prothrombin time (PT/INR) clotting test CPT 85610 85610 4832	$8.27	$9.72	$2.24–$12.99	58% below	15%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME BCE	$24.65	$29.00	$2.24–$24.65	26% above	15%
Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time and INR	$24.65	$29.00	$2.24–$24.65	26% above	15%
Prothrombin time (PT/INR) clotting test CPT 85610 INR (POCT)	$24.65	$29.00	$2.24–$24.65	26% above	15%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME	$24.65	$29.00	$2.24–$24.65	26% above	15%
Prothrombin time (PT/INR) clotting test CPT 85610 INR POC	$24.65	$29.00	$2.24–$24.65	26% above	15%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 85610 4832	$8.27	$9.72	$5.83–$852.12	—	15%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME BCE	$24.65	$29.00	$17.40–$852.12	—	15%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 INR (POCT)	$24.65	$29.00	$17.40–$852.12	—	15%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME	$24.65	$29.00	$17.40–$852.12	—	15%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 INR POC	$24.65	$29.00	$17.40–$852.12	—	15%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time and INR	$24.65	$29.00	$17.40–$852.12	—	15%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 Urine Drug Screen POC	$48.45	$57.00	$6.59–$54.38	29% above	15%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 Urine Drug Screen 14 Panel McKesson POC	$48.45	$57.00	$6.59–$54.38	29% above	15%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 Urine Drug Screen 14 Panel McKesson POC	$48.45	$57.00	$34.20–$852.12	—	15%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 Urine Drug Screen POC	$48.45	$57.00	$34.20–$852.12	—	15%
Rapid flu test (influenza antigen) CPT 87804 Influenza Screen POC	$63.75	$75.00	$8.66–$71.42	33% above	15%
Rapid flu test (influenza antigen) CPT 87804 87804 INFLUENZA ASSAY W/OPTIC B UC	$63.75	$75.00	$8.66–$71.42	33% above	15%
Rapid flu test (influenza antigen) CPT 87804 87804 INFLUENZA ASSAY W/OPTIC A UC	$63.75	$75.00	$8.66–$71.42	33% above	15%
Rapid flu test (influenza antigen) CPT 87804 Influenza Assay w Optics	$63.75	$75.00	$8.66–$71.42	33% above	15%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA ASSAY W/ OPTIC B	$63.75	$75.00	$8.66–$71.42	33% above	15%
Rapid flu test (influenza antigen) CPT 87804 Influenza A/B (POCT)	$63.75	$75.00	$8.66–$71.42	33% above	15%
Rapid flu test (influenza antigen) CPT 87804 87804 3442	$63.75	$75.00	$8.66–$71.42	33% above	15%
Rapid flu test (influenza antigen) inpatient CPT 87804 87804 3442	$63.75	$75.00	$45.00–$852.12	—	15%
Rapid flu test (influenza antigen) inpatient CPT 87804 Influenza Screen POC	$63.75	$75.00	$45.00–$852.12	—	15%
Rapid flu test (influenza antigen) inpatient CPT 87804 Influenza Assay w Optics	$63.75	$75.00	$45.00–$852.12	—	15%
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA ASSAY W/ OPTIC B	$63.75	$75.00	$45.00–$852.12	—	15%
Rapid flu test (influenza antigen) inpatient CPT 87804 87804 INFLUENZA ASSAY W/OPTIC B UC	$63.75	$75.00	$45.00–$852.12	—	15%
Rapid flu test (influenza antigen) inpatient CPT 87804 87804 INFLUENZA ASSAY W/OPTIC A UC	$63.75	$75.00	$45.00–$852.12	—	15%
Rapid flu test (influenza antigen) inpatient CPT 87804 Influenza A/B (POCT)	$63.75	$75.00	$45.00–$852.12	—	15%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Rapid Strep A (POCT)	$63.75	$75.00	$8.65–$71.34	19% above	15%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Rapid Strep POC	$63.75	$75.00	$8.65–$71.34	19% above	15%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Streptococcus A Throat (N)	$65.45	$77.00	$8.65–$71.34	22% above	15%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 Rapid Strep POC	$63.75	$75.00	$45.00–$852.12	—	15%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 Rapid Strep A (POCT)	$63.75	$75.00	$45.00–$852.12	—	15%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 Streptococcus A Throat (N)	$65.45	$77.00	$46.20–$852.12	—	15%
Renin blood test CPT 84244 Renin Activity, Plasma	$11.90	$14.00	$5.29–$94.89	71% below	15%
Renin blood test CPT 84244 Renin Direct	$80.75	$95.00	$11.50–$94.89	94% above	15%
Renin blood test inpatient CPT 84244 Renin Activity, Plasma	$11.90	$14.00	$8.40–$852.12	—	15%
Renin blood test inpatient CPT 84244 Renin Direct	$80.75	$95.00	$57.00–$852.12	—	15%
Rh blood typing CPT 86901 BLOOD TYPING SEROLOGIC RH(D)	$37.40	$44.00	$3.50–$63.27	81% above	15%
Rh blood typing CPT 86901 86901 BLOOD TYPING, RH	$37.40	$44.00	$3.50–$63.27	81% above	15%
Rh blood typing inpatient CPT 86901 86901 BLOOD TYPING, RH	$37.40	$44.00	$26.40–$852.12	—	15%
Rh blood typing inpatient CPT 86901 BLOOD TYPING SEROLOGIC RH(D)	$37.40	$44.00	$26.40–$852.12	—	15%
Rheumatoid factor (RF) test CPT 86431 Rheumatoid Factor	$34.00	$40.00	$2.97–$34.00	1% below	15%
Rheumatoid factor (RF) test CPT 86431 Rheumatoid Factor Panel IgA/IgM	$42.50	$50.00	$2.97–$42.50	24% above	15%
Rheumatoid factor (RF) test inpatient CPT 86431 Rheumatoid Factor	$34.00	$40.00	$24.00–$852.12	—	15%
Rheumatoid factor (RF) test inpatient CPT 86431 Rheumatoid Factor Panel IgA/IgM	$42.50	$50.00	$30.00–$852.12	—	15%
Rubella antibody test (immunity check) CPT 86762 Rubella Antibody IgG	$55.25	$65.00	$7.53–$62.09	8% above	15%
Rubella antibody test (immunity check) inpatient CPT 86762 Rubella Antibody IgG	$55.25	$65.00	$39.00–$852.12	—	15%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 Erythrocyte Sedimentation Rate	$32.30	$38.00	$1.41–$32.30	35% above	15%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 Erythrocyte Sedimentation Rate	$32.30	$38.00	$22.80–$852.12	—	15%
Sodium blood test CPT 84295 iSTAT Blood Profile (POCT)	$30.60	$36.00	$1.40–$30.60	47% above	15%
Sodium blood test CPT 84295 Sodium Whole Blood	$30.60	$36.00	$1.40–$30.60	47% above	15%
Sodium blood test CPT 84295 Sodium Level	$30.60	$36.00	$1.40–$30.60	47% above	15%
Sodium blood test inpatient CPT 84295 Sodium Level	$30.60	$36.00	$21.60–$852.12	—	15%
Sodium blood test inpatient CPT 84295 Sodium Whole Blood	$30.60	$36.00	$21.60–$852.12	—	15%
Sodium blood test inpatient CPT 84295 iSTAT Blood Profile (POCT)	$30.60	$36.00	$21.60–$852.12	—	15%
Stool ova and parasites exam CPT 87177 Ova and Parasite, Travel History or Immunocompromised, Feces	$10.20	$12.00	$4.53–$38.41	77% below	15%
Stool ova and parasites exam inpatient CPT 87177 Ova and Parasite, Travel History or Immunocompromised, Feces	$10.20	$12.00	$7.20–$852.12	—	15%
Stool test for hidden blood (guaiac FOBT) CPT 82270 Occult Blood, Stools (POCT)	$27.20	$32.00	$2.29–$27.20	55% above	15%
Stool test for hidden blood (guaiac FOBT) CPT 82270 Occult Blood Stool Screen (OP)	$27.20	$32.00	$2.29–$27.20	55% above	15%
Stool test for hidden blood (guaiac FOBT) CPT 82270 Fecal Occult Blood 3 card POC	$28.90	$34.00	$2.29–$28.90	65% above	15%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Occult Blood Stool Screen (OP)	$27.20	$32.00	$19.20–$852.12	—	15%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Occult Blood, Stools (POCT)	$27.20	$32.00	$19.20–$852.12	—	15%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Fecal Occult Blood 3 card POC	$28.90	$34.00	$20.40–$852.12	—	15%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 Fecal Occult Blood, Colorectal Cancer Screen, Qualitative, Immunochemical, Feces	$56.02	$65.90	$8.33–$68.71	19% above	15%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 Occult Blood, Stool Immunochemical	$60.35	$71.00	$8.33–$68.71	28% above	15%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 Fecal Immunochemical Test POC	$60.35	$71.00	$8.33–$68.71	28% above	15%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 Fecal Occult Blood, Colorectal Cancer Screen, Qualitative, Immunochemical, Feces	$56.02	$65.90	$39.54–$852.12	—	15%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 Fecal Immunochemical Test POC	$60.35	$71.00	$42.60–$852.12	—	15%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 Occult Blood, Stool Immunochemical	$60.35	$71.00	$42.60–$852.12	—	15%
Syphilis antibody test (Treponema pallidum) CPT 86780 Syphilis IgG with Reflex, Enzyme Immunoassay, Serum	$12.54	$14.75	$5.57–$57.13	73% below	15%
Syphilis antibody test (Treponema pallidum) CPT 86780 Syphilis Antibody, Treponema pallidum-Particle Agglutination (TP-PA), Serum	$50.07	$58.90	$6.92–$57.13	7% above	15%
Syphilis antibody test (Treponema pallidum) CPT 86780 Syphilis Antibodies	$70.55	$83.00	$6.92–$70.55	51% above	15%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 Syphilis IgG with Reflex, Enzyme Immunoassay, Serum	$12.54	$14.75	$8.85–$852.12	—	15%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 Syphilis Antibody, Treponema pallidum-Particle Agglutination (TP-PA), Serum	$50.07	$58.90	$35.34–$852.12	—	15%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 Syphilis Antibodies	$70.55	$83.00	$49.80–$852.12	—	15%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 VDRL, Spinal Fluid	$8.50	$10.00	$2.23–$10.63	51% below	15%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Rapid Plasma Reagin Screen with Reflex to Titer, Serum	$36.79	$43.28	$2.23–$36.79	114% above	15%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 zzRapid Plasma Reagin (RPR) with Reflex to Treponema pallidum Particle Agglutination, Serum	$36.79	$43.28	$2.23–$36.79	114% above	15%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Rapid Plasma Reagin (RPR) Screen with Reflex to Titer, Serum	$36.79	$43.28	$2.23–$36.79	114% above	15%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 VDRL, Spinal Fluid	$8.50	$10.00	$6.00–$852.12	—	15%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Rapid Plasma Reagin (RPR) Screen with Reflex to Titer, Serum	$36.79	$43.28	$25.97–$852.12	—	15%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 zzRapid Plasma Reagin (RPR) with Reflex to Treponema pallidum Particle Agglutination, Serum	$36.79	$43.28	$25.97–$852.12	—	15%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Rapid Plasma Reagin Screen with Reflex to Titer, Serum	$36.79	$43.28	$25.97–$852.12	—	15%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 .Quantiferon NIL	$237.15	$279.00	$32.42–$267.49	87% above	15%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 .Quantiferon NIL	$237.15	$279.00	$167.40–$852.12	—	15%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone, Total, Bioavailable, and Free, Serum	$8.93	$10.50	$3.97–$47.24	75% below	15%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Level Total	$119.85	$141.00	$13.50–$119.85	236% above	15%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone, Total, Bioavailable, and Free, Serum	$8.93	$10.50	$6.30–$852.12	—	15%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone Level Total	$119.85	$141.00	$84.60–$852.12	—	15%
Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroperoxidase Antibodies, Serum	$13.35	$15.70	$5.93–$62.79	71% below	15%
Thyroid peroxidase (TPO) antibody test CPT 86376 Liver/Kidney Microsome Type 1 Antibodies, Serum	$19.44	$22.87	$7.61–$62.79	58% below	15%
Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroid Peroxidase Antibodies	$96.05	$113.00	$7.61–$96.05	108% above	15%
Thyroid peroxidase (TPO) antibody test CPT 86376 86376 3992	$96.05	$113.00	$7.61–$96.05	108% above	15%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Thyroperoxidase Antibodies, Serum	$13.35	$15.70	$9.42–$852.12	—	15%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Liver/Kidney Microsome Type 1 Antibodies, Serum	$19.44	$22.87	$13.72–$852.12	—	15%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 86376 3992	$96.05	$113.00	$67.80–$852.12	—	15%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Thyroid Peroxidase Antibodies	$96.05	$113.00	$67.80–$852.12	—	15%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid-Stimulating Hormone-Sensitive (s-TSH), Serum	$28.25	$33.23	$8.79–$33.06	56% below	15%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH with Reflex to FT4	$119.85	$141.00	$8.79–$119.85	86% above	15%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Function Cascade	$119.85	$141.00	$8.79–$119.85	86% above	15%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Stimulating Hormone	$119.85	$141.00	$8.79–$119.85	86% above	15%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid-Stimulating Hormone-Sensitive (s-TSH), Serum	$28.25	$33.23	$19.94–$852.12	—	15%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Stimulating Hormone	$119.85	$141.00	$84.60–$852.12	—	15%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH with Reflex to FT4	$119.85	$141.00	$84.60–$852.12	—	15%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Function Cascade	$119.85	$141.00	$84.60–$852.12	—	15%
Total IgE blood test CPT 82785 Immunoglobulin E (IgE), Serum	$10.20	$12.00	$4.53–$71.03	77% below	15%
Total IgE blood test CPT 82785 Respiratory Profile, Region 7, Northern Midwest (MI, MN, WI), Serum	$10.20	$12.00	$4.53–$71.03	77% below	15%
Total IgE blood test CPT 82785 Immunoglobulin E	$107.10	$126.00	$8.61–$107.10	142% above	15%
Total IgE blood test inpatient CPT 82785 Respiratory Profile, Region 7, Northern Midwest (MI, MN, WI), Serum	$10.20	$12.00	$7.20–$852.12	—	15%
Total IgE blood test inpatient CPT 82785 Immunoglobulin E (IgE), Serum	$10.20	$12.00	$7.20–$852.12	—	15%
Total IgE blood test inpatient CPT 82785 Immunoglobulin E	$107.10	$126.00	$75.60–$852.12	—	15%
Total cholesterol blood test CPT 82465 Cholesterol Body Fluid	$25.50	$30.00	$1.40–$25.50	28% above	15%
Total cholesterol blood test CPT 82465 Cholesterol Total	$25.50	$30.00	$1.40–$25.50	28% above	15%
Total cholesterol blood test inpatient CPT 82465 Cholesterol Body Fluid	$25.50	$30.00	$18.00–$852.12	—	15%
Total cholesterol blood test inpatient CPT 82465 Cholesterol Total	$25.50	$30.00	$18.00–$852.12	—	15%
Total thyroxine (T4) blood test CPT 84436 Total T4 Level	$36.55	$43.00	$3.59–$36.55	20% above	15%
Total thyroxine (T4) blood test inpatient CPT 84436 Total T4 Level	$36.55	$43.00	$25.80–$852.12	—	15%
Total triiodothyronine (T3) blood test CPT 84480 T3 Total	$87.55	$103.00	$7.42–$87.55	90% above	15%
Total triiodothyronine (T3) blood test inpatient CPT 84480 T3 Total	$87.55	$103.00	$61.80–$852.12	—	15%
Transferrin blood test CPT 84466 Transferrin	$68.00	$80.00	$6.67–$68.00	19% above	15%
Transferrin blood test inpatient CPT 84466 Transferrin	$68.00	$80.00	$48.00–$852.12	—	15%
Trichomonas test (NAAT) CPT 87661 Trichomonas Vaginalis	$85.00	$100.00	$18.35–$151.44	15% above	15%
Trichomonas test (NAAT) inpatient CPT 87661 Trichomonas Vaginalis	$85.00	$100.00	$60.00–$852.12	—	15%
Triglycerides blood test CPT 84478 Lipid Analysis, Body Fluid	$6.63	$7.80	$1.40–$24.78	66% below	15%
Triglycerides blood test CPT 84478 Triglycerides	$30.60	$36.00	$1.40–$30.60	59% above	15%
Triglycerides blood test CPT 84478 Triglycerides Body Fluid	$157.25	$185.00	$1.40–$157.25	716% above	15%
Triglycerides blood test inpatient CPT 84478 Lipid Analysis, Body Fluid	$6.63	$7.80	$4.68–$852.12	—	15%
Triglycerides blood test inpatient CPT 84478 Triglycerides	$30.60	$36.00	$21.60–$852.12	—	15%
Triglycerides blood test inpatient CPT 84478 Triglycerides Body Fluid	$157.25	$185.00	$111.00–$852.12	—	15%
Troponin test, quantitative CPT 84484 Troponin T, 5th Generation, Plasma	$42.50	$50.00	$6.52–$42.50	at median	15%
Troponin test, quantitative CPT 84484 Troponin High Sensitivity, Random	$95.20	$112.00	$6.52–$95.20	124% above	15%
Troponin test, quantitative CPT 84484 Troponin High Sensitivity, 2 Hour	$95.20	$112.00	$6.52–$95.20	124% above	15%
Troponin test, quantitative CPT 84484 Troponin High Sensitivity, 4 Hour	$95.20	$112.00	$6.52–$95.20	124% above	15%
Troponin test, quantitative CPT 84484 Troponin High Sensitivity, Baseline (0HR)	$95.20	$112.00	$6.52–$95.20	124% above	15%
Troponin test, quantitative inpatient CPT 84484 Troponin T, 5th Generation, Plasma	$42.50	$50.00	$30.00–$852.12	—	15%
Troponin test, quantitative inpatient CPT 84484 Troponin High Sensitivity, Baseline (0HR)	$95.20	$112.00	$67.20–$852.12	—	15%
Troponin test, quantitative inpatient CPT 84484 Troponin High Sensitivity, 4 Hour	$95.20	$112.00	$67.20–$852.12	—	15%
Troponin test, quantitative inpatient CPT 84484 Troponin High Sensitivity, 2 Hour	$95.20	$112.00	$67.20–$852.12	—	15%
Troponin test, quantitative inpatient CPT 84484 Troponin High Sensitivity, Random	$95.20	$112.00	$67.20–$852.12	—	15%
Uric acid blood test CPT 84550 Uric Acid Rasburicase	$32.30	$38.00	$1.40–$32.30	43% above	15%
Uric acid blood test CPT 84550 Uric Acid	$32.30	$38.00	$1.40–$32.30	43% above	15%
Uric acid blood test inpatient CPT 84550 Uric Acid	$32.30	$38.00	$22.80–$852.12	—	15%
Uric acid blood test inpatient CPT 84550 Uric Acid Rasburicase	$32.30	$38.00	$22.80–$852.12	—	15%
Urinalysis with microscope exam, automated CPT 81001 Urinalysis with Microscopic	$31.45	$37.00	$1.66–$31.45	57% above	15%
Urinalysis with microscope exam, automated CPT 81001 Urinalysis with Culture if Indicated	$31.45	$37.00	$1.66–$31.45	57% above	15%
Urinalysis with microscope exam, automated CPT 81001 Urinalysis Dipstick auto w/ Micro POC	$31.45	$37.00	$1.66–$31.45	57% above	15%
Urinalysis with microscope exam, automated inpatient CPT 81001 Urinalysis with Culture if Indicated	$31.45	$37.00	$22.20–$852.12	—	15%
Urinalysis with microscope exam, automated inpatient CPT 81001 Urinalysis with Microscopic	$31.45	$37.00	$22.20–$852.12	—	15%
Urinalysis with microscope exam, automated inpatient CPT 81001 Urinalysis Dipstick auto w/ Micro POC	$31.45	$37.00	$22.20–$852.12	—	15%
Urinalysis with microscope exam, manual CPT 81000 Urinalysis Dipstick non-auto with Micro POC	$36.55	$43.00	$2.10–$36.55	144% above	15%
Urinalysis with microscope exam, manual inpatient CPT 81000 Urinalysis Dipstick non-auto with Micro POC	$36.55	$43.00	$25.80–$852.12	—	15%
Urinalysis without microscope exam, automated CPT 81003 Ketones Urine	$17.00	$20.00	$1.18–$17.00	31% above	15%
Urinalysis without microscope exam, automated CPT 81003 pH Urine	$17.00	$20.00	$1.18–$17.00	31% above	15%
Urinalysis without microscope exam, automated CPT 81003 POC Urine Dip (nsg) Automated Task - UC Only	$19.55	$23.00	$1.18–$19.55	50% above	15%
Urinalysis without microscope exam, automated CPT 81003 Urinalysis Dipstick (POCT)	$19.55	$23.00	$1.18–$19.55	50% above	15%
Urinalysis without microscope exam, automated CPT 81003 Urinalysis Dipstick auto POC - UC	$19.55	$23.00	$1.18–$19.55	50% above	15%
Urinalysis without microscope exam, automated CPT 81003 Urinalysis Dipstick auto POC	$19.55	$23.00	$1.18–$19.55	50% above	15%
Urinalysis without microscope exam, automated CPT 81003 POC Urinalysis Dipstick auto - UC	$19.55	$23.00	$1.18–$19.55	50% above	15%
Urinalysis without microscope exam, automated inpatient CPT 81003 Ketones Urine	$17.00	$20.00	$12.00–$852.12	—	15%
Urinalysis without microscope exam, automated inpatient CPT 81003 pH Urine	$17.00	$20.00	$12.00–$852.12	—	15%
Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis Dipstick auto POC	$19.55	$23.00	$13.80–$852.12	—	15%
Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis Dipstick auto POC - UC	$19.55	$23.00	$13.80–$852.12	—	15%
Urinalysis without microscope exam, automated inpatient CPT 81003 POC Urinalysis Dipstick auto - UC	$19.55	$23.00	$13.80–$852.12	—	15%
Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis Dipstick (POCT)	$19.55	$23.00	$13.80–$852.12	—	15%
Urinalysis without microscope exam, automated inpatient CPT 81003 POC Urine Dip (nsg) Automated Task - UC Only	$19.55	$23.00	$13.80–$852.12	—	15%
Urinalysis without microscope exam, manual CPT 81002 81002 URINALYSIS NONAUTO W/O SCOP BCE	$21.25	$25.00	$1.82–$21.25	39% above	15%
Urinalysis without microscope exam, manual CPT 81002 Urinalysis Dipstick non-auto POC	$21.25	$25.00	$1.82–$21.25	39% above	15%
Urinalysis without microscope exam, manual CPT 81002 Urinalysis Dipstick non-auto POC - UC	$21.25	$25.00	$1.82–$21.25	39% above	15%
Urinalysis without microscope exam, manual CPT 81002 DIPSTICK URINE BCE	$21.25	$25.00	$1.82–$21.25	39% above	15%
Urinalysis without microscope exam, manual inpatient CPT 81002 Urinalysis Dipstick non-auto POC	$21.25	$25.00	$15.00–$852.12	—	15%
Urinalysis without microscope exam, manual inpatient CPT 81002 Urinalysis Dipstick non-auto POC - UC	$21.25	$25.00	$15.00–$852.12	—	15%
Urinalysis without microscope exam, manual inpatient CPT 81002 DIPSTICK URINE BCE	$21.25	$25.00	$15.00–$852.12	—	15%
Urinalysis without microscope exam, manual inpatient CPT 81002 81002 URINALYSIS NONAUTO W/O SCOP BCE	$21.25	$25.00	$15.00–$852.12	—	15%
Urine culture for bacteria, with colony count CPT 87086 Urine Culture	$53.55	$63.00	$4.22–$53.55	3% below	15%
Urine culture for bacteria, with colony count inpatient CPT 87086 Urine Culture	$53.55	$63.00	$37.80–$852.12	—	15%
Urine microalbumin (albumin) test CPT 82043 Albumin, Random, Urine	$6.28	$7.38	$2.79–$12.99	76% below	15%
Urine microalbumin (albumin) test CPT 82043 Microalbumin Level 24 Hour Urine	$45.90	$54.00	$3.02–$45.90	77% above	15%
Urine microalbumin (albumin) test CPT 82043 Albumin/Creatinine Ratio Urine	$45.90	$54.00	$3.02–$45.90	77% above	15%
Urine microalbumin (albumin) test inpatient CPT 82043 Albumin, Random, Urine	$6.28	$7.38	$4.43–$852.12	—	15%
Urine microalbumin (albumin) test inpatient CPT 82043 Microalbumin Level 24 Hour Urine	$45.90	$54.00	$32.40–$852.12	—	15%
Urine microalbumin (albumin) test inpatient CPT 82043 Albumin/Creatinine Ratio Urine	$45.90	$54.00	$32.40–$852.12	—	15%
Urine pregnancy test, read by color change CPT 81025 HCG Urine POC	$51.00	$60.00	$4.50–$51.00	122% above	15%
Urine pregnancy test, read by color change CPT 81025 POC Urine Preg (nsg) Automated - UCN Only	$51.00	$60.00	$4.50–$51.00	122% above	15%
Urine pregnancy test, read by color change CPT 81025 POC Urine Preg (nsg) Automated - UC Only	$51.00	$60.00	$4.50–$51.00	122% above	15%
Urine pregnancy test, read by color change CPT 81025 Urine Pregnancy Test (N)	$51.00	$60.00	$4.50–$51.00	122% above	15%
Urine pregnancy test, read by color change CPT 81025 Pregnancy Test Urine	$51.00	$60.00	$4.50–$51.00	122% above	15%
Urine pregnancy test, read by color change CPT 81025 Beta hCG Urine Automated (POCT)	$51.00	$60.00	$4.50–$51.00	122% above	15%
Urine pregnancy test, read by color change CPT 81025 POC HCG Urine - UC	$51.00	$60.00	$4.50–$51.00	122% above	15%
Urine pregnancy test, read by color change inpatient CPT 81025 HCG Urine POC	$51.00	$60.00	$36.00–$852.12	—	15%
Urine pregnancy test, read by color change inpatient CPT 81025 POC Urine Preg (nsg) Automated - UC Only	$51.00	$60.00	$36.00–$852.12	—	15%
Urine pregnancy test, read by color change inpatient CPT 81025 POC HCG Urine - UC	$51.00	$60.00	$36.00–$852.12	—	15%
Urine pregnancy test, read by color change inpatient CPT 81025 Beta hCG Urine Automated (POCT)	$51.00	$60.00	$36.00–$852.12	—	15%
Urine pregnancy test, read by color change inpatient CPT 81025 Pregnancy Test Urine	$51.00	$60.00	$36.00–$852.12	—	15%
Urine pregnancy test, read by color change inpatient CPT 81025 Urine Pregnancy Test (N)	$51.00	$60.00	$36.00–$852.12	—	15%
Urine pregnancy test, read by color change inpatient CPT 81025 POC Urine Preg (nsg) Automated - UCN Only	$51.00	$60.00	$36.00–$852.12	—	15%
Vitamin B12 (cobalamin) blood test CPT 82607 Pernicious Anemia Cascade, Serum	$12.75	$15.00	$5.67–$65.08	78% below	15%
Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B12 Level	$104.55	$123.00	$7.89–$104.55	76% above	15%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Pernicious Anemia Cascade, Serum	$12.75	$15.00	$9.00–$852.12	—	15%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Vitamin B12 Level	$104.55	$123.00	$73.80–$852.12	—	15%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 25-Hydroxyvitamin D2 and D3, Serum	$17.00	$20.00	$7.55–$53.15	81% below	15%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D 25 Hydroxy Level	$96.05	$113.00	$15.48–$96.05	9% above	15%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 25-Hydroxyvitamin D2 and D3, Serum	$17.00	$20.00	$12.00–$852.12	—	15%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D 25 Hydroxy Level	$96.05	$113.00	$67.80–$852.12	—	15%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 1,25-Dihydroxyvitamin D, Serum	$18.19	$21.40	$8.08–$166.16	77% below	15%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 1,25 Dihydroxy Vitamin D	$160.65	$189.00	$20.14–$166.16	103% above	15%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 1,25-Dihydroxyvitamin D, Serum	$18.19	$21.40	$12.84–$852.12	—	15%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 1,25 Dihydroxy Vitamin D	$160.65	$189.00	$113.40–$852.12	—	15%
Zinc blood test CPT 84630 Zinc Serum	$9.78	$11.50	$4.34–$49.16	59% below	15%
Zinc blood test CPT 84630 Zinc, RBC to QST	$62.20	$73.17	$5.96–$62.19	161% above	15%
Zinc blood test inpatient CPT 84630 Zinc Serum	$9.78	$11.50	$6.90–$852.12	—	15%
Zinc blood test inpatient CPT 84630 Zinc, RBC to QST	$62.20	$73.17	$43.90–$852.12	—	15%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Beta-Human Chorionic Gonadotropin, Quantitative, Serum	$17.00	$20.00	$7.55–$25.59	65% below	15%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Beta-HCG Quantitative	$91.80	$108.00	$7.87–$91.80	88% above	15%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Beta-Human Chorionic Gonadotropin, Quantitative, Serum	$17.00	$20.00	$12.00–$852.12	—	15%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Beta-HCG Quantitative	$91.80	$108.00	$64.80–$852.12	—	15%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Michigan	Off list
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 MA Exams	$3,417.00	$4,020.00	$860.68–$3,417.00	50% above	15%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 MA GUIDED BREAST STEREOTACTIC RT	$3,417.00	$4,020.00	$860.68–$3,417.00	50% above	15%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 MA GUIDED BREAST STEREOTACTIC LT	$3,417.00	$4,020.00	$860.68–$3,417.00	50% above	15%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 MA Exams	$3,417.00	$4,020.00	$852.12–$3,417.00	—	15%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient one side CPT 19081 MA GUIDED BREAST STEREOTACTIC RT	$3,417.00	$4,020.00	$852.12–$3,417.00	—	15%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient one side CPT 19081 MA GUIDED BREAST STEREOTACTIC LT	$3,417.00	$4,020.00	$852.12–$3,417.00	—	15%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 Treatment Of Ankle Fracture 27786	$575.45	$677.00	$128.54–$575.45	56% above	15%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 Treatment Of Ankle Fracture 27786	$575.45	$677.00	$406.20–$852.12	—	15%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 Metatarsal Fracture Closed w/ manipulation each 28470	$396.95	$467.00	$128.54–$417.83	6% above	15%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 Metatarsal Fracture Closed w/ manipulation each 28470	$396.95	$467.00	$280.20–$852.12	—	15%
Bunion correction with a bone cut near the head of the first metatarsal CPT 28296 Correc Bunion W/Metatrsl Osteoto 28296	$1,958.40	$2,304.00	$870.22–$5,874.48	56% below	15%
Bunion correction with a bone cut near the head of the first metatarsal inpatient CPT 28296 Correc Bunion W/Metatrsl Osteoto 28296	$1,958.40	$2,304.00	$852.12–$1,958.40	—	15%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ELECTRIC EXT BCE	$1,416.95	$1,667.00	$344.43–$1,416.95	44% above	15%
Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion elective electrical conversion of arrhythmia external	$1,416.95	$1,667.00	$344.43–$1,416.95	44% above	15%
Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion - Procedure Name	$1,416.95	$1,667.00	$344.43–$1,416.95	44% above	15%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION BCE	$1,416.95	$1,667.00	$344.43–$1,416.95	44% above	15%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION BCE	$1,416.95	$1,667.00	$852.12–$1,416.95	—	15%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Cardioversion - Procedure Name	$1,416.95	$1,667.00	$852.12–$1,416.95	—	15%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION ELECTRIC EXT BCE	$1,416.95	$1,667.00	$852.12–$1,416.95	—	15%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Cardioversion elective electrical conversion of arrhythmia external	$1,416.95	$1,667.00	$852.12–$1,416.95	—	15%
Cervical biopsy CPT 57500 Biopsy Cervix Single/Multiple 57500	$278.80	$328.00	$123.89–$1,560.16	68% below	15%
Cervical biopsy inpatient CPT 57500 Biopsy Cervix Single/Multiple 57500	$278.80	$328.00	$196.80–$852.12	—	15%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION BCE	$2,994.55	$3,523.00	$1,089.34–$3,540.87	78% above	15%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION W/REGIONAL BLOCK BCE	$2,994.55	$3,523.00	$1,089.34–$3,540.87	78% above	15%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION W/REGIONL BLOCK BCE	$2,994.55	$3,523.00	$1,089.34–$3,540.87	78% above	15%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 Circumcision w/Regionl Block Inpt (C/G)	$2,994.55	$3,523.00	$1,089.34–$3,540.87	78% above	15%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 Circumcision w/Regionl Block Outpt (C/G)	$2,994.55	$3,523.00	$1,089.34–$3,540.87	78% above	15%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION OUTPATIENT	$2,994.55	$3,523.00	$1,089.34–$3,540.87	78% above	15%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 Circumcision WH	$2,994.55	$3,523.00	$1,089.34–$3,540.87	78% above	15%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 MAT Circumcision	$2,994.55	$3,523.00	$1,089.34–$3,540.87	78% above	15%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 Circumcision w/Regionl Block Outpt (C/G)	$2,994.55	$3,523.00	$852.12–$2,994.55	—	15%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 CIRCUMCISION BCE	$2,994.55	$3,523.00	$852.12–$2,994.55	—	15%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 CIRCUMCISION OUTPATIENT	$2,994.55	$3,523.00	$852.12–$2,994.55	—	15%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 Circumcision WH	$2,994.55	$3,523.00	$852.12–$2,994.55	—	15%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 Circumcision w/Regionl Block Inpt (C/G)	$2,994.55	$3,523.00	$852.12–$2,994.55	—	15%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 CIRCUMCISION W/REGIONL BLOCK BCE	$2,994.55	$3,523.00	$852.12–$2,994.55	—	15%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 CIRCUMCISION W/REGIONAL BLOCK BCE	$2,994.55	$3,523.00	$852.12–$2,994.55	—	15%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 MAT Circumcision	$2,994.55	$3,523.00	$852.12–$2,994.55	—	15%
Circumcision, surgical, older than a newborn CPT 54160 Circumcision-Surgical Excision-Neonate 54160	$488.75	$575.00	$217.18–$1,588.51	49% below	15%
Circumcision, surgical, older than a newborn inpatient CPT 54160 Circumcision-Surgical Excision-Neonate 54160	$488.75	$575.00	$345.00–$852.12	—	15%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 Fracture Distal radial 25600	$624.75	$735.00	$128.54–$624.75	65% above	15%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 Fracture Distal radial 25600	$624.75	$735.00	$441.00–$852.12	—	15%
Colonoscopy, diagnostic CPT 45378 Colonoscopy Low G0121 45378	$757.35	$891.00	$336.53–$1,731.66	29% below	15%
Colonoscopy, diagnostic CPT 45378 Colonoscopy High G0105 45378	$757.35	$891.00	$336.53–$1,731.66	29% below	15%
Colonoscopy, diagnostic inpatient CPT 45378 Colonoscopy Low G0121 45378	$757.35	$891.00	$534.60–$852.12	—	15%
Colonoscopy, diagnostic inpatient CPT 45378 Colonoscopy High G0105 45378	$757.35	$891.00	$534.60–$852.12	—	15%
Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 Colposcopy w/Leep 57460	$708.05	$833.00	$314.62–$5,483.32	83% below	15%
Colposcopy with LEEP (loop electrosurgical excision) inpatient CPT 57460 Colposcopy w/Leep 57460	$708.05	$833.00	$499.80–$852.12	—	15%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 Bx/Curett Of Cervix W/Scope 57454	$304.30	$358.00	$135.22–$516.18	20% below	15%
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 Bx/Curett Of Cervix W/Scope 57454	$304.30	$358.00	$214.80–$852.12	—	15%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOSCOPY BCE	$736.95	$867.00	$327.47–$1,685.62	14% below	15%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOURETHROSCOPY	$827.05	$973.00	$363.37–$1,685.62	4% below	15%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 CYSTOSCOPY BCE	$736.95	$867.00	$520.20–$852.12	—	15%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 CYSTOURETHROSCOPY	$827.05	$973.00	$583.80–$852.12	—	15%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 Destruct premalg 1 lesion 17000	$90.95	$107.00	$40.41–$339.85	53% below	15%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 Lesion Destr 1st Any Site (N)	$271.15	$319.00	$104.55–$339.85	41% above	15%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 Destruct premalg 1 lesion 17000	$90.95	$107.00	$64.20–$852.12	—	15%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 Lesion Destr 1st Any Site (N)	$271.15	$319.00	$191.40–$852.12	—	15%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVE IMPACTED EAR WAX UNI LVG	$283.90	$334.00	$30.74–$283.90	179% above	15%
Earwax removal by irrigation (rinsing), one ear CPT 69209 Rem Impact Ear Was Irr/Lav Uni (N)	$283.90	$334.00	$30.74–$283.90	179% above	15%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVE IMPACTED EAR WAX UNI	$283.90	$334.00	$30.74–$283.90	179% above	15%
Earwax removal by irrigation (rinsing), one ear CPT 69209 Cerumen Removal Irrigation/Lavage 69209	$283.90	$334.00	$30.74–$283.90	179% above	15%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 REMOVE IMPACTED EAR WAX UNI	$283.90	$334.00	$200.40–$852.12	—	15%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 REMOVE IMPACTED EAR WAX UNI LVG	$283.90	$334.00	$200.40–$852.12	—	15%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 Cerumen Removal Irrigation/Lavage 69209	$283.90	$334.00	$200.40–$852.12	—	15%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 Rem Impact Ear Was Irr/Lav Uni (N)	$283.90	$334.00	$200.40–$852.12	—	15%
Earwax removal with instruments, one ear CPT 69210 REMOVE IMPACT EARWAX W/ INSTRU BCE	$111.35	$131.00	$30.74–$114.83	18% above	15%
Earwax removal with instruments, one ear CPT 69210 Removal impacted cerumen separate procedure one or both ears	$111.35	$131.00	$30.74–$114.83	18% above	15%
Earwax removal with instruments, one ear CPT 69210 Cerumen Removal Instrumentation 69210	$111.35	$131.00	$30.74–$114.83	18% above	15%
Earwax removal with instruments, one ear CPT 69210 Remove Impact Earwax Instrum Uni (N)	$111.35	$131.00	$30.74–$114.83	18% above	15%
Earwax removal with instruments, one ear inpatient CPT 69210 Removal impacted cerumen separate procedure one or both ears	$111.35	$131.00	$78.60–$852.12	—	15%
Earwax removal with instruments, one ear inpatient CPT 69210 Remove Impact Earwax Instrum Uni (N)	$111.35	$131.00	$78.60–$852.12	—	15%
Earwax removal with instruments, one ear inpatient CPT 69210 REMOVE IMPACT EARWAX W/ INSTRU BCE	$111.35	$131.00	$78.60–$852.12	—	15%
Earwax removal with instruments, one ear inpatient CPT 69210 Cerumen Removal Instrumentation 69210	$111.35	$131.00	$78.60–$852.12	—	15%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 EMB w/wo endocervical biopsy w/o cervical dilation any method 58100	$182.75	$215.00	$81.21–$342.45	23% below	15%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 EMB w/wo endocervical biopsy w/o cervical dilation any method 58100	$182.75	$215.00	$129.00–$852.12	—	15%
Eye injection into the vitreous (intravitreal injection) CPT 67028 INJECTION EYE DRG BCE	$623.90	$734.00	$172.13–$623.90	at median	15%
Eye injection into the vitreous (intravitreal injection) inpatient CPT 67028 INJECTION EYE DRG BCE	$623.90	$734.00	$440.40–$852.12	—	15%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 Sigmoidoscopy flex 45330	$334.90	$394.00	$148.81–$1,575.24	86% below	15%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 Sigmoidoscopy flex 45330	$334.90	$394.00	$236.40–$852.12	—	15%
Hemorrhoid banding (rubber band ligation) CPT 46221 Ligation of hemorrhoid(s) 46221	$510.85	$601.00	$227.00–$1,575.24	64% below	15%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 Ligation of hemorrhoid(s) 46221	$510.85	$601.00	$360.60–$852.12	—	15%
Hip replacement after an earlier hip surgery (conversion to total hip) CPT 27132 Total Hip Arthroplasty 27132	$3,704.30	$4,358.00	$1,646.02–$21,747.27	18% above	15%
Hip replacement after an earlier hip surgery (conversion to total hip) inpatient CPT 27132 Total Hip Arthroplasty 27132	$3,704.30	$4,358.00	$852.12–$3,704.30	—	15%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 Cath & intro of saline/contrast sonohystero/hysterosalpingography 58340	$331.50	$390.00	$114.91–$683.44	33% below	15%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 1242 INTRO SALINE OR CONTRAST	$530.40	$624.00	$114.91–$683.44	7% above	15%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 INTRO SALINE OR CONTRAST	$530.40	$624.00	$114.91–$683.44	7% above	15%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 Cath & intro of saline/contrast sonohystero/hysterosalpingography 58340	$331.50	$390.00	$234.00–$852.12	—	15%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 1242 INTRO SALINE OR CONTRAST	$530.40	$624.00	$374.40–$852.12	—	15%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 INTRO SALINE OR CONTRAST	$530.40	$624.00	$374.40–$852.12	—	15%
Hysteroscopy with endometrial ablation CPT 58563 Hysteroscopy surgical w/endometrial ablation (eg endometrial resection electrosurg ablation 58563	$4,787.20	$5,632.00	$2,127.21–$8,538.48	at median	15%
Hysteroscopy with endometrial ablation inpatient CPT 58563 Hysteroscopy surgical w/endometrial ablation (eg endometrial resection electrosurg ablation 58563	$4,787.20	$5,632.00	$852.12–$4,787.20	—	15%
IUD insertion (the device itself billed separately) CPT 58300 Insert Intrauterine Device 58300	$198.90	$234.00	$52.30–$807.57	40% below	15%
IUD insertion (the device itself billed separately) CPT 58300 INSERT INTRAUTERINE DEVICE OB	$731.85	$861.00	$52.30–$807.57	122% above	15%
IUD insertion (the device itself billed separately) CPT 58300 INSERT IUD FAILED ATTEMPT	$731.85	$861.00	$52.30–$807.57	122% above	15%
IUD insertion (the device itself billed separately) CPT 58300 INSERT INTRAUTERINE DEVICE BCE	$731.85	$861.00	$52.30–$807.57	122% above	15%
IUD insertion (the device itself billed separately) CPT 58300 INSERT IUD FAILED ATTEMPT BCE	$731.85	$861.00	$52.30–$807.57	122% above	15%
IUD insertion (the device itself billed separately) CPT 58300 MAT Insert IUD	$731.85	$861.00	$52.30–$807.57	122% above	15%
IUD insertion (the device itself billed separately) CPT 58300 MAT Insert IUD Failed Attempt	$731.85	$861.00	$52.30–$807.57	122% above	15%
IUD insertion (the device itself billed separately) CPT 58300 Insert IUD Failed Attempt (C/G)	$731.85	$861.00	$52.30–$807.57	122% above	15%
IUD insertion (the device itself billed separately) inpatient CPT 58300 Insert Intrauterine Device 58300	$198.90	$234.00	$140.40–$852.12	—	15%
IUD insertion (the device itself billed separately) inpatient CPT 58300 INSERT INTRAUTERINE DEVICE BCE	$731.85	$861.00	$516.60–$852.12	—	15%
IUD insertion (the device itself billed separately) inpatient CPT 58300 MAT Insert IUD	$731.85	$861.00	$516.60–$852.12	—	15%
IUD insertion (the device itself billed separately) inpatient CPT 58300 INSERT IUD FAILED ATTEMPT BCE	$731.85	$861.00	$516.60–$852.12	—	15%
IUD insertion (the device itself billed separately) inpatient CPT 58300 Insert IUD Failed Attempt (C/G)	$731.85	$861.00	$516.60–$852.12	—	15%
IUD insertion (the device itself billed separately) inpatient CPT 58300 INSERT INTRAUTERINE DEVICE OB	$731.85	$861.00	$516.60–$852.12	—	15%
IUD insertion (the device itself billed separately) inpatient CPT 58300 INSERT IUD FAILED ATTEMPT	$731.85	$861.00	$516.60–$852.12	—	15%
IUD insertion (the device itself billed separately) inpatient CPT 58300 MAT Insert IUD Failed Attempt	$731.85	$861.00	$516.60–$852.12	—	15%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D simple abscess of skin 10060	$225.25	$265.00	$100.09–$339.85	17% below	15%
Incision and drainage of a simple or single skin abscess CPT 10060 DRAINAGE OF SKIN ABSCESS PO	$428.40	$504.00	$104.55–$428.40	57% above	15%
Incision and drainage of a simple or single skin abscess CPT 10060 DRAINAGE OF SKIN ABSCESS BCE	$428.40	$504.00	$104.55–$428.40	57% above	15%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D Absc Smpl or Sgl (N)	$428.40	$504.00	$104.55–$428.40	57% above	15%
Incision and drainage of a simple or single skin abscess CPT 10060 Incision and drainage of abscess eg carbuncle simple or single	$432.65	$509.00	$104.55–$432.65	58% above	15%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D simple abscess of skin 10060	$225.25	$265.00	$159.00–$852.12	—	15%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 DRAINAGE OF SKIN ABSCESS BCE	$428.40	$504.00	$302.40–$852.12	—	15%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 DRAINAGE OF SKIN ABSCESS PO	$428.40	$504.00	$302.40–$852.12	—	15%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D Absc Smpl or Sgl (N)	$428.40	$504.00	$302.40–$852.12	—	15%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 Incision and drainage of abscess eg carbuncle simple or single	$432.65	$509.00	$305.40–$852.12	—	15%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Injection(s) Single Tendon Sheath Or Ligament Aponeurosis 20550	$104.55	$123.00	$46.46–$672.60	74% below	15%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 US Exams	$812.60	$956.00	$81.02–$812.60	106% above	15%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ TENDON SHEATH/LIGAMENT	$812.60	$956.00	$81.02–$812.60	106% above	15%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 US Injection Tendon Sheath/Ligament	$853.40	$1,004.00	$81.02–$853.40	116% above	15%
Injection into a tendon sheath or ligament (for example trigger finger) one side CPT 20550 US GUIDED JOINT INJECTION PIRIFORMIS LT	$812.60	$956.00	$81.02–$812.60	106% above	15%
Injection into a tendon sheath or ligament (for example trigger finger) one side CPT 20550 US GUIDED JOINT INJECTION PIRIFORMIS RT	$812.60	$956.00	$81.02–$812.60	106% above	15%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 Injection(s) Single Tendon Sheath Or Ligament Aponeurosis 20550	$104.55	$123.00	$73.80–$852.12	—	15%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJ TENDON SHEATH/LIGAMENT	$812.60	$956.00	$573.60–$852.12	—	15%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 US Exams	$812.60	$956.00	$573.60–$852.12	—	15%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 US Injection Tendon Sheath/Ligament	$853.40	$1,004.00	$602.40–$853.40	—	15%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient one side CPT 20550 US GUIDED JOINT INJECTION PIRIFORMIS LT	$812.60	$956.00	$573.60–$852.12	—	15%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient one side CPT 20550 US GUIDED JOINT INJECTION PIRIFORMIS RT	$812.60	$956.00	$573.60–$852.12	—	15%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 MAJOR JOINT: hip, knee, shoulder	$857.65	$1,009.00	$159.96–$857.65	103% above	15%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Arthrocentesis/aspiration/inject major joint/bursa w/o US guid 20610	$857.65	$1,009.00	$159.96–$857.65	103% above	15%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Arthro/Asp/Inject Large (N)	$857.65	$1,009.00	$159.96–$857.65	103% above	15%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Arthrocentesis aspiration andor injection major joint or bursa	$857.65	$1,009.00	$159.96–$857.65	103% above	15%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Arthro/Asp/Inject Large (N)	$857.65	$1,009.00	$605.40–$857.65	—	15%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Arthrocentesis/aspiration/inject major joint/bursa w/o US guid 20610	$857.65	$1,009.00	$605.40–$857.65	—	15%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Arthrocentesis aspiration andor injection major joint or bursa	$857.65	$1,009.00	$605.40–$857.65	—	15%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 MAJOR JOINT: hip, knee, shoulder	$857.65	$1,009.00	$605.40–$857.65	—	15%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 11981 INSERTION DRUG DLVR IMPLANT BCE	$198.90	$234.00	$69.33–$225.37	19% above	15%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 Insert Drug Implant Device 11981	$224.40	$264.00	$69.33–$225.37	35% above	15%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 11981 INSERTION DRUG DLVR IMPLANT BCE	$198.90	$234.00	$140.40–$852.12	—	15%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 Insert Drug Implant Device 11981	$224.40	$264.00	$158.40–$852.12	—	15%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Arthrocentesis/aspiration/inject intermed joint/bursa w/o US guid 20605	$100.30	$118.00	$44.57–$672.60	69% below	15%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Arthrocentesis aspiration andor injection intermediate joint or bursa	$545.70	$642.00	$82.03–$672.60	68% above	15%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 INTERMEDIATE JOINT: ankle, elbow, wrist	$545.70	$642.00	$82.03–$672.60	68% above	15%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Arthro/Asp/Inject Medium (N)	$545.70	$642.00	$82.03–$672.60	68% above	15%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/INJ JOINT/BURSA W/O US	$990.25	$1,165.00	$82.03–$990.25	205% above	15%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Arthrocentesis/aspiration/inject intermed joint/bursa w/o US guid 20605	$100.30	$118.00	$70.80–$852.12	—	15%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Arthro/Asp/Inject Medium (N)	$545.70	$642.00	$385.20–$852.12	—	15%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Arthrocentesis aspiration andor injection intermediate joint or bursa	$545.70	$642.00	$385.20–$852.12	—	15%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 INTERMEDIATE JOINT: ankle, elbow, wrist	$545.70	$642.00	$385.20–$852.12	—	15%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 DRAIN/INJ JOINT/BURSA W/O US	$990.25	$1,165.00	$699.00–$990.25	—	15%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Arthrocentesis/aspiration/inject small joint/bursa w/o US guid 20600	$95.20	$112.00	$42.30–$519.94	72% below	15%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Arthrocentesis aspiration andor injection small joint or bursa eg fingers toes	$857.65	$1,009.00	$78.00–$857.65	154% above	15%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 SMALL JOINT: finger, toe	$857.65	$1,009.00	$78.00–$857.65	154% above	15%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 Arthrocentesis/aspiration/inject small joint/bursa w/o US guid 20600	$95.20	$112.00	$67.20–$852.12	—	15%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 Arthrocentesis aspiration andor injection small joint or bursa eg fingers toes	$857.65	$1,009.00	$605.40–$857.65	—	15%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 SMALL JOINT: finger, toe	$857.65	$1,009.00	$605.40–$857.65	—	15%
Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 LAP W REM ADNEXAL STRUCTU	$8,616.45	$10,137.00	$3,150.44–$10,668.44	20% above	15%
Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 MAT Lap w Rem Adnexal Structures	$8,616.45	$10,137.00	$3,150.44–$10,668.44	20% above	15%
Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 LAP W REM ADNEXAL STRUCTU BCE	$8,616.45	$10,137.00	$3,150.44–$10,668.44	20% above	15%
Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 Laparoscopy Remove Adnexa (C)	$8,616.45	$10,137.00	$3,150.44–$10,668.44	20% above	15%
Laparoscopic removal of fallopian tubes and/or ovaries inpatient CPT 58661 LAP W REM ADNEXAL STRUCTU	$8,616.45	$10,137.00	$852.12–$8,616.45	—	15%
Laparoscopic removal of fallopian tubes and/or ovaries inpatient CPT 58661 LAP W REM ADNEXAL STRUCTU BCE	$8,616.45	$10,137.00	$852.12–$8,616.45	—	15%
Laparoscopic removal of fallopian tubes and/or ovaries inpatient CPT 58661 MAT Lap w Rem Adnexal Structures	$8,616.45	$10,137.00	$852.12–$8,616.45	—	15%
Laparoscopic removal of fallopian tubes and/or ovaries inpatient CPT 58661 Laparoscopy Remove Adnexa (C)	$8,616.45	$10,137.00	$852.12–$8,616.45	—	15%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Layered repair S/A/T/E 2.5 cm or < 12031	$474.30	$558.00	$210.76–$688.59	27% above	15%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Suture Int Sate < 2.6cm (N)	$556.75	$655.00	$211.84–$688.59	49% above	15%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Layer closure of wounds of scalp axillae feet 25 cm or less	$556.75	$655.00	$211.84–$688.59	49% above	15%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 Layered repair S/A/T/E 2.5 cm or < 12031	$474.30	$558.00	$334.80–$852.12	—	15%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 Layer closure of wounds of scalp axillae feet 25 cm or less	$556.75	$655.00	$393.00–$852.12	—	15%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 Suture Int Sate < 2.6cm (N)	$556.75	$655.00	$393.00–$852.12	—	15%
Lower-back epidural injection, with imaging guidance CPT 62323 Injection with imaging guidance 62323	$575.45	$677.00	$255.70–$1,303.42	44% below	15%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 Injection with imaging guidance 62323	$575.45	$677.00	$406.20–$852.12	—	15%
Lower-back epidural injection, without imaging guidance CPT 62322 NJX INTER LMBR/SAC MAT BCE	$1,261.40	$1,484.00	$460.92–$1,498.20	12% above	15%
Lower-back epidural injection, without imaging guidance CPT 62322 62322 NJX INTERLAMINAR LMBR/SAC	$1,261.40	$1,484.00	$460.92–$1,498.20	12% above	15%
Lower-back epidural injection, without imaging guidance CPT 62322 INJECT LUMBAR DIAGNOSTIC/1	$1,805.40	$2,124.00	$460.92–$1,805.40	60% above	15%
Lower-back epidural injection, without imaging guidance CPT 62322 1808 INJECT LUMBAR DIAGNOSTIC/1	$1,805.40	$2,124.00	$460.92–$1,805.40	60% above	15%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 NJX INTER LMBR/SAC MAT BCE	$1,261.40	$1,484.00	$852.12–$1,261.40	—	15%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 62322 NJX INTERLAMINAR LMBR/SAC	$1,261.40	$1,484.00	$852.12–$1,261.40	—	15%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 INJECT LUMBAR DIAGNOSTIC/1	$1,805.40	$2,124.00	$852.12–$1,805.40	—	15%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 1808 INJECT LUMBAR DIAGNOSTIC/1	$1,805.40	$2,124.00	$852.12–$1,805.40	—	15%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 Excise benign T/A/L 0.5cm or < 11400	$231.20	$272.00	$102.73–$1,199.50	66% below	15%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC TR-EXT B9+MARG 0.5 CM< UC	$231.20	$272.00	$102.73–$1,199.50	66% below	15%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXC TR-EXT B9+MARG 0.5 CM< UC	$231.20	$272.00	$163.20–$852.12	—	15%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 Excise benign T/A/L 0.5cm or < 11400	$231.20	$272.00	$163.20–$852.12	—	15%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 Excise benign face 0.5cm or < 11440	$257.55	$303.00	$114.44–$1,199.50	65% below	15%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 Excise benign face 0.5cm or < 11440	$257.55	$303.00	$181.80–$852.12	—	15%
Nail removal (partial or complete), one nail CPT 11730 Removal Of Nail Plate 11730	$206.55	$243.00	$91.78–$339.85	1% above	15%
Nail removal (partial or complete), one nail CPT 11730 REMOVAL OF NAIL PLATE	$291.55	$343.00	$104.55–$339.85	42% above	15%
Nail removal (partial or complete), one nail CPT 11730 Avulsion of nail plate partial or complete simple single	$291.55	$343.00	$104.55–$339.85	42% above	15%
Nail removal (partial or complete), one nail CPT 11730 Nail Avulsion Single (N)	$604.35	$711.00	$104.55–$604.35	195% above	15%
Nail removal (partial or complete), one nail inpatient CPT 11730 Removal Of Nail Plate 11730	$206.55	$243.00	$145.80–$852.12	—	15%
Nail removal (partial or complete), one nail inpatient CPT 11730 Avulsion of nail plate partial or complete simple single	$291.55	$343.00	$205.80–$852.12	—	15%
Nail removal (partial or complete), one nail inpatient CPT 11730 REMOVAL OF NAIL PLATE	$291.55	$343.00	$205.80–$852.12	—	15%
Nail removal (partial or complete), one nail inpatient CPT 11730 Nail Avulsion Single (N)	$604.35	$711.00	$426.60–$852.12	—	15%
Occipital nerve block (injection for headaches) CPT 64405 N Block Inj - Occipital 64405	$1,216.35	$1,431.00	$105.34–$1,216.35	135% above	15%
Occipital nerve block (injection for headaches) CPT 64405 64405 NJX AA&/STRD GR OCPL NRV	$1,216.35	$1,431.00	$105.34–$1,216.35	135% above	15%
Occipital nerve block (injection for headaches) CPT 64405 64405 NJX AA&/STRD GR OCPL NRV BIL	$1,824.95	$2,147.00	$105.34–$1,824.95	253% above	15%
Occipital nerve block (injection for headaches) inpatient CPT 64405 64405 NJX AA&/STRD GR OCPL NRV	$1,216.35	$1,431.00	$852.12–$1,216.35	—	15%
Occipital nerve block (injection for headaches) inpatient CPT 64405 N Block Inj - Occipital 64405	$1,216.35	$1,431.00	$852.12–$1,216.35	—	15%
Occipital nerve block (injection for headaches) inpatient CPT 64405 64405 NJX AA&/STRD GR OCPL NRV BIL	$1,824.95	$2,147.00	$852.12–$1,824.95	—	15%
Paracentesis with imaging guidance CPT 49083 Abdominal paracentesis (diagnostic or therapeutic); with imaging guidance.	$1,294.55	$1,523.00	$472.65–$1,536.33	6% above	15%
Paracentesis with imaging guidance CPT 49083 US GUIDED PARACENTESIS	$1,294.55	$1,523.00	$472.65–$1,536.33	6% above	15%
Paracentesis with imaging guidance CPT 49083 US Exams	$1,294.55	$1,523.00	$472.65–$1,536.33	6% above	15%
Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS W/IMAGING BCE	$1,644.75	$1,935.00	$472.65–$1,644.75	35% above	15%
Paracentesis with imaging guidance inpatient CPT 49083 Abdominal paracentesis (diagnostic or therapeutic); with imaging guidance.	$1,294.55	$1,523.00	$852.12–$1,294.55	—	15%
Paracentesis with imaging guidance inpatient CPT 49083 US GUIDED PARACENTESIS	$1,294.55	$1,523.00	$852.12–$1,294.55	—	15%
Paracentesis with imaging guidance inpatient CPT 49083 US Exams	$1,294.55	$1,523.00	$852.12–$1,294.55	—	15%
Paracentesis with imaging guidance inpatient CPT 49083 ABD PARACENTESIS W/IMAGING BCE	$1,644.75	$1,935.00	$852.12–$1,644.75	—	15%
Partial knee replacement (one compartment) CPT 27446 Revision Of Knee Joint 27446	$2,550.85	$3,001.00	$1,133.48–$21,837.99	at median	15%
Partial knee replacement (one compartment) inpatient CPT 27446 Revision Of Knee Joint 27446	$2,550.85	$3,001.00	$852.12–$2,550.85	—	15%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Excision nail & matrix partl/complt - ingrown nail permanent 11750	$285.60	$336.00	$126.91–$688.59	45% below	15%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Removal Of Nail Bed 11750	$285.60	$336.00	$126.91–$688.59	45% below	15%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Nail Excision (N)	$839.80	$988.00	$211.84–$839.80	62% above	15%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 REMOVAL OF NAIL BED BCE	$868.70	$1,022.00	$211.84–$868.70	67% above	15%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Excision of nail and nail matrix partial or complete	$868.70	$1,022.00	$211.84–$868.70	67% above	15%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Excision nail & matrix partl/complt - ingrown nail permanent 11750	$285.60	$336.00	$201.60–$852.12	—	15%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Removal Of Nail Bed 11750	$285.60	$336.00	$201.60–$852.12	—	15%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Nail Excision (N)	$839.80	$988.00	$592.80–$852.12	—	15%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 REMOVAL OF NAIL BED BCE	$868.70	$1,022.00	$613.20–$868.70	—	15%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Excision of nail and nail matrix partial or complete	$868.70	$1,022.00	$613.20–$868.70	—	15%
Prostate biopsy CPT 55700 Prostate Biopsy Needle/Punch-1 or more 55700	$536.35	$631.00	$238.33–$3,424.95	65% below	15%
Prostate biopsy inpatient CPT 55700 Prostate Biopsy Needle/Punch-1 or more 55700	$536.35	$631.00	$378.60–$852.12	—	15%
Removal of a breast lump, open surgery CPT 19120 Biopsy 19120	$1,160.25	$1,365.00	$515.56–$6,632.30	78% below	15%
Removal of a breast lump, open surgery inpatient CPT 19120 Biopsy 19120	$1,160.25	$1,365.00	$819.00–$1,160.25	—	15%
Removal of a foreign object under the skin, simple CPT 10120 Remove Foreign Body Simple 10120	$337.45	$397.00	$149.95–$688.59	9% below	15%
Removal of a foreign object under the skin, simple CPT 10120 Incision and removal of foreign body subcutaneous tissues simple	$337.45	$397.00	$149.95–$688.59	9% below	15%
Removal of a foreign object under the skin, simple CPT 10120 Inc & Rem FB Sq Smpl (N)	$998.75	$1,175.00	$211.84–$998.75	171% above	15%
Removal of a foreign object under the skin, simple inpatient CPT 10120 Remove Foreign Body Simple 10120	$337.45	$397.00	$238.20–$852.12	—	15%
Removal of a foreign object under the skin, simple inpatient CPT 10120 Incision and removal of foreign body subcutaneous tissues simple	$337.45	$397.00	$238.20–$852.12	—	15%
Removal of a foreign object under the skin, simple inpatient CPT 10120 Inc & Rem FB Sq Smpl (N)	$998.75	$1,175.00	$705.00–$998.75	—	15%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 Colonoscopy Low G0121 45378	$757.35	$891.00	$336.53–$1,731.66	24% below	15%
Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 Colonoscopy Low G0121 45378	$757.35	$891.00	$534.60–$852.12	—	15%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 Colonoscopy High G0105 45378	$757.35	$891.00	$336.53–$1,731.66	24% below	15%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 Colonoscopy High G0105 45378	$757.35	$891.00	$534.60–$852.12	—	15%
Short arm cast (elbow to hand) CPT 29075 Application; elbow to finger (short arm)	$130.05	$153.00	$57.79–$473.77	47% below	15%
Short arm cast (elbow to hand) CPT 29075 APPLICATION OF FOREARM CAST UC	$130.05	$153.00	$57.79–$473.77	47% below	15%
Short arm cast (elbow to hand) CPT 29075 Application Of Forearm Cast 29075	$158.95	$187.00	$70.63–$473.77	36% below	15%
Short arm cast (elbow to hand) inpatient CPT 29075 Application; elbow to finger (short arm)	$130.05	$153.00	$91.80–$852.12	—	15%
Short arm cast (elbow to hand) inpatient CPT 29075 APPLICATION OF FOREARM CAST UC	$130.05	$153.00	$91.80–$852.12	—	15%
Short arm cast (elbow to hand) inpatient CPT 29075 Application Of Forearm Cast 29075	$158.95	$187.00	$112.20–$852.12	—	15%
Short arm splint (forearm and hand) CPT 29125 Application Short Arm Splint Static 29125	$148.75	$175.00	$66.10–$225.37	20% below	15%
Short arm splint (forearm and hand) CPT 29125 29125 APPLY FOREARM SPLINT CO	$561.00	$660.00	$69.33–$561.00	200% above	15%
Short arm splint (forearm and hand) CPT 29125 29125 APPLY FOREARM SPLINT	$561.00	$660.00	$69.33–$561.00	200% above	15%
Short arm splint (forearm and hand) CPT 29125 Apply Splint Shortarm (N)	$561.00	$660.00	$69.33–$561.00	200% above	15%
Short arm splint (forearm and hand) CPT 29125 APPLY FOREARM SPLINT	$568.65	$669.00	$69.33–$568.65	204% above	15%
Short arm splint (forearm and hand) inpatient CPT 29125 Application Short Arm Splint Static 29125	$148.75	$175.00	$105.00–$852.12	—	15%
Short arm splint (forearm and hand) inpatient CPT 29125 29125 APPLY FOREARM SPLINT	$561.00	$660.00	$396.00–$852.12	—	15%
Short arm splint (forearm and hand) inpatient CPT 29125 29125 APPLY FOREARM SPLINT CO	$561.00	$660.00	$396.00–$852.12	—	15%
Short arm splint (forearm and hand) inpatient CPT 29125 Apply Splint Shortarm (N)	$561.00	$660.00	$396.00–$852.12	—	15%
Short arm splint (forearm and hand) inpatient CPT 29125 APPLY FOREARM SPLINT	$568.65	$669.00	$401.40–$852.12	—	15%
Short leg cast (below the knee) CPT 29405 Application Short Leg Cast 29405	$143.65	$169.00	$63.83–$593.49	47% below	15%
Short leg cast (below the knee) CPT 29405 Application of short leg cast (below knee to toes);.	$493.00	$580.00	$141.81–$593.49	81% above	15%
Short leg cast (below the knee) inpatient CPT 29405 Application Short Leg Cast 29405	$143.65	$169.00	$101.40–$852.12	—	15%
Short leg cast (below the knee) inpatient CPT 29405 Application of short leg cast (below knee to toes);.	$493.00	$580.00	$348.00–$852.12	—	15%
Short leg splint (calf to foot) CPT 29515 Application Lower Leg Splint 29515	$160.65	$189.00	$71.39–$275.26	at median	15%
Short leg splint (calf to foot) CPT 29515 Application of short leg splint (calf to foot).	$516.80	$608.00	$84.68–$516.80	222% above	15%
Short leg splint (calf to foot) CPT 29515 Apply Short Leg Splint (N)	$546.55	$643.00	$84.68–$546.55	240% above	15%
Short leg splint (calf to foot) inpatient CPT 29515 Application Lower Leg Splint 29515	$160.65	$189.00	$113.40–$852.12	—	15%
Short leg splint (calf to foot) inpatient CPT 29515 Application of short leg splint (calf to foot).	$516.80	$608.00	$364.80–$852.12	—	15%
Short leg splint (calf to foot) inpatient CPT 29515 Apply Short Leg Splint (N)	$546.55	$643.00	$385.80–$852.12	—	15%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 Shoulder Arthroscopy/Surgery 29824	$1,671.10	$1,966.00	$742.56–$8,175.34	15% above	15%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) inpatient CPT 29824 Shoulder Arthroscopy/Surgery 29824	$1,671.10	$1,966.00	$852.12–$1,671.10	—	15%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Simple Lac Repair Ext/Scalp 2.5CM LESS 12001	$211.65	$249.00	$94.05–$339.85	at median	15%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Simple repair S/N/A/G/T/E 2.5cm or< 12001	$211.65	$249.00	$94.05–$339.85	at median	15%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Simple repair of superficial wounds 25 cm or less	$351.90	$414.00	$104.55–$351.90	67% above	15%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Suture Smpl Snagte < 2.5 cm (N)	$351.90	$414.00	$104.55–$351.90	67% above	15%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 Simple Lac Repair Ext/Scalp 2.5CM LESS 12001	$211.65	$249.00	$149.40–$852.12	—	15%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 Simple repair S/N/A/G/T/E 2.5cm or< 12001	$211.65	$249.00	$149.40–$852.12	—	15%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 Suture Smpl Snagte < 2.5 cm (N)	$351.90	$414.00	$248.40–$852.12	—	15%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 Simple repair of superficial wounds 25 cm or less	$351.90	$414.00	$248.40–$852.12	—	15%
Skin biopsy, punch, one lesion CPT 11104 Punch biopsy of skin 1 lesion 11104	$226.95	$267.00	$100.85–$688.59	38% below	15%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BX SKIN SINGLE LESION WC	$440.30	$518.00	$195.65–$688.59	20% above	15%
Skin biopsy, punch, one lesion inpatient CPT 11104 Punch biopsy of skin 1 lesion 11104	$226.95	$267.00	$160.20–$852.12	—	15%
Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BX SKIN SINGLE LESION WC	$440.30	$518.00	$310.80–$852.12	—	15%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 Excise malig T/A/L 0.5cm or < 11600	$442.00	$520.00	$182.11–$1,199.50	34% above	15%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 Excise malig T/A/L 0.5cm or < 11600	$442.00	$520.00	$312.00–$852.12	—	15%
Skin tag removal, up to 15 tags CPT 11200 Removal of skin Tags <= 15 Tags 11200	$164.05	$193.00	$72.90–$339.85	6% below	15%
Skin tag removal, up to 15 tags CPT 11200 Remove Skin Tags Up to 15 (N)	$164.05	$193.00	$72.90–$339.85	6% below	15%
Skin tag removal, up to 15 tags inpatient CPT 11200 Remove Skin Tags Up to 15 (N)	$164.05	$193.00	$115.80–$852.12	—	15%
Skin tag removal, up to 15 tags inpatient CPT 11200 Removal of skin Tags <= 15 Tags 11200	$164.05	$193.00	$115.80–$852.12	—	15%
Spinal tap (lumbar puncture), diagnostic CPT 62270 Lumbar puncture - Procedure Name	$1,019.15	$1,199.00	$367.85–$2,098.28	19% above	15%
Spinal tap (lumbar puncture), diagnostic CPT 62270 62270 DX LMBR SPI PNXR	$1,019.15	$1,199.00	$367.85–$2,098.28	19% above	15%
Spinal tap (lumbar puncture), diagnostic CPT 62270 Spinal puncture lumbar diagnostic	$1,019.15	$1,199.00	$367.85–$2,098.28	19% above	15%
Spinal tap (lumbar puncture), diagnostic CPT 62270 DX LMBR SPI PNXR BCE	$1,019.15	$1,199.00	$367.85–$2,098.28	19% above	15%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 Lumbar puncture - Procedure Name	$1,019.15	$1,199.00	$719.40–$1,019.15	—	15%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 62270 DX LMBR SPI PNXR	$1,019.15	$1,199.00	$719.40–$1,019.15	—	15%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 Spinal puncture lumbar diagnostic	$1,019.15	$1,199.00	$719.40–$1,019.15	—	15%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 DX LMBR SPI PNXR BCE	$1,019.15	$1,199.00	$719.40–$1,019.15	—	15%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Simple Lac Repair Ext/Scalp 2.6-7.5CM 12002	$255.00	$300.00	$104.55–$371.74	6% above	15%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Simple repair S/N/A/G/T/E 2.6-7.5 cm 12002	$255.00	$300.00	$104.55–$371.74	6% above	15%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Simple repair of superficial wounds 26 cm to 75 cm	$369.75	$435.00	$104.55–$371.74	53% above	15%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Suture Smpl Snagte 2.6 - 7.5cm (N)	$369.75	$435.00	$104.55–$371.74	53% above	15%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 Simple repair S/N/A/G/T/E 2.6-7.5 cm 12002	$255.00	$300.00	$180.00–$852.12	—	15%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 Simple Lac Repair Ext/Scalp 2.6-7.5CM 12002	$255.00	$300.00	$180.00–$852.12	—	15%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 Suture Smpl Snagte 2.6 - 7.5cm (N)	$369.75	$435.00	$261.00–$852.12	—	15%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 Simple repair of superficial wounds 26 cm to 75 cm	$369.75	$435.00	$261.00–$852.12	—	15%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Simple Lac Repair Face 2.5CM LESS 12011	$251.60	$296.00	$104.55–$339.85	7% above	15%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Rep Superfic Wounds 2.5Cm Less 12011	$251.60	$296.00	$104.55–$339.85	7% above	15%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Simple repair of superficial wounds of face 25 cm or less	$351.90	$414.00	$104.55–$351.90	49% above	15%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Simple repair face 2.5 cm or < 12011	$351.90	$414.00	$104.55–$351.90	49% above	15%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Suture Smpl Feenlm < 2.6cm (N)	$351.90	$414.00	$104.55–$351.90	49% above	15%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 Rep Superfic Wounds 2.5Cm Less 12011	$251.60	$296.00	$177.60–$852.12	—	15%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 Simple Lac Repair Face 2.5CM LESS 12011	$251.60	$296.00	$177.60–$852.12	—	15%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 Simple repair of superficial wounds of face 25 cm or less	$351.90	$414.00	$248.40–$852.12	—	15%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 Simple repair face 2.5 cm or < 12011	$351.90	$414.00	$248.40–$852.12	—	15%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 Suture Smpl Feenlm < 2.6cm (N)	$351.90	$414.00	$248.40–$852.12	—	15%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 Tangential skin biopsy 1 lesion 11102	$182.75	$215.00	$81.21–$688.59	36% below	15%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGNTL BX SKIN SINGLE LES	$369.75	$435.00	$117.92–$688.59	29% above	15%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 Tangential skin biopsy 1 lesion 11102	$182.75	$215.00	$129.00–$852.12	—	15%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 TANGNTL BX SKIN SINGLE LES	$369.75	$435.00	$261.00–$852.12	—	15%
Thoracentesis with imaging guidance CPT 32555 Thoracentesis needle or catheter aspiration of the pleural space with imaging guidance	$1,354.90	$1,594.00	$326.90–$1,354.90	24% above	15%
Thoracentesis with imaging guidance CPT 32555 THORACENTESIS W/ IMAGING BCE	$1,354.90	$1,594.00	$326.90–$1,354.90	24% above	15%
Thoracentesis with imaging guidance CPT 32555 US Exams	$1,354.90	$1,594.00	$326.90–$1,354.90	24% above	15%
Thoracentesis with imaging guidance CPT 32555 US GUIDED THORACENTESIS	$1,354.90	$1,594.00	$326.90–$1,354.90	24% above	15%
Thoracentesis with imaging guidance CPT 32555 ASPIRATE PLEURA W/ IMAGING BCE	$1,354.90	$1,594.00	$326.90–$1,354.90	24% above	15%
Thoracentesis with imaging guidance inpatient CPT 32555 US GUIDED THORACENTESIS	$1,354.90	$1,594.00	$852.12–$1,354.90	—	15%
Thoracentesis with imaging guidance inpatient CPT 32555 Thoracentesis needle or catheter aspiration of the pleural space with imaging guidance	$1,354.90	$1,594.00	$852.12–$1,354.90	—	15%
Thoracentesis with imaging guidance inpatient CPT 32555 ASPIRATE PLEURA W/ IMAGING BCE	$1,354.90	$1,594.00	$852.12–$1,354.90	—	15%
Thoracentesis with imaging guidance inpatient CPT 32555 THORACENTESIS W/ IMAGING BCE	$1,354.90	$1,594.00	$852.12–$1,354.90	—	15%
Thoracentesis with imaging guidance inpatient CPT 32555 US Exams	$1,354.90	$1,594.00	$852.12–$1,354.90	—	15%
Total thyroid removal (thyroidectomy) CPT 60240 Thyroidectomy total complete 60240	$2,040.00	$2,400.00	$906.48–$10,240.44	75% below	15%
Total thyroid removal (thyroidectomy) inpatient CPT 60240 Thyroidectomy total complete 60240	$2,040.00	$2,400.00	$852.12–$2,040.00	—	15%
Trigger point injections, 1 or 2 muscles CPT 20552 Injection Single/Mlt Trigger Point 1/2 Muscles 20552	$119.00	$140.00	$52.88–$519.94	67% below	15%
Trigger point injections, 1 or 2 muscles CPT 20552 Injections single or multiple trigger points 1 or 2 muscles	$459.85	$541.00	$85.08–$519.94	26% above	15%
Trigger point injections, 1 or 2 muscles CPT 20552 zzInit Tx 1st Degr Burn (N)	$543.15	$639.00	$85.08–$543.15	49% above	15%
Trigger point injections, 1 or 2 muscles CPT 20552 20552 INJ TRIGGER POINT 1/2 MUSCL	$543.15	$639.00	$85.08–$543.15	49% above	15%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINT 1/2 MUSCL UC	$543.15	$639.00	$85.08–$543.15	49% above	15%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Injection Single/Mlt Trigger Point 1/2 Muscles 20552	$119.00	$140.00	$84.00–$852.12	—	15%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Injections single or multiple trigger points 1 or 2 muscles	$459.85	$541.00	$324.60–$852.12	—	15%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ TRIGGER POINT 1/2 MUSCL UC	$543.15	$639.00	$383.40–$852.12	—	15%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 20552 INJ TRIGGER POINT 1/2 MUSCL	$543.15	$639.00	$383.40–$852.12	—	15%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 zzInit Tx 1st Degr Burn (N)	$543.15	$639.00	$383.40–$852.12	—	15%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 US Exams	$2,403.80	$2,828.00	$860.68–$2,797.62	30% above	15%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 Bx Breast 1st Lesion US Imag 19083	$2,403.80	$2,828.00	$860.68–$2,797.62	30% above	15%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US GUIDED BREAST CORE BIOPSY RT	$2,403.80	$2,828.00	$860.68–$2,797.62	30% above	15%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US GUIDED BREAST CORE BIOPSY LT	$2,403.80	$2,828.00	$860.68–$2,797.62	30% above	15%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US GUIDED BRST CORE BIOPSY LT	$2,403.80	$2,828.00	$860.68–$2,797.62	30% above	15%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US GUIDED BRST CORE BIOPSY RT	$2,403.80	$2,828.00	$860.68–$2,797.62	30% above	15%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 US Exams	$2,403.80	$2,828.00	$852.12–$2,403.80	—	15%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 Bx Breast 1st Lesion US Imag 19083	$2,403.80	$2,828.00	$852.12–$2,403.80	—	15%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 US GUIDED BREAST CORE BIOPSY LT	$2,403.80	$2,828.00	$852.12–$2,403.80	—	15%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 US GUIDED BREAST CORE BIOPSY RT	$2,403.80	$2,828.00	$852.12–$2,403.80	—	15%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 US GUIDED BRST CORE BIOPSY LT	$2,403.80	$2,828.00	$852.12–$2,403.80	—	15%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 US GUIDED BRST CORE BIOPSY RT	$2,403.80	$2,828.00	$852.12–$2,403.80	—	15%
Vaginal birth after cesarean (VBAC), including prenatal and postpartum care CPT 59610 Vbac Delivery 59610	$5,109.35	$6,011.00	$1,218.68–$8,539.93	74% above	15%
Vaginal birth after cesarean (VBAC), including prenatal and postpartum care inpatient CPT 59610 Vbac Delivery 59610	$5,109.35	$6,011.00	$852.12–$5,109.35	—	15%
Vasectomy, one or both sides, including follow-up semen testing CPT 55250 Vasectomy 55250	$598.40	$704.00	$265.90–$3,540.87	82% below	15%
Vasectomy, one or both sides, including follow-up semen testing inpatient CPT 55250 Vasectomy 55250	$598.40	$704.00	$422.40–$852.12	—	15%
Wart removal, up to 14 warts CPT 17110 Destruct benign lesions 1-14 17110	$204.00	$240.00	$90.65–$339.85	at median	15%
Wart removal, up to 14 warts CPT 17110 Destruc of Warts up to 14 Lesions (N)	$271.15	$319.00	$104.55–$339.85	34% above	15%
Wart removal, up to 14 warts inpatient CPT 17110 Destruct benign lesions 1-14 17110	$204.00	$240.00	$144.00–$852.12	—	15%
Wart removal, up to 14 warts inpatient CPT 17110 Destruc of Warts up to 14 Lesions (N)	$271.15	$319.00	$191.40–$852.12	—	15%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Debride/subq tissue/20 sq cm or less 11042	$287.30	$338.00	$127.66–$708.77	48% below	15%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 zzDebridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm	$964.75	$1,135.00	$211.84–$964.75	73% above	15%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEB SUBQ TISSUE 20 SQ CM/<	$964.75	$1,135.00	$211.84–$964.75	73% above	15%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 Debride/subq tissue/20 sq cm or less 11042	$287.30	$338.00	$202.80–$852.12	—	15%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEB SUBQ TISSUE 20 SQ CM/<	$964.75	$1,135.00	$681.00–$964.75	—	15%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 zzDebridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm	$964.75	$1,135.00	$681.00–$964.75	—	15%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Michigan	Off list
Blood transfusion (giving blood or blood components) CPT 36430 36430 TRANSFUSION BLOOD BCE	$1,055.70	$1,242.00	$107.37–$1,055.70	40% above	15%
Blood transfusion (giving blood or blood components) CPT 36430 zzBlood Administration (C)	$1,055.70	$1,242.00	$107.37–$1,055.70	40% above	15%
Blood transfusion (giving blood or blood components) CPT 36430 Transfusion blood or blood components	$1,055.70	$1,242.00	$107.37–$1,055.70	40% above	15%
Blood transfusion (giving blood or blood components) CPT 36430 36430 TRANSFUSION BLOOD	$1,055.70	$1,242.00	$107.37–$1,055.70	40% above	15%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 36430 TRANSFUSION BLOOD BCE	$1,055.70	$1,242.00	$745.20–$1,055.70	—	15%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 zzBlood Administration (C)	$1,055.70	$1,242.00	$745.20–$1,055.70	—	15%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Transfusion blood or blood components	$1,055.70	$1,242.00	$745.20–$1,055.70	—	15%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 36430 TRANSFUSION BLOOD	$1,055.70	$1,242.00	$745.20–$1,055.70	—	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Inhalation treatment initial (chg) - Charges, Nebulizer Therapy	$232.90	$274.00	$30.30–$370.92	37% above	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Inhalation treatment initial (chg) - Charges, Inhaler Therapy	$232.90	$274.00	$30.30–$370.92	37% above	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Inhalation treatment initial (chg) - Charges, Bronchial Hygiene Therapy	$232.90	$274.00	$30.30–$370.92	37% above	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Inhalation treatment initial (chg) - Charges, Hyperinflation Therapy	$232.90	$274.00	$30.30–$370.92	37% above	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Inhalation Tx for AAO for Ther or Diag Purposes (Neb MDI IPPB device) 94640	$283.90	$334.00	$30.30–$370.92	67% above	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Aerosol Treatment (N)	$283.90	$334.00	$30.30–$370.92	67% above	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Aerosol-Subsequent (N)	$283.90	$334.00	$30.30–$370.92	67% above	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AIRWAY INHALATION TREATMENT	$283.90	$334.00	$30.30–$370.92	67% above	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 94640 Neb tx admin - Admin Charge (Medication)	$283.90	$334.00	$30.30–$370.92	67% above	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Airway Inhalation Treatm Subq (C/G)	$283.90	$334.00	$30.30–$370.92	67% above	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Airway Inhalation Treatment (C/G)	$283.90	$334.00	$30.30–$370.92	67% above	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Airway Inhalation Treatment (chg)	$283.90	$334.00	$30.30–$370.92	67% above	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT Inhalation Treatment Initial	$283.90	$334.00	$30.30–$370.92	67% above	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Inhalation treatment initial (chg) - Charges, Nebulizer Therapy	$232.90	$274.00	$164.40–$852.12	—	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Inhalation treatment initial (chg) - Charges, Bronchial Hygiene Therapy	$232.90	$274.00	$164.40–$852.12	—	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Inhalation treatment initial (chg) - Charges, Hyperinflation Therapy	$232.90	$274.00	$164.40–$852.12	—	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Inhalation treatment initial (chg) - Charges, Inhaler Therapy	$232.90	$274.00	$164.40–$852.12	—	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AIRWAY INHALATION TREATMENT	$283.90	$334.00	$200.40–$852.12	—	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Airway Inhalation Treatment (C/G)	$283.90	$334.00	$200.40–$852.12	—	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Airway Inhalation Treatment (chg)	$283.90	$334.00	$200.40–$852.12	—	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Aerosol-Subsequent (N)	$283.90	$334.00	$200.40–$852.12	—	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Inhalation Tx for AAO for Ther or Diag Purposes (Neb MDI IPPB device) 94640	$283.90	$334.00	$200.40–$852.12	—	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Airway Inhalation Treatm Subq (C/G)	$283.90	$334.00	$200.40–$852.12	—	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 94640 Neb tx admin - Admin Charge (Medication)	$283.90	$334.00	$200.40–$852.12	—	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RT Inhalation Treatment Initial	$283.90	$334.00	$200.40–$852.12	—	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Aerosol Treatment (N)	$283.90	$334.00	$200.40–$852.12	—	15%
Chemotherapy IV infusion, first hour CPT 96413 CHEMO IV INFUSION 1 HR BCE	$551.65	$649.00	$172.13–$559.50	5% above	15%
Chemotherapy IV infusion, first hour CPT 96413 CHEMO IV INFUSION 1 HR IC	$551.65	$649.00	$172.13–$559.50	5% above	15%
Chemotherapy IV infusion, first hour CPT 96413 CHEMO INFUSION PRIMARY 1ST HR BCE	$551.65	$649.00	$172.13–$559.50	5% above	15%
Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO INFUSION PRIMARY 1ST HR BCE	$551.65	$649.00	$389.40–$852.12	—	15%
Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO IV INFUSION 1 HR IC	$551.65	$649.00	$389.40–$852.12	—	15%
Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO IV INFUSION 1 HR BCE	$551.65	$649.00	$389.40–$852.12	—	15%
Critical care, first 30 to 74 minutes CPT 99291 Critical care first hour 99291 POS	$470.05	$553.00	$208.87–$1,476.18	76% below	15%
Critical care, first 30 to 74 minutes CPT 99291 Critical care first hour 99291	$605.20	$712.00	$268.92–$1,476.18	69% below	15%
Critical care, first 30 to 74 minutes CPT 99291 Critical care EM of the critically ill or critically injured patient first 3074 minutes	$3,297.15	$3,879.00	$430.46–$3,297.15	67% above	15%
Critical care, first 30 to 74 minutes CPT 99291 MMC LV2 TRAUMA NO PRENOTIFICATION W/CC E/M	$3,297.15	$3,879.00	$430.46–$3,297.15	67% above	15%
Critical care, first 30 to 74 minutes CPT 99291 MMC LV2 TRAUMA PRENOTIFICATION W/CC E/M	$3,297.15	$3,879.00	$430.46–$3,297.15	67% above	15%
Critical care, first 30 to 74 minutes CPT 99291 Critical Care E/M 1st 30-75 Min (N)	$3,297.15	$3,879.00	$430.46–$3,297.15	67% above	15%
Critical care, first 30 to 74 minutes CPT 99291 TRAUMA ACT PRENOTIFICATI W/CC E/M	$3,297.15	$3,879.00	$430.46–$3,297.15	67% above	15%
Critical care, first 30 to 74 minutes CPT 99291 TRAUMA ACT NO PRENOTIFIC W/CC E/M	$3,297.15	$3,879.00	$430.46–$3,297.15	67% above	15%
Critical care, first 30 to 74 minutes CPT 99291 MMC LV1 TRAUMA NO PRENOTIFICATION W/CC E/M	$3,297.15	$3,879.00	$430.46–$3,297.15	67% above	15%
Critical care, first 30 to 74 minutes CPT 99291 MMC LV1 TRAUMA PRENOTIFICATION W/CC E/M	$3,297.15	$3,879.00	$430.46–$3,297.15	67% above	15%
Critical care, first 30 to 74 minutes inpatient CPT 99291 Critical care first hour 99291 POS	$470.05	$553.00	$331.80–$852.12	—	15%
Critical care, first 30 to 74 minutes inpatient CPT 99291 Critical care first hour 99291	$605.20	$712.00	$427.20–$852.12	—	15%
Critical care, first 30 to 74 minutes inpatient CPT 99291 TRAUMA ACT PRENOTIFICATI W/CC E/M	$3,297.15	$3,879.00	$852.12–$3,297.15	—	15%
Critical care, first 30 to 74 minutes inpatient CPT 99291 TRAUMA ACT NO PRENOTIFIC W/CC E/M	$3,297.15	$3,879.00	$852.12–$3,297.15	—	15%
Critical care, first 30 to 74 minutes inpatient CPT 99291 MMC LV2 TRAUMA PRENOTIFICATION W/CC E/M	$3,297.15	$3,879.00	$852.12–$3,297.15	—	15%
Critical care, first 30 to 74 minutes inpatient CPT 99291 MMC LV2 TRAUMA NO PRENOTIFICATION W/CC E/M	$3,297.15	$3,879.00	$852.12–$3,297.15	—	15%
Critical care, first 30 to 74 minutes inpatient CPT 99291 MMC LV1 TRAUMA PRENOTIFICATION W/CC E/M	$3,297.15	$3,879.00	$852.12–$3,297.15	—	15%
Critical care, first 30 to 74 minutes inpatient CPT 99291 Critical Care E/M 1st 30-75 Min (N)	$3,297.15	$3,879.00	$852.12–$3,297.15	—	15%
Critical care, first 30 to 74 minutes inpatient CPT 99291 MMC LV1 TRAUMA NO PRENOTIFICATION W/CC E/M	$3,297.15	$3,879.00	$852.12–$3,297.15	—	15%
Critical care, first 30 to 74 minutes inpatient CPT 99291 Critical care EM of the critically ill or critically injured patient first 3074 minutes	$3,297.15	$3,879.00	$852.12–$3,297.15	—	15%
EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG Awake & Drowsy Incomplete	$1,056.55	$1,243.00	$112.52–$1,312.28	36% above	15%
EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG Awake & Drowsy	$1,056.55	$1,243.00	$112.52–$1,312.28	36% above	15%
EEG (brain wave test), awake and drowsy, routine CPT 95816 95816 EEG AWAKE&DROWSY RDC	$1,056.55	$1,243.00	$112.52–$1,312.28	36% above	15%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 EEG Awake & Drowsy Incomplete	$1,056.55	$1,243.00	$745.80–$1,056.55	—	15%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 95816 EEG AWAKE&DROWSY RDC	$1,056.55	$1,243.00	$745.80–$1,056.55	—	15%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 EEG Awake & Drowsy	$1,056.55	$1,243.00	$745.80–$1,056.55	—	15%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 ELECTROCARDIOGRAM COMPLETE	$131.75	$155.00	$7.67–$131.75	53% above	15%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 EKG - UC 93000	$190.40	$224.00	$7.67–$190.40	122% above	15%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 Electrocardiogram (ECG) Routine 12-Lead Tracing and I&R (Global) 93000	$190.40	$224.00	$7.67–$190.40	122% above	15%
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 ELECTROCARDIOGRAM COMPLETE	$131.75	$155.00	$93.00–$852.12	—	15%
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 Electrocardiogram (ECG) Routine 12-Lead Tracing and I&R (Global) 93000	$190.40	$224.00	$134.40–$852.12	—	15%
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 EKG - UC 93000	$190.40	$224.00	$134.40–$852.12	—	15%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 RHC - EKG w/o Interpretation (C/G)	$183.60	$216.00	$18.70–$183.60	41% above	15%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 12 Lead EKG	$183.60	$216.00	$18.70–$183.60	41% above	15%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 93005 12 LEAD EKG DIFF PHYS UC	$190.40	$224.00	$18.70–$190.40	46% above	15%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 12 Lead EKG (N)	$190.40	$224.00	$18.70–$190.40	46% above	15%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 zzELECTROCARDIOGRAM TRACING RHC POC	$190.40	$224.00	$18.70–$190.40	46% above	15%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Electrocardiogram Tracing (G)	$190.40	$224.00	$18.70–$190.40	46% above	15%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 12 LEAD EKG TRACING ONLY	$190.40	$224.00	$18.70–$190.40	46% above	15%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 12 LEAD EKG TRACING ONLY BCE	$190.40	$224.00	$18.70–$190.40	46% above	15%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG W/O Interpretation (C/G)	$190.40	$224.00	$18.70–$190.40	46% above	15%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ELECTROCARDIOGRAM TRACING 93005	$190.40	$224.00	$18.70–$190.40	46% above	15%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ELECTROCARDIOGRAM TRACING	$190.40	$224.00	$18.70–$190.40	46% above	15%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 93005 12 LEAD EKG SAME PHYS	$190.40	$224.00	$18.70–$190.40	46% above	15%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 12 Lead EKG (MCARE/MCAID)	$190.40	$224.00	$18.70–$190.40	46% above	15%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 RHC - EKG w/o Interpretation (C/G)	$183.60	$216.00	$129.60–$852.12	—	15%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 12 Lead EKG	$183.60	$216.00	$129.60–$852.12	—	15%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 Electrocardiogram Tracing (G)	$190.40	$224.00	$134.40–$852.12	—	15%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 93005 12 LEAD EKG SAME PHYS	$190.40	$224.00	$134.40–$852.12	—	15%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 zzELECTROCARDIOGRAM TRACING RHC POC	$190.40	$224.00	$134.40–$852.12	—	15%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 12 Lead EKG (N)	$190.40	$224.00	$134.40–$852.12	—	15%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 12 Lead EKG (MCARE/MCAID)	$190.40	$224.00	$134.40–$852.12	—	15%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ELECTROCARDIOGRAM TRACING	$190.40	$224.00	$134.40–$852.12	—	15%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ELECTROCARDIOGRAM TRACING 93005	$190.40	$224.00	$134.40–$852.12	—	15%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG W/O Interpretation (C/G)	$190.40	$224.00	$134.40–$852.12	—	15%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 12 LEAD EKG TRACING ONLY BCE	$190.40	$224.00	$134.40–$852.12	—	15%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 12 LEAD EKG TRACING ONLY	$190.40	$224.00	$134.40–$852.12	—	15%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 93005 12 LEAD EKG DIFF PHYS UC	$190.40	$224.00	$134.40–$852.12	—	15%
Electroconvulsive therapy (ECT), one session CPT 90870 ECT	$1,201.90	$1,414.00	$447.51–$1,454.61	45% above	15%
Electroconvulsive therapy (ECT), one session inpatient CPT 90870 ECT	$1,201.90	$1,414.00	$848.40–$1,201.90	—	15%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 EMR DPT VST MAYX REQ PHY/QHP OB	$217.60	$256.00	$43.94–$217.60	17% above	15%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 MMC LV1 TRAUMA NO PRENOTIFICATION ER E/M LV1	$217.60	$256.00	$43.94–$217.60	17% above	15%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 MMC LV2 TRAUMA NO PRENOTIFICATION ER E/M LV1	$217.60	$256.00	$43.94–$217.60	17% above	15%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 TRAUMA ACT NO PRENOTIF ER E/M LV1	$217.60	$256.00	$43.94–$217.60	17% above	15%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 TRAUMA ACT PRENOTIFICA ER E/M LV1	$217.60	$256.00	$43.94–$217.60	17% above	15%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 MMC LV1 TRAUMA PRENOTIFICATION ER E/M LV1	$217.60	$256.00	$43.94–$217.60	17% above	15%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ED visit for the EM Counseling andor coordination of	$219.30	$258.00	$43.94–$219.30	18% above	15%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 MMC LV2 TRAUMA PRENOTIFICATION ER E/M LV1	$221.85	$261.00	$43.94–$221.85	19% above	15%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 EMR DPT VST MAYX REQ PHY/QHP OB	$217.60	$256.00	$153.60–$852.12	—	15%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 MMC LV1 TRAUMA PRENOTIFICATION ER E/M LV1	$217.60	$256.00	$153.60–$852.12	—	15%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 MMC LV2 TRAUMA NO PRENOTIFICATION ER E/M LV1	$217.60	$256.00	$153.60–$852.12	—	15%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 TRAUMA ACT NO PRENOTIF ER E/M LV1	$217.60	$256.00	$153.60–$852.12	—	15%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 TRAUMA ACT PRENOTIFICA ER E/M LV1	$217.60	$256.00	$153.60–$852.12	—	15%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 MMC LV1 TRAUMA NO PRENOTIFICATION ER E/M LV1	$217.60	$256.00	$153.60–$852.12	—	15%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ED visit for the EM Counseling andor coordination of	$219.30	$258.00	$154.80–$852.12	—	15%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 MMC LV2 TRAUMA PRENOTIFICATION ER E/M LV1	$221.85	$261.00	$156.60–$852.12	—	15%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 TRAUMA ACT NO PRENOTIF ER E/M LV2	$404.60	$476.00	$80.01–$404.60	19% above	15%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 MMC LV2 TRAUMA NO PRENOTIFICATION ER E/M LV2	$404.60	$476.00	$80.01–$404.60	19% above	15%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 MMC LV2 TRAUMA PRENOTIFICATION ER E/M LV2	$404.60	$476.00	$80.01–$404.60	19% above	15%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 TRAUMA ACT PRENOTIFICA ER E/M LV2	$404.60	$476.00	$80.01–$404.60	19% above	15%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 EMERGENCY DEPT VISIT SF MDM OB	$404.60	$476.00	$80.01–$404.60	19% above	15%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 MMC LV1 TRAUMA NO PRENOTIFICATION ER E/M LV2	$404.60	$476.00	$80.01–$404.60	19% above	15%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 MMC LV1 TRAUMA PRENOTIFICATION ER E/M LV2	$404.60	$476.00	$80.01–$404.60	19% above	15%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ED visit for the EM problem focused history	$406.30	$478.00	$80.01–$406.30	20% above	15%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 MMC LV2 TRAUMA NO PRENOTIFICATION ER E/M LV2	$404.60	$476.00	$285.60–$852.12	—	15%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 EMERGENCY DEPT VISIT SF MDM OB	$404.60	$476.00	$285.60–$852.12	—	15%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 TRAUMA ACT PRENOTIFICA ER E/M LV2	$404.60	$476.00	$285.60–$852.12	—	15%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 TRAUMA ACT NO PRENOTIF ER E/M LV2	$404.60	$476.00	$285.60–$852.12	—	15%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 MMC LV2 TRAUMA PRENOTIFICATION ER E/M LV2	$404.60	$476.00	$285.60–$852.12	—	15%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 MMC LV1 TRAUMA PRENOTIFICATION ER E/M LV2	$404.60	$476.00	$285.60–$852.12	—	15%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 MMC LV1 TRAUMA NO PRENOTIFICATION ER E/M LV2	$404.60	$476.00	$285.60–$852.12	—	15%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ED visit for the EM problem focused history	$406.30	$478.00	$286.80–$852.12	—	15%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 MMC LV2 TRAUMA NO PRENOTIFICATION ER E/M LV3	$720.80	$848.00	$142.25–$720.80	13% above	15%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 MMC LV1 TRAUMA PRENOTIFICATION ER E/M LV3	$720.80	$848.00	$142.25–$720.80	13% above	15%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 MMC LV1 TRAUMA NO PRENOTIFICATION ER E/M LV3	$720.80	$848.00	$142.25–$720.80	13% above	15%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 TRAUMA ACT NO PRENOTIF ER E/M LV3	$720.80	$848.00	$142.25–$720.80	13% above	15%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 MMC LV2 TRAUMA PRENOTIFICATION ER E/M LV3	$720.80	$848.00	$142.25–$720.80	13% above	15%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 TRAUMA ACT PRENOTIFICA ER E/M LV3	$720.80	$848.00	$142.25–$720.80	13% above	15%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 EMERGENCY DEPT VISIT LOW MDM OB	$720.80	$848.00	$142.25–$720.80	13% above	15%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ED visit for the EM expanded problem focused examination	$723.35	$851.00	$142.25–$723.35	14% above	15%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 MMC LV2 TRAUMA NO PRENOTIFICATION ER E/M LV3	$720.80	$848.00	$508.80–$852.12	—	15%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 EMERGENCY DEPT VISIT LOW MDM OB	$720.80	$848.00	$508.80–$852.12	—	15%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 TRAUMA ACT NO PRENOTIF ER E/M LV3	$720.80	$848.00	$508.80–$852.12	—	15%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 MMC LV1 TRAUMA NO PRENOTIFICATION ER E/M LV3	$720.80	$848.00	$508.80–$852.12	—	15%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 MMC LV1 TRAUMA PRENOTIFICATION ER E/M LV3	$720.80	$848.00	$508.80–$852.12	—	15%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 MMC LV2 TRAUMA PRENOTIFICATION ER E/M LV3	$720.80	$848.00	$508.80–$852.12	—	15%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 TRAUMA ACT PRENOTIFICA ER E/M LV3	$720.80	$848.00	$508.80–$852.12	—	15%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ED visit for the EM expanded problem focused examination	$723.35	$851.00	$510.60–$852.12	—	15%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 TRAUMA ACT NO PRENOTIF ER E/M LV4	$1,144.10	$1,346.00	$217.44–$1,144.10	8% above	15%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 EMERGENCY DEPT VISIT MOD MDM OB	$1,144.10	$1,346.00	$217.44–$1,144.10	8% above	15%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 MMC LV2 TRAUMA PRENOTIFICATION ER E/M LV4	$1,144.10	$1,346.00	$217.44–$1,144.10	8% above	15%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 MMC LV2 TRAUMA NO PRENOTIFICATION ER E/M LV4	$1,144.10	$1,346.00	$217.44–$1,144.10	8% above	15%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 MMC LV1 TRAUMA PRENOTIFICATION ER E/M LV4	$1,144.10	$1,346.00	$217.44–$1,144.10	8% above	15%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 MMC LV1 TRAUMA NO PRENOTIFICATION ER E/M LV4	$1,144.10	$1,346.00	$217.44–$1,144.10	8% above	15%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 TRAUMA ACT PRENOTIFICA ER E/M LV4	$1,144.10	$1,346.00	$217.44–$1,144.10	8% above	15%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ED visit for the EM of a patient which requires these three key components	$1,145.80	$1,348.00	$217.44–$1,145.80	9% above	15%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 TRAUMA ACT PRENOTIFICA ER E/M LV4	$1,144.10	$1,346.00	$807.60–$1,144.10	—	15%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 MMC LV1 TRAUMA NO PRENOTIFICATION ER E/M LV4	$1,144.10	$1,346.00	$807.60–$1,144.10	—	15%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 MMC LV1 TRAUMA PRENOTIFICATION ER E/M LV4	$1,144.10	$1,346.00	$807.60–$1,144.10	—	15%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 MMC LV2 TRAUMA NO PRENOTIFICATION ER E/M LV4	$1,144.10	$1,346.00	$807.60–$1,144.10	—	15%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 MMC LV2 TRAUMA PRENOTIFICATION ER E/M LV4	$1,144.10	$1,346.00	$807.60–$1,144.10	—	15%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 TRAUMA ACT NO PRENOTIF ER E/M LV4	$1,144.10	$1,346.00	$807.60–$1,144.10	—	15%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 EMERGENCY DEPT VISIT MOD MDM OB	$1,144.10	$1,346.00	$807.60–$1,144.10	—	15%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ED visit for the EM of a patient which requires these three key components	$1,145.80	$1,348.00	$808.80–$1,145.80	—	15%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 TRAUMA ACT PRENOTIFICA ER E/M LV5	$1,694.05	$1,993.00	$310.34–$1,694.05	1% above	15%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 TRAUMA ACT NO PRENOTIF ER E/M LV5	$1,694.05	$1,993.00	$310.34–$1,694.05	1% above	15%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 MMC LV2 TRAUMA PRENOTIFICATION ER E/M LV5	$1,694.05	$1,993.00	$310.34–$1,694.05	1% above	15%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 EMERGENCY DEPT VISIT HI MDM OB	$1,694.05	$1,993.00	$310.34–$1,694.05	1% above	15%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 MMC LV2 TRAUMA NO PRENOTIFICATION ER E/M LV5	$1,694.05	$1,993.00	$310.34–$1,694.05	1% above	15%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 MMC LV1 TRAUMA PRENOTIFICATION ER E/M LV5	$1,694.05	$1,993.00	$310.34–$1,694.05	1% above	15%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 MMC LV1 TRAUMA NO PRENOTIFICATION ER E/M LV5	$1,694.05	$1,993.00	$310.34–$1,694.05	1% above	15%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ED visit for the EM of a patient which requires these three key components win the constraints impo	$1,695.75	$1,995.00	$310.34–$1,695.75	1% above	15%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 EMERGENCY DEPT VISIT HI MDM OB	$1,694.05	$1,993.00	$852.12–$1,694.05	—	15%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 MMC LV1 TRAUMA NO PRENOTIFICATION ER E/M LV5	$1,694.05	$1,993.00	$852.12–$1,694.05	—	15%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 MMC LV1 TRAUMA PRENOTIFICATION ER E/M LV5	$1,694.05	$1,993.00	$852.12–$1,694.05	—	15%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 MMC LV2 TRAUMA NO PRENOTIFICATION ER E/M LV5	$1,694.05	$1,993.00	$852.12–$1,694.05	—	15%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 MMC LV2 TRAUMA PRENOTIFICATION ER E/M LV5	$1,694.05	$1,993.00	$852.12–$1,694.05	—	15%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 TRAUMA ACT NO PRENOTIF ER E/M LV5	$1,694.05	$1,993.00	$852.12–$1,694.05	—	15%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 TRAUMA ACT PRENOTIFICA ER E/M LV5	$1,694.05	$1,993.00	$852.12–$1,694.05	—	15%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ED visit for the EM of a patient which requires these three key components win the constraints impo	$1,695.75	$1,995.00	$852.12–$1,695.75	—	15%
Exercise stress test, tracing only, the hospital charge CPT 93017 279 EKG TREADMILL ABORT	$811.75	$955.00	$112.52–$811.75	11% above	15%
Exercise stress test, tracing only, the hospital charge CPT 93017 Cardiolyte Stress Test (C)	$974.95	$1,147.00	$112.52–$974.95	34% above	15%
Exercise stress test, tracing only, the hospital charge CPT 93017 278 EKG TREADMILL	$974.95	$1,147.00	$112.52–$974.95	34% above	15%
Exercise stress test, tracing only, the hospital charge CPT 93017 CARDIOVASCULAR STRESS TEST RDC	$1,007.25	$1,185.00	$112.52–$1,007.25	38% above	15%
Exercise stress test, tracing only, the hospital charge CPT 93017 EKG Treadmill Alone (C/G)	$1,007.25	$1,185.00	$112.52–$1,007.25	38% above	15%
Exercise stress test, tracing only, the hospital charge CPT 93017 CARDIOVASCULAR STRESS TEST	$1,007.25	$1,185.00	$112.52–$1,007.25	38% above	15%
Exercise stress test, tracing only, the hospital charge CPT 93017 CV Stress Test Tracing Only w/o I&R 93017	$1,007.25	$1,185.00	$112.52–$1,007.25	38% above	15%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 279 EKG TREADMILL ABORT	$811.75	$955.00	$573.00–$852.12	—	15%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 278 EKG TREADMILL	$974.95	$1,147.00	$688.20–$974.95	—	15%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Cardiolyte Stress Test (C)	$974.95	$1,147.00	$688.20–$974.95	—	15%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CARDIOVASCULAR STRESS TEST RDC	$1,007.25	$1,185.00	$711.00–$1,007.25	—	15%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CARDIOVASCULAR STRESS TEST	$1,007.25	$1,185.00	$711.00–$1,007.25	—	15%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CV Stress Test Tracing Only w/o I&R 93017	$1,007.25	$1,185.00	$711.00–$1,007.25	—	15%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 EKG Treadmill Alone (C/G)	$1,007.25	$1,185.00	$711.00–$1,007.25	—	15%
Family therapy with the patient, 50 minutes CPT 90847 Family Couples Psychotherapy w/ Patient 90847	$176.80	$208.00	$39.48–$300.66	34% above	15%
Family therapy with the patient, 50 minutes inpatient CPT 90847 Family Couples Psychotherapy w/ Patient 90847	$176.80	$208.00	$124.80–$852.12	—	15%
Family therapy without the patient, 50 minutes CPT 90846 Family Couples Psychotherapy W/O Patient 90846	$210.80	$248.00	$47.42–$300.66	43% above	15%
Family therapy without the patient, 50 minutes inpatient CPT 90846 Family Couples Psychotherapy W/O Patient 90846	$210.80	$248.00	$148.80–$852.12	—	15%
Group psychotherapy session CPT 90853 Group Therapy 90853	$48.45	$57.00	$20.78–$172.08	17% below	15%
Group psychotherapy session inpatient CPT 90853 Group Therapy 90853	$48.45	$57.00	$34.20–$852.12	—	15%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV Infusion Hydration Initial 31-90 min 96360	$72.25	$85.00	$32.10–$360.29	72% below	15%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 OB Hydration 31 Min to 1 Hour (C/G)	$379.95	$447.00	$75.54–$379.95	46% above	15%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Intravenous infusion hydration initial 31 minutes to 1 hour	$379.95	$447.00	$75.54–$379.95	46% above	15%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRATION IV INFUSION INIT 59 BCE	$379.95	$447.00	$75.54–$379.95	46% above	15%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRATION IV INFUSION INIT BCE	$379.95	$447.00	$75.54–$379.95	46% above	15%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRATION-PRIM SVC-1ST H BCE	$379.95	$447.00	$75.54–$379.95	46% above	15%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRATION-PRIMARY-1ST HR BCE	$379.95	$447.00	$75.54–$379.95	46% above	15%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRATION IV INFUSION INIT 31-60	$379.95	$447.00	$75.54–$379.95	46% above	15%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 MAT IV Hydration - Prim SVC - 1st Hr	$379.95	$447.00	$75.54–$379.95	46% above	15%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV Hydration Initial Hr (N)	$379.95	$447.00	$75.54–$379.95	46% above	15%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV Hydration-Primary-1st Hr (PC-2600)	$379.95	$447.00	$75.54–$379.95	46% above	15%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 OB IV THERAPY HYDRATION 1ST HR	$379.95	$447.00	$75.54–$379.95	46% above	15%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV Infusion Hydration Initial 31-90 min 96360	$72.25	$85.00	$51.00–$852.12	—	15%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV HYDRATION-PRIMARY-1ST HR BCE	$379.95	$447.00	$268.20–$852.12	—	15%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV Hydration-Primary-1st Hr (PC-2600)	$379.95	$447.00	$268.20–$852.12	—	15%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 OB IV THERAPY HYDRATION 1ST HR	$379.95	$447.00	$268.20–$852.12	—	15%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 OB Hydration 31 Min to 1 Hour (C/G)	$379.95	$447.00	$268.20–$852.12	—	15%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 MAT IV Hydration - Prim SVC - 1st Hr	$379.95	$447.00	$268.20–$852.12	—	15%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV Hydration Initial Hr (N)	$379.95	$447.00	$268.20–$852.12	—	15%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HYDRATION IV INFUSION INIT 31-60	$379.95	$447.00	$268.20–$852.12	—	15%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV HYDRATION-PRIM SVC-1ST H BCE	$379.95	$447.00	$268.20–$852.12	—	15%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HYDRATION IV INFUSION INIT BCE	$379.95	$447.00	$268.20–$852.12	—	15%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HYDRATION IV INFUSION INIT 59 BCE	$379.95	$447.00	$268.20–$852.12	—	15%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 Intravenous infusion hydration initial 31 minutes to 1 hour	$379.95	$447.00	$268.20–$852.12	—	15%
IV infusion of a medicine, first hour CPT 96365 Infus (Not Chemo)Ea Addl Hr (PC-2600)	$134.30	$158.00	$59.68–$360.29	55% below	15%
IV infusion of a medicine, first hour CPT 96365 IV Infusion Ther/Prop/Dx Initial 16-90 Min 96365	$142.80	$168.00	$63.45–$360.29	53% below	15%
IV infusion of a medicine, first hour CPT 96365 THER/PROPH/DIAG IV INF INIT =<1 H IC	$481.95	$567.00	$110.84–$481.95	60% above	15%
IV infusion of a medicine, first hour CPT 96365 THER/PROPH/DIAG IV INF INIT =<1 H BCE	$481.95	$567.00	$110.84–$481.95	60% above	15%
IV infusion of a medicine, first hour CPT 96365 IV INF THERPY DX =/<1HR 59	$481.95	$567.00	$110.84–$481.95	60% above	15%
IV infusion of a medicine, first hour CPT 96365 THER/PROPH/DIAG IV INF INIT	$481.95	$567.00	$110.84–$481.95	60% above	15%
IV infusion of a medicine, first hour CPT 96365 INFUSION NOT CHEMO PRIMARY 1ST H BCE	$481.95	$567.00	$110.84–$481.95	60% above	15%
IV infusion of a medicine, first hour CPT 96365 OB IV THERAPY 1ST HOUR	$481.95	$567.00	$110.84–$481.95	60% above	15%
IV infusion of a medicine, first hour CPT 96365 THER/PROPH/DIAG IV INF INIT IVT BCE	$481.95	$567.00	$110.84–$481.95	60% above	15%
IV infusion of a medicine, first hour CPT 96365 OB Inf Initial 16-60 Min (C/G)	$481.95	$567.00	$110.84–$481.95	60% above	15%
IV infusion of a medicine, first hour CPT 96365 THER/PROPH/DIAG IV INF INIT MAT BCE	$481.95	$567.00	$110.84–$481.95	60% above	15%
IV infusion of a medicine, first hour CPT 96365 THER/PROPH/DIAG IV INF INIT BCE	$481.95	$567.00	$110.84–$481.95	60% above	15%
IV infusion of a medicine, first hour CPT 96365 MAT IV Infusion TPY 1st Hr	$481.95	$567.00	$110.84–$481.95	60% above	15%
IV infusion of a medicine, first hour CPT 96365 96365 IV INFUSION TPY OR DX UC	$481.95	$567.00	$110.84–$481.95	60% above	15%
IV infusion of a medicine, first hour CPT 96365 THER/PROPH/DIAG IV INF INIT 59 BCE	$481.95	$567.00	$110.84–$481.95	60% above	15%
IV infusion of a medicine, first hour CPT 96365 RIS - Infus(Not Chemo) Prim 1st Hr 96365	$487.90	$574.00	$110.84–$487.90	62% above	15%
IV infusion of a medicine, first hour inpatient CPT 96365 Infus (Not Chemo)Ea Addl Hr (PC-2600)	$134.30	$158.00	$94.80–$852.12	—	15%
IV infusion of a medicine, first hour inpatient CPT 96365 IV Infusion Ther/Prop/Dx Initial 16-90 Min 96365	$142.80	$168.00	$100.80–$852.12	—	15%
IV infusion of a medicine, first hour inpatient CPT 96365 OB Inf Initial 16-60 Min (C/G)	$481.95	$567.00	$340.20–$852.12	—	15%
IV infusion of a medicine, first hour inpatient CPT 96365 THER/PROPH/DIAG IV INF INIT 59 BCE	$481.95	$567.00	$340.20–$852.12	—	15%
IV infusion of a medicine, first hour inpatient CPT 96365 THER/PROPH/DIAG IV INF INIT IVT BCE	$481.95	$567.00	$340.20–$852.12	—	15%
IV infusion of a medicine, first hour inpatient CPT 96365 THER/PROPH/DIAG IV INF INIT MAT BCE	$481.95	$567.00	$340.20–$852.12	—	15%
IV infusion of a medicine, first hour inpatient CPT 96365 THER/PROPH/DIAG IV INF INIT BCE	$481.95	$567.00	$340.20–$852.12	—	15%
IV infusion of a medicine, first hour inpatient CPT 96365 THER/PROPH/DIAG IV INF INIT =<1 H IC	$481.95	$567.00	$340.20–$852.12	—	15%
IV infusion of a medicine, first hour inpatient CPT 96365 96365 IV INFUSION TPY OR DX UC	$481.95	$567.00	$340.20–$852.12	—	15%
IV infusion of a medicine, first hour inpatient CPT 96365 MAT IV Infusion TPY 1st Hr	$481.95	$567.00	$340.20–$852.12	—	15%
IV infusion of a medicine, first hour inpatient CPT 96365 OB IV THERAPY 1ST HOUR	$481.95	$567.00	$340.20–$852.12	—	15%
IV infusion of a medicine, first hour inpatient CPT 96365 INFUSION NOT CHEMO PRIMARY 1ST H BCE	$481.95	$567.00	$340.20–$852.12	—	15%
IV infusion of a medicine, first hour inpatient CPT 96365 THER/PROPH/DIAG IV INF INIT	$481.95	$567.00	$340.20–$852.12	—	15%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INF THERPY DX =/<1HR 59	$481.95	$567.00	$340.20–$852.12	—	15%
IV infusion of a medicine, first hour inpatient CPT 96365 THER/PROPH/DIAG IV INF INIT =<1 H BCE	$481.95	$567.00	$340.20–$852.12	—	15%
IV infusion of a medicine, first hour inpatient CPT 96365 RIS - Infus(Not Chemo) Prim 1st Hr 96365	$487.90	$574.00	$344.40–$852.12	—	15%
IV push of a medicine, first drug CPT 96374 Therapy/Proph/Dx Injection IV Push Single or Initial Drug - 96374	$83.30	$98.00	$37.01–$360.29	56% below	15%
IV push of a medicine, first drug CPT 96374 Therapy/Proph/Dx Injection IV Push Single or Initial Drug 96374	$83.30	$98.00	$37.01–$360.29	56% below	15%
IV push of a medicine, first drug CPT 96374 zzTherapy/Proph/Dx Injection IV Push Single or Initial Drug - 96374	$83.30	$98.00	$37.01–$360.29	56% below	15%
IV push of a medicine, first drug CPT 96374 THER/PROPH/DIAG INJ IV PUSH IVT BCE	$261.80	$308.00	$85.28–$360.29	38% above	15%
IV push of a medicine, first drug CPT 96374 Inject IVP - Initial	$304.30	$358.00	$85.28–$360.29	60% above	15%
IV push of a medicine, first drug CPT 96374 INJECT IVP - INITIAL BCE	$306.85	$361.00	$85.28–$360.29	62% above	15%
IV push of a medicine, first drug CPT 96374 THER/PROPH/DIAG INJ IV PUSH MAT BCE	$306.85	$361.00	$85.28–$360.29	62% above	15%
IV push of a medicine, first drug CPT 96374 IV Push Adminstration for Meds (N)	$306.85	$361.00	$85.28–$360.29	62% above	15%
IV push of a medicine, first drug CPT 96374 THER/PROPH/DIAG INJ IV PUSH BCE	$306.85	$361.00	$85.28–$360.29	62% above	15%
IV push of a medicine, first drug CPT 96374 MAT Inject IVP Inital Drug	$306.85	$361.00	$85.28–$360.29	62% above	15%
IV push of a medicine, first drug CPT 96374 OB IVP 1 to 15 Min SGL or Initial Inj (C/G)	$306.85	$361.00	$85.28–$360.29	62% above	15%
IV push of a medicine, first drug CPT 96374 OB IV INJECTION INITIAL	$306.85	$361.00	$85.28–$360.29	62% above	15%
IV push of a medicine, first drug CPT 96374 THER/PROPH/DIAG INJ IV PUSH 59 BCE	$306.85	$361.00	$85.28–$360.29	62% above	15%
IV push of a medicine, first drug CPT 96374 Therapeutic prophylactic or diagnostic injection specify substance or drug intravenous push	$306.85	$361.00	$85.28–$360.29	62% above	15%
IV push of a medicine, first drug CPT 96374 THER/PROPH/DIAG INJ IVP 59	$306.85	$361.00	$85.28–$360.29	62% above	15%
IV push of a medicine, first drug CPT 96374 THER/PROPH/DIAG INJ IV PUSH	$306.85	$361.00	$85.28–$360.29	62% above	15%
IV push of a medicine, first drug inpatient CPT 96374 Therapy/Proph/Dx Injection IV Push Single or Initial Drug 96374	$83.30	$98.00	$58.80–$852.12	—	15%
IV push of a medicine, first drug inpatient CPT 96374 zzTherapy/Proph/Dx Injection IV Push Single or Initial Drug - 96374	$83.30	$98.00	$58.80–$852.12	—	15%
IV push of a medicine, first drug inpatient CPT 96374 Therapy/Proph/Dx Injection IV Push Single or Initial Drug - 96374	$83.30	$98.00	$58.80–$852.12	—	15%
IV push of a medicine, first drug inpatient CPT 96374 THER/PROPH/DIAG INJ IV PUSH IVT BCE	$261.80	$308.00	$184.80–$852.12	—	15%
IV push of a medicine, first drug inpatient CPT 96374 Inject IVP - Initial	$304.30	$358.00	$214.80–$852.12	—	15%
IV push of a medicine, first drug inpatient CPT 96374 THER/PROPH/DIAG INJ IV PUSH 59 BCE	$306.85	$361.00	$216.60–$852.12	—	15%
IV push of a medicine, first drug inpatient CPT 96374 THER/PROPH/DIAG INJ IV PUSH MAT BCE	$306.85	$361.00	$216.60–$852.12	—	15%
IV push of a medicine, first drug inpatient CPT 96374 THER/PROPH/DIAG INJ IV PUSH BCE	$306.85	$361.00	$216.60–$852.12	—	15%
IV push of a medicine, first drug inpatient CPT 96374 INJECT IVP - INITIAL BCE	$306.85	$361.00	$216.60–$852.12	—	15%
IV push of a medicine, first drug inpatient CPT 96374 IV Push Adminstration for Meds (N)	$306.85	$361.00	$216.60–$852.12	—	15%
IV push of a medicine, first drug inpatient CPT 96374 MAT Inject IVP Inital Drug	$306.85	$361.00	$216.60–$852.12	—	15%
IV push of a medicine, first drug inpatient CPT 96374 OB IVP 1 to 15 Min SGL or Initial Inj (C/G)	$306.85	$361.00	$216.60–$852.12	—	15%
IV push of a medicine, first drug inpatient CPT 96374 OB IV INJECTION INITIAL	$306.85	$361.00	$216.60–$852.12	—	15%
IV push of a medicine, first drug inpatient CPT 96374 THER/PROPH/DIAG INJ IV PUSH	$306.85	$361.00	$216.60–$852.12	—	15%
IV push of a medicine, first drug inpatient CPT 96374 THER/PROPH/DIAG INJ IVP 59	$306.85	$361.00	$216.60–$852.12	—	15%
IV push of a medicine, first drug inpatient CPT 96374 Therapeutic prophylactic or diagnostic injection specify substance or drug intravenous push	$306.85	$361.00	$216.60–$852.12	—	15%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 IM/SUB Q INJECTION BCE	$105.40	$124.00	$23.41–$121.96	16% above	15%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PHOPH/DIAG INJ SC/IM 59	$105.40	$124.00	$23.41–$121.96	16% above	15%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DIAG INJ SC/IM IC	$105.40	$124.00	$23.41–$121.96	16% above	15%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DIAG INJ SC/IM 59 BCE	$105.40	$124.00	$23.41–$121.96	16% above	15%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION (IM SUBQ)	$105.40	$124.00	$23.41–$121.96	16% above	15%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DIAG INJ SC/IM OB	$105.40	$124.00	$23.41–$121.96	16% above	15%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Therapeutic Prophylactic/Dx Injection Subq/Im 96372	$105.40	$124.00	$23.41–$121.96	16% above	15%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 INJECTION SC / IM	$105.40	$124.00	$23.41–$121.96	16% above	15%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Injection SC/IM (N)	$105.40	$124.00	$23.41–$121.96	16% above	15%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 IM/ SUB Q ADMINISTRATION BCE	$105.40	$124.00	$23.41–$121.96	16% above	15%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 MAT Injection IM/SQ Inj	$105.40	$124.00	$23.41–$121.96	16% above	15%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Ther/Proph/Diag Inj Sc/IM (C/G)	$105.40	$124.00	$23.41–$121.96	16% above	15%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 OB INJ THER DRUG SUBQ OR IM	$105.40	$124.00	$23.41–$121.96	16% above	15%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DIAG INJ SC/IM ED	$105.40	$124.00	$23.41–$121.96	16% above	15%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 zzInject Sub Q or IM (C)	$105.40	$124.00	$23.41–$121.96	16% above	15%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 zz96372 - Inj IM/SubQ admin - Admin Charge (Medication)	$105.40	$124.00	$23.41–$121.96	16% above	15%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DIAG INJ SC/IM MAT BCE	$105.40	$124.00	$23.41–$121.96	16% above	15%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DIAG INJ SC/IM BCE	$105.40	$124.00	$23.41–$121.96	16% above	15%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECT SUB Q OR IM BCE	$105.40	$124.00	$23.41–$121.96	16% above	15%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 - Inj IM/SubQ admin - Admin Charge (Medication)	$105.40	$124.00	$23.41–$121.96	16% above	15%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 Inj IM/ SubQ admin - Admin Charge (Medication)	$105.40	$124.00	$23.41–$121.96	16% above	15%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 REPEAT VST IM SUBQ INJ	$105.40	$124.00	$23.41–$121.96	16% above	15%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECT SQ OR IM NOT CHEMO BCE	$105.40	$124.00	$23.41–$121.96	16% above	15%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Inject Sub Q or IM	$134.30	$158.00	$23.41–$134.30	48% above	15%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 OB INJ THER DRUG SUBQ OR IM	$105.40	$124.00	$74.40–$852.12	—	15%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 IM/SUB Q INJECTION BCE	$105.40	$124.00	$74.40–$852.12	—	15%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJECT SQ OR IM NOT CHEMO BCE	$105.40	$124.00	$74.40–$852.12	—	15%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJECT SUB Q OR IM BCE	$105.40	$124.00	$74.40–$852.12	—	15%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THER/PROPH/DIAG INJ SC/IM BCE	$105.40	$124.00	$74.40–$852.12	—	15%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THER/PROPH/DIAG INJ SC/IM MAT BCE	$105.40	$124.00	$74.40–$852.12	—	15%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 zz96372 - Inj IM/SubQ admin - Admin Charge (Medication)	$105.40	$124.00	$74.40–$852.12	—	15%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 zzInject Sub Q or IM (C)	$105.40	$124.00	$74.40–$852.12	—	15%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THER/PROPH/DIAG INJ SC/IM ED	$105.40	$124.00	$74.40–$852.12	—	15%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THER/PROPH/DIAG INJ SC/IM 59 BCE	$105.40	$124.00	$74.40–$852.12	—	15%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJECTION (IM SUBQ)	$105.40	$124.00	$74.40–$852.12	—	15%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 REPEAT VST IM SUBQ INJ	$105.40	$124.00	$74.40–$852.12	—	15%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THER/PHOPH/DIAG INJ SC/IM 59	$105.40	$124.00	$74.40–$852.12	—	15%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THER/PROPH/DIAG INJ SC/IM IC	$105.40	$124.00	$74.40–$852.12	—	15%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Therapeutic Prophylactic/Dx Injection Subq/Im 96372	$105.40	$124.00	$74.40–$852.12	—	15%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 INJECTION SC / IM	$105.40	$124.00	$74.40–$852.12	—	15%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Injection SC/IM (N)	$105.40	$124.00	$74.40–$852.12	—	15%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 IM/ SUB Q ADMINISTRATION BCE	$105.40	$124.00	$74.40–$852.12	—	15%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 MAT Injection IM/SQ Inj	$105.40	$124.00	$74.40–$852.12	—	15%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Ther/Proph/Diag Inj Sc/IM (C/G)	$105.40	$124.00	$74.40–$852.12	—	15%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THER/PROPH/DIAG INJ SC/IM OB	$105.40	$124.00	$74.40–$852.12	—	15%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 Inj IM/ SubQ admin - Admin Charge (Medication)	$105.40	$124.00	$74.40–$852.12	—	15%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 - Inj IM/SubQ admin - Admin Charge (Medication)	$105.40	$124.00	$74.40–$852.12	—	15%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Inject Sub Q or IM	$134.30	$158.00	$94.80–$852.12	—	15%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 New Patient Assessment 90791	$308.55	$363.00	$92.50–$308.55	38% above	15%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 Psych Diagnostic Eval W/O Med Mgmt 90791	$308.55	$363.00	$92.50–$308.55	38% above	15%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 New Patient Assessment 90791	$308.55	$363.00	$217.80–$852.12	—	15%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 Psych Diagnostic Eval W/O Med Mgmt 90791	$308.55	$363.00	$217.80–$852.12	—	15%
Neuromuscular re-education, 15 minutes CPT 97112 97112 NEUROMUSCULAR REEDUCATION E OT IP	$96.90	$114.00	$16.43–$96.90	3% above	15%
Neuromuscular re-education, 15 minutes CPT 97112 PT 97112 PTM NEUROMUSC TRNG 15 MIN	$96.90	$114.00	$16.43–$96.90	3% above	15%
Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSCULAR TRNG 15M CQ	$96.90	$114.00	$16.43–$96.90	3% above	15%
Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSCULAR REEDUCATION 15M CQ	$96.90	$114.00	$16.43–$96.90	3% above	15%
Neuromuscular re-education, 15 minutes CPT 97112 PTA Neuromuscular Training 15min	$96.90	$114.00	$16.43–$96.90	3% above	15%
Neuromuscular re-education, 15 minutes CPT 97112 PT Neuromuscular Training 15min	$96.90	$114.00	$16.43–$96.90	3% above	15%
Neuromuscular re-education, 15 minutes CPT 97112 Neuromuscular Trng 15 min - PT MMC	$96.90	$114.00	$16.43–$96.90	3% above	15%
Neuromuscular re-education, 15 minutes CPT 97112 97112 NEUROMUSCULAR REEDUCATION E PT IP	$96.90	$114.00	$16.43–$96.90	3% above	15%
Neuromuscular re-education, 15 minutes CPT 97112 97112 OT NEUROMUSCUL REED 15 CO	$96.90	$114.00	$16.43–$96.90	3% above	15%
Neuromuscular re-education, 15 minutes CPT 97112 OT Neuromuscular Training each 15min	$96.90	$114.00	$16.43–$96.90	3% above	15%
Neuromuscular re-education, 15 minutes CPT 97112 COTA Neuromuscular Training each 15min	$96.90	$114.00	$16.43–$96.90	3% above	15%
Neuromuscular re-education, 15 minutes CPT 97112 Neuromuscular Trng 15 min - OT	$96.90	$114.00	$16.43–$96.90	3% above	15%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEUROMUSCULAR TRNG 15M CQ	$96.90	$114.00	$68.40–$852.12	—	15%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 PT 97112 PTM NEUROMUSC TRNG 15 MIN	$96.90	$114.00	$68.40–$852.12	—	15%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEUROMUSCULAR REEDUCATION 15M CQ	$96.90	$114.00	$68.40–$852.12	—	15%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 PTA Neuromuscular Training 15min	$96.90	$114.00	$68.40–$852.12	—	15%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 97112 NEUROMUSCULAR REEDUCATION E OT IP	$96.90	$114.00	$68.40–$852.12	—	15%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 PT Neuromuscular Training 15min	$96.90	$114.00	$68.40–$852.12	—	15%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 Neuromuscular Trng 15 min - PT MMC	$96.90	$114.00	$68.40–$852.12	—	15%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 97112 NEUROMUSCULAR REEDUCATION E PT IP	$96.90	$114.00	$68.40–$852.12	—	15%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 97112 OT NEUROMUSCUL REED 15 CO	$96.90	$114.00	$68.40–$852.12	—	15%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 OT Neuromuscular Training each 15min	$96.90	$114.00	$68.40–$852.12	—	15%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 Neuromuscular Trng 15 min - OT	$96.90	$114.00	$68.40–$852.12	—	15%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 COTA Neuromuscular Training each 15min	$96.90	$114.00	$68.40–$852.12	—	15%
New patient office visit, about 30 minutes CPT 99203 Office Outpatient Visit New L3	$118.15	$139.00	$52.50–$192.35	6% above	15%
New patient office visit, about 30 minutes CPT 99203 Office Visit Level 3 New 99203	$118.15	$139.00	$52.50–$192.35	6% above	15%
New patient office visit, about 30 minutes inpatient CPT 99203 Office Visit Level 3 New 99203	$118.15	$139.00	$83.40–$852.12	—	15%
New patient office visit, about 30 minutes inpatient CPT 99203 Office Outpatient Visit New L3	$118.15	$139.00	$83.40–$852.12	—	15%
New patient office visit, about 45 minutes CPT 99204 Office Outpatient Visit New L4	$118.15	$139.00	$52.50–$291.07	at median	15%
New patient office visit, about 45 minutes CPT 99204 Office Visit Level 4 New 99204	$118.15	$139.00	$52.50–$291.07	at median	15%
New patient office visit, about 45 minutes inpatient CPT 99204 Office Outpatient Visit New L4	$118.15	$139.00	$83.40–$852.12	—	15%
New patient office visit, about 45 minutes inpatient CPT 99204 Office Visit Level 4 New 99204	$118.15	$139.00	$83.40–$852.12	—	15%
New patient office visit, about 60 minutes CPT 99205 Office Outpatient Visit New L5	$118.15	$139.00	$52.50–$389.26	14% below	15%
New patient office visit, about 60 minutes CPT 99205 Office Visit Level 5 New 99205	$118.15	$139.00	$52.50–$389.26	14% below	15%
New patient office visit, about 60 minutes inpatient CPT 99205 Office Outpatient Visit New L5	$118.15	$139.00	$83.40–$852.12	—	15%
New patient office visit, about 60 minutes inpatient CPT 99205 Office Visit Level 5 New 99205	$118.15	$139.00	$83.40–$852.12	—	15%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 Office Outpatient Visit New L2	$118.15	$139.00	$37.56–$139.81	42% above	15%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 Office Visit Level 2 New 99202	$118.15	$139.00	$37.56–$139.81	42% above	15%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 Office Outpatient Visit New L2	$118.15	$139.00	$83.40–$852.12	—	15%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 Office Visit Level 2 New 99202	$118.15	$139.00	$83.40–$852.12	—	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 INIT NUTRITION THERAPY EACH 15M	$56.95	$67.00	$18.39–$73.79	24% above	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Mnt Initial Indiv Ea 15m Co 59 PO (F&NS)	$65.45	$77.00	$18.39–$73.79	42% above	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Rd Initial Indiv Ea 15 Min Dia PO	$65.45	$77.00	$18.39–$73.79	42% above	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Rd Initial Individual Ea 15 Min Diab	$65.45	$77.00	$18.39–$73.79	42% above	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 zzMnt Initial Indiv Ea 15m Coml PO (F&NS)	$65.45	$77.00	$18.39–$73.79	42% above	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 RD INITIAL INDIV EA 15 MIN DIA NT PO	$65.45	$77.00	$18.39–$73.79	42% above	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 RD INITIAL INDIV EA 15 MIN DIAB	$65.45	$77.00	$18.39–$73.79	42% above	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 RD Re Indiv Ea 15 m/Dia GT (C)	$65.45	$77.00	$18.39–$73.79	42% above	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 RD Initial Indiv Ea 15 Min Diab (C)	$65.45	$77.00	$18.39–$73.79	42% above	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 RD INIT INDIV EA 15 M/DIA GT	$65.45	$77.00	$18.39–$73.79	42% above	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 NUTRITION CONS-INIT EA 15 MIN	$65.45	$77.00	$18.39–$73.79	42% above	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Mnt Initial Indiv Ea 15m Co 59 (F&NS)	$65.45	$77.00	$18.39–$73.79	42% above	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Mnt Initial Indiv Ea 15m Co 59	$65.45	$77.00	$18.39–$73.79	42% above	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Mnt Init Indiv Ea 15 M Coml (F&NS)	$65.45	$77.00	$18.39–$73.79	42% above	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MNT INIT INDIV EA 15M 59	$65.45	$77.00	$18.39–$73.79	42% above	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 RD Init Indiv Ea 15 m/Dia GT (C)	$65.45	$77.00	$18.39–$73.79	42% above	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Mnt F/U Ind 15 Min (C/G)	$65.45	$77.00	$18.39–$73.79	42% above	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 INIT NUTRITION THERAPY EACH 15M	$56.95	$67.00	$40.20–$852.12	—	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 NUTRITION CONS-INIT EA 15 MIN	$65.45	$77.00	$46.20–$852.12	—	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 zzMnt Initial Indiv Ea 15m Coml PO (F&NS)	$65.45	$77.00	$46.20–$852.12	—	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 RD INITIAL INDIV EA 15 MIN DIA NT PO	$65.45	$77.00	$46.20–$852.12	—	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 RD INITIAL INDIV EA 15 MIN DIAB	$65.45	$77.00	$46.20–$852.12	—	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 RD INIT INDIV EA 15 M/DIA GT	$65.45	$77.00	$46.20–$852.12	—	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 Mnt Initial Indiv Ea 15m Co 59 (F&NS)	$65.45	$77.00	$46.20–$852.12	—	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 Mnt Initial Indiv Ea 15m Co 59 PO (F&NS)	$65.45	$77.00	$46.20–$852.12	—	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 Mnt Init Indiv Ea 15 M Coml (F&NS)	$65.45	$77.00	$46.20–$852.12	—	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MNT INIT INDIV EA 15M 59	$65.45	$77.00	$46.20–$852.12	—	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 Mnt F/U Ind 15 Min (C/G)	$65.45	$77.00	$46.20–$852.12	—	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 RD Re Indiv Ea 15 m/Dia GT (C)	$65.45	$77.00	$46.20–$852.12	—	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 RD Initial Indiv Ea 15 Min Diab (C)	$65.45	$77.00	$46.20–$852.12	—	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 RD Init Indiv Ea 15 m/Dia GT (C)	$65.45	$77.00	$46.20–$852.12	—	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 Rd Initial Individual Ea 15 Min Diab	$65.45	$77.00	$46.20–$852.12	—	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 Rd Initial Indiv Ea 15 Min Dia PO	$65.45	$77.00	$46.20–$852.12	—	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 Mnt Initial Indiv Ea 15m Co 59	$65.45	$77.00	$46.20–$852.12	—	15%
Occupational therapy evaluation, low complexity CPT 97165 Low Complexity Evaluation - OT Untimed Charges	$207.40	$244.00	$50.38–$207.40	at median	15%
Occupational therapy evaluation, low complexity CPT 97165 OT Eval OP 30 Min - OT	$217.60	$256.00	$50.38–$217.60	5% above	15%
Occupational therapy evaluation, low complexity CPT 97165 OT EVAL OP 30 MIN	$217.60	$256.00	$50.38–$217.60	5% above	15%
Occupational therapy evaluation, low complexity CPT 97165 OT EVAL LOW COMPLEX 30 MIN IP	$217.60	$256.00	$50.38–$217.60	5% above	15%
Occupational therapy evaluation, low complexity CPT 97165 97165 OT EVAL OP 30 MIN OT IP	$217.60	$256.00	$50.38–$217.60	5% above	15%
Occupational therapy evaluation, low complexity CPT 97165 OT 97165 OT EVAL LOW COMPLEX 30 M OP	$253.30	$298.00	$50.38–$253.30	22% above	15%
Occupational therapy evaluation, low complexity inpatient CPT 97165 Low Complexity Evaluation - OT Untimed Charges	$207.40	$244.00	$146.40–$852.12	—	15%
Occupational therapy evaluation, low complexity inpatient CPT 97165 OT EVAL OP 30 MIN	$217.60	$256.00	$153.60–$852.12	—	15%
Occupational therapy evaluation, low complexity inpatient CPT 97165 OT EVAL LOW COMPLEX 30 MIN IP	$217.60	$256.00	$153.60–$852.12	—	15%
Occupational therapy evaluation, low complexity inpatient CPT 97165 97165 OT EVAL OP 30 MIN OT IP	$217.60	$256.00	$153.60–$852.12	—	15%
Occupational therapy evaluation, low complexity inpatient CPT 97165 OT Eval OP 30 Min - OT	$217.60	$256.00	$153.60–$852.12	—	15%
Occupational therapy evaluation, low complexity inpatient CPT 97165 OT 97165 OT EVAL LOW COMPLEX 30 M OP	$253.30	$298.00	$178.80–$852.12	—	15%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 High Complexity Evaluation - PT Untimed Charges	$262.65	$309.00	$49.11–$262.65	12% above	15%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT Eval 45 Min - PT MMC	$275.40	$324.00	$49.11–$275.40	17% above	15%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 97163 PT EVAL 45 MIN PT IP	$275.40	$324.00	$49.11–$275.40	17% above	15%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT 97163 PT EVAL HIGH COMPLEX 45M OP	$275.40	$324.00	$49.11–$275.40	17% above	15%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 High Complexity Evaluation - PT Untimed Charges	$262.65	$309.00	$185.40–$852.12	—	15%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 97163 PT EVAL 45 MIN PT IP	$275.40	$324.00	$194.40–$852.12	—	15%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT 97163 PT EVAL HIGH COMPLEX 45M OP	$275.40	$324.00	$194.40–$852.12	—	15%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT Eval 45 Min - PT MMC	$275.40	$324.00	$194.40–$852.12	—	15%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Low Complexity Evaluation - PT Untimed Charges	$217.60	$256.00	$49.11–$217.60	11% above	15%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT Eval 20 Min - PT MMC	$228.65	$269.00	$49.11–$228.65	16% above	15%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT 97161 PT EVAL LOW COMPLEX 20M OP	$228.65	$269.00	$49.11–$228.65	16% above	15%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 Low Complexity Evaluation - PT Untimed Charges	$217.60	$256.00	$153.60–$852.12	—	15%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT Eval 20 Min - PT MMC	$228.65	$269.00	$161.40–$852.12	—	15%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT 97161 PT EVAL LOW COMPLEX 20M OP	$228.65	$269.00	$161.40–$852.12	—	15%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Moderate Complexity Evaluation - PT Untimed Charges	$240.55	$283.00	$49.11–$240.55	7% above	15%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 97162 PT EVAL MOD COMPLEX 30 MIN	$246.50	$290.00	$49.11–$246.50	10% above	15%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT EVAL IP 30 MIN	$252.45	$297.00	$49.11–$252.45	12% above	15%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT 97162 PT EVAL MOD COMPLEX 30M OP	$252.45	$297.00	$49.11–$252.45	12% above	15%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 97162 PT EVAL 30 MIN PT IP	$252.45	$297.00	$49.11–$252.45	12% above	15%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT Eval 30 Min - PT MMC	$252.45	$297.00	$49.11–$252.45	12% above	15%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 Moderate Complexity Evaluation - PT Untimed Charges	$240.55	$283.00	$169.80–$852.12	—	15%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 97162 PT EVAL MOD COMPLEX 30 MIN	$246.50	$290.00	$174.00–$852.12	—	15%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT Eval 30 Min - PT MMC	$252.45	$297.00	$178.20–$852.12	—	15%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT EVAL IP 30 MIN	$252.45	$297.00	$178.20–$852.12	—	15%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT 97162 PT EVAL MOD COMPLEX 30M OP	$252.45	$297.00	$178.20–$852.12	—	15%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 97162 PT EVAL 30 MIN PT IP	$252.45	$297.00	$178.20–$852.12	—	15%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PTA Manual Therapy 15min	$119.00	$140.00	$13.93–$119.00	23% above	15%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Manual Therapy 15 min - PT MMC	$119.00	$140.00	$13.93–$119.00	23% above	15%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 97140 MANUAL THERAPY EA 15 MINS PT IP	$119.00	$140.00	$13.93–$119.00	23% above	15%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 OT Manual Therapy each 15min	$119.00	$140.00	$13.93–$119.00	23% above	15%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 OT Manual Therapy Ea 15 Min - OT	$119.00	$140.00	$13.93–$119.00	23% above	15%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 97140 OT MANUAL THERAPY 15 MIN CO	$119.00	$140.00	$13.93–$119.00	23% above	15%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 97140 OT MANUAL THERAPY 15 MIN	$119.00	$140.00	$13.93–$119.00	23% above	15%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PT 97140 PTM MANUAL THERAPY 15 MIN	$119.00	$140.00	$13.93–$119.00	23% above	15%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 97140 PT MAN THERAPY 15 M CQ	$119.00	$140.00	$13.93–$119.00	23% above	15%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 COTA Manual Therapy each 15min	$119.00	$140.00	$13.93–$119.00	23% above	15%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PT Manual Therapy 15min	$119.00	$140.00	$13.93–$119.00	23% above	15%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 OT Manual Therapy Ea 15 Min - OT	$119.00	$140.00	$84.00–$852.12	—	15%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 PT Manual Therapy 15min	$119.00	$140.00	$84.00–$852.12	—	15%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 Manual Therapy 15 min - PT MMC	$119.00	$140.00	$84.00–$852.12	—	15%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 97140 MANUAL THERAPY EA 15 MINS PT IP	$119.00	$140.00	$84.00–$852.12	—	15%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 97140 OT MANUAL THERAPY 15 MIN CO	$119.00	$140.00	$84.00–$852.12	—	15%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 97140 OT MANUAL THERAPY 15 MIN	$119.00	$140.00	$84.00–$852.12	—	15%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 COTA Manual Therapy each 15min	$119.00	$140.00	$84.00–$852.12	—	15%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 OT Manual Therapy each 15min	$119.00	$140.00	$84.00–$852.12	—	15%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 97140 PT MAN THERAPY 15 M CQ	$119.00	$140.00	$84.00–$852.12	—	15%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 PTA Manual Therapy 15min	$119.00	$140.00	$84.00–$852.12	—	15%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 PT 97140 PTM MANUAL THERAPY 15 MIN	$119.00	$140.00	$84.00–$852.12	—	15%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 97110 ST THERAPEUTIC EXERCISE	$106.25	$125.00	$14.60–$106.25	14% above	15%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 97110 THERAPEUTIC EXERCISES EA 15 OT IP	$106.25	$125.00	$14.60–$106.25	14% above	15%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 COTA Therapeutic Exercise 15min	$106.25	$125.00	$14.60–$106.25	14% above	15%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT Therapeutic Exercise 15min	$106.25	$125.00	$14.60–$106.25	14% above	15%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exercise 15 min - OT	$106.25	$125.00	$14.60–$106.25	14% above	15%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 97110 OT THERAPEUTIC EX 15 MIN CO	$106.25	$125.00	$14.60–$106.25	14% above	15%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 97110 THERAPEUTIC EXERCISES EA 15 PT IP	$106.25	$125.00	$14.60–$106.25	14% above	15%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT Therapeutic Exercise 15min	$106.25	$125.00	$14.60–$106.25	14% above	15%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PTA Therapeutic Exercise 15min	$106.25	$125.00	$14.60–$106.25	14% above	15%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exercise 15 min - PT MMC	$106.25	$125.00	$14.60–$106.25	14% above	15%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 97110 PT THERAPEUTIC EX 15 MIN CQ	$106.25	$125.00	$14.60–$106.25	14% above	15%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT 97110 PTM THERAPEUTIC EX 15 MIN	$106.25	$125.00	$14.60–$106.25	14% above	15%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 ST 97110 ST THER EX FACE 15 MIN	$106.25	$125.00	$14.60–$106.25	14% above	15%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 COTA Therapeutic Exercise 15min	$106.25	$125.00	$75.00–$852.12	—	15%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT Therapeutic Exercise 15min	$106.25	$125.00	$75.00–$852.12	—	15%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 ST 97110 ST THER EX FACE 15 MIN	$106.25	$125.00	$75.00–$852.12	—	15%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 97110 ST THERAPEUTIC EXERCISE	$106.25	$125.00	$75.00–$852.12	—	15%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT 97110 PTM THERAPEUTIC EX 15 MIN	$106.25	$125.00	$75.00–$852.12	—	15%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 97110 PT THERAPEUTIC EX 15 MIN CQ	$106.25	$125.00	$75.00–$852.12	—	15%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic Exercise 15 min - PT MMC	$106.25	$125.00	$75.00–$852.12	—	15%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PTA Therapeutic Exercise 15min	$106.25	$125.00	$75.00–$852.12	—	15%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT Therapeutic Exercise 15min	$106.25	$125.00	$75.00–$852.12	—	15%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 97110 THERAPEUTIC EXERCISES EA 15 PT IP	$106.25	$125.00	$75.00–$852.12	—	15%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 97110 OT THERAPEUTIC EX 15 MIN CO	$106.25	$125.00	$75.00–$852.12	—	15%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic Exercise 15 min - OT	$106.25	$125.00	$75.00–$852.12	—	15%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 97110 THERAPEUTIC EXERCISES EA 15 OT IP	$106.25	$125.00	$75.00–$852.12	—	15%
Preventive checkup, new patient aged 18–39 CPT 99385 Initial Comp Preventive Med 18 to 39 years New 99385	$209.95	$247.00	$67.64–$221.16	32% above	15%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 Initial Comp Preventive Med 18 to 39 years New 99385	$209.95	$247.00	$148.20–$852.12	—	15%
Preventive checkup, new patient aged 40–64 CPT 99386 Initial Comp Preventive Med 40 to 64 years New 99386	$241.40	$284.00	$78.43–$254.93	28% above	15%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 Initial Comp Preventive Med 40 to 64 years New 99386	$241.40	$284.00	$170.40–$852.12	—	15%
Preventive checkup, new patient aged 65 or older CPT 99387 Initial Preventive Medicine New Patient 65Yrs&Greater than 99387	$261.80	$308.00	$84.95–$276.11	23% above	15%
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 Initial Preventive Medicine New Patient 65Yrs&Greater than 99387	$261.80	$308.00	$184.80–$852.12	—	15%
Preventive checkup, returning patient aged 18–39 CPT 99395 Periodic Comp Preventive Med 18 to 39 years Est 99395	$189.55	$223.00	$61.13–$198.70	27% above	15%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 Periodic Comp Preventive Med 18 to 39 years Est 99395	$189.55	$223.00	$133.80–$852.12	—	15%
Preventive checkup, returning patient aged 40–64 CPT 99396 Periodic Comp Preventive Med 40 to 64 years Est 99396	$199.75	$235.00	$64.90–$210.97	22% above	15%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 Periodic Comp Preventive Med 40 to 64 years Est 99396	$199.75	$235.00	$141.00–$852.12	—	15%
Preventive checkup, returning patient aged 65 or older CPT 99397 Periodic Comp Preventive Med 65& years Est 99397	$215.90	$254.00	$69.84–$227.01	13% above	15%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 Periodic Comp Preventive Med 65& years Est 99397	$215.90	$254.00	$152.40–$852.12	—	15%
Psychiatric evaluation with medical services CPT 90792 Psych Diagnostic Eval w/ Med Mgmt 90792	$346.80	$408.00	$92.50–$346.80	75% above	15%
Psychiatric evaluation with medical services inpatient CPT 90792 Psych Diagnostic Eval w/ Med Mgmt 90792	$346.80	$408.00	$244.80–$852.12	—	15%
Psychotherapy for crisis, first 60 minutes CPT 90839 Crisis Psychotherapy 90839	$249.90	$294.00	$92.50–$300.66	145% above	15%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 Crisis Psychotherapy 90839	$249.90	$294.00	$176.40–$852.12	—	15%
Psychotherapy session, 30 minutes CPT 90832 Psychotherapy 30 Mins 90832	$134.30	$158.00	$59.68–$300.66	30% below	15%
Psychotherapy session, 30 minutes inpatient CPT 90832 Psychotherapy 30 Mins 90832	$134.30	$158.00	$94.80–$852.12	—	15%
Psychotherapy session, 45 minutes CPT 90834 Psychotherapy 45 Mins 90834	$213.35	$251.00	$92.50–$300.66	at median	15%
Psychotherapy session, 45 minutes CPT 90834 Psych Thpy 45 Min 90834	$242.25	$285.00	$92.50–$400.00	14% above	15%
Psychotherapy session, 45 minutes CPT 90834 VIDEO Psychotherapy 45 Mins 90834	$242.25	$285.00	$92.50–$300.66	14% above	15%
Psychotherapy session, 45 minutes CPT 90834 Psych THPY 45 Min PO 90834	$242.25	$285.00	$92.50–$400.00	14% above	15%
Psychotherapy session, 45 minutes inpatient CPT 90834 Psychotherapy 45 Mins 90834	$213.35	$251.00	$150.60–$852.12	—	15%
Psychotherapy session, 45 minutes inpatient CPT 90834 Psych Thpy 45 Min 90834	$242.25	$285.00	$171.00–$852.12	—	15%
Psychotherapy session, 45 minutes inpatient CPT 90834 VIDEO Psychotherapy 45 Mins 90834	$242.25	$285.00	$171.00–$852.12	—	15%
Psychotherapy session, 45 minutes inpatient CPT 90834 Psych THPY 45 Min PO 90834	$242.25	$285.00	$171.00–$852.12	—	15%
Psychotherapy session, 60 minutes CPT 90837 Psychotherapy 60 Mins 90837	$260.10	$306.00	$92.50–$300.66	13% above	15%
Psychotherapy session, 60 minutes inpatient CPT 90837 Psychotherapy 60 Mins 90837	$260.10	$306.00	$183.60–$852.12	—	15%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 TOBACCO CESS SYMP 3-10 MIN	$42.50	$50.00	$16.33–$63.47	4% above	15%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 TOBACC CESS SYMP 3-10 MIN	$42.50	$50.00	$16.33–$63.47	4% above	15%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 99406 BEHAV CHNG SMOKING 3-10 MIN WC	$51.85	$61.00	$16.33–$63.47	26% above	15%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 Tobacco Use Cessation Intermediate 3-10 Minutes 99406	$51.85	$61.00	$16.33–$63.47	26% above	15%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 Behav Chng Smoking 3-10 Min 99406	$51.85	$61.00	$16.33–$63.47	26% above	15%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 BEHAV CHNG SMOKING 3-10 MIN	$143.65	$169.00	$16.33–$143.65	250% above	15%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 TOBACCO CESS SYMP 3-10 MIN	$42.50	$50.00	$30.00–$852.12	—	15%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 TOBACC CESS SYMP 3-10 MIN	$42.50	$50.00	$30.00–$852.12	—	15%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 Tobacco Use Cessation Intermediate 3-10 Minutes 99406	$51.85	$61.00	$36.60–$852.12	—	15%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 99406 BEHAV CHNG SMOKING 3-10 MIN WC	$51.85	$61.00	$36.60–$852.12	—	15%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 Behav Chng Smoking 3-10 Min 99406	$51.85	$61.00	$36.60–$852.12	—	15%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 BEHAV CHNG SMOKING 3-10 MIN	$143.65	$169.00	$101.40–$852.12	—	15%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE/OUTPATIENT VISIT EST LV5 IC	$67.15	$79.00	$29.84–$315.01	59% below	15%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Office Visit Level 5 Est 99215	$118.15	$139.00	$52.50–$315.01	29% below	15%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Office Outpatient Visit Est L525 (N)	$118.15	$139.00	$52.50–$315.01	29% below	15%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 99215 OFFICE OUTPATIENT VISIT L5 UC	$118.15	$139.00	$52.50–$315.01	29% below	15%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Office Outpatient Visit Est L5 (N)	$118.15	$139.00	$52.50–$315.01	29% below	15%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Est Pt E&M Fac >= 40 M w/Ser	$250.75	$295.00	$96.91–$315.01	51% above	15%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 E&M Fac >= 40 Min Only Serv	$250.75	$295.00	$96.91–$315.01	51% above	15%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 PT OFFICE O/P EST HI 40 MIN	$253.30	$298.00	$96.91–$315.01	53% above	15%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 EST PT E&M FAC >= 40 M W/SER BCE	$253.30	$298.00	$96.91–$315.01	53% above	15%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 EST PT E&M FAC >= 40 MIN BCE	$253.30	$298.00	$96.91–$315.01	53% above	15%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 EST PT LEVEL 5 FAC BCE	$253.30	$298.00	$96.91–$315.01	53% above	15%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE O/P EST HI 40 MIN BCE	$253.30	$298.00	$96.91–$315.01	53% above	15%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE O/P EST HI 40 MIN MAT BCE	$253.30	$298.00	$96.91–$315.01	53% above	15%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Office O/P Est Hi 40 Min (C/G)	$253.30	$298.00	$96.91–$315.01	53% above	15%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 LACTATION COMPREHENSIVE ESTABL	$253.30	$298.00	$96.91–$315.01	53% above	15%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 CCR 99215 OFFICE/OUTPATIENT VISIT PN	$253.30	$298.00	$96.91–$315.01	53% above	15%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Est Pt E&M Fac >= 40 Min (WOCN)	$253.30	$298.00	$96.91–$315.01	53% above	15%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 EST PT E&M FACIL LVL 5	$253.30	$298.00	$96.91–$315.01	53% above	15%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Office O/P Est Hi 40-54 min (chg)	$253.30	$298.00	$96.91–$315.01	53% above	15%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Est PT E&M Fac >= 40 Min (C)	$253.30	$298.00	$96.91–$315.01	53% above	15%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Office/Outpatient Visit Est Lv5	$253.30	$298.00	$96.91–$315.01	53% above	15%
Returning patient office visit, high complexity or 40+ minutes one side CPT 99215 Office O/P Est Hi 40 min RT (C/G)	$253.30	$298.00	$96.91–$315.01	53% above	15%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OFFICE/OUTPATIENT VISIT EST LV5 IC	$67.15	$79.00	$47.40–$852.12	—	15%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Office Outpatient Visit Est L5 (N)	$118.15	$139.00	$83.40–$852.12	—	15%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Office Outpatient Visit Est L525 (N)	$118.15	$139.00	$83.40–$852.12	—	15%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Office Visit Level 5 Est 99215	$118.15	$139.00	$83.40–$852.12	—	15%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 99215 OFFICE OUTPATIENT VISIT L5 UC	$118.15	$139.00	$83.40–$852.12	—	15%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Est Pt E&M Fac >= 40 M w/Ser	$250.75	$295.00	$177.00–$852.12	—	15%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 E&M Fac >= 40 Min Only Serv	$250.75	$295.00	$177.00–$852.12	—	15%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 EST PT E&M FAC >= 40 MIN BCE	$253.30	$298.00	$178.80–$852.12	—	15%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Est Pt E&M Fac >= 40 Min (WOCN)	$253.30	$298.00	$178.80–$852.12	—	15%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 EST PT E&M FACIL LVL 5	$253.30	$298.00	$178.80–$852.12	—	15%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Office O/P Est Hi 40-54 min (chg)	$253.30	$298.00	$178.80–$852.12	—	15%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Est PT E&M Fac >= 40 Min (C)	$253.30	$298.00	$178.80–$852.12	—	15%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 PT OFFICE O/P EST HI 40 MIN	$253.30	$298.00	$178.80–$852.12	—	15%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 CCR 99215 OFFICE/OUTPATIENT VISIT PN	$253.30	$298.00	$178.80–$852.12	—	15%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 LACTATION COMPREHENSIVE ESTABL	$253.30	$298.00	$178.80–$852.12	—	15%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Office O/P Est Hi 40 Min (C/G)	$253.30	$298.00	$178.80–$852.12	—	15%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OFFICE O/P EST HI 40 MIN MAT BCE	$253.30	$298.00	$178.80–$852.12	—	15%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OFFICE O/P EST HI 40 MIN BCE	$253.30	$298.00	$178.80–$852.12	—	15%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 EST PT LEVEL 5 FAC BCE	$253.30	$298.00	$178.80–$852.12	—	15%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 EST PT E&M FAC >= 40 M W/SER BCE	$253.30	$298.00	$178.80–$852.12	—	15%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Office/Outpatient Visit Est Lv5	$253.30	$298.00	$178.80–$852.12	—	15%
Returning patient office visit, high complexity or 40+ minutes inpatient one side CPT 99215 Office O/P Est Hi 40 min RT (C/G)	$253.30	$298.00	$178.80–$852.12	—	15%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE/OUTPATIENT VISIT EST LV3 IC	$67.15	$79.00	$29.84–$158.91	30% below	15%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Office Outpatient Visit Est L325 (N)	$118.15	$139.00	$47.77–$158.91	23% above	15%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE OUTPATIENT VISIT EST L325	$118.15	$139.00	$47.77–$158.91	23% above	15%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Office Visit Level 3 Est 99213	$118.15	$139.00	$47.77–$158.91	23% above	15%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Office Outpatient Visit Est L3 (N)	$118.15	$139.00	$47.77–$158.91	23% above	15%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 E&M Fac 15 Min Only Serv	$139.40	$164.00	$47.77–$158.91	45% above	15%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 E&M Fac 15 Min w/Service	$139.40	$164.00	$47.77–$158.91	45% above	15%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 E&M FAC 15 MIN W/SERVICE BCE	$141.10	$166.00	$47.77–$158.91	47% above	15%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Office O/P Est Low 20-29 min (chg)	$141.10	$166.00	$47.77–$158.91	47% above	15%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Office O/P Est Low 20 Min (C/G)	$141.10	$166.00	$47.77–$158.91	47% above	15%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Est Pt E&M Facility 15 Min (WOCN)	$141.10	$166.00	$47.77–$158.91	47% above	15%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 EST PT E&M FACIL LVL 3	$141.10	$166.00	$47.77–$158.91	47% above	15%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE O/P EST LOW 20 MIN MAT BCE	$141.10	$166.00	$47.77–$158.91	47% above	15%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE O/P EST LOW 20 MIN BCE	$141.10	$166.00	$47.77–$158.91	47% above	15%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 EST PT LEVEL 3 FAC BCE	$141.10	$166.00	$47.77–$158.91	47% above	15%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 EST PT E&M FACIL 15 MIN BCE	$141.10	$166.00	$47.77–$158.91	47% above	15%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Office/Outpatient Visit Est Lv3	$141.10	$166.00	$47.77–$158.91	47% above	15%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 zzEst PT E&M Facility 15 Min (C)	$141.10	$166.00	$47.77–$158.91	47% above	15%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 PT OFFICE O/P EST LOW 20 MIN	$141.10	$166.00	$47.77–$158.91	47% above	15%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 CCR 99213 OFFICE/OUTPATIENT VISIT PN	$141.10	$166.00	$47.77–$158.91	47% above	15%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 LACTATION INTERMEDIATE ESTABLI	$141.10	$166.00	$47.77–$158.91	47% above	15%
Returning patient office visit, low complexity or 20+ minutes one side CPT 99213 Office O/P Est Low 20 min RT (C/G)	$141.10	$166.00	$47.77–$158.91	47% above	15%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OFFICE/OUTPATIENT VISIT EST LV3 IC	$67.15	$79.00	$47.40–$852.12	—	15%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Office Visit Level 3 Est 99213	$118.15	$139.00	$83.40–$852.12	—	15%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Office Outpatient Visit Est L3 (N)	$118.15	$139.00	$83.40–$852.12	—	15%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Office Outpatient Visit Est L325 (N)	$118.15	$139.00	$83.40–$852.12	—	15%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OFFICE OUTPATIENT VISIT EST L325	$118.15	$139.00	$83.40–$852.12	—	15%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 E&M Fac 15 Min w/Service	$139.40	$164.00	$98.40–$852.12	—	15%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 E&M Fac 15 Min Only Serv	$139.40	$164.00	$98.40–$852.12	—	15%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 PT OFFICE O/P EST LOW 20 MIN	$141.10	$166.00	$99.60–$852.12	—	15%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 CCR 99213 OFFICE/OUTPATIENT VISIT PN	$141.10	$166.00	$99.60–$852.12	—	15%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 E&M FAC 15 MIN W/SERVICE BCE	$141.10	$166.00	$99.60–$852.12	—	15%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Office O/P Est Low 20 Min (C/G)	$141.10	$166.00	$99.60–$852.12	—	15%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 EST PT E&M FACIL 15 MIN BCE	$141.10	$166.00	$99.60–$852.12	—	15%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 LACTATION INTERMEDIATE ESTABLI	$141.10	$166.00	$99.60–$852.12	—	15%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 zzEst PT E&M Facility 15 Min (C)	$141.10	$166.00	$99.60–$852.12	—	15%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 EST PT LEVEL 3 FAC BCE	$141.10	$166.00	$99.60–$852.12	—	15%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OFFICE O/P EST LOW 20 MIN BCE	$141.10	$166.00	$99.60–$852.12	—	15%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OFFICE O/P EST LOW 20 MIN MAT BCE	$141.10	$166.00	$99.60–$852.12	—	15%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Est Pt E&M Facility 15 Min (WOCN)	$141.10	$166.00	$99.60–$852.12	—	15%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 EST PT E&M FACIL LVL 3	$141.10	$166.00	$99.60–$852.12	—	15%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Office O/P Est Low 20-29 min (chg)	$141.10	$166.00	$99.60–$852.12	—	15%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Office/Outpatient Visit Est Lv3	$141.10	$166.00	$99.60–$852.12	—	15%
Returning patient office visit, low complexity or 20+ minutes inpatient one side CPT 99213 Office O/P Est Low 20 min RT (C/G)	$141.10	$166.00	$99.60–$852.12	—	15%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 LACTATION EXTENDED ESTABLISHED	$56.10	$66.00	$23.62–$221.68	53% below	15%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Office O/P Est Mod 30 Min (C/G)	$56.10	$66.00	$23.62–$221.68	53% below	15%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE/OUTPATIENT VISIT EST LV4 IC	$67.15	$79.00	$29.84–$221.68	44% below	15%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Office Visit Level 4 Est 99214	$118.15	$139.00	$52.50–$221.68	1% below	15%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Office Outpatient Visit Est L4 (N)	$118.15	$139.00	$52.50–$221.68	1% below	15%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Office Outpatient Visit Est L425 (N)	$118.15	$139.00	$52.50–$221.68	1% below	15%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 E&M Fac 25 Min Only Serv	$190.40	$224.00	$68.20–$221.68	60% above	15%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 E&M Fac 25 Min w/Service	$190.40	$224.00	$68.20–$221.68	60% above	15%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 EST PT E&M FACIL LVL 4	$192.10	$226.00	$68.20–$221.68	61% above	15%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 CCR 99214 OFFICE/OUTPATIENT VISIT PN	$192.10	$226.00	$68.20–$221.68	61% above	15%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Office/Outpatient Visit Est Lv4	$192.10	$226.00	$68.20–$221.68	61% above	15%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 E&M FAC 25 MIN W/SERVICE BCE	$192.10	$226.00	$68.20–$221.68	61% above	15%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 EST PT E&M FACIL 25 MIN BCE	$192.10	$226.00	$68.20–$221.68	61% above	15%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 PT OFFICE O/P EST MOD 30 MIN	$192.10	$226.00	$68.20–$221.68	61% above	15%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 zzEst PT E&M Facility 25 Min (C)	$192.10	$226.00	$68.20–$221.68	61% above	15%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Office O/P Est Mod 30-39 min (chg)	$192.10	$226.00	$68.20–$221.68	61% above	15%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214 E&M FACIL 25 MIN	$192.10	$226.00	$68.20–$221.68	61% above	15%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214 E&M FACIL 25 MIN PO	$192.10	$226.00	$68.20–$221.68	61% above	15%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214 EST E&M W/OTH SVC 25 MIN	$192.10	$226.00	$68.20–$221.68	61% above	15%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214 FOLLOW UP E&M FACIL 25 MIN	$192.10	$226.00	$68.20–$221.68	61% above	15%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214 FOLLOW UP E&M FACIL 25 M PO	$192.10	$226.00	$68.20–$221.68	61% above	15%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214 FUP E&M FAC W/OTH SVC 25 MN	$192.10	$226.00	$68.20–$221.68	61% above	15%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Est Pt E&M Facility 25 Min (WOCN)	$192.10	$226.00	$68.20–$221.68	61% above	15%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE O/P EST MOD 30 MIN MAT BCE	$192.10	$226.00	$68.20–$221.68	61% above	15%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE O/P EST MOD 30 MIN BCE	$192.10	$226.00	$68.20–$221.68	61% above	15%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 EST PT LEVEL 4 FAC BCE	$192.10	$226.00	$68.20–$221.68	61% above	15%
Returning patient office visit, moderate complexity or 30+ minutes one side CPT 99214 Office O/P Est Mod 30 min RT (C/G)	$192.10	$226.00	$68.20–$221.68	61% above	15%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Office O/P Est Mod 30 Min (C/G)	$56.10	$66.00	$39.60–$852.12	—	15%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 LACTATION EXTENDED ESTABLISHED	$56.10	$66.00	$39.60–$852.12	—	15%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OFFICE/OUTPATIENT VISIT EST LV4 IC	$67.15	$79.00	$47.40–$852.12	—	15%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Office Outpatient Visit Est L4 (N)	$118.15	$139.00	$83.40–$852.12	—	15%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Office Visit Level 4 Est 99214	$118.15	$139.00	$83.40–$852.12	—	15%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Office Outpatient Visit Est L425 (N)	$118.15	$139.00	$83.40–$852.12	—	15%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 E&M Fac 25 Min w/Service	$190.40	$224.00	$134.40–$852.12	—	15%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 E&M Fac 25 Min Only Serv	$190.40	$224.00	$134.40–$852.12	—	15%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 99214 FUP E&M FAC W/OTH SVC 25 MN	$192.10	$226.00	$135.60–$852.12	—	15%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 CCR 99214 OFFICE/OUTPATIENT VISIT PN	$192.10	$226.00	$135.60–$852.12	—	15%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Est Pt E&M Facility 25 Min (WOCN)	$192.10	$226.00	$135.60–$852.12	—	15%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 EST PT E&M FACIL 25 MIN BCE	$192.10	$226.00	$135.60–$852.12	—	15%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 EST PT LEVEL 4 FAC BCE	$192.10	$226.00	$135.60–$852.12	—	15%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OFFICE O/P EST MOD 30 MIN BCE	$192.10	$226.00	$135.60–$852.12	—	15%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OFFICE O/P EST MOD 30 MIN MAT BCE	$192.10	$226.00	$135.60–$852.12	—	15%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 EST PT E&M FACIL LVL 4	$192.10	$226.00	$135.60–$852.12	—	15%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 PT OFFICE O/P EST MOD 30 MIN	$192.10	$226.00	$135.60–$852.12	—	15%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 zzEst PT E&M Facility 25 Min (C)	$192.10	$226.00	$135.60–$852.12	—	15%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Office O/P Est Mod 30-39 min (chg)	$192.10	$226.00	$135.60–$852.12	—	15%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 99214 E&M FACIL 25 MIN	$192.10	$226.00	$135.60–$852.12	—	15%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 99214 E&M FACIL 25 MIN PO	$192.10	$226.00	$135.60–$852.12	—	15%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 99214 EST E&M W/OTH SVC 25 MIN	$192.10	$226.00	$135.60–$852.12	—	15%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 99214 FOLLOW UP E&M FACIL 25 MIN	$192.10	$226.00	$135.60–$852.12	—	15%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 99214 FOLLOW UP E&M FACIL 25 M PO	$192.10	$226.00	$135.60–$852.12	—	15%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Office/Outpatient Visit Est Lv4	$192.10	$226.00	$135.60–$852.12	—	15%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 E&M FAC 25 MIN W/SERVICE BCE	$192.10	$226.00	$135.60–$852.12	—	15%
Returning patient office visit, moderate complexity or 30+ minutes inpatient one side CPT 99214 Office O/P Est Mod 30 min RT (C/G)	$192.10	$226.00	$135.60–$852.12	—	15%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE/OUTPATIENT VISIT EST LV2 IC	$67.15	$79.00	$29.68–$111.87	1% below	15%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 E&M Fac 10 Min Only Serv	$97.75	$115.00	$29.68–$111.87	44% above	15%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 E&M Fac 10 Min w/Service	$97.75	$115.00	$29.68–$111.87	44% above	15%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 EST PT LEVEL 2 FAC BCE	$99.45	$117.00	$29.68–$111.87	46% above	15%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 EST PT E&M FACIL 10 MIN BCE	$99.45	$117.00	$29.68–$111.87	46% above	15%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 zzE&M Facil 10 Min (C)	$99.45	$117.00	$29.68–$111.87	46% above	15%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Office O/P Est Sf 10-19 min (chg)	$99.45	$117.00	$29.68–$111.87	46% above	15%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 E&M FAC 10 MIN W/SERVICE BCE	$99.45	$117.00	$29.68–$111.87	46% above	15%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Office/Outpatient Visit Est Lv2	$99.45	$117.00	$29.68–$111.87	46% above	15%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 LACTATION LIMITED ESTABLISHED	$99.45	$117.00	$29.68–$111.87	46% above	15%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Office O/P Est Sf 10 Min (C/G)	$99.45	$117.00	$29.68–$111.87	46% above	15%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 PT OFFICE O/P EST SF 10 MIN	$99.45	$117.00	$29.68–$111.87	46% above	15%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 CCR 99212 OFFICE/OUTPATIENT VISIT PN	$99.45	$117.00	$29.68–$111.87	46% above	15%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE O/P EST SF 10 MIN BCE	$99.45	$117.00	$29.68–$111.87	46% above	15%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE O/P EST SF 10 MIN MAT BCE	$99.45	$117.00	$29.68–$111.87	46% above	15%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 EST PT E&M FACIL LVL 2	$99.45	$117.00	$29.68–$111.87	46% above	15%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Est Pt E&M Facility 10 Min (WOCN)	$99.45	$117.00	$29.68–$111.87	46% above	15%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Office Outpatient Visit Est L225 (N)	$118.15	$139.00	$29.68–$118.15	74% above	15%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Office Outpatient Visit Est L2 (N)	$118.15	$139.00	$29.68–$118.15	74% above	15%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Office Visit Level 2 Est 99212	$118.15	$139.00	$29.68–$118.15	74% above	15%
Returning patient office visit, straightforward problem or 10+ minutes one side CPT 99212 Office O/P Est Sf 10 min RT (C/G)	$99.45	$117.00	$29.68–$111.87	46% above	15%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OFFICE/OUTPATIENT VISIT EST LV2 IC	$67.15	$79.00	$47.40–$852.12	—	15%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 E&M Fac 10 Min Only Serv	$97.75	$115.00	$69.00–$852.12	—	15%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 E&M Fac 10 Min w/Service	$97.75	$115.00	$69.00–$852.12	—	15%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 CCR 99212 OFFICE/OUTPATIENT VISIT PN	$99.45	$117.00	$70.20–$852.12	—	15%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Office/Outpatient Visit Est Lv2	$99.45	$117.00	$70.20–$852.12	—	15%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 E&M FAC 10 MIN W/SERVICE BCE	$99.45	$117.00	$70.20–$852.12	—	15%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 EST PT E&M FACIL 10 MIN BCE	$99.45	$117.00	$70.20–$852.12	—	15%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 EST PT LEVEL 2 FAC BCE	$99.45	$117.00	$70.20–$852.12	—	15%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OFFICE O/P EST SF 10 MIN BCE	$99.45	$117.00	$70.20–$852.12	—	15%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OFFICE O/P EST SF 10 MIN MAT BCE	$99.45	$117.00	$70.20–$852.12	—	15%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Est Pt E&M Facility 10 Min (WOCN)	$99.45	$117.00	$70.20–$852.12	—	15%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 EST PT E&M FACIL LVL 2	$99.45	$117.00	$70.20–$852.12	—	15%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Office O/P Est Sf 10 Min (C/G)	$99.45	$117.00	$70.20–$852.12	—	15%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 LACTATION LIMITED ESTABLISHED	$99.45	$117.00	$70.20–$852.12	—	15%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 PT OFFICE O/P EST SF 10 MIN	$99.45	$117.00	$70.20–$852.12	—	15%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 zzE&M Facil 10 Min (C)	$99.45	$117.00	$70.20–$852.12	—	15%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Office O/P Est Sf 10-19 min (chg)	$99.45	$117.00	$70.20–$852.12	—	15%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Office Outpatient Visit Est L225 (N)	$118.15	$139.00	$83.40–$852.12	—	15%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Office Outpatient Visit Est L2 (N)	$118.15	$139.00	$83.40–$852.12	—	15%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Office Visit Level 2 Est 99212	$118.15	$139.00	$83.40–$852.12	—	15%
Returning patient office visit, straightforward problem or 10+ minutes inpatient one side CPT 99212 Office O/P Est Sf 10 min RT (C/G)	$99.45	$117.00	$70.20–$852.12	—	15%
Specialist consultation, low complexity or 30+ minutes CPT 99243 Office Consult Level 3 99243	$251.60	$296.00	$56.90–$251.60	35% above	15%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 Office Consult Level 3 99243	$251.60	$296.00	$177.60–$852.12	—	15%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 Office Consult Level 4 99244	$358.70	$422.00	$81.60–$358.70	59% above	15%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 Office Consult Level 4 99244	$358.70	$422.00	$253.20–$852.12	—	15%
Speech and language evaluation CPT 92523 Sound production with language eval - ST EvaluationType	$597.55	$703.00	$114.01–$910.43	59% above	15%
Speech and language evaluation CPT 92523 Language only eval - ST EvaluationType	$597.55	$703.00	$114.01–$910.43	59% above	15%
Speech and language evaluation CPT 92523 ST 92523 ST LANGUAGE ONLY EVA RDC	$627.30	$738.00	$114.01–$910.43	66% above	15%
Speech and language evaluation CPT 92523 ST SPEECH SOUND LANG COMPREHE RDC POMH	$627.30	$738.00	$114.01–$910.43	66% above	15%
Speech and language evaluation CPT 92523 ST Language Only Eval - IP ST	$627.30	$738.00	$114.01–$910.43	66% above	15%
Speech and language evaluation CPT 92523 92523 ST LANGUAGE ONLY EVAL ST IP	$627.30	$738.00	$114.01–$910.43	66% above	15%
Speech and language evaluation CPT 92523 92523 SPEECH SOUND LANG COMPREHEN ST IP	$627.30	$738.00	$114.01–$910.43	66% above	15%
Speech and language evaluation CPT 92523 ST Sound Prod w/Lang Eval - IP ST	$627.30	$738.00	$114.01–$910.43	66% above	15%
Speech and language evaluation CPT 92523 ST SPEECH SOUND LANG COMPREHE RDC KMH	$627.30	$738.00	$114.01–$910.43	66% above	15%
Speech and language evaluation CPT 92523 SP SND PROD - EVAL IP GRY	$627.30	$738.00	$114.01–$910.43	66% above	15%
Speech and language evaluation CPT 92523 SP SND PROD - EVAL IP CAD	$627.30	$738.00	$114.01–$910.43	66% above	15%
Speech and language evaluation inpatient CPT 92523 Sound production with language eval - ST EvaluationType	$597.55	$703.00	$421.80–$852.12	—	15%
Speech and language evaluation inpatient CPT 92523 Language only eval - ST EvaluationType	$597.55	$703.00	$421.80–$852.12	—	15%
Speech and language evaluation inpatient CPT 92523 ST 92523 ST LANGUAGE ONLY EVA RDC	$627.30	$738.00	$442.80–$852.12	—	15%
Speech and language evaluation inpatient CPT 92523 ST SPEECH SOUND LANG COMPREHE RDC KMH	$627.30	$738.00	$442.80–$852.12	—	15%
Speech and language evaluation inpatient CPT 92523 ST SPEECH SOUND LANG COMPREHE RDC POMH	$627.30	$738.00	$442.80–$852.12	—	15%
Speech and language evaluation inpatient CPT 92523 SP SND PROD - EVAL IP GRY	$627.30	$738.00	$442.80–$852.12	—	15%
Speech and language evaluation inpatient CPT 92523 SP SND PROD - EVAL IP CAD	$627.30	$738.00	$442.80–$852.12	—	15%
Speech and language evaluation inpatient CPT 92523 ST Sound Prod w/Lang Eval - IP ST	$627.30	$738.00	$442.80–$852.12	—	15%
Speech and language evaluation inpatient CPT 92523 ST Language Only Eval - IP ST	$627.30	$738.00	$442.80–$852.12	—	15%
Speech and language evaluation inpatient CPT 92523 92523 ST LANGUAGE ONLY EVAL ST IP	$627.30	$738.00	$442.80–$852.12	—	15%
Speech and language evaluation inpatient CPT 92523 92523 SPEECH SOUND LANG COMPREHEN ST IP	$627.30	$738.00	$442.80–$852.12	—	15%
Speech therapy session, individual CPT 92507 60 minutes - ST Individual treatment	$290.70	$342.00	$38.38–$290.70	36% above	15%
Speech therapy session, individual CPT 92507 45 minutes - ST Individual treatment	$290.70	$342.00	$38.38–$290.70	36% above	15%
Speech therapy session, individual CPT 92507 30 minutes - ST Individual treatment	$290.70	$342.00	$38.38–$290.70	36% above	15%
Speech therapy session, individual CPT 92507 15 minutes - ST Individual treatment	$290.70	$342.00	$38.38–$290.70	36% above	15%
Speech therapy session, individual CPT 92507 Voice prosthesis mod and training - ST EvaluationType	$290.70	$342.00	$38.38–$290.70	36% above	15%
Speech therapy session, individual CPT 92507 Voice Pros Mod & Trng - IP Speech Therapy	$305.15	$359.00	$38.38–$305.15	43% above	15%
Speech therapy session, individual CPT 92507 ST Indiv Therapy - IP ST	$305.15	$359.00	$38.38–$305.15	43% above	15%
Speech therapy session, individual CPT 92507 92507 SPEECH/HEARING THERAPY INDI ST	$305.15	$359.00	$38.38–$305.15	43% above	15%
Speech therapy session, individual CPT 92507 92507 SPEECH/HEARING THERAPY INDI ST IP	$305.15	$359.00	$38.38–$305.15	43% above	15%
Speech therapy session, individual inpatient CPT 92507 30 minutes - ST Individual treatment	$290.70	$342.00	$205.20–$852.12	—	15%
Speech therapy session, individual inpatient CPT 92507 Voice prosthesis mod and training - ST EvaluationType	$290.70	$342.00	$205.20–$852.12	—	15%
Speech therapy session, individual inpatient CPT 92507 60 minutes - ST Individual treatment	$290.70	$342.00	$205.20–$852.12	—	15%
Speech therapy session, individual inpatient CPT 92507 15 minutes - ST Individual treatment	$290.70	$342.00	$205.20–$852.12	—	15%
Speech therapy session, individual inpatient CPT 92507 45 minutes - ST Individual treatment	$290.70	$342.00	$205.20–$852.12	—	15%
Speech therapy session, individual inpatient CPT 92507 ST Indiv Therapy - IP ST	$305.15	$359.00	$215.40–$852.12	—	15%
Speech therapy session, individual inpatient CPT 92507 92507 SPEECH/HEARING THERAPY INDI ST IP	$305.15	$359.00	$215.40–$852.12	—	15%
Speech therapy session, individual inpatient CPT 92507 92507 SPEECH/HEARING THERAPY INDI ST	$305.15	$359.00	$215.40–$852.12	—	15%
Speech therapy session, individual inpatient CPT 92507 Voice Pros Mod & Trng - IP Speech Therapy	$305.15	$359.00	$215.40–$852.12	—	15%
Spirometry (breathing test) CPT 94010 Spirometry 94010	$60.35	$71.00	$26.82–$365.75	70% below	15%
Spirometry (breathing test) CPT 94010 Breathing Capacity Test (chg)	$243.95	$287.00	$64.85–$365.75	20% above	15%
Spirometry (breathing test) CPT 94010 Breathing Capacity Test Rdc (chg)	$243.95	$287.00	$64.85–$365.75	20% above	15%
Spirometry (breathing test) CPT 94010 Breathing Capacity Test (C/G)	$243.95	$287.00	$64.85–$365.75	20% above	15%
Spirometry (breathing test) CPT 94010 Breathing Capacity Test Rdc (C/G)	$243.95	$287.00	$64.85–$365.75	20% above	15%
Spirometry (breathing test) inpatient CPT 94010 Spirometry 94010	$60.35	$71.00	$42.60–$852.12	—	15%
Spirometry (breathing test) inpatient CPT 94010 Breathing Capacity Test (chg)	$243.95	$287.00	$172.20–$852.12	—	15%
Spirometry (breathing test) inpatient CPT 94010 Breathing Capacity Test (C/G)	$243.95	$287.00	$172.20–$852.12	—	15%
Spirometry (breathing test) inpatient CPT 94010 Breathing Capacity Test Rdc (C/G)	$243.95	$287.00	$172.20–$852.12	—	15%
Spirometry (breathing test) inpatient CPT 94010 Breathing Capacity Test Rdc (chg)	$243.95	$287.00	$172.20–$852.12	—	15%
Spirometry before and after a bronchodilator CPT 94060 Spiro w/ and w/o Bronchodilator 94060	$86.70	$102.00	$28.15–$632.09	78% below	15%
Spirometry before and after a bronchodilator CPT 94060 zzzPFT Spirometry with bronchodilator POC	$86.70	$102.00	$38.53–$632.09	78% below	15%
Spirometry before and after a bronchodilator CPT 94060 Evaluation of Wheezing (C/G)	$374.00	$440.00	$109.84–$632.09	5% below	15%
Spirometry before and after a bronchodilator CPT 94060 Evaluation of Wheezing (chg)	$374.00	$440.00	$109.84–$632.09	5% below	15%
Spirometry before and after a bronchodilator CPT 94060 EVALUATION WHEEZING RHC POC	$374.00	$440.00	$109.84–$632.09	5% below	15%
Spirometry before and after a bronchodilator inpatient CPT 94060 zzzPFT Spirometry with bronchodilator POC	$86.70	$102.00	$61.20–$852.12	—	15%
Spirometry before and after a bronchodilator inpatient CPT 94060 Spiro w/ and w/o Bronchodilator 94060	$86.70	$102.00	$61.20–$852.12	—	15%
Spirometry before and after a bronchodilator inpatient CPT 94060 Evaluation of Wheezing (C/G)	$374.00	$440.00	$264.00–$852.12	—	15%
Spirometry before and after a bronchodilator inpatient CPT 94060 EVALUATION WHEEZING RHC POC	$374.00	$440.00	$264.00–$852.12	—	15%
Spirometry before and after a bronchodilator inpatient CPT 94060 Evaluation of Wheezing (chg)	$374.00	$440.00	$264.00–$852.12	—	15%
Therapeutic activities (functional training), 15 minutes CPT 97530 97530 PT THERAPEUTIC ACT 15 MI CQ	$96.90	$114.00	$17.45–$96.90	20% above	15%
Therapeutic activities (functional training), 15 minutes CPT 97530 97530 THERAPEUTIC ACTIVITIES OT OT IP	$96.90	$114.00	$17.45–$96.90	20% above	15%
Therapeutic activities (functional training), 15 minutes CPT 97530 COTA Therapeutic Activity 15min	$96.90	$114.00	$17.45–$96.90	20% above	15%
Therapeutic activities (functional training), 15 minutes CPT 97530 OT Therapeutic Activity 15min	$96.90	$114.00	$17.45–$96.90	20% above	15%
Therapeutic activities (functional training), 15 minutes CPT 97530 Therapeutic Activity 15 min - OT	$96.90	$114.00	$17.45–$96.90	20% above	15%
Therapeutic activities (functional training), 15 minutes CPT 97530 zzOT Low Vision 15min	$96.90	$114.00	$17.45–$96.90	20% above	15%
Therapeutic activities (functional training), 15 minutes CPT 97530 Low Vision OT 15 M - OT Rehab Unit	$96.90	$114.00	$17.45–$96.90	20% above	15%
Therapeutic activities (functional training), 15 minutes CPT 97530 97530 OT THERAPEUTIC ACT 15 CO	$96.90	$114.00	$17.45–$96.90	20% above	15%
Therapeutic activities (functional training), 15 minutes CPT 97530 THERAPEUTIC ACTIVITY 15 MIN - OT OP	$96.90	$114.00	$17.45–$96.90	20% above	15%
Therapeutic activities (functional training), 15 minutes CPT 97530 PT Therapy Activity 15min	$96.90	$114.00	$17.45–$96.90	20% above	15%
Therapeutic activities (functional training), 15 minutes CPT 97530 PTA Therapy Activity 15min	$96.90	$114.00	$17.45–$96.90	20% above	15%
Therapeutic activities (functional training), 15 minutes CPT 97530 Therap Activity 15 min - PT MMC	$96.90	$114.00	$17.45–$96.90	20% above	15%
Therapeutic activities (functional training), 15 minutes CPT 97530 PT 97530 PTM THERAPEUTIC ACTIVITY 15	$96.90	$114.00	$17.45–$96.90	20% above	15%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 97530 PT THERAPEUTIC ACT 15 MI CQ	$96.90	$114.00	$68.40–$852.12	—	15%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 97530 THERAPEUTIC ACTIVITIES OT OT IP	$96.90	$114.00	$68.40–$852.12	—	15%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 COTA Therapeutic Activity 15min	$96.90	$114.00	$68.40–$852.12	—	15%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 OT Therapeutic Activity 15min	$96.90	$114.00	$68.40–$852.12	—	15%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Therapeutic Activity 15 min - OT	$96.90	$114.00	$68.40–$852.12	—	15%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 zzOT Low Vision 15min	$96.90	$114.00	$68.40–$852.12	—	15%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Low Vision OT 15 M - OT Rehab Unit	$96.90	$114.00	$68.40–$852.12	—	15%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 97530 OT THERAPEUTIC ACT 15 CO	$96.90	$114.00	$68.40–$852.12	—	15%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THERAPEUTIC ACTIVITY 15 MIN - OT OP	$96.90	$114.00	$68.40–$852.12	—	15%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 PT Therapy Activity 15min	$96.90	$114.00	$68.40–$852.12	—	15%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 PTA Therapy Activity 15min	$96.90	$114.00	$68.40–$852.12	—	15%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 PT 97530 PTM THERAPEUTIC ACTIVITY 15	$96.90	$114.00	$68.40–$852.12	—	15%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Therap Activity 15 min - PT MMC	$96.90	$114.00	$68.40–$852.12	—	15%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 zzPHLEBOTOMY THERAPEUTIC BCE	$168.30	$198.00	$69.33–$349.15	28% below	15%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY BCE	$168.30	$198.00	$69.33–$349.15	28% below	15%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY THERAPEUTIC	$337.45	$397.00	$69.33–$349.15	44% above	15%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Phlebotomy BCE	$337.45	$397.00	$69.33–$349.15	44% above	15%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY BCE	$168.30	$198.00	$118.80–$852.12	—	15%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 zzPHLEBOTOMY THERAPEUTIC BCE	$168.30	$198.00	$118.80–$852.12	—	15%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 Phlebotomy BCE	$337.45	$397.00	$238.20–$852.12	—	15%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY THERAPEUTIC	$337.45	$397.00	$238.20–$852.12	—	15%
Treadmill or drug stress test with ECG, supervision and report CPT 93015 CV Stress Test Proctor Tracing and I&R (Complete Global) 93015	$1,007.25	$1,185.00	$36.35–$1,007.25	208% above	15%
Treadmill or drug stress test with ECG, supervision and report CPT 93015 EKG TREADMILL ALONE 93015	$1,007.25	$1,185.00	$36.35–$1,007.25	208% above	15%
Treadmill or drug stress test with ECG, supervision and report inpatient CPT 93015 CV Stress Test Proctor Tracing and I&R (Complete Global) 93015	$1,007.25	$1,185.00	$711.00–$1,007.25	—	15%
Treadmill or drug stress test with ECG, supervision and report inpatient CPT 93015 EKG TREADMILL ALONE 93015	$1,007.25	$1,185.00	$711.00–$1,007.25	—	15%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Michigan	Off list
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 Influenza ADJUVANTED TRIV (pts 65 yrs and over) Vaccine 0.5 mL Syringe (Fluad)	$46.64	$54.86	$32.92–$166.87	48% below	15%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 90653-Influ Adj. Trivalent, PF 0.5mL - influenza vaccine, split, inactiv Charge	$49.30	$58.00	$34.80–$166.87	45% below	15%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 Influenza ADJUVANTED TRIV (pts 65 yrs and over) Vaccine 0.5 mL Syringe (Fluad)	$46.64	$54.86	$32.92–$852.12	—	15%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 90653-Influ Adj. Trivalent, PF 0.5mL - influenza vaccine, split, inactiv Charge	$49.30	$58.00	$34.80–$852.12	—	15%
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 moderna covid-19 12y+ Charge	$385.05	$453.00	$84.54–$385.05	39% above	15%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 moderna covid-19 12y+ Charge	$385.05	$453.00	$271.80–$852.12	—	15%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 pfizer covid-19 12y+ Charge	$233.75	$275.00	$88.06–$286.23	9% above	15%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 pfizer covid-19 12y+ Charge	$233.75	$275.00	$165.00–$852.12	—	15%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 varicella virus vaccine Charge	$430.10	$506.00	$191.12–$430.10	113% above	15%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 varicella virus vaccine Charge	$430.10	$506.00	$303.60–$852.12	—	15%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 diphtheria/pertussis,acel/tetanus/polio Charge	$131.75	$155.00	$58.54–$131.75	113% above	15%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 diphtheria/pertussis,acel/tetanus/polio Charge	$131.75	$155.00	$93.00–$852.12	—	15%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 Diphtheria-Pertussis (acellular)-Tetanus (pts < 7 yrs) 0.5mL Inject	$61.94	$72.87	$27.52–$61.94	60% above	15%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 Infanrix (DTaP) IM suspension Charge	$66.30	$78.00	$29.46–$66.30	71% above	15%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DTAP Vaccine < 7 yrs IM UC	$69.63	$81.91	$30.94–$69.62	80% above	15%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 Daptacel (DTaP) IM suspension Charge	$104.55	$123.00	$33.31–$104.55	170% above	15%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 Diphtheria-Pertussis (acellular)-Tetanus (pts < 7 yrs) 0.5mL Inject	$61.94	$72.87	$43.72–$852.12	—	15%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 Infanrix (DTaP) IM suspension Charge	$66.30	$78.00	$46.80–$852.12	—	15%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DTAP Vaccine < 7 yrs IM UC	$69.63	$81.91	$49.15–$852.12	—	15%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 Daptacel (DTaP) IM suspension Charge	$104.55	$123.00	$73.80–$852.12	—	15%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 diphtheria/hepB/pert,acel/polio/tetanus Charge	$178.50	$210.00	$79.32–$178.50	43% above	15%
DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 diphtheria/hepB/pert,acel/polio/tetanus Charge	$178.50	$210.00	$126.00–$852.12	—	15%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 Diphtheria-Pertussis (acellular)-Tetanus-Haemophilus-Polio 0.5 mL Inject	$174.08	$204.79	$77.35–$199.07	11% above	15%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 diphth/haemophilus/pertussis/tetanus/polio Charge	$182.75	$215.00	$81.21–$199.07	17% above	15%
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 Diphtheria-Pertussis (acellular)-Tetanus-Haemophilus-Polio 0.5 mL Inject	$174.08	$204.79	$122.87–$852.12	—	15%
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 diphth/haemophilus/pertussis/tetanus/polio Charge	$182.75	$215.00	$129.00–$852.12	—	15%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 90656-Influ Trivalent, PF 0.5mL - influenza vaccine, split, inactiv Charge	$17.85	$21.00	$12.14–$39.47	44% below	15%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 90656-Influ Trivalent, PF 0.5mL - influenza vaccine, split, inactiv Charge	$17.85	$21.00	$12.60–$852.12	—	15%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HPV vacc 9-valent IM suspension Charge	$695.30	$818.00	$308.96–$695.30	108% above	15%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HPV vacc 9-valent IM suspension Charge	$695.30	$818.00	$490.80–$852.12	—	15%
Hepatitis A vaccine, adult dose CPT 90632 Hepatitis A Adult Vaccine Charge	$188.70	$222.00	$83.85–$188.70	60% above	15%
Hepatitis A vaccine, adult dose inpatient CPT 90632 Hepatitis A Adult Vaccine Charge	$188.70	$222.00	$133.20–$852.12	—	15%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 hepatitis A pediatric vaccine Charge	$84.15	$99.00	$37.39–$84.15	12% above	15%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 hepatitis A pediatric vaccine Charge	$84.15	$99.00	$59.40–$852.12	—	15%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 Hepatitis B Adult Vaccine Charge	$128.35	$151.00	$39.30–$128.35	53% above	15%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 Hepatitis B Adult Vaccine Charge	$128.35	$151.00	$90.60–$852.12	—	15%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 Hepatitis B pediatric vaccine Charge	$56.95	$67.00	$17.37–$56.95	76% above	15%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 Hepatitis B pediatric vaccine Charge	$56.95	$67.00	$40.20–$852.12	—	15%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 haemophilus b conjugate (PRP-OMP) vaccine Charge	$78.20	$92.00	$34.75–$78.20	59% above	15%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) inpatient CPT 90647 haemophilus b conjugate (PRP-OMP) vaccine Charge	$78.20	$92.00	$55.20–$852.12	—	15%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 ActHIB Haemophilus B Conj (PRP-T) Vaccine 0.5mL Inject	$29.33	$34.50	$13.03–$29.33	29% below	15%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 haemophilus b conjugate (PRP-T) vaccine Charge	$39.10	$46.00	$14.87–$39.10	5% below	15%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 ActHIB Haemophilus B Conj (PRP-T) Vaccine 0.5mL Inject	$29.33	$34.50	$20.70–$852.12	—	15%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 haemophilus b conjugate (PRP-T) vaccine Charge	$39.10	$46.00	$27.60–$852.12	—	15%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Fluzone HIGH-Dose (pts >or=65 yrs) 2019-2020 Vaccine 0.5 mL Syringe	$103.75	$122.05	$51.34–$166.87	30% above	15%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Fluzone High-Dose (pts >or= 65yrs) 2018-2019 Vaccine 0.5 mL Syringe	$111.70	$131.40	$51.34–$166.87	40% above	15%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Fluzone HIGH-Dose (pts >or=65yrs) 2018-2019 Vaccine 0.5 mL Syringe	$111.70	$131.40	$51.34–$166.87	40% above	15%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 Fluzone HIGH-Dose (pts >or=65 yrs) 2019-2020 Vaccine 0.5 mL Syringe	$103.75	$122.05	$73.23–$852.12	—	15%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 Fluzone HIGH-Dose (pts >or=65yrs) 2018-2019 Vaccine 0.5 mL Syringe	$111.70	$131.40	$78.84–$852.12	—	15%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 Fluzone High-Dose (pts >or= 65yrs) 2018-2019 Vaccine 0.5 mL Syringe	$111.70	$131.40	$78.84–$852.12	—	15%
Japanese encephalitis vaccine (Ixiaro), 2-dose schedule CPT 90738 japanese enceph Charge	$804.95	$947.00	$336.40–$804.95	82% above	15%
Japanese encephalitis vaccine (Ixiaro), 2-dose schedule inpatient CPT 90738 japanese enceph Charge	$804.95	$947.00	$568.20–$852.12	—	15%
MMR vaccine (measles, mumps and rubella), live CPT 90707 Measles/Mumps/Rubella Vaccine (Priorix) 0.5 mL Inject	$225.40	$265.17	$100.15–$225.39	66% above	15%
MMR vaccine (measles, mumps and rubella), live CPT 90707 Measles/mumps/rubella virus vaccine Charge	$226.95	$267.00	$100.85–$226.95	68% above	15%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 Measles/Mumps/Rubella Vaccine (Priorix) 0.5 mL Inject	$225.40	$265.17	$159.10–$852.12	—	15%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 Measles/mumps/rubella virus vaccine Charge	$226.95	$267.00	$160.20–$852.12	—	15%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 measles/mumps/rubella/varicella virus vacc Charge	$707.20	$832.00	$314.25–$707.20	99% above	15%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 measles/mumps/rubella/varicella virus vacc Charge	$707.20	$832.00	$499.20–$852.12	—	15%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 Meningococcal (Menveo-IM) Vaccine 0.5 mL Inject (2 Vials)	$546.25	$642.64	$189.95–$546.24	163% above	15%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 90734-Menveo/Menactra - Meningococcal conjugate vaccine Charge	$800.70	$942.00	$189.95–$800.70	286% above	15%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 Meningococcal (Menveo-IM) Vaccine 0.5 mL Inject (2 Vials)	$546.25	$642.64	$385.58–$852.12	—	15%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 90734-Menveo/Menactra - Meningococcal conjugate vaccine Charge	$800.70	$942.00	$565.20–$852.12	—	15%
Meningococcal ACWY vaccine (MenQuadfi) CPT 90619 Meningococcal (MenQuadfi-IM) Vaccine 0.5 mL Inject	$279.99	$329.40	$124.41–$279.99	19% above	15%
Meningococcal ACWY vaccine (MenQuadfi) CPT 90619 90619-MenQuadfi - Meningococcal conjugate vaccine Charge	$584.80	$688.00	$201.76–$584.80	148% above	15%
Meningococcal ACWY vaccine (MenQuadfi) inpatient CPT 90619 Meningococcal (MenQuadfi-IM) Vaccine 0.5 mL Inject	$279.99	$329.40	$197.64–$852.12	—	15%
Meningococcal ACWY vaccine (MenQuadfi) inpatient CPT 90619 90619-MenQuadfi - Meningococcal conjugate vaccine Charge	$584.80	$688.00	$412.80–$852.12	—	15%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 Meningococcal B vaccine Charge	$396.10	$466.00	$176.01–$396.10	22% above	15%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 Meningococcal Group B Vaccine 0.5 mL Syringe (Bexsero)	$428.99	$504.69	$190.62–$428.99	32% above	15%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 90620- Bexsero - Meningococcal B vaccine Charge	$471.75	$555.00	$209.62–$471.75	45% above	15%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 Meningococcal B vaccine Charge	$396.10	$466.00	$279.60–$852.12	—	15%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 Meningococcal Group B Vaccine 0.5 mL Syringe (Bexsero)	$428.99	$504.69	$302.81–$852.12	—	15%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 90620- Bexsero - Meningococcal B vaccine Charge	$471.75	$555.00	$333.00–$852.12	—	15%
Meningococcal B vaccine (Trumenba) CPT 90621 Meningococcal Group B Vaccine 0.5 mL Syringe (Trumenba)	$347.23	$408.50	$154.29–$347.23	87% above	15%
Meningococcal B vaccine (Trumenba) CPT 90621 90621-Trumenba - Meningococcal B vaccine Charge	$392.70	$462.00	$174.50–$392.70	112% above	15%
Meningococcal B vaccine (Trumenba) inpatient CPT 90621 Meningococcal Group B Vaccine 0.5 mL Syringe (Trumenba)	$347.23	$408.50	$245.10–$852.12	—	15%
Meningococcal B vaccine (Trumenba) inpatient CPT 90621 90621-Trumenba - Meningococcal B vaccine Charge	$392.70	$462.00	$277.20–$852.12	—	15%
Nasal spray flu vaccine, live (FluMist) CPT 90660 influenza virus vaccine, live Charge	$28.05	$33.00	$12.46–$50.51	3% above	15%
Nasal spray flu vaccine, live (FluMist) inpatient CPT 90660 influenza virus vaccine, live Charge	$28.05	$33.00	$19.80–$852.12	—	15%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 Prevnar (Pneumococcal 13-Valent) Vaccine 0.5 mL Syringe	$428.21	$503.78	$134.93–$438.58	59% above	15%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 Pneumococcal 13-valent conjugate vaccine Charge	$584.80	$688.00	$134.93–$584.80	117% above	15%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 Prevnar (Pneumococcal 13-Valent) Vaccine 0.5 mL Syringe	$428.21	$503.78	$302.27–$852.12	—	15%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 Pneumococcal 13-valent conjugate vaccine Charge	$584.80	$688.00	$412.80–$852.12	—	15%
Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) CPT 90671 pneumococcal 15-valent conj vacc Charge	$167.45	$197.00	$118.20–$457.82	76% below	15%
Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) inpatient CPT 90671 pneumococcal 15-valent conj vacc Charge	$167.45	$197.00	$118.20–$852.12	—	15%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 pneumococcal 20-valent conjugate vaccine Charge	$387.60	$456.00	$163.65–$531.93	2% above	15%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 Pneumococcal (Prevnar 20) 20-Valent Vaccine 0.5 mL Inject	$569.02	$669.43	$163.65–$569.02	49% above	15%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 pneumococcal 20-valent conjugate vaccine Charge	$387.60	$456.00	$273.60–$852.12	—	15%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 Pneumococcal (Prevnar 20) 20-Valent Vaccine 0.5 mL Inject	$569.02	$669.43	$401.66–$852.12	—	15%
Pneumonia vaccine, 21-valent conjugate (Capvaxive) CPT 90684 pneumococcal 21-valent conj vacc Charge	$629.05	$740.05	$180.04–$629.04	40% above	15%
Pneumonia vaccine, 21-valent conjugate (Capvaxive) inpatient CPT 90684 pneumococcal 21-valent conj vacc Charge	$629.05	$740.05	$444.03–$852.12	—	15%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Pneumovax (Pneumococcal 23-Valent) Vaccine 0.5 mL Syringe	$213.42	$251.08	$69.80–$226.90	35% above	15%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Pneumococcal 23-polyvalent vaccine Charge	$342.55	$403.00	$69.80–$342.55	116% above	15%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 Pneumovax (Pneumococcal 23-Valent) Vaccine 0.5 mL Syringe	$213.42	$251.08	$150.65–$852.12	—	15%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 Pneumococcal 23-polyvalent vaccine Charge	$342.55	$403.00	$241.80–$852.12	—	15%
Polio vaccine, inactivated (IPV) CPT 90713 poliovirus vaccine, inactivated Charge	$73.95	$87.00	$32.86–$73.95	21% above	15%
Polio vaccine, inactivated (IPV) inpatient CPT 90713 poliovirus vaccine, inactivated Charge	$73.95	$87.00	$52.20–$852.12	—	15%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 90381 nirsevimab 100 mg/1 mL - nirsevimab Charge	$1,462.00	$1,720.00	$649.64–$1,462.00	97% above	15%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 90381 nirsevimab 100 mg/1 mL - nirsevimab Charge	$1,462.00	$1,720.00	$852.12–$1,462.00	—	15%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 90380 nirsevimab 50 mg/0.5 mL - nirsevimab Charge	$1,462.00	$1,720.00	$649.64–$1,462.00	97% above	15%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 90380 nirsevimab 50 mg/0.5 mL - nirsevimab Charge	$1,462.00	$1,720.00	$852.12–$1,462.00	—	15%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 RSV vac preF A-preF B recomb Charge	$804.95	$947.00	$357.68–$804.95	68% above	15%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 RSV vac preF A-preF B recomb Charge	$804.95	$947.00	$568.20–$852.12	—	15%
Rabies vaccine, one dose CPT 90675 Imovax Rabies Vaccine 1 mL Vial	$574.63	$676.03	$167.23–$662.82	11% above	15%
Rabies vaccine, one dose CPT 90675 Rabavert Rabies Vaccine	$702.06	$825.94	$167.23–$702.05	36% above	15%
Rabies vaccine, one dose CPT 90675 Imovax Rabies Vaccine	$834.89	$982.21	$167.23–$834.88	62% above	15%
Rabies vaccine, one dose CPT 90675 Rabavert Rabies Vaccine 1 mL Vial	$949.05	$1,116.53	$167.23–$949.05	84% above	15%
Rabies vaccine, one dose CPT 90675 rabies vaccine, purified Charge	$1,071.00	$1,260.00	$167.23–$1,071.00	108% above	15%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE IM UC	$1,071.00	$1,260.00	$167.23–$1,071.00	108% above	15%
Rabies vaccine, one dose CPT 90675 Rabavert Rabies Vaccine Vial	$1,082.52	$1,273.55	$167.23–$1,082.52	110% above	15%
Rabies vaccine, one dose CPT 90675 Rabies Vaccine (RabAvert) 1 mL Inject	$1,117.33	$1,314.50	$167.23–$1,117.33	117% above	15%
Rabies vaccine, one dose inpatient CPT 90675 Imovax Rabies Vaccine 1 mL Vial	$574.63	$676.03	$405.62–$852.12	—	15%
Rabies vaccine, one dose inpatient CPT 90675 Rabavert Rabies Vaccine	$702.06	$825.94	$495.57–$852.12	—	15%
Rabies vaccine, one dose inpatient CPT 90675 Imovax Rabies Vaccine	$834.89	$982.21	$589.33–$852.12	—	15%
Rabies vaccine, one dose inpatient CPT 90675 Rabavert Rabies Vaccine 1 mL Vial	$949.05	$1,116.53	$669.92–$949.05	—	15%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE IM UC	$1,071.00	$1,260.00	$756.00–$1,071.00	—	15%
Rabies vaccine, one dose inpatient CPT 90675 rabies vaccine, purified Charge	$1,071.00	$1,260.00	$756.00–$1,071.00	—	15%
Rabies vaccine, one dose inpatient CPT 90675 Rabavert Rabies Vaccine Vial	$1,082.52	$1,273.55	$764.13–$1,082.52	—	15%
Rabies vaccine, one dose inpatient CPT 90675 Rabies Vaccine (RabAvert) 1 mL Inject	$1,117.33	$1,314.50	$788.70–$1,117.33	—	15%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) CPT 90681 90681 RV1 2 DOSE LIVE ORAL - rotavirus vaccine Charge	$200.60	$236.00	$89.14–$224.22	1% above	15%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) inpatient CPT 90681 90681 RV1 2 DOSE LIVE ORAL - rotavirus vaccine Charge	$200.60	$236.00	$141.60–$852.12	—	15%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 90680 RV5 VAC 3 DOSE LIVE ORAL - rotavirus vaccine Charge	$82.45	$97.00	$36.64–$156.69	at median	15%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 90680 RV5 VAC 3 DOSE LIVE ORAL - rotavirus vaccine Charge	$82.45	$97.00	$58.20–$852.12	—	15%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 Zoster vaccine, Inactivated Charge	$374.00	$440.00	$166.19–$374.00	92% above	15%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 Zoster vaccine, Inactivated Charge	$374.00	$440.00	$264.00–$852.12	—	15%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 Tetanus-diphth toxoids (Td) adult/adol Charge	$73.10	$86.00	$32.48–$73.10	35% above	15%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 Diphtheria-Tetanus Toxoid 0.5 mL Syringe **(age 7 years through adult)	$111.47	$131.13	$49.53–$111.46	106% above	15%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 Tetanus-diphth toxoids (Td) adult/adol Charge	$73.10	$86.00	$51.60–$852.12	—	15%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 Diphtheria-Tetanus Toxoid 0.5 mL Syringe **(age 7 years through adult)	$111.47	$131.13	$78.68–$852.12	—	15%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Boostrix Tdap 0.5 mL Syringe	$73.11	$86.00	$32.48–$74.35	at median	15%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDAP Vaccine > 7 Panel (N)	$103.70	$122.00	$46.08–$103.70	43% above	15%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Tetanus/ Reduced Diptheria/Acellular Pertussis (pts 7 and older)**	$103.79	$122.10	$46.12–$103.79	43% above	15%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Boostrix intramuscular suspension Charge	$108.80	$128.00	$48.35–$108.80	50% above	15%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Tetanus/diphth/pertuss (Tdap) adult/adol Charge	$108.80	$128.00	$48.35–$108.80	50% above	15%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Boostrix Tdap 0.5 mL Syringe	$73.11	$86.00	$51.60–$852.12	—	15%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TDAP Vaccine > 7 Panel (N)	$103.70	$122.00	$73.20–$852.12	—	15%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Tetanus/ Reduced Diptheria/Acellular Pertussis (pts 7 and older)**	$103.79	$122.10	$73.26–$852.12	—	15%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Boostrix intramuscular suspension Charge	$108.80	$128.00	$76.80–$852.12	—	15%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Tetanus/diphth/pertuss (Tdap) adult/adol Charge	$108.80	$128.00	$76.80–$852.12	—	15%
Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 typhoid vaccine Charge	$254.15	$299.00	$112.93–$254.15	67% above	15%
Typhoid vaccine, injectable (Vi polysaccharide) inpatient CPT 90691 typhoid vaccine Charge	$254.15	$299.00	$179.40–$852.12	—	15%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471 IM VFC 1st - Admin Charge (Immunization)	$19.55	$23.00	$8.69–$121.96	15% below	15%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IM VFC 1st 90471 - zzInfluenza virus vacc inactiv admin (Inj) Charge	$19.55	$23.00	$8.69–$121.96	15% below	15%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471 - IM VFC 1st - Admin Charge (Immunization)	$19.55	$23.00	$8.69–$121.96	15% below	15%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 zz90471 - IM VFC 1st - Admin Charge (Immunization)	$19.55	$23.00	$8.69–$121.96	15% below	15%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Imm admin 1st vaccine-90471 - zzInfluenza virus vacc inactiv admin (Inj) Charge	$20.40	$24.00	$9.06–$121.96	11% below	15%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471 - Imm admin 1st vaccine - Admin Charge (Immunization)	$34.00	$40.00	$15.11–$121.96	48% above	15%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471 Imm admin 1st vaccine - Admin Charge (Immunization)	$34.00	$40.00	$15.11–$121.96	48% above	15%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN 1 VACCINE	$93.50	$110.00	$37.52–$121.96	306% above	15%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Immunization admin includes percu intradermal subcu intramuscular and jet injection	$93.50	$110.00	$37.52–$121.96	306% above	15%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 MAT Initial Vaccine Admin	$93.50	$110.00	$37.52–$121.96	306% above	15%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 OB Immunization Admin (C/G)	$93.50	$110.00	$37.52–$121.96	306% above	15%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 OB IMMUNIZATION ADMIN	$93.50	$110.00	$37.52–$121.96	306% above	15%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 INITIAL VACCINE ADMIN BCE	$93.50	$110.00	$37.52–$121.96	306% above	15%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN	$93.50	$110.00	$37.52–$121.96	306% above	15%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN BCE	$93.50	$110.00	$37.52–$121.96	306% above	15%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN IVT BCE	$93.50	$110.00	$37.52–$121.96	306% above	15%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN UC	$93.50	$110.00	$37.52–$121.96	306% above	15%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 90471 - IM VFC 1st - Admin Charge (Immunization)	$19.55	$23.00	$13.80–$852.12	—	15%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 zz90471 - IM VFC 1st - Admin Charge (Immunization)	$19.55	$23.00	$13.80–$852.12	—	15%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IM VFC 1st 90471 - zzInfluenza virus vacc inactiv admin (Inj) Charge	$19.55	$23.00	$13.80–$852.12	—	15%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 90471 IM VFC 1st - Admin Charge (Immunization)	$19.55	$23.00	$13.80–$852.12	—	15%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Imm admin 1st vaccine-90471 - zzInfluenza virus vacc inactiv admin (Inj) Charge	$20.40	$24.00	$14.40–$852.12	—	15%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 90471 - Imm admin 1st vaccine - Admin Charge (Immunization)	$34.00	$40.00	$24.00–$852.12	—	15%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 90471 Imm admin 1st vaccine - Admin Charge (Immunization)	$34.00	$40.00	$24.00–$852.12	—	15%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 INITIAL VACCINE ADMIN BCE	$93.50	$110.00	$66.00–$852.12	—	15%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMIN BCE	$93.50	$110.00	$66.00–$852.12	—	15%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMIN IVT BCE	$93.50	$110.00	$66.00–$852.12	—	15%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Immunization admin includes percu intradermal subcu intramuscular and jet injection	$93.50	$110.00	$66.00–$852.12	—	15%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMIN 1 VACCINE	$93.50	$110.00	$66.00–$852.12	—	15%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMIN UC	$93.50	$110.00	$66.00–$852.12	—	15%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 MAT Initial Vaccine Admin	$93.50	$110.00	$66.00–$852.12	—	15%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 OB Immunization Admin (C/G)	$93.50	$110.00	$66.00–$852.12	—	15%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 OB IMMUNIZATION ADMIN	$93.50	$110.00	$66.00–$852.12	—	15%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMIN	$93.50	$110.00	$66.00–$852.12	—	15%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 zz90472 - Imm admin each addtl vaccine - Admin Charge (Immunization)	$16.15	$19.00	$7.18–$28.18	18% below	15%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 90472 - Imm admin each addtl vaccine - Admin Charge (Immunization)	$16.15	$19.00	$7.18–$28.18	18% below	15%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 90472 Imm admin each addtl vaccine - Admin Charge (Immunization)	$16.15	$19.00	$7.18–$28.18	18% below	15%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 zz90472 - IM VFC Ea Addtl - Admin Charge (Immunization)	$19.55	$23.00	$7.92–$28.18	1% below	15%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IM VFC Ea Addtl 90472 - zzInfluenza virus vacc inactiv admin (Inj) Charge	$19.55	$23.00	$7.92–$28.18	1% below	15%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 90472 - IM VFC Ea Addtl - Admin Charge (Immunization)	$19.55	$23.00	$7.92–$28.18	1% below	15%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 90472 IM VFC Ea Addtl - Admin Charge (Immunization)	$19.55	$23.00	$7.92–$28.18	1% below	15%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Imm admin each addtl vaccine-90472 - zzInfluenza virus vacc inactiv admin (Inj) Charge	$20.40	$24.00	$7.92–$28.18	3% above	15%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Immunization admin includes percutaneous intradermal subcu intramuscular and jet injections	$33.15	$39.00	$7.92–$33.15	68% above	15%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Addl Administration Each (N)	$33.15	$39.00	$7.92–$33.15	68% above	15%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 MAT Ea Addl Vaccine Admin	$33.15	$39.00	$7.92–$33.15	68% above	15%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMIN EACH ADD	$33.15	$39.00	$7.92–$33.15	68% above	15%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 EA ADDL VACCINE ADMIN BCE	$33.15	$39.00	$7.92–$33.15	68% above	15%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 OB Immunization Admin Each Add (C/G)	$33.15	$39.00	$7.92–$33.15	68% above	15%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMIN EACH ADD BCE	$33.15	$39.00	$7.92–$33.15	68% above	15%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMIN EACH ADD IVT BCE	$33.15	$39.00	$7.92–$33.15	68% above	15%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 90472 ADDL ADMINISTRATION EACH	$105.40	$124.00	$7.92–$105.40	433% above	15%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 90472 Imm admin each addtl vaccine - Admin Charge (Immunization)	$16.15	$19.00	$11.40–$852.12	—	15%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 zz90472 - Imm admin each addtl vaccine - Admin Charge (Immunization)	$16.15	$19.00	$11.40–$852.12	—	15%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 90472 - Imm admin each addtl vaccine - Admin Charge (Immunization)	$16.15	$19.00	$11.40–$852.12	—	15%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 90472 IM VFC Ea Addtl - Admin Charge (Immunization)	$19.55	$23.00	$13.80–$852.12	—	15%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 zz90472 - IM VFC Ea Addtl - Admin Charge (Immunization)	$19.55	$23.00	$13.80–$852.12	—	15%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 90472 - IM VFC Ea Addtl - Admin Charge (Immunization)	$19.55	$23.00	$13.80–$852.12	—	15%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IM VFC Ea Addtl 90472 - zzInfluenza virus vacc inactiv admin (Inj) Charge	$19.55	$23.00	$13.80–$852.12	—	15%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Imm admin each addtl vaccine-90472 - zzInfluenza virus vacc inactiv admin (Inj) Charge	$20.40	$24.00	$14.40–$852.12	—	15%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUNIZATION ADMIN EACH ADD BCE	$33.15	$39.00	$23.40–$852.12	—	15%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Addl Administration Each (N)	$33.15	$39.00	$23.40–$852.12	—	15%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Immunization admin includes percutaneous intradermal subcu intramuscular and jet injections	$33.15	$39.00	$23.40–$852.12	—	15%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUNIZATION ADMIN EACH ADD IVT BCE	$33.15	$39.00	$23.40–$852.12	—	15%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 EA ADDL VACCINE ADMIN BCE	$33.15	$39.00	$23.40–$852.12	—	15%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUNIZATION ADMIN EACH ADD	$33.15	$39.00	$23.40–$852.12	—	15%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 OB Immunization Admin Each Add (C/G)	$33.15	$39.00	$23.40–$852.12	—	15%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 MAT Ea Addl Vaccine Admin	$33.15	$39.00	$23.40–$852.12	—	15%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 90472 ADDL ADMINISTRATION EACH	$105.40	$124.00	$74.40–$852.12	—	15%
Yellow fever vaccine, live CPT 90717 yellow fever Charge	$1,013.20	$1,192.00	$292.21–$1,013.20	332% above	15%
Yellow fever vaccine, live inpatient CPT 90717 yellow fever Charge	$1,013.20	$1,192.00	$715.20–$1,013.20	—	15%

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/8134/471156297_munson-healthcare-cadillac_standardcharges.csv