Hospital Atlantic City-Hammonton, NJ

Atlanticare Regional Medical Center - Mainland Division

Listed in its price file as “AtlantiCare Health System”.

Atlanticare Regional Medical Center - Mainland Division in Pomona, NJ publishes cash prices for 293 common procedures listed here, from its own machine-readable price file updated Mar 18, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the New Jersey median for 202 of 289 procedures and above it for 78. By typical cash price it ranks #1 of 41 New Jersey hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

65 West Jimmie Leeds Road, Pomona NJ 08240 Collected Sep 22, 2026 Source price file (609) 441-8020

Acute care hospital Emergency department CMS star rating 4 of 5 CCN 310064 · CMS hospital register NPI 1013919315

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs New Jersey	Off list
Abdominal CT scan without and with contrast CPT 74170 CT ABDOMEN W&W/O CONTRAST	$944.85	$6,299.00	$813.20–$5,984.05	33% above	85%
Abdominal X-ray, 2 views CPT 74019 ABDOMEN XRAY 2 VIEWS	$91.80	$612.00	$79.01–$581.40	33% below	85%
Ankle X-ray, complete, 3 or more views both sides CPT 73610 ANKLE 3+VIEWS BILATERAL	$110.10	$734.00	$94.76–$697.30	—	85%
Ankle X-ray, complete, 3 or more views one side CPT 73610 ANKLE 3+ VIEWS-RT	$98.10	$654.00	$84.43–$621.30	17% below	85%
Ankle X-ray, complete, 3 or more views one side CPT 73610 ANKLE 3+ VIEWS-LT	$98.10	$654.00	$84.43–$621.30	17% below	85%
Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 VP-UP OR LO EXT.ART.LMT.BILAT-2LV	$153.75	$1,025.00	$132.33–$973.75	—	85%
Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 UP/LOW BILAT EXTR ART STDY/1-2LVL	$153.75	$1,025.00	$132.33–$973.75	—	85%
Ankle-brachial index (ABI), blood pressure test for leg arteries one side CPT 93922 VP-ABI,SINGLE LEVEL,UNILATERAL	$110.70	$738.00	$95.28–$701.10	36% below	85%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT EXTREM/UP W/O CONTRAST LT	$450.00	$3,000.00	$387.30–$2,850.00	at median	85%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT EXTREM/UP W/O CONTRAST RT	$450.00	$3,000.00	$387.30–$2,850.00	at median	85%
Barium swallow (esophagus X-ray with contrast) CPT 74220 ESOPHAGUS - 1 CONTRAST STUDY	$158.70	$1,058.00	$136.59–$1,005.10	30% below	85%
Bone scan, whole body (nuclear medicine) CPT 78306 BONE &/OR JOINT IMAG-WHOLE BODY	$422.25	$2,815.00	$363.42–$2,674.25	20% below	85%
Breast ultrasound, complete, one breast one side CPT 76641 U/S-BREAST-COMPLETE-UNILAT-LEFT	$91.80	$612.00	$79.01–$581.40	36% below	85%
Breast ultrasound, complete, one breast one side CPT 76641 U/S-BREAST-COMPLETE-UNILAT-RIGHT	$91.80	$612.00	$79.01–$581.40	36% below	85%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 U/S-BREAST-LIMITED-UNILAT-RIGHT	$72.15	$481.00	$62.10–$456.95	48% below	85%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 U/S-BREAST-LIMITED-UNILAT-LEFT	$72.15	$481.00	$62.10–$456.95	48% below	85%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CT ANGIO ABD&PELV W/O&W/DYE	$918.90	$6,126.00	$790.87–$5,819.70	75% above	85%
CT angiography (CTA) of the head CPT 70496 CTA HEAD	$798.60	$5,324.00	$687.33–$5,057.80	10% above	85%
CT angiography (CTA) of the neck CPT 70498 CTA NECK	$798.60	$5,324.00	$687.33–$5,057.80	6% above	85%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA CHEST	$798.60	$5,324.00	$687.33–$5,057.80	at median	85%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CT ANGIO HRT W/3D IMAGE	$354.60	$2,364.00	$305.19–$2,245.80	26% below	85%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD AND PELVIS W/O CONTRAST	$762.90	$5,086.00	$656.60–$4,831.70	83% above	85%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD AND PELVIS W/CONTRAST	$921.15	$6,141.00	$792.80–$5,833.95	10% above	85%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD AND PELVIS W/O AND W/CONTR	$1,133.70	$7,558.00	$975.74–$7,180.10	22% above	85%
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W/CONTRAST	$767.40	$5,116.00	$660.48–$4,860.20	63% above	85%
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/O CONTRAST	$635.85	$4,239.00	$547.25–$4,027.05	26% above	85%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIAL W/O CONTRAST	$516.60	$3,444.00	$444.62–$3,271.80	2% above	85%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT SINUS(MAXILLOFACIAL)W/O CONTR.	$516.60	$3,444.00	$444.62–$3,271.80	2% above	85%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD OR BRAIN W/O CONTRAST	$413.70	$2,758.00	$356.06–$2,620.10	9% above	85%
CT scan of the head with contrast CPT 70460 CT HEAD OR BRAIN W/ CONTRAST	$636.45	$4,243.00	$547.77–$4,030.85	35% above	85%
CT scan of the head without and with contrast CPT 70470 CT HEAD OR BRAIN W&W/O CONTRAST	$791.10	$5,274.00	$680.87–$5,010.30	15% above	85%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMB SPINE W/O CONTRAST	$508.65	$3,391.00	$437.78–$3,221.45	13% below	85%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT CERV SPINE W/O CONTRAST	$508.65	$3,391.00	$437.78–$3,221.45	8% below	85%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS WITH CONTRAST	$434.40	$2,896.00	$373.87–$2,751.20	at median	85%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS, WITH CONTRAST	$434.40	$2,896.00	$373.87–$2,751.20	at median	85%
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 CAROTID DUPLEX COMPLETE	$273.90	$1,826.00	$235.74–$1,734.70	15% below	85%
Chest CT scan without and with contrast CPT 71270 CT CHEST (THORAX)W/& W/O CONTRAST	$981.75	$6,545.00	$844.96–$6,217.75	33% above	85%
Chest X-ray, 2 views CPT 71046 CHEST XRAY 2 VIEWS	$74.25	$495.00	$63.90–$470.25	37% below	85%
Chest X-ray, single view CPT 71045 CHEST XRAY 1 VIEW	$62.85	$419.00	$54.09–$398.05	44% below	85%
Collarbone (clavicle) X-ray, complete both sides CPT 73000 CLAVICLE, BILATERAL	$65.85	$439.00	$56.67–$417.05	—	85%
Collarbone (clavicle) X-ray, complete both sides CPT 73000 CLAVICLE BILATERAL	$65.85	$439.00	$56.67–$417.05	—	85%
Collarbone (clavicle) X-ray, complete one side CPT 73000 CLAVICLE UNILATERAL-RT	$63.60	$424.00	$54.74–$402.80	46% below	85%
Collarbone (clavicle) X-ray, complete one side CPT 73000 CLAVICLE UNILATERAL-LT	$63.60	$424.00	$54.74–$402.80	46% below	85%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 ABDOMEN RETROPERT COM	$166.65	$1,111.00	$143.43–$1,055.45	12% above	85%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DXA BONE DENSITY,AXIAL	$101.40	$676.00	$87.27–$642.20	25% below	85%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 DXA BONE DENSITY,PERIPHERAL	$41.70	$278.00	$35.89–$264.10	63% below	85%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 U/S DETAIL FETAL ANATOMIC 1ST TRI	$249.60	$1,664.00	$214.82–$1,580.80	23% below	85%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US PREG RLTIME DTLD FETAL 1ST GES	$249.60	$1,664.00	$214.82–$1,580.80	23% below	85%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST (THORAX) W/O CONTRAST	$508.65	$3,391.00	$437.78–$3,221.45	145% above	85%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST (THORAX) W/ CONTRAST	$633.45	$4,223.00	$545.19–$4,011.85	35% above	85%
Diagnostic mammogram, both breasts both sides CPT 77066 MAMMO-SCREEN THEN BILAT DIAG.	$223.35	$1,489.00	$192.23–$1,414.55	—	85%
Diagnostic mammogram, both breasts CPT 77066 DIAG.MAMMOGRAM W/CAD-BOTH BREASTS	$223.35	$1,489.00	$192.23–$1,414.55	42% above	85%
Diagnostic mammogram, one breast CPT 77065 DIAG.MAMMOGRAM W/CAD-ONE BREAST	$135.30	$902.00	$116.45–$856.90	18% below	85%
Diagnostic mammogram, one breast one side CPT 77065 MAMMO-SCREEN THEN UNILAT DIAG.	$135.30	$902.00	$116.45–$856.90	18% below	85%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 DUPLEX-LOW.EXTR.ART.-COMPL.BILAT	$143.25	$955.00	$123.29–$907.25	—	85%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 VC-DUPLEX-LOW.EXT.ART.-COMP.BILAT	$143.25	$955.00	$123.29–$907.25	—	85%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 VP-DUPLEX-LOW.EXT.ART.-COMP.BILAT	$143.25	$955.00	$123.29–$907.25	—	85%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 VP-EXTR.VENOUS DUPLEX,COMPL,BILAT	$213.45	$1,423.00	$183.71–$1,351.85	—	85%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 DUP SCAN EXT VEINS COMP BILATERAL	$392.55	$2,617.00	$337.85–$2,486.15	—	85%
Duplex ultrasound of the leg veins, both legs CPT 93970 VWD-DUP SCAN EXTR VEINS-COMP(BI)	$392.55	$2,617.00	$337.85–$2,486.15	22% above	85%
Elbow X-ray, 2 views both sides CPT 73070 ELBOW 2 VIEWS BILATERAL	$65.85	$439.00	$56.67–$417.05	—	85%
Elbow X-ray, 2 views both sides CPT 73070 ELBOW 2 VIEWS, BILATERAL	$65.85	$439.00	$56.67–$417.05	—	85%
Elbow X-ray, 2 views one side CPT 73070 ELBOW-2 VIEWS-LT	$57.00	$380.00	$49.06–$361.00	49% below	85%
Elbow X-ray, 2 views one side CPT 73070 ELBOW 2 VIEWS-RT	$57.00	$380.00	$49.06–$361.00	49% below	85%
Elbow X-ray, complete, 3 or more views both sides CPT 73080 ELBOW 3 VIEWS BILATERAL	$84.90	$566.00	$73.07–$537.70	—	85%
Elbow X-ray, complete, 3 or more views both sides CPT 73080 ELBOW 3 VIEWS, BILATERAL	$84.90	$566.00	$73.07–$537.70	—	85%
Elbow X-ray, complete, 3 or more views one side CPT 73080 ELBOW 3 VIEWS-LT	$79.35	$529.00	$68.29–$502.55	32% below	85%
Elbow X-ray, complete, 3 or more views one side CPT 73080 ELBOW 3 VIEWS-RT	$79.35	$529.00	$68.29–$502.55	32% below	85%
Eye socket (orbit) CT scan without contrast CPT 70480 CT ORBIT/EAR/FOSSA W/O CONTRAST	$434.40	$2,896.00	$373.87–$2,751.20	53% above	85%
Facial bones X-ray, complete, 3 or more views CPT 70150 FACIAL BONES 3 VIEWS	$62.55	$417.00	$53.83–$396.15	56% below	85%
Forearm X-ray (radius and ulna), 2 views both sides CPT 73090 FOREARM 2 VIEWS BILATERAL	$100.95	$673.00	$86.88–$639.35	—	85%
Forearm X-ray (radius and ulna), 2 views both sides CPT 73090 FOREARM 2 VIEWS, BILATERAL	$100.95	$673.00	$86.88–$639.35	—	85%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 FOREARM 2 VIEWS-RT	$96.30	$642.00	$82.88–$609.90	18% below	85%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 FOREARM 2 VIEWS-LT	$96.30	$642.00	$82.88–$609.90	18% below	85%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HEPATOBILIARY SYSTEM IMAGIN	$324.00	$2,160.00	$278.86–$2,052.00	37% below	85%
Hand X-ray, 2 views both sides CPT 73120 HAND 2 VIEWS, BILATERAL	$101.25	$675.00	$87.14–$641.25	—	85%
Hand X-ray, 2 views both sides CPT 73120 HAND 2 VIEWS BILATERAL	$101.25	$675.00	$87.14–$641.25	—	85%
Hand X-ray, 2 views one side CPT 73120 HAND 2 VIEWS-RT	$92.25	$615.00	$79.40–$584.25	32% below	85%
Hand X-ray, 2 views one side CPT 73120 HAND 2 VIEWS-LT	$92.25	$615.00	$79.40–$584.25	32% below	85%
Heel bone (calcaneus) X-ray, 2 or more views both sides CPT 73650 OS CALCIS 2+ VIEWS, BILATERAL	$96.45	$643.00	$83.01–$610.85	—	85%
Heel bone (calcaneus) X-ray, 2 or more views both sides CPT 73650 OS CALCIS 2+ VIEWS BILATERAL	$96.45	$643.00	$83.01–$610.85	—	85%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 OS CALCIS 2+ VIEWS-RT	$81.30	$542.00	$69.97–$514.90	29% below	85%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 OS CALCIS 2+ VIEWS-LT	$81.30	$542.00	$69.97–$514.90	29% below	85%
Knee X-ray, 3 views both sides CPT 73562 KNEE 3 VIEWS BILATERAL	$130.35	$869.00	$112.19–$825.55	—	85%
Knee X-ray, 3 views one side CPT 73562 KNEE 3 VIEWS-RT	$109.20	$728.00	$93.98–$691.60	7% below	85%
Knee X-ray, 3 views one side CPT 73562 KNEE 3 VIEWS-LT	$109.20	$728.00	$93.98–$691.60	7% below	85%
Knee X-ray, complete, 4 or more views one side CPT 73564 KNEE COMP 4+ VIEWS-RT	$125.10	$834.00	$107.67–$792.30	12% below	85%
Knee X-ray, complete, 4 or more views one side CPT 73564 KNEE COMP 4+ VIEWS-LT	$125.10	$834.00	$107.67–$792.30	12% below	85%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT EXTREM/LOW W/O CONTRAST LT	$562.20	$3,748.00	$483.87–$3,560.60	24% above	85%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT EXTREM/LOW W/O CONTRAST RT	$562.20	$3,748.00	$483.87–$3,560.60	24% above	85%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 IR-U/S ABDOMEN LIMITED/FOLLOWUP	$164.70	$1,098.00	$141.75–$1,043.10	16% above	85%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ABDOMEN,LIMITED	$164.70	$1,098.00	$141.75–$1,043.10	16% above	85%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US LIMITD JNT/FCL NON-VASC.W/IMAG	$88.65	$591.00	$76.30–$561.45	35% below	85%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT THORAX-LOW DOSE-LUNG SCREEN	$55.80	$372.00	$48.03–$353.40	59% below	85%
Lower leg X-ray (tibia and fibula), 2 views both sides CPT 73590 TIBIA & FIBULA, 2 VIEWS BILATERAL	$82.20	$548.00	$70.75–$520.60	—	85%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 TIBIA & FIBULA 2 VIEW-LT	$75.45	$503.00	$64.94–$477.85	36% below	85%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 TIBIA & FIBULA 2 VIEW-RT	$75.45	$503.00	$64.94–$477.85	36% below	85%
MR angiography (MRA) of the head without contrast CPT 70544 MRA HEAD W/O CONTRAST	$579.00	$3,860.00	$498.33–$3,667.00	40% above	85%
MR angiography (MRA) of the head without contrast CPT 70544 MRV HEAD W/O CONTRAST	$579.00	$3,860.00	$498.33–$3,667.00	40% above	85%
MRI of both breasts, without and then with contrast dye both sides CPT 77049 MRI BREAST W&W/O CONT&CAD-BILAT	$362.40	$2,416.00	$311.91–$2,295.20	—	85%
MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 MRI LOWER EXT ANY JOINT BILATERAL	$1,662.30	$11,082.00	$1,430.69–$10,527.90	—	85%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI LOWER EXTREM ANY JOINT BILATE	$1,662.30	$11,082.00	$1,430.69–$10,527.90	301% above	85%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LO.EXTR-ANY JNT-RT W/O CONTR.	$572.55	$3,817.00	$492.77–$3,626.15	38% above	85%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LO.EXTR-ANY JNT-LT W/O CONTR.	$572.55	$3,817.00	$492.77–$3,626.15	38% above	85%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LO.EXTR-ANY JT-LT W&W/O CONTR	$813.90	$5,426.00	$700.50–$5,154.70	13% above	85%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LO.EXTR-ANY JT-RT W&W/O CONTR	$813.90	$5,426.00	$700.50–$5,154.70	13% above	85%
MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN WITHOUT CONTRAST	$466.80	$3,112.00	$401.76–$2,956.40	13% above	85%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN W/O THEN W/CONTRAST	$811.20	$5,408.00	$698.17–$5,137.60	12% above	85%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O CONTRAST	$620.85	$4,139.00	$534.34–$3,932.05	50% above	85%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W & W/O CONTRAST	$889.05	$5,927.00	$765.18–$5,630.65	23% above	85%
MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR SPINE W/O CONTRAST	$736.35	$4,909.00	$633.75–$4,663.55	78% above	85%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI LUMBAR SPINE W & W/O CONTRAST	$1,042.80	$6,952.00	$897.50–$6,604.40	45% above	85%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI THORACIC SPINE W/O CONTRAST	$681.90	$4,546.00	$586.89–$4,318.70	64% above	85%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI CERVICAL SPINE W&W/O CONTRAST	$945.45	$6,303.00	$813.72–$5,987.85	31% above	85%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI CERVICAL SPINE W/O CONTRAST	$636.45	$4,243.00	$547.77–$4,030.85	54% above	85%
MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS W & W/O CONTRAST	$677.40	$4,516.00	$583.02–$4,290.20	at median	85%
MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS W/O CONTRAST	$583.50	$3,890.00	$502.20–$3,695.50	41% above	85%
MRI of the shoulder, elbow or wrist joint, no contrast dye both sides CPT 73221 MRI UP EXT ANY JOINT BILATERAL	$1,301.25	$8,675.00	$1,119.94–$8,241.25	—	85%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI UP.EXTR-ANY JNT-RT W/O CONTR.	$498.90	$3,326.00	$429.39–$3,159.70	20% above	85%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI UP.EXTR-ANY JNT-LT W/O CONTR.	$498.90	$3,326.00	$429.39–$3,159.70	20% above	85%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 CERVICAL SPINE 4 OR 5 VIEWS	$86.25	$575.00	$74.23–$546.25	39% below	85%
Neck soft tissue CT scan with contrast CPT 70491 CT SOFT TISSUE NECK W/ CONTRAST	$591.75	$3,945.00	$509.30–$3,747.75	26% above	85%
Neck soft tissue CT scan without contrast CPT 70490 CT SOFT TISSUE NECK W/O CONTRAST	$566.70	$3,778.00	$487.74–$3,589.10	8% above	85%
Neck soft tissue X-ray CPT 70360 NECK FOR SOFT TISSUE	$76.95	$513.00	$66.23–$487.35	32% below	85%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HT MUSCLE IMAGE SPECT, MULT	$1,032.30	$6,882.00	$888.47–$6,537.90	38% below	85%
Pelvic CT scan without contrast CPT 72192 CT PELVIS, WITHOUT CONTRAST	$508.50	$3,390.00	$437.65–$3,220.50	1% above	85%
Pelvic CT scan without contrast CPT 72192 CT PELVIS W/O CONTRAST	$508.65	$3,391.00	$437.78–$3,221.45	1% above	85%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 PELVIS LTD NON-OBSTETRIC	$87.30	$582.00	$75.14–$552.90	38% below	85%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 PELVIS COMPLETE NON-OB	$205.80	$1,372.00	$177.13–$1,303.40	45% above	85%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OB,US,>/=14WKS,SINGLE FETUS	$99.90	$666.00	$85.98–$632.70	30% below	85%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 ECHOGRPH. PELVIC B-SCAN	$160.50	$1,070.00	$138.14–$1,016.50	13% above	85%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 U/S 1ST TRIMESTER FETAL MATERNAL	$155.70	$1,038.00	$134.01–$986.10	11% above	85%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US PREG RLTIME<14WKS SGL/1ST GEST	$162.45	$1,083.00	$139.82–$1,028.85	16% above	85%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US PREG.UTERUS LIMITED,1/>FETUSES	$121.20	$808.00	$104.31–$767.60	15% below	85%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 ECHOGRPH PELVIC LIMITED/AFI	$181.95	$1,213.00	$156.60–$1,152.35	28% above	85%
Rib X-ray, one side, 2 views one side CPT 71100 RIB UNILATERAL 2 VIEWS-LT	$83.10	$554.00	$71.52–$526.30	26% below	85%
Rib X-ray, one side, 2 views one side CPT 71100 RIB UNILATERAL 2 VIEWS-RT	$83.10	$554.00	$71.52–$526.30	26% below	85%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 RIBS UNILAT & PA CHES-RT	$108.75	$725.00	$93.60–$688.75	19% below	85%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 RIBS UNILAT & PA CHES-LT	$108.75	$725.00	$93.60–$688.75	19% below	85%
Screening mammogram, both breasts both sides CPT 77067 SCREEN.MAMMO.W/CAD-BILAT-2VIEW/BR	$108.15	$721.00	$93.08–$684.95	—	85%
Screening mammogram, both breasts CPT 77067 SCREEN.MAMMO.W/CAD-W/MED.NEC,DIAG	$108.15	$721.00	$93.08–$684.95	17% below	85%
Screening mammogram, both breasts one side CPT 77067 SCREEN.MAMMO.W/CAD-UNILAT-2 VW/BR	$84.90	$566.00	$73.07–$537.70	35% below	85%
Shoulder X-ray, complete, 2 or more views both sides CPT 73030 SHOULDER 2 VIEWS, BILATERAL	$118.80	$792.00	$102.25–$752.40	—	85%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER 2 VIEWS-LT	$105.30	$702.00	$90.63–$666.90	10% below	85%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER 2 VIEWS-RT	$105.30	$702.00	$90.63–$666.90	10% below	85%
Sinus X-ray, complete, 3 or more views CPT 70220 SINUSES PARANASA COMP	$147.30	$982.00	$126.78–$932.90	12% above	85%
Skull X-ray, fewer than 4 views CPT 70250 SKULL LESS THAN 4 VIEWS	$46.95	$313.00	$40.41–$297.35	64% below	85%
Swallow study (modified barium swallow, video X-ray) CPT 74230 SWALLOW FUNCT-VIDEO CONTR.STUDY	$142.20	$948.00	$122.39–$900.60	40% below	85%
Thigh bone (femur) X-ray, 2 or more views both sides CPT 73552 FEMUR, 2+ VIEWS-BILAT	$82.35	$549.00	$70.88–$521.55	—	85%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 FEMUR, 2+ VIEWS-LT	$82.35	$549.00	$70.88–$521.55	27% below	85%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 FEMUR, 2+ VIEWS-RT	$82.35	$549.00	$70.88–$521.55	27% below	85%
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT THOR SPINE W/O CONTRAST	$508.65	$3,391.00	$437.78–$3,221.45	at median	85%
Toe X-ray, 2 or more views one side CPT 73660 TOES 2+ VIEWS-RT	$91.05	$607.00	$78.36–$576.65	19% below	85%
Toe X-ray, 2 or more views one side CPT 73660 TOES 2+ VIEWS-LT	$91.05	$607.00	$78.36–$576.65	19% below	85%
Transvaginal pelvic ultrasound CPT 76830 ENDOVAGINAL ULTRASOUND	$160.35	$1,069.00	$138.01–$1,015.55	at median	85%
Transvaginal ultrasound during pregnancy CPT 76817 U/S PREG UTERUS TRANSVAGINAL	$224.40	$1,496.00	$193.13–$1,421.20	61% above	85%
Transvaginal ultrasound during pregnancy CPT 76817 US PREG REALTIME TRANSVAG W/DOCUM	$224.40	$1,496.00	$193.13–$1,421.20	61% above	85%
Ultrasound of the abdomen, complete CPT 76700 ABDOMEN,COMPLETE	$207.15	$1,381.00	$178.29–$1,311.95	46% above	85%
Ultrasound of the scrotum and testicles CPT 76870 SCROTAL SONOGRAPHY	$152.25	$1,015.00	$131.04–$964.25	at median	85%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 THYROID SONOGRAPHY	$161.70	$1,078.00	$139.17–$1,024.10	at median	85%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 ULTRASOUND,SOFT TISSUE,HEAD/NECK	$161.70	$1,078.00	$139.17–$1,024.10	at median	85%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 GI TRACT UPPER-1 CONTRAST STUDY	$132.30	$882.00	$113.87–$837.90	44% below	85%
Upper arm X-ray (humerus), 2 views both sides CPT 73060 HUMERUS 2 VIEWS BILATERAL	$76.65	$511.00	$65.97–$485.45	—	85%
Upper arm X-ray (humerus), 2 views both sides CPT 73060 HUMERUS 2 VIEWS, BILATERAL	$76.65	$511.00	$65.97–$485.45	—	85%
Upper arm X-ray (humerus), 2 views one side CPT 73060 HUMERUS 2 VIEWS-LT	$75.75	$505.00	$65.20–$479.75	36% below	85%
Upper arm X-ray (humerus), 2 views one side CPT 73060 HUMERUS 2 VIEWS-RT	$75.75	$505.00	$65.20–$479.75	36% below	85%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 VWD-DUP SCAN EXTR VEINS-LMTD/UNI	$310.95	$2,073.00	$267.62–$1,969.35	74% above	85%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 DUP SCAN EXT VEINS LTD	$310.95	$2,073.00	$267.62–$1,969.35	74% above	85%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 VP-EXTR.VENOUS DUPLEX,LMTD,UNILAT	$179.10	$1,194.00	$154.15–$1,134.30	at median	85%
Wrist X-ray, 2 views both sides CPT 73100 WRIST 2 VIEWS BILATERAL	$69.45	$463.00	$59.77–$439.85	—	85%
Wrist X-ray, 2 views both sides CPT 73100 WRIST 2 VIEWS, BILATERAL	$69.45	$463.00	$59.77–$439.85	—	85%
Wrist X-ray, 2 views one side CPT 73100 WRIST 2 VIEWS-LT	$69.15	$461.00	$59.52–$437.95	38% below	85%
Wrist X-ray, 2 views one side CPT 73100 WRIST 2 VIEWS-RT	$69.15	$461.00	$59.52–$437.95	38% below	85%
Wrist X-ray, complete, 3 or more views both sides CPT 73110 WRIST 3 VIEWS BILATERAL	$117.75	$785.00	$101.34–$745.75	—	85%
Wrist X-ray, complete, 3 or more views both sides CPT 73110 WRIST 3 VIEWS, BILATERAL	$117.75	$785.00	$101.34–$745.75	—	85%
Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST 3 VIEWS-RT	$98.55	$657.00	$84.82–$624.15	16% below	85%
Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST 3 VIEWS-LT	$98.55	$657.00	$84.82–$624.15	16% below	85%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP (PELVIS),UNILAT,2-3 VIEWS-LT	$76.65	$511.00	$65.97–$485.45	32% below	85%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP (PELVIS),UNILAT,2-3 VIEWS-RT	$76.65	$511.00	$65.97–$485.45	32% below	85%
X-ray of the abdomen, 1 view CPT 74018 ABDOMEN XRAY 1 VIEW	$68.10	$454.00	$58.61–$431.30	39% below	85%
X-ray of the ankle, 2 views both sides CPT 73600 ANKLE 2 VIEWS BILATERAL	$87.00	$580.00	$74.88–$551.00	—	85%
X-ray of the ankle, 2 views one side CPT 73600 ANKLE 2 VIEWS - LT	$78.00	$520.00	$67.13–$494.00	31% below	85%
X-ray of the ankle, 2 views one side CPT 73600 ANKLE 2 VIEWS-RT	$78.00	$520.00	$67.13–$494.00	31% below	85%
X-ray of the finger(s), 2 or more views one side CPT 73140 FINGERS 2 VIEWS-LT	$76.05	$507.00	$65.45–$481.65	32% below	85%
X-ray of the finger(s), 2 or more views one side CPT 73140 FINGERS 2 VIEWS-RT	$76.05	$507.00	$65.45–$481.65	32% below	85%
X-ray of the foot, 2 views both sides CPT 73620 FOOT 2 VIEWS BILATERAL	$103.20	$688.00	$88.82–$653.60	—	85%
X-ray of the foot, 2 views one side CPT 73620 FOOT 2 VIEWS-LT	$93.45	$623.00	$80.43–$591.85	20% below	85%
X-ray of the foot, 2 views one side CPT 73620 FOOT 2 VIEWS-RT	$93.45	$623.00	$80.43–$591.85	20% below	85%
X-ray of the foot, complete, 3 or more views both sides CPT 73630 FOOT 3 VIEWS BILATERAL	$111.00	$740.00	$95.53–$703.00	—	85%
X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT 3+ VIEWS-RT	$97.65	$651.00	$84.04–$618.45	17% below	85%
X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT 3+ VIEWS-LT	$97.65	$651.00	$84.04–$618.45	17% below	85%
X-ray of the hand, 3 or more views both sides CPT 73130 HAND 3 VIEWS, BILATERAL	$105.45	$703.00	$90.76–$667.85	—	85%
X-ray of the hand, 3 or more views both sides CPT 73130 HAND 3 VIEWS BILATERAL	$105.45	$703.00	$90.76–$667.85	—	85%
X-ray of the hand, 3 or more views one side CPT 73130 HAND 3 VIEWS-LT	$93.90	$626.00	$80.82–$594.70	20% below	85%
X-ray of the hand, 3 or more views one side CPT 73130 HAND 3 VIEWS-RT	$93.90	$626.00	$80.82–$594.70	20% below	85%
X-ray of the knee, 1 or 2 views both sides CPT 73560 KNEE 1-2 VIEWS BILATERAL	$107.25	$715.00	$92.31–$679.25	—	85%
X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE 1 OR 2 VIEWS-RT	$79.65	$531.00	$68.55–$504.45	32% below	85%
X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE 1 OR 2 VIEWS-LT	$79.65	$531.00	$68.55–$504.45	32% below	85%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 LUMBO SAC SP AP & LAT	$100.20	$668.00	$86.24–$634.60	29% below	85%
X-ray of the lower back, 4 or more views CPT 72110 LUMBO SACRAL COMP OBL	$120.90	$806.00	$104.05–$765.70	19% below	85%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 THORACIC SPINE 2 VIEW	$69.30	$462.00	$59.64–$438.90	49% below	85%
X-ray of the nasal bones, 3 or more views CPT 70160 NASAL BONES	$91.80	$612.00	$79.01–$581.40	22% below	85%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 CERVICAL SPINE, 2 OR 3 VIEWS	$79.20	$528.00	$68.16–$501.60	33% below	85%
X-ray of the pelvis, 1 or 2 views CPT 72170 XRAY EXAM-PELVIS-1 OR 2 VIEWS	$91.95	$613.00	$79.14–$582.35	32% below	85%
X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS AP POST REDUCTION	$91.95	$613.00	$79.14–$582.35	32% below	85%
X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS AP POST-REDUCTION	$91.95	$613.00	$79.14–$582.35	32% below	85%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 SACRUM &/OR COCCYX 2 VIEW	$76.05	$507.00	$65.45–$481.65	35% below	85%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs New Jersey	Off list
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 ASSAY-NATRIURETIC PEPTIDE	$49.65	$331.00	$46.01–$314.45	5% below	85%
Basic metabolic panel (blood test) CPT 80048 CC-BASIC METABOLIC PANEL	$27.60	$184.00	$25.58–$174.80	33% below	85%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 ROUTINE VENIPUNCTURE	$5.10	$34.00	$4.73–$32.30	51% below	85%
Blood glucose (sugar) test CPT 82947 CC-GLUCOSE QUANT-BLOOD	$9.30	$62.00	$8.62–$58.90	9% below	85%
Blood glucose (sugar) test CPT 82947 GLUCOSE, QUANT, BLOOD.	$9.30	$62.00	$8.62–$58.90	9% below	85%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPING, ABO	$20.70	$138.00	$18.55–$131.10	85% below	85%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 DNA/RNA SARS-COVID19 AMP.PROBE-SO	$83.70	$558.00	$77.56–$530.10	42% above	85%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 DNA/RNA SARS-COVID19 AMP.PROBE-IN	$83.70	$558.00	$77.56–$530.10	42% above	85%
Carcinoembryonic antigen (CEA) test CPT 82378 CARCINOEMBRYONIC ANTIGEN (CEA)	$60.30	$402.00	$55.88–$381.90	39% above	85%
Comprehensive metabolic panel (blood test) CPT 80053 CC-COMPREHENSIVE METABOLIC PANEL	$36.90	$246.00	$34.19–$233.70	48% below	85%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRESUM.-CHEM.ANALZR-DOS	$41.10	$274.00	$38.09–$260.30	42% below	85%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 CC-ELECTROLYTE PANEL	$18.75	$125.00	$17.38–$118.75	5% above	85%
Fibrinogen blood test CPT 85384 TEG-FIBRINOGEN ACTIVITY	$27.45	$183.00	$25.44–$173.85	146% above	85%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV-1 AG W/HIV-1&2 ANTBDY-1 RESLT	$33.60	$224.00	$31.14–$212.80	21% above	85%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 MC-HEMOGLOBIN GLYCOSYLATED (A1C)	$33.90	$226.00	$31.41–$214.70	44% above	85%
Lactate (lactic acid) blood test CPT 83605 LACTATE, LACTIC ACID.	$33.60	$224.00	$31.14–$212.80	140% above	85%
Lactate dehydrogenase (LDH) blood test CPT 83615 CC-LDH SERUM	$19.50	$130.00	$18.07–$123.50	160% above	85%
Magnesium blood test CPT 83735 CC-MAGNESIUM ASSAY	$21.30	$142.00	$19.74–$134.90	135% above	85%
Phosphorus (phosphate) blood test CPT 84100 CC-PHOSPHORUS INORGANIC ASSAY	$15.15	$101.00	$14.04–$95.95	58% above	85%
Potassium blood test CPT 84132 POTASSIUM, SERUM.	$12.60	$84.00	$11.68–$79.80	114% above	85%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHOMBIN TIME W/ MODIFIER QW	$14.70	$98.00	$13.62–$93.10	10% above	85%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 DRUG TEST PRESUM.-DIR.OPT.OBS-DOS	$39.45	$263.00	$36.56–$249.85	91% above	85%
Rh blood typing CPT 86901 BLOOD TYPING, RH	$16.20	$108.00	$14.52–$102.60	65% below	85%
Sodium blood test CPT 84295 SODIUM, SERUM.	$6.15	$41.00	$5.70–$38.95	11% above	85%
Syphilis antibody test (Treponema pallidum) CPT 86780 TREPONEMA PALLIDUM ANTIBODY(I-H)	$29.85	$199.00	$27.66–$189.05	39% above	85%
Uric acid blood test CPT 84550 CC-URIC ACID, BLOOD	$19.80	$132.00	$18.35–$125.40	16% above	85%
Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY TEST	$11.40	$76.00	$10.56–$72.20	7% above	85%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs New Jersey	Off list
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 BREAST BX,STEREOTACTIC,1ST LESION	$750.15	$5,001.00	$645.63–$4,750.95	65% below	85%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 CL TR DISTAL FIBULAR FX	$190.20	$1,268.00	$175.11–$1,268.00	35% below	85%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 CL TR METATARSAL FX W/O MANIP	$202.65	$1,351.00	$186.57–$1,351.00	24% below	85%
Cardiac catheterization with coronary angiogram CPT 93458 L HRT ARTERY/VENTRICLE ANGIO	$3,015.00	$20,100.00	$2,594.91–$19,095.00	26% below	85%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ELECTRICAL EXTERNAL	$342.60	$2,284.00	$315.42–$2,284.00	59% below	85%
Catheter ablation for atrial fibrillation CPT 93656 TX ATRIAL FIB PULM VEIN ISOL-8246	$9,408.30	$62,722.00	$8,097.41–$59,585.90	65% below	85%
Cervical biopsy CPT 57500 BIOPSY,SINGLE/MULTIPLE CERVIX	$260.25	$1,735.00	$223.99–$1,648.25	77% below	85%
Cervical biopsy CPT 57500 BIOPSY CERVIX,SINGLE/MULTIPLE	$260.25	$1,735.00	$223.99–$1,648.25	77% below	85%
Circumcision, surgical, older than a newborn CPT 54160 CIRCUMCISION	$234.00	$1,560.00	$201.40–$1,482.00	68% below	85%
Circumcision, surgical, older than a newborn CPT 54160 CIRCUMCISION NURSERY NEWBORN	$234.00	$1,560.00	$201.40–$1,482.00	68% below	85%
Circumcision, surgical, older than a newborn CPT 54160 CIRCUMCISION MATERNITY NEWBORN	$234.00	$1,560.00	$201.40–$1,482.00	68% below	85%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 TREAT FRAC RADIUS/ULNA W/O MANIP	$151.65	$1,011.00	$139.62–$1,011.00	88% below	85%
Colonoscopy with endoscopic ultrasound CPT 45391 COLON-US EXAM LMTD-REC. TO CECUM	$850.50	$5,670.00	$732.00–$5,386.50	39% below	85%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 BX/CURETT OF CERVIX W/SCOPE	$128.85	$859.00	$110.90–$816.05	64% below	85%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 BIOPSY/CURETTAGE-CERVIX W/SCOPE	$128.85	$859.00	$110.90–$816.05	64% below	85%
Cystoscopy with ureteral stent placement CPT 52332 CYSTOURETHROSCOPY W/INSERT STENT	$1,160.55	$7,737.00	$998.85–$7,350.15	75% below	85%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOURETHROSCOPY (SEPARATE PROCE	$149.10	$994.00	$137.27–$994.00	80% below	85%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTR.PREMAL.LESION(ANY METH)-1ST	$37.65	$251.00	$34.66–$251.00	84% below	85%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 REM. IMPACTED CERUMEN,IRR/LAV-UNI	$64.50	$430.00	$59.38–$430.00	19% below	85%
Earwax removal with instruments, one ear CPT 69210 REMOVE IMPACTED EAR WAX	$85.20	$568.00	$78.44–$568.00	11% above	85%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 BIOPSY OF UTERINE LINING	$60.15	$401.00	$51.77–$380.95	75% below	85%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 BIOPSY OF UTERUS LINING	$60.15	$401.00	$51.77–$380.95	75% below	85%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 INJ DX/TH PARAVERT FCT JT-L/S1LVL	$477.45	$3,183.00	$410.93–$3,023.85	60% below	85%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 DIAGNOSTIC SIGMOIDOSCOPY	$180.00	$1,200.00	$165.72–$1,200.00	83% below	85%
Hemorrhoid banding (rubber band ligation) CPT 46221 HEMORRHOIDECTOMY BY BANDING	$383.40	$2,556.00	$329.98–$2,428.20	65% below	85%
Hysterectomy through an abdominal incision (total) CPT 58150 HYSTERECTOMY, TOTAL	$2,991.15	$19,941.00	$2,574.38–$18,943.95	28% above	85%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 INJECT HYSTEROSALPINGO EXAM	$67.95	$453.00	$58.48–$430.35	80% below	85%
Incision and drainage of a simple or single skin abscess CPT 10060 DRAIN SKIN ABSCESS SIMPLE ADD-ON	$98.10	$654.00	$84.43–$621.30	63% below	85%
Incision and drainage of a simple or single skin abscess CPT 10060 INCISE&DRAIN ABSCESS-SINGLE/SIMPL	$135.00	$900.00	$116.19–$855.00	49% below	85%
Incision and drainage of a simple or single skin abscess one side CPT 10060 INCISE&DRAIN ABSCESS-SINGLE/SIMPL	$135.00	$900.00	$124.29–$900.00	49% below	85%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ASPIRATION, HIP KNEE SHOULDER	$109.80	$732.00	$94.50–$695.40	72% below	85%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 DRAIN/INJECT JOINT/BURSA-MAJOR	$295.95	$1,973.00	$272.47–$1,973.00	25% below	85%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 INSERT DRUG IMPLANT DEVICE	$47.25	$315.00	$40.67–$299.25	69% below	85%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/INJECT JOINT/BURSA-INTERM	$137.40	$916.00	$126.50–$916.00	67% below	85%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAIN/INJECT,SMALL JOINT/BURSA	$129.60	$864.00	$119.32–$864.00	68% below	85%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 LYR CLSR WND,2.5 OR LS	$169.95	$1,133.00	$156.47–$1,133.00	76% below	85%
Left heart catheterization, diagnostic one side CPT 93452 LEFT HRT CATH W/VENTRCLGRPHY	$2,519.55	$16,797.00	$2,168.49–$15,957.15	40% below	85%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJECT,FORAMEN EPIDURAL-L/S,1 LVL	$303.75	$2,025.00	$261.43–$1,923.75	74% below	85%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJ,FORAMEN EPIDURAL-LMB/SA,1 LVL	$303.75	$2,025.00	$261.43–$1,923.75	74% below	85%
Miscarriage treatment with D&C, first trimester CPT 59820 CARE OF MISCARRIAGE	$895.50	$5,970.00	$824.46–$5,970.00	75% below	85%
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	$102.00	$680.00	$93.91–$680.00	90% below	85%
Nail removal (partial or complete), one nail CPT 11730 REMOVAL OF NAIL PLATE SINGLE	$60.75	$405.00	$52.29–$384.75	77% below	85%
Occipital nerve block (injection for headaches) CPT 64405 NBLOCK INJ OCCIPITAL	$69.60	$464.00	$64.08–$464.00	87% below	85%
Occipital nerve block (injection for headaches) CPT 64405 NJX AA&/STRD GR OCPL NRV	$193.50	$1,290.00	$166.54–$1,225.50	65% below	85%
Pacemaker implant (dual chamber) CPT 33208 INSRT HEART PM ATRIAL &VENTRI	$4,254.00	$28,360.00	$3,661.28–$26,942.00	68% below	85%
Paracentesis with imaging guidance CPT 49083 ER ONLY-ABD PARACENTESIS W/IMAGE	$380.40	$2,536.00	$350.22–$2,536.00	66% below	85%
Paracentesis with imaging guidance CPT 49083 ABDOM.PARACENTESIS W/ IMAGE GUID	$380.40	$2,536.00	$327.40–$2,409.20	66% below	85%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 REMOVAL OF NAIL BED	$265.05	$1,767.00	$244.02–$1,767.00	47% below	85%
Prostate biopsy CPT 55700 BIOPSY PROSTATE NEEDLE EXAM	$249.90	$1,666.00	$215.08–$1,582.70	90% below	85%
Prostate biopsy CPT 55700 ULTRASOUND PROSTATE BIOPS	$709.35	$4,729.00	$610.51–$4,492.55	70% below	85%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 DSTR.NEUR.AGNT-1FACET JNT-LMB/SAC	$1,027.50	$6,850.00	$884.34–$6,507.50	60% below	85%
Removal of a breast lump, open surgery CPT 19120 REMOVAL OF BREAST LESION	$700.65	$4,671.00	$645.07–$4,671.00	86% below	85%
Removal of a foreign object under the skin, simple CPT 10120 REMOVE FOREIGN BODY	$143.55	$957.00	$132.16–$957.00	71% below	85%
Short arm cast (elbow to hand) CPT 29075 APPL OF FOREARM CAST	$79.50	$530.00	$73.19–$530.00	76% below	85%
Short arm splint (forearm and hand) one side CPT 29125 APPLY SHORT ARM SPLINT-STATIC	$76.20	$508.00	$70.15–$508.00	88% below	85%
Short leg cast (below the knee) CPT 29405 APPLY SHORT LEG CAST	$50.55	$337.00	$46.54–$337.00	86% below	85%
Short leg splint (calf to foot) one side CPT 29515 APPL LOWER LEG SPLINT	$80.85	$539.00	$74.44–$539.00	87% below	85%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs one side CPT 12001 SIM REP WND-SC/NK/TRNK/EX-2.5CM/<	$169.50	$1,130.00	$156.05–$1,130.00	35% below	85%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BIOPSY SKIN-SINGLE LESION	$148.80	$992.00	$128.07–$942.40	71% below	85%
Skin tag removal, up to 15 tags CPT 11200 REMOVAL OF SKIN TAGS,UP TO 15 LES	$67.05	$447.00	$61.73–$447.00	77% below	85%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL FLUID TAP, DIAGNOSTIC	$212.10	$1,414.00	$195.27–$1,414.00	77% below	85%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL PUNCTURE, LUMBAR	$262.65	$1,751.00	$226.05–$1,663.45	71% below	85%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL PUNCTURE,LUMBAR,DIAGNOSTIC	$268.35	$1,789.00	$230.96–$1,699.55	71% below	85%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL PUNCTURE,LUMBAR DIAGNOSTIC	$268.35	$1,789.00	$230.96–$1,699.55	71% below	85%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL PUNCTURE,LUMBAR,DIAGNOTIC	$270.15	$1,801.00	$232.51–$1,710.95	70% below	85%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs one side CPT 12002 SIM RPR WND,2.6-7.5CM	$169.50	$1,130.00	$156.05–$1,130.00	35% below	85%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair one side CPT 12011 SIM RPR WND,2.5CM OR LS (FACE)	$170.25	$1,135.00	$156.74–$1,135.00	37% below	85%
Thoracentesis with imaging guidance both sides CPT 32555 ASPIRATE PLEURA-BILAT W/IMAGING	$752.25	$5,015.00	$647.44–$4,764.25	—	85%
Thoracentesis with imaging guidance CPT 32555 ASPIRATE PLEURA W/IMAGING	$417.75	$2,785.00	$359.54–$2,645.75	49% below	85%
Thoracentesis with imaging guidance one side CPT 32555 ASPIRATE PLEURA W/IMAGING	$417.75	$2,785.00	$384.61–$2,785.00	49% below	85%
Thoracentesis with imaging guidance one side CPT 32555 ASPIRATE PLEURA-UNILAT W/IMAGING	$417.75	$2,785.00	$359.54–$2,645.75	49% below	85%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINT(S) 1-2 MUSCLES	$97.50	$650.00	$89.77–$650.00	74% below	85%
Tubal ligation, laparoscopic (tubes sealed by cautery) CPT 58670 LIGATION,TUBAL,POSTPARTUM	$1,539.15	$10,261.00	$1,324.70–$9,747.95	77% below	85%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 BREAST BX,ULTRASOUND,1ST LESION	$716.70	$4,778.00	$616.84–$4,539.10	67% below	85%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 EGD-ESOPH.BALLOON DILATION,< 30MM	$1,142.40	$7,616.00	$983.23–$7,235.20	49% below	85%
Upper endoscopy (EGD) with injection into the lining CPT 43236 EGD-W/SUBMUCOSAL INJ(S),ANY SUB	$716.55	$4,777.00	$616.71–$4,538.15	35% below	85%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 EGD-INSERT GWIRE W/DILATOR(SAVORY	$630.75	$4,205.00	$542.87–$3,994.75	43% below	85%
Upper endoscopy with drainage of a pseudocyst through the stomach wall CPT 43240 EGD-W/TRANSMURAL DRAINAGE CYST	$1,176.60	$7,844.00	$1,012.66–$7,451.80	83% below	85%
Vein ablation, radiofrequency, first vein CPT 36475 VP-COVIDIEN ABLATION PROCEDURE	$748.80	$4,992.00	$644.47–$4,742.40	85% below	85%
Vein ablation, radiofrequency, first vein CPT 36475 VP-ENDOVEN.ABLAT.EXTR.RF,1ST VEIN	$881.85	$5,879.00	$758.98–$5,585.05	82% below	85%
Wart removal, up to 14 warts CPT 17110 DESCTRUCT BENIGN LESIONS-UP TO 14	$66.30	$442.00	$61.04–$442.00	73% below	85%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDE SKIN /TISSUE	$74.85	$499.00	$68.91–$499.00	85% below	85%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDE SUBQ TISSUE,FIRST 20 SQCM	$227.85	$1,519.00	$196.10–$1,443.05	55% below	85%
Wrist fracture surgery (plate and screws), distal radius CPT 25607 TREAT FX RAD EXTRA-ARTICUL	$2,809.80	$18,732.00	$2,586.89–$18,732.00	71% below	85%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs New Jersey	Off list
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSFUSION SERVICE	$158.25	$1,055.00	$136.20–$1,002.25	72% below	85%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AIRWAY INHALATION TREATMENT	$19.65	$131.00	$16.91–$124.45	92% below	85%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HELIOX TREATMENT SUBSEQUENT	$26.10	$174.00	$22.46–$165.30	90% below	85%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AEROSOLIZED TREATMENT SUBSEQUENT	$36.00	$240.00	$30.98–$228.00	86% below	85%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HELIOX TREATMENT	$36.00	$240.00	$30.98–$228.00	86% below	85%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AEROSOL TRMT/INITIAL EVAL	$39.75	$265.00	$34.21–$251.75	84% below	85%
Chemotherapy IV infusion, first hour CPT 96413 CHEMO.ADMIN,IV INFUS,16-90 MIN.	$275.25	$1,835.00	$236.90–$1,743.25	36% below	85%
Chemotherapy IV infusion, first hour CPT 96413 CHEMOTX ADM, IV INF UP TO 1HR	$275.25	$1,835.00	$236.90–$1,743.25	36% below	85%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE H W/MOD 25	$276.75	$1,845.00	$254.79–$1,845.00	74% below	85%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE,1ST HR W/MOD25-H	$589.95	$3,933.00	$543.15–$3,933.00	45% below	85%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE, FIRST HOUR H	$589.95	$3,933.00	$543.15–$3,933.00	45% below	85%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE,1ST HR W/MODIFIER25	$589.95	$3,933.00	$543.15–$3,933.00	45% below	85%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE, FIRST HOUR	$589.95	$3,933.00	$543.15–$3,933.00	45% below	85%
EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG W/ HYPER VENT & PHOTIC STIM	$273.30	$1,822.00	$235.22–$1,730.90	25% below	85%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 PREADMISSION EKG	$48.15	$321.00	$41.44–$304.95	36% below	85%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ROUTINE ECG-12+LEADS-TRACING ONLY	$48.15	$321.00	$41.44–$304.95	36% below	85%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG(INCL RHYTHM STRIP)REPEAT	$48.15	$321.00	$41.44–$304.95	36% below	85%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG(INCL RHYTHM STRIP)	$48.15	$321.00	$41.44–$304.95	36% below	85%
Electroconvulsive therapy (ECT), one session CPT 90870 ELECTROCONVULSIVE THERAPY-W/MONIT	$232.50	$1,550.00	$200.11–$1,472.50	60% below	85%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 OB EMERGENCY VISIT-LEVEL 1	$108.30	$722.00	$99.71–$722.00	8% below	85%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER VISIT - LEVEL 1	$108.30	$722.00	$99.71–$722.00	8% below	85%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 SERVICE LEVEL I WITH MODIFIER 25	$108.30	$722.00	$99.71–$722.00	8% below	85%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 PIP MED CLEARANCE/LEV 1 W/25 MODI	$108.30	$722.00	$99.71–$722.00	8% below	85%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 PIP MED CLEARANCE/LEV 1	$108.30	$722.00	$99.71–$722.00	8% below	85%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER VIST LEVEL I W/MOD 25H	$108.30	$722.00	$99.71–$722.00	8% below	85%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 PIP MED CLEARANCE/LEV 2	$213.45	$1,423.00	$196.52–$1,423.00	1% above	85%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 PIP MED CLEARANCE/LEV 2 W/25 MODI	$213.45	$1,423.00	$196.52–$1,423.00	1% above	85%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ER VISIT LEVEL II W/MOD 25H	$213.45	$1,423.00	$196.52–$1,423.00	1% above	85%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ER VISIT - LEVEL 2	$213.45	$1,423.00	$196.52–$1,423.00	1% above	85%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 SERVICE LEVEL II WITH MODIFIER 25	$213.45	$1,423.00	$196.52–$1,423.00	1% above	85%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 OB EMERGENCY VISIT-LEVEL 2	$213.45	$1,423.00	$196.52–$1,423.00	1% above	85%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ER VISIT - LEVEL 3	$322.35	$2,149.00	$296.78–$2,149.00	7% below	85%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 OB EMERGENCY VISIT-LEVEL 3	$322.35	$2,149.00	$296.78–$2,149.00	7% below	85%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ER VISIT LEVEL III W/MOD 25H	$322.35	$2,149.00	$296.78–$2,149.00	7% below	85%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 PIP MED CLEARANCE/LEV 3	$322.35	$2,149.00	$296.78–$2,149.00	7% below	85%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 PIP MED CLEARANCE/LEV 3 W/25 MODI	$322.35	$2,149.00	$296.78–$2,149.00	7% below	85%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 SERVICE LEVEL III WITH MODIFIER 2	$322.35	$2,149.00	$296.78–$2,149.00	7% below	85%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 OB EMERGENCY VISIT-LEVEL 4	$401.25	$2,675.00	$369.42–$2,675.00	25% below	85%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ER VISIT LEVEL IV W/MOD 25H	$401.25	$2,675.00	$369.42–$2,675.00	25% below	85%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 PIP MED CLEARANCE/LEV 4	$401.25	$2,675.00	$369.42–$2,675.00	25% below	85%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 PIP MED CLEARANCE/LEV 4 W/25 MODI	$401.25	$2,675.00	$369.42–$2,675.00	25% below	85%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 SERVICE LEVEL IV WITH MODIFIER 25	$401.25	$2,675.00	$369.42–$2,675.00	25% below	85%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ER VISIT - LEVEL 4	$401.25	$2,675.00	$369.42–$2,675.00	25% below	85%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 PIP MED CLEARANCE/LEV 5	$504.75	$3,365.00	$464.71–$3,365.00	34% below	85%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 OB EMERGENCY VISIT-LEVEL 5	$504.75	$3,365.00	$464.71–$3,365.00	34% below	85%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ER VISIT LEVEL V W/MOD 25 H	$504.75	$3,365.00	$464.71–$3,365.00	34% below	85%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 PIP MED CLEARANCE/LEV 5 W/25 MODI	$504.75	$3,365.00	$464.71–$3,365.00	34% below	85%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 SERVICE LEVEL V WITH MODIFIER 25	$504.75	$3,365.00	$464.71–$3,365.00	34% below	85%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ER VISIT - LEVEL 5	$504.75	$3,365.00	$464.71–$3,365.00	34% below	85%
Exercise stress test, tracing only, the hospital charge CPT 93017 STRESS TEST - TRACING ONLY	$252.75	$1,685.00	$217.53–$1,600.75	31% below	85%
Exercise stress test, tracing only, the hospital charge CPT 93017 PHARMACOLOGIC STRESS	$252.75	$1,685.00	$217.53–$1,600.75	31% below	85%
Exercise stress test, tracing only, the hospital charge CPT 93017 STRESS TEST DONE BY APNS	$252.75	$1,685.00	$217.53–$1,600.75	31% below	85%
Family therapy with the patient, 50 minutes CPT 90847 APH-FAMILY PSYCHOTHER.W/ PAT.	$75.00	$500.00	$64.55–$475.00	64% below	85%
Group psychotherapy session CPT 90853 CV-AUD GROUP PSYCHOTHERAPY	$75.00	$500.00	$64.55–$475.00	35% below	85%
Group psychotherapy session CPT 90853 CV-A&V GROUP PSYCHOTHERAPY	$75.00	$500.00	$64.55–$475.00	35% below	85%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRATION IV INFUSION,INIT.	$94.05	$627.00	$80.95–$595.65	65% below	85%
IV infusion of a medicine, first hour CPT 96365 THER/PROPH/DIAG IV INF INITIAL	$111.15	$741.00	$95.66–$703.95	59% below	85%
IV infusion of a medicine, first hour CPT 96365 THER/PROPH/DIAG IV INF,INIT.	$119.55	$797.00	$102.89–$757.15	55% below	85%
IV infusion of a medicine, first hour CPT 96365 THER/PROPH/DIAG IV INF,16-90 MIN.	$123.90	$826.00	$106.64–$784.70	54% below	85%
IV push of a medicine, first drug CPT 96374 IR-THER/PROPH/DIAG INJ,IV PUSH	$84.30	$562.00	$72.55–$533.90	68% below	85%
IV push of a medicine, first drug CPT 96374 THER/PROPH/DIAG INJ,IV PUSH	$84.30	$562.00	$72.55–$533.90	68% below	85%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 MP-THER/PROPH/DIAG INJ SUBQ/IM	$29.10	$194.00	$25.05–$184.30	68% below	85%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DIAG INJ SUBQ/IM	$32.40	$216.00	$27.89–$205.20	64% below	85%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DIAG INJ, SUBCU/IM	$32.40	$216.00	$27.89–$205.20	64% below	85%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DIAG INJ, SC/IM	$32.40	$216.00	$27.89–$205.20	64% below	85%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DIAG INJ,SC/IM	$32.40	$216.00	$27.89–$205.20	64% below	85%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 APH-DIAGNOSTIC INTERVIEW W/ OTHER	$145.05	$967.00	$124.84–$918.65	30% below	85%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 CRISIS STABILIZATION	$145.05	$967.00	$124.84–$918.65	30% below	85%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 CV-AUD PSYCHIATRIC DX INTRVW ONLY	$145.05	$967.00	$124.84–$918.65	30% below	85%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 CV-A&V PSYCHIATRIC DX INTRVW ONLY	$145.05	$967.00	$124.84–$918.65	30% below	85%
Neuromuscular re-education, 15 minutes CPT 97112 OT-NEUROMUSC.RE-EDUCATION-@ 15MIN	$26.25	$175.00	$22.59–$166.25	36% below	85%
Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSCULAR RE-EDUCATION-@15MIN	$35.40	$236.00	$30.47–$224.20	14% below	85%
Neuromuscular re-education, 15 minutes CPT 97112 A-COORDIN & BALANCE P.T-EA.15 MIN	$35.40	$236.00	$30.47–$224.20	14% below	85%
Neuromuscular re-education, 15 minutes CPT 97112 A-NEUROMUSC.REEDUCATION-EA. 15MIN	$35.40	$236.00	$30.47–$224.20	14% below	85%
Neuromuscular re-education, 15 minutes CPT 97112 COORDINATION&BALANCE P.T.-@ 15MIN	$35.40	$236.00	$30.47–$224.20	14% below	85%
New patient office visit, about 30 minutes CPT 99203 VWD-OUTPT VISIT NEW PT LVL 3 W/25	$36.15	$241.00	$31.11–$228.95	63% below	85%
New patient office visit, about 30 minutes CPT 99203 NEW PATIENT LEVEL 3	$36.15	$241.00	$31.11–$228.95	63% below	85%
New patient office visit, about 30 minutes CPT 99203 NEW PATIENT LEVEL III W/MOD 25	$36.15	$241.00	$31.11–$228.95	63% below	85%
New patient office visit, about 30 minutes CPT 99203 O/P VISIT-NEW PAT LEVEL 3 W/25	$36.15	$241.00	$31.11–$228.95	63% below	85%
New patient office visit, about 30 minutes CPT 99203 NEW PAT.,DETAILED/LOW,LEVEL 3	$36.15	$241.00	$31.11–$228.95	63% below	85%
New patient office visit, about 30 minutes CPT 99203 NEW PATIENT, DETAILED, LEVEL 3	$36.15	$241.00	$31.11–$228.95	63% below	85%
New patient office visit, about 30 minutes CPT 99203 OUTPATIENT VISIT-NEW LEVEL 3	$36.15	$241.00	$31.11–$228.95	63% below	85%
New patient office visit, about 30 minutes CPT 99203 OUTPATIENT VISIT-NEW LEVEL 3 W/25	$36.15	$241.00	$31.11–$228.95	63% below	85%
New patient office visit, about 30 minutes CPT 99203 VP-OUTPT VISIT,NEW PT,LEVEL 3	$36.15	$241.00	$31.11–$228.95	63% below	85%
New patient office visit, about 30 minutes CPT 99203 O/P VISIT-NEW PATIENT LEVEL 3	$36.15	$241.00	$31.11–$228.95	63% below	85%
New patient office visit, about 30 minutes CPT 99203 NEW PATIENT LEVEL III	$36.15	$241.00	$31.11–$228.95	63% below	85%
New patient office visit, about 30 minutes CPT 99203 NEW PAT,DETAILED/LOW,LEVEL 3	$36.15	$241.00	$31.11–$228.95	63% below	85%
New patient office visit, about 30 minutes CPT 99203 VWD-OUTPT VISIT NEW PT LEVEL 3	$36.15	$241.00	$31.11–$228.95	63% below	85%
New patient office visit, about 30 minutes CPT 99203 NEW PATIENT VISIT LEVEL 3	$36.15	$241.00	$31.11–$228.95	63% below	85%
New patient office visit, about 45 minutes CPT 99204 NEW PATIENT LEVEL IV	$61.05	$407.00	$52.54–$386.65	61% below	85%
New patient office visit, about 45 minutes CPT 99204 NEW PATIENT LEVEL IV W/MOD 25	$61.05	$407.00	$52.54–$386.65	61% below	85%
New patient office visit, about 45 minutes CPT 99204 O/P VISIT-NEW PAT LEVEL 4 W/25	$61.05	$407.00	$52.54–$386.65	61% below	85%
New patient office visit, about 45 minutes CPT 99204 NEW PATIENT,COMPREHENSIVE,LEVEL 4	$61.05	$407.00	$52.54–$386.65	61% below	85%
New patient office visit, about 45 minutes CPT 99204 OUTPATIENT VISIT-NEW LEVEL 4	$61.05	$407.00	$52.54–$386.65	61% below	85%
New patient office visit, about 45 minutes CPT 99204 O/P VISIT-NEW PATIENT LEVEL 4	$61.05	$407.00	$52.54–$386.65	61% below	85%
New patient office visit, about 45 minutes CPT 99204 NEW PATIENT LEVEL 4	$61.05	$407.00	$52.54–$386.65	61% below	85%
New patient office visit, about 45 minutes CPT 99204 NEW PAT.,COMPREH/MODERATE,LEVEL 4	$61.05	$407.00	$52.54–$386.65	61% below	85%
New patient office visit, about 45 minutes CPT 99204 VWD-OUTPT VISIT NEW PT LEVEL 4	$61.05	$407.00	$52.54–$386.65	61% below	85%
New patient office visit, about 45 minutes CPT 99204 NEW PATIENT VISIT LEVEL 4	$61.05	$407.00	$52.54–$386.65	61% below	85%
New patient office visit, about 45 minutes CPT 99204 VWD-OUTPT VISIT NEW PT LVL 4 W/25	$61.05	$407.00	$52.54–$386.65	61% below	85%
New patient office visit, about 45 minutes CPT 99204 VP-OUTPT VISIT,NEW PT,LEVEL 4	$61.05	$407.00	$52.54–$386.65	61% below	85%
New patient office visit, about 45 minutes CPT 99204 OUTPATIENT VISIT-NEW LEVEL 4 W/25	$61.05	$407.00	$52.54–$386.65	61% below	85%
New patient office visit, about 60 minutes CPT 99205 VWD-OUTPT VISIT NEW PT LVL 5 W/25	$76.95	$513.00	$66.23–$487.35	64% below	85%
New patient office visit, about 60 minutes CPT 99205 VP-OUTPT VISIT,NEW PT,LEVEL 5	$76.95	$513.00	$66.23–$487.35	64% below	85%
New patient office visit, about 60 minutes CPT 99205 OUTPATIENT VISIT-NEW LEVEL 5 W/25	$76.95	$513.00	$66.23–$487.35	64% below	85%
New patient office visit, about 60 minutes CPT 99205 O/P VISIT-NEW PAT LEVEL 5 W/25	$76.95	$513.00	$66.23–$487.35	64% below	85%
New patient office visit, about 60 minutes CPT 99205 NEW PATIENT LEVEL V W/MOD 25	$76.95	$513.00	$66.23–$487.35	64% below	85%
New patient office visit, about 60 minutes CPT 99205 NEW PAT.,COMPLEX/HIGH,LEVEL 5	$76.95	$513.00	$66.23–$487.35	64% below	85%
New patient office visit, about 60 minutes CPT 99205 NEW PATIENT,HIGH COMPLEX,LEVEL 5	$76.95	$513.00	$66.23–$487.35	64% below	85%
New patient office visit, about 60 minutes CPT 99205 OUTPATIENT VISIT-NEW LEVEL 5	$76.95	$513.00	$66.23–$487.35	64% below	85%
New patient office visit, about 60 minutes CPT 99205 O/P VISIT-NEW PATIENT LEVEL 5	$76.95	$513.00	$66.23–$487.35	64% below	85%
New patient office visit, about 60 minutes CPT 99205 NEW PATIENT,COMPLEX/HIGH,LEVEL 5	$76.95	$513.00	$66.23–$487.35	64% below	85%
New patient office visit, about 60 minutes CPT 99205 NEW PATIENT LEVEL V	$76.95	$513.00	$66.23–$487.35	64% below	85%
New patient office visit, about 60 minutes CPT 99205 NEW PATIENT LEVEL 5	$76.95	$513.00	$66.23–$487.35	64% below	85%
New patient office visit, about 60 minutes CPT 99205 NEW PAT,COMPLEX/HIGH,LEVEL 5	$76.95	$513.00	$66.23–$487.35	64% below	85%
New patient office visit, about 60 minutes CPT 99205 VWD-OUTPT VISIT NEW PT LEVEL 5	$76.95	$513.00	$66.23–$487.35	64% below	85%
New patient office visit, about 60 minutes CPT 99205 NEW PATIENT VISIT LEVEL 5	$76.95	$513.00	$66.23–$487.35	64% below	85%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 OUTPATIENT VISIT-NEW LEVEL 2 W/25	$25.95	$173.00	$22.33–$164.35	54% below	85%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW PAT.,EXPANDED FOCUSED,LEVEL 2	$25.95	$173.00	$22.33–$164.35	54% below	85%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW PATIENT LEVEL 2	$25.95	$173.00	$22.33–$164.35	54% below	85%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 CONSULT LEVEL 2	$25.95	$173.00	$22.33–$164.35	54% below	85%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW PATIENT LEVEL II W/MOD 25	$25.95	$173.00	$22.33–$164.35	54% below	85%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 VWD-OUTPT VISIT NEW PT LVL 2 W/25	$25.95	$173.00	$22.33–$164.35	54% below	85%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 VP-OUTPT VISIT,NEW PT,LEVEL 2	$25.95	$173.00	$22.33–$164.35	54% below	85%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 O/P VISIT-NEW PAT LEVEL 2 W/25	$25.95	$173.00	$22.33–$164.35	54% below	85%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW PATIENT, EXPANDED, LEVEL 2	$25.95	$173.00	$22.33–$164.35	54% below	85%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 OUTPATIENT VISIT-NEW LEVEL 2	$25.95	$173.00	$22.33–$164.35	54% below	85%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 O/P VISIT-NEW PATIENT LEVEL 2	$25.95	$173.00	$22.33–$164.35	54% below	85%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW PATIENT LEVEL II	$25.95	$173.00	$22.33–$164.35	54% below	85%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW PAT,EXPANDED FOCUSED,LEVEL 2	$25.95	$173.00	$22.33–$164.35	54% below	85%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 VWD-OUTPT VISIT NEW PT LEVEL 2	$25.95	$173.00	$22.33–$164.35	54% below	85%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW PATIENT VISIT LEVEL 2	$25.95	$173.00	$22.33–$164.35	54% below	85%
Occupational therapy evaluation, low complexity CPT 97165 OT-EVAL-LOW COMPLEXITY	$69.60	$464.00	$59.90–$440.80	46% below	85%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT EVAL-HIGH COMPLEXITY (45 MIN)	$91.65	$611.00	$78.88–$580.45	27% below	85%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT EVAL-LOW COMPLEXITY (20 MIN)	$72.30	$482.00	$62.23–$457.90	43% below	85%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT EVAL-MODERATE COMPLEX.(30 MIN)	$75.00	$500.00	$64.55–$475.00	41% below	85%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 A-MANUAL THER.-1/+REG-EACH 15 MIN	$33.45	$223.00	$28.79–$211.85	5% below	85%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THER.-1/+ REG.-EACH 15 MIN	$33.45	$223.00	$28.79–$211.85	5% below	85%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 A-RANGE OF MOTION P.T-EACH 15 MIN	$23.85	$159.00	$20.53–$151.05	36% below	85%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 RANGE OF MOTION P.T.	$23.85	$159.00	$20.53–$151.05	36% below	85%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISE P.T.	$30.00	$200.00	$25.82–$190.00	19% below	85%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 A-THERAPEUTIC EXERCISE-EACH 15MIN	$30.00	$200.00	$25.82–$190.00	19% below	85%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT-THERAPEUTIC EXERCISES @ 15MIN	$32.55	$217.00	$28.01–$206.15	12% below	85%
Psychiatric evaluation with medical services CPT 90792 CV-AUD PSYCHIATRIC DX INTRVW +E/M	$130.35	$869.00	$112.19–$825.55	35% below	85%
Psychiatric evaluation with medical services CPT 90792 CV-A&V PSYCHIATRIC DX INTRVW +E/M	$130.35	$869.00	$112.19–$825.55	35% below	85%
Psychiatric evaluation with medical services CPT 90792 APH-DIAGNOSTIC INTERVIEW-DR/APN	$130.35	$869.00	$112.19–$825.55	35% below	85%
Psychotherapy session, 30 minutes CPT 90832 CV-A&V INDIV.PSYCHOTHER.20-30 MIN	$94.50	$630.00	$81.33–$598.50	54% below	85%
Psychotherapy session, 30 minutes CPT 90832 APH-PATIENT PSYCHOTHER.-30 MIN.	$94.50	$630.00	$81.33–$598.50	54% below	85%
Psychotherapy session, 30 minutes CPT 90832 CV-AUD INDIV.PSYCHOTHER.20-30 MIN	$94.50	$630.00	$81.33–$598.50	54% below	85%
Psychotherapy session, 45 minutes CPT 90834 CV-A&V INDIV.PSYCHOTHER.45-50 MIN	$97.50	$650.00	$83.92–$617.50	52% below	85%
Psychotherapy session, 45 minutes CPT 90834 CV-AUD INDIV.PSYCHOTHER.45-50 MIN	$97.50	$650.00	$83.92–$617.50	52% below	85%
Psychotherapy session, 45 minutes CPT 90834 APH-PATIENT PSYCHOTHER.-45 MIN.	$97.50	$650.00	$83.92–$617.50	52% below	85%
Psychotherapy session, 60 minutes CPT 90837 APH-PATIENT PSYCHOTHER.-60 MIN.	$105.00	$700.00	$90.37–$665.00	49% below	85%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 BEHAV CHNG SMOKING 3-10 MIN	$9.90	$66.00	$8.52–$62.70	78% below	85%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 SMOKE/TOB.CESS.COUNS.VIS,3-10 MIN	$9.90	$66.00	$8.52–$62.70	78% below	85%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 O/P VISIT-ESTAB PAT LEVEL 5 W/25	$76.80	$512.00	$66.10–$486.40	55% below	85%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 EST PATIENT LEVEL V W/MOD 25	$76.80	$512.00	$66.10–$486.40	55% below	85%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 EST.PATIENT,COMPLEX/HIGH,LEVEL 5	$76.80	$512.00	$66.10–$486.40	55% below	85%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 EST.PAT.,COMPLEX/HIGH,LEVEL 5	$76.80	$512.00	$66.10–$486.40	55% below	85%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 EST PATIENT,COMPREHENSIVE,LEVEL 5	$76.80	$512.00	$66.10–$486.40	55% below	85%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OUTPATIENT VISIT-EST LEVEL 5	$76.80	$512.00	$66.10–$486.40	55% below	85%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 O/P VISIT-ESTAB PATIENT LEVEL 5	$76.80	$512.00	$66.10–$486.40	55% below	85%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 EST PATIENT LEVEL V	$76.80	$512.00	$66.10–$486.40	55% below	85%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 ESTAB PT LEVEL 5	$76.80	$512.00	$66.10–$486.40	55% below	85%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 EST.PAT,COMPLEX/HIGH,LEVEL 5	$76.80	$512.00	$66.10–$486.40	55% below	85%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 VWD-OUTPT VISIT EST PT LEVEL 5	$76.80	$512.00	$66.10–$486.40	55% below	85%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OUTPATIENT VISIT-EST LEVEL 5 W/25	$76.80	$512.00	$66.10–$486.40	55% below	85%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 VP-OUTPT VISIT,EST PT,LEVEL 5	$76.80	$512.00	$66.10–$486.40	55% below	85%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 VWD-OUTPT VISIT EST PT LVL 5 W/25	$76.80	$512.00	$66.10–$486.40	55% below	85%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 ESTAB.PATIENT VISIT LEVEL 5	$76.80	$512.00	$66.10–$486.40	55% below	85%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 ESTAB.PATIENT VISIT LEVEL 3	$48.30	$322.00	$41.57–$305.90	38% below	85%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 CV-A&V ESTAB.PAT.VISIT-LOW(15)	$48.30	$322.00	$41.57–$305.90	38% below	85%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OUTPATIENT VISIT-EST LEVEL 3 W/25	$48.30	$322.00	$41.57–$305.90	38% below	85%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 VWD-OUTPT VISIT EST PT LVL 3 W/25	$48.30	$322.00	$41.57–$305.90	38% below	85%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 VP-OUTPT VISIT,EST PT,LEVEL 3	$48.30	$322.00	$41.57–$305.90	38% below	85%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 EST.PAT.,EXPANDED FOCUSED,LEVEL 3	$48.30	$322.00	$41.57–$305.90	38% below	85%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 ESTAB PT LEVEL 3	$48.30	$322.00	$41.57–$305.90	38% below	85%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 EST PATIENT LEVEL III W/MOD 25	$48.30	$322.00	$41.57–$305.90	38% below	85%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 O/P VISIT-ESTAB PAT LEVEL 3 W/25	$48.30	$322.00	$41.57–$305.90	38% below	85%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 ESTAB PATIENT,EXPANDED,LEVEL 3	$48.30	$322.00	$41.57–$305.90	38% below	85%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OUTPATIENT VISIT-EST LEVEL 3	$48.30	$322.00	$41.57–$305.90	38% below	85%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 O/P VISIT-ESTAB PATIENT LEVEL 3	$48.30	$322.00	$41.57–$305.90	38% below	85%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 EST PATIENT LEVEL III	$48.30	$322.00	$41.57–$305.90	38% below	85%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 APH-MED.MANAGEMENT-EXPAND/LOW	$48.30	$322.00	$41.57–$305.90	38% below	85%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 EST.PAT,EXPANDED FOCUSED,LEVEL 3	$48.30	$322.00	$41.57–$305.90	38% below	85%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 VWD-OUTPT VISIT EST PT LEVEL 3	$48.30	$322.00	$41.57–$305.90	38% below	85%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OUTPATIENT VISIT-EST LEVEL 4	$63.15	$421.00	$54.35–$399.95	45% below	85%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 EST PATIENT LEVEL IV W/MOD 25	$63.15	$421.00	$54.35–$399.95	45% below	85%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 O/P VISIT-ESTAB PAT LEVEL 4 W/25	$63.15	$421.00	$54.35–$399.95	45% below	85%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OUTPATIENT VISIT-EST LEVEL 4 W/25	$63.15	$421.00	$54.35–$399.95	45% below	85%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 VP-OUTPT VISIT,EST PT,LEVEL 4	$63.15	$421.00	$54.35–$399.95	45% below	85%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 VWD-OUTPT VISIT EST PT LVL 4 W/25	$63.15	$421.00	$54.35–$399.95	45% below	85%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 CV-A&V ESTAB.PAT.VISIT-MODER.(25)	$63.15	$421.00	$54.35–$399.95	45% below	85%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 ESTAB.PATIENT VISIT LEVEL 4	$63.15	$421.00	$54.35–$399.95	45% below	85%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 VWD-OUTPT VISIT EST PT LEVEL 4	$63.15	$421.00	$54.35–$399.95	45% below	85%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 EST.PAT,DETAILED/MODER.,LEVEL 4	$63.15	$421.00	$54.35–$399.95	45% below	85%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 APH-MED.MANAGEMENT-DETAIL/MODER.	$63.15	$421.00	$54.35–$399.95	45% below	85%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 ESTAB PT LEVEL 4	$63.15	$421.00	$54.35–$399.95	45% below	85%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 EST PATIENT LEVEL IV	$63.15	$421.00	$54.35–$399.95	45% below	85%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 O/P VISIT-ESTAB PATIENT LEVEL 4	$63.15	$421.00	$54.35–$399.95	45% below	85%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 EST.PAT.,DETAILED/MODER.,LEVEL 4	$63.15	$421.00	$54.35–$399.95	45% below	85%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 ESTAB PATIENT,DETAILED,LEVEL 4	$63.15	$421.00	$54.35–$399.95	45% below	85%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 VWD-OUTPT VISIT EST PT LVL 2 W/25	$24.90	$166.00	$21.43–$157.70	61% below	85%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 VP-OUTPT VISIT,EST PT,LEVEL 2	$24.90	$166.00	$21.43–$157.70	61% below	85%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OUTPATIENT VISIT-EST LEVEL 2 W/25	$24.90	$166.00	$21.43–$157.70	61% below	85%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 O/P VISIT-ESTAB PAT LEVEL 2 W/25	$24.90	$166.00	$21.43–$157.70	61% below	85%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 EST PATIENT LEVEL II W/MOD 25	$24.90	$166.00	$21.43–$157.70	61% below	85%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 ESTAB PATIENT,FOCUSED,LEVEL 2	$24.90	$166.00	$21.43–$157.70	61% below	85%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OUTPATIENT VISIT-EST LEVEL 2	$24.90	$166.00	$21.43–$157.70	61% below	85%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 O/P VISIT-ESTAB PATIENT LEVEL 2	$24.90	$166.00	$21.43–$157.70	61% below	85%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 EST PATIENT LEVEL II	$24.90	$166.00	$21.43–$157.70	61% below	85%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 APH-MED.MANAGEMENT-BRIEF/STRTFOR.	$24.90	$166.00	$21.43–$157.70	61% below	85%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 EST.PAT,PROBLEM FOCUSED,LEVEL 2	$24.90	$166.00	$21.43–$157.70	61% below	85%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 VWD-OUTPT VISIT EST PT LEVEL 2	$24.90	$166.00	$21.43–$157.70	61% below	85%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 ESTAB.PATIENT VISIT LEVEL 2	$24.90	$166.00	$21.43–$157.70	61% below	85%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 CV-A&V ESTAB.PAT.VISIT-MINOR(10)	$24.90	$166.00	$21.43–$157.70	61% below	85%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 ESTAB PT LEVEL 2	$24.90	$166.00	$21.43–$157.70	61% below	85%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 MEDICATION MONITORING	$24.90	$166.00	$21.43–$157.70	61% below	85%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 EST.PAT.,PROBLEM FOCUSED,LEVEL 2	$24.90	$166.00	$21.43–$157.70	61% below	85%
Speech and language evaluation CPT 92523 ST-SPEECH/SOUND/LANG COMP&EXPRESS	$118.05	$787.00	$101.60–$747.65	60% below	85%
Speech therapy session, individual CPT 92507 ST-SPEECH/LANG/VOICE/AUD TRT-IND	$63.00	$420.00	$54.22–$399.00	36% below	85%
Spirometry (breathing test) CPT 94010 BREATHING CAPACITY TEST	$49.20	$328.00	$42.34–$311.60	75% below	85%
Spirometry before and after a bronchodilator CPT 94060 BASIC PRE/POST BRONCHIO	$103.65	$691.00	$89.21–$656.45	74% below	85%
Spirometry before and after a bronchodilator CPT 94060 BRONCHDLT RESP SPROMTRY&PRE/POST	$126.15	$841.00	$108.57–$798.95	68% below	85%
Therapeutic activities (functional training), 15 minutes CPT 97530 TRANSFER TRAINING P.T.	$28.65	$191.00	$24.66–$181.45	36% below	85%
Therapeutic activities (functional training), 15 minutes CPT 97530 BED MOBILITY P.T.	$28.65	$191.00	$24.66–$181.45	36% below	85%
Therapeutic activities (functional training), 15 minutes CPT 97530 A-TRANSFER TRAIN(1/1)-EACH 15 MIN	$28.65	$191.00	$24.66–$181.45	36% below	85%
Therapeutic activities (functional training), 15 minutes CPT 97530 A-BED MOBILITY P.T.-EACH 15 MIN	$28.65	$191.00	$24.66–$181.45	36% below	85%
Therapeutic activities (functional training), 15 minutes CPT 97530 OT-FUNCTIONAL TREATMENT @ 15MIN	$33.60	$224.00	$28.92–$212.80	25% below	85%
Therapeutic activities (functional training), 15 minutes CPT 97530 OT-PERCEPTUAL MOTOR TASKS @ 15MIN	$33.60	$224.00	$28.92–$212.80	25% below	85%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY,THERAPEUTIC	$38.10	$254.00	$32.79–$241.30	77% below	85%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY, THERAPEUTIC	$38.10	$254.00	$32.79–$241.30	77% below	85%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY THERAPEUTIC	$57.30	$382.00	$49.32–$362.90	65% below	85%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs New Jersey	Off list
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 SARS-CoV-2 (COVID-19) MODERNA 2024-2025 VACCINE PF SYR (12+ YR) 50 MCG/0.5 ML	$289.19	$1,927.91	$248.89–$1,831.51	25% below	85%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 SARS-CoV-2 (COVID-19) MODERNA 2024-2025 VACCINE PF SYR (12+ YR) 50 MCG/0.5 ML	$289.19	$1,927.91	$248.89–$1,831.51	—	85%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VIRUS VACCINE	$122.09	$813.91	$105.08–$773.21	49% below	85%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA VIRUS VACCINE	$122.09	$813.91	$105.08–$773.21	—	85%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 DIPHTHERIA-TETANUS-PERTUS-POLIO 0.5 mL (SYR)	$86.02	$573.44	$74.03–$544.77	54% below	85%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 DIPHTHERIA-TETANUS-PERTUS-POLIO 0.5 mL (SYR)	$86.02	$573.44	$74.03–$544.77	—	85%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DIPHTHER-ACEL-PERTUSS-TET (INFANRIX) (DTaP) VACCINE INJ 0.5 ML	$39.74	$264.93	$34.20–$251.68	56% below	85%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DIPHTHERIA/TETANUS/PERTUSSIS (DAPTACEL) (DTaP) PED 15 units-5 units-23 mcg/0.5 mL	$60.43	$402.84	$52.01–$382.70	33% below	85%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DIPHTHER-ACEL-PERTUSS-TET (INFANRIX) (DTaP) VACCINE INJ 0.5 ML	$39.74	$264.93	$34.20–$251.68	—	85%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DIPHTHERIA/TETANUS/PERTUSSIS (DAPTACEL) (DTaP) PED 15 units-5 units-23 mcg/0.5 mL	$60.43	$402.84	$52.01–$382.70	—	85%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 DIPHTHERIA-TETANUS-PERTUS-HEP B-POLIO 0.5 mL (SYR)	$131.12	$874.10	$112.85–$830.40	68% below	85%
DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 DIPHTHERIA-TETANUS-PERTUS-HEP B-POLIO 0.5 mL (SYR)	$131.12	$874.10	$112.85–$830.40	—	85%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 DIPHTH/HAEMOPHILUS/PERTUSSIS/TETANUS/POLIO (PENTACEL) - Kit	$101.16	$674.42	$87.07–$640.70	52% below	85%
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 DIPHTH/HAEMOPHILUS/PERTUSSIS/TETANUS/POLIO (PENTACEL) - Kit	$101.16	$674.42	$87.07–$640.70	—	85%
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) CPT 90697 DIPHTH/HAEM/HEPB/ACELPERTUSSIS/POLIO/TETANUS (VAXELIS)	$218.00	$1,453.30	$187.62–$1,380.64	43% above	85%
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) inpatient CPT 90697 DIPHTH/HAEM/HEPB/ACELPERTUSSIS/POLIO/TETANUS (VAXELIS)	$218.00	$1,453.30	$187.62–$1,380.64	—	85%
Flu shot, recombinant, egg-free (Flublok) CPT 90673 INFLUENZA VIRUS VACCINE TRIVALENT RECOMB. HEMAGGLUTININ	$161.21	$1,074.72	$138.75–$1,020.98	56% above	85%
Flu shot, recombinant, egg-free (Flublok) inpatient CPT 90673 INFLUENZA VIRUS VACCINE TRIVALENT RECOMB. HEMAGGLUTININ	$161.21	$1,074.72	$138.75–$1,020.98	—	85%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 INFLUENZA VIRUS VACCINE TRIVALENT INJ SYRINGE (0.5 ML)	$41.79	$278.58	$35.96–$264.65	44% below	85%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 INFLUENZA VIRUS VACCINE TRIVALENT INJ SYRINGE (0.5 ML)	$41.79	$278.58	$35.96–$264.65	—	85%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HUMAN PAPILLOMAVIRUS VACCINE (9-VALENT)	$379.56	$2,530.37	$326.67–$2,403.85	at median	85%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HUMAN PAPILLOMAVIRUS VACCINE (9-VALENT)	$379.56	$2,530.37	$326.67–$2,403.85	—	85%
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 HEPATITIS A AND B RECOMB VACCINE 1 ML PF SYR	$101.46	$676.39	$87.32–$642.57	7% below	85%
Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 HEPATITIS A AND B RECOMB VACCINE 1 ML PF SYR	$101.46	$676.39	$87.32–$642.57	—	85%
Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A ADULT VACCINE 1440 UNITS/ML PF SYR	$67.31	$448.71	$57.93–$426.27	30% below	85%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITIS A ADULT VACCINE 1440 UNITS/ML PF SYR	$67.31	$448.71	$57.93–$426.27	—	85%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HEPATITIS A PEDIATRIC VACCINE 720 UNITS / 0.5 mL	$57.60	$384.03	$49.58–$364.83	46% below	85%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HEPATITIS A PEDIATRIC VACCINE 25 UNITS / 0.5 mL	$65.06	$433.74	$56.00–$412.05	39% below	85%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 HEPATITIS A PEDIATRIC VACCINE 720 UNITS / 0.5 mL	$57.60	$384.03	$49.58–$364.83	—	85%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 HEPATITIS A PEDIATRIC VACCINE 25 UNITS / 0.5 mL	$65.06	$433.74	$56.00–$412.05	—	85%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B VACCINE 20 MCG/ML	$52.26	$348.37	$44.97–$330.95	63% below	85%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B VACCINE 20 MCG/ML	$52.26	$348.37	$44.97–$330.95	—	85%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPATITIS B VACCINE 10 MCG/0.5 ML (PEDIATRIC)	$41.30	$275.30	$35.54–$261.54	28% above	85%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPATITIS B VACCINE 5 MCG/0.5 ML (PEDIATRIC)	$48.84	$325.62	$42.04–$309.34	51% above	85%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEPATITIS B VACCINE 10 MCG/0.5 ML (PEDIATRIC)	$41.30	$275.30	$35.54–$261.54	—	85%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEPATITIS B VACCINE 5 MCG/0.5 ML (PEDIATRIC)	$48.84	$325.62	$42.04–$309.34	—	85%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 HAEMOPHILUS B CONJUGATE (PRP-T) VACCINE	$12.29	$81.94	$10.58–$77.84	75% below	85%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 HAEMOPHILUS B CONJUGATE (PRP-T) VACCINE	$12.29	$81.94	$10.58–$77.84	—	85%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 INFLUENZA VIRUS VACCINE TRIVALENT INJ (HIGH DOSE) 0.5 mL	$161.46	$1,076.42	$138.97–$1,022.60	33% below	85%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 INFLUENZA VIRUS VACCINE TRIVALENT INJ (HIGH DOSE) 0.5 mL	$161.46	$1,076.42	$138.97–$1,022.60	—	85%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES-MUMPS-RUBELLA VACC INJ	$72.32	$482.11	$62.24–$458.00	32% below	85%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES-MUMPS-RUBELLA VACC INJ	$72.32	$482.11	$62.24–$458.00	—	85%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 MEASLES/MUMPS/RUBELLA/VARICELLA (MMRV) VACC	$187.11	$1,247.39	$161.04–$1,185.02	5% above	85%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 MEASLES/MUMPS/RUBELLA/VARICELLA (MMRV) VACC	$187.11	$1,247.39	$161.04–$1,185.02	—	85%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOCOCCAL CONGUGATE VACCINE	$107.82	$718.83	$92.80–$682.89	29% below	85%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOCOCCAL CONGUGATE VACCINE POWDER (2-VIAL) for INJ	$116.87	$779.14	$100.59–$740.18	24% below	85%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOCOCCAL CONGUGATE VACCINE SOLUTION (1-VIAL) for INJ	$301.29	$2,008.63	$259.31–$1,908.20	97% above	85%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENINGOCOCCAL CONGUGATE VACCINE	$107.82	$718.83	$92.80–$682.89	—	85%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENINGOCOCCAL CONGUGATE VACCINE POWDER (2-VIAL) for INJ	$116.87	$779.14	$100.59–$740.18	—	85%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENINGOCOCCAL CONGUGATE VACCINE SOLUTION (1-VIAL) for INJ	$301.29	$2,008.63	$259.31–$1,908.20	—	85%
Meningococcal ACWY vaccine (MenQuadfi) CPT 90619 MENINGOCOCCAL CONGUGATE VACCINE POLYSACCHARIDE TETANUS TOXOID ACYW	$350.46	$2,336.43	$301.63–$2,219.61	160% above	85%
Meningococcal ACWY vaccine (MenQuadfi) inpatient CPT 90619 MENINGOCOCCAL CONGUGATE VACCINE POLYSACCHARIDE TETANUS TOXOID ACYW	$350.46	$2,336.43	$301.63–$2,219.61	—	85%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENINGOCOCCAL GROUP B OMV VACCINE INJ	$305.67	$2,037.80	$263.08–$1,935.91	4% above	85%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 MENINGOCOCCAL GROUP B OMV VACCINE INJ	$305.67	$2,037.80	$263.08–$1,935.91	—	85%
Meningococcal B vaccine (Trumenba) CPT 90621 MENINGOCOCCAL GROUP B VACCINE INJ	$246.08	$1,640.51	$211.79–$1,558.48	9% above	85%
Meningococcal B vaccine (Trumenba) inpatient CPT 90621 MENINGOCOCCAL GROUP B VACCINE INJ	$246.08	$1,640.51	$211.79–$1,558.48	—	85%
Mpox and smallpox vaccine (Jynneos), 2-dose schedule CPT 90611 SMALLPOX AND MONKEYPOX VACCINE 0.5ML	$550.64	$3,670.92	$473.92–$3,487.37	—	85%
Mpox and smallpox vaccine (Jynneos), 2-dose schedule inpatient CPT 90611 SMALLPOX AND MONKEYPOX VACCINE 0.5ML	$550.64	$3,670.92	$473.92–$3,487.37	—	85%
Nasal spray flu vaccine, live (FluMist) CPT 90660 INFLUENZA VIRUS VACCINE TRIVALENT 0.2 ML NASAL SPRAY	$25.19	$167.91	$21.68–$159.51	—	85%
Nasal spray flu vaccine, live (FluMist) inpatient CPT 90660 INFLUENZA VIRUS VACCINE TRIVALENT 0.2 ML NASAL SPRAY	$25.19	$167.91	$21.68–$159.51	—	85%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PNEUMOCOCCAL 13-VALENT VACCINE 0.5 ML	$365.66	$2,437.74	$314.71–$2,315.85	4% above	85%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 PNEUMOCOCCAL 13-VALENT VACCINE 0.5 ML	$365.66	$2,437.74	$314.71–$2,315.85	—	85%
Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) CPT 90671 PNEUMOCOCCAL 15-VALENT VACCINE 0.5 ML	$440.43	$2,936.20	$379.06–$2,789.39	110% above	85%
Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) inpatient CPT 90671 PNEUMOCOCCAL 15-VALENT VACCINE 0.5 ML	$440.43	$2,936.20	$379.06–$2,789.39	—	85%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCOCCAL 20-VALENT VACCINE 0.5 ML	$507.55	$3,383.69	$436.83–$3,214.51	41% above	85%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOCOCCAL 20-VALENT VACCINE 0.5 ML	$507.55	$3,383.69	$436.83–$3,214.51	—	85%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL 23-VALENT VACCINE (0.5 ML)	$192.75	$1,285.01	$165.89–$1,220.76	19% below	85%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL 23-VALENT VACCINE (0.5 ML)	$192.75	$1,285.01	$165.89–$1,220.76	—	85%
Polio vaccine, inactivated (IPV) CPT 90713 POLIOVIRUS VACCINE INACTIVATED INJ	$64.94	$432.90	$55.89–$411.26	40% below	85%
Polio vaccine, inactivated (IPV) inpatient CPT 90713 POLIOVIRUS VACCINE INACTIVATED INJ	$64.94	$432.90	$55.89–$411.26	—	85%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 NIRSEVIMAB-ALIP PF INJ 100 MG	$529.99	$3,533.26	$456.14–$3,356.60	41% below	85%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 NIRSEVIMAB-ALIP PF INJ 100 MG	$529.99	$3,533.26	$456.14–$3,356.60	—	85%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 NIRSEVIMAB-ALIP PF INJ 50 MG	$1,009.50	$6,730.02	$868.85–$6,393.52	13% above	85%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 NIRSEVIMAB-ALIP PF INJ 50 MG	$1,009.50	$6,730.02	$868.85–$6,393.52	—	85%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 RSV VACCINE preF A-preF B RECOMBINANT 60 MCG-60 MCG PF SYR	$300.81	$2,005.41	$258.90–$1,905.14	63% below	85%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 RSV VACCINE preF A-preF B RECOMBINANT 60 MCG-60 MCG PF VIAL	$312.84	$2,085.63	$269.25–$1,981.35	62% below	85%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 RSV VACCINE preF A-preF B RECOMBINANT 60 MCG-60 MCG PF SYR	$300.81	$2,005.41	$258.90–$1,905.14	—	85%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 RSV VACCINE preF A-preF B RECOMBINANT 60 MCG-60 MCG PF VIAL	$312.84	$2,085.63	$269.25–$1,981.35	—	85%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE HUMAN INJ (1 ML)	$381.54	$2,543.59	$328.38–$2,416.41	24% below	85%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE INJ CHICK EMBRYO (1 ML)	$386.51	$2,576.73	$332.66–$2,447.89	23% below	85%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE HUMAN INJ (1 ML)	$381.54	$2,543.59	$328.38–$2,416.41	—	85%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE INJ CHICK EMBRYO (1 ML)	$386.51	$2,576.73	$332.66–$2,447.89	—	85%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) CPT 90681 ROTAVIRUS VACCINE MONOVALENT LIQUID FOR ORAL SUSP (1.5 mL)	$91.50	$609.99	$78.75–$579.49	41% below	85%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) CPT 90681 ROTAVIRUS VACCINE MONOVALENT PWD for ORAL SUSP (1 mL)	$107.39	$715.93	$92.43–$680.13	30% below	85%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) inpatient CPT 90681 ROTAVIRUS VACCINE MONOVALENT LIQUID FOR ORAL SUSP (1.5 mL)	$91.50	$609.99	$78.75–$579.49	—	85%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) inpatient CPT 90681 ROTAVIRUS VACCINE MONOVALENT PWD for ORAL SUSP (1 mL)	$107.39	$715.93	$92.43–$680.13	—	85%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 ROTAVIRUS VACCINE PENTAVALENT ORAL SUSP (2 mL)	$39.87	$265.81	$34.32–$252.52	66% below	85%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 ROTAVIRUS VACCINE PENTAVALENT ORAL SUSP (2 mL)	$39.87	$265.81	$34.32–$252.52	—	85%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 ZOSTER VACCINE 50 MCG / 0.5 mL	$142.76	$951.72	$122.87–$904.13	33% below	85%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 ZOSTER VACCINE 50 MCG / 0.5 mL	$142.76	$951.72	$122.87–$904.13	—	85%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS / DIPHTHERIA ADULT 2 units-2 units (0.5 ML) (APG ONLY)	$48.80	$325.30	$42.00–$309.04	5% above	85%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS / DIPHTHERIA ADULT 5 units-2 units (0.5 ML)	$66.56	$443.76	$57.29–$421.57	43% above	85%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS / DIPHTHERIA ADULT 2 units-2 units (0.5 ML) (APG ONLY)	$48.80	$325.30	$42.00–$309.04	—	85%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS / DIPHTHERIA ADULT 5 units-2 units (0.5 ML)	$66.56	$443.76	$57.29–$421.57	—	85%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TETANUS/DIPHTHER/PERTUSSIS 5 UNIT/2.5 UNIT/18.5 MCG PER 0.5 ML SYR	$69.40	$462.67	$59.73–$439.54	10% above	85%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TETANUS/DIPHTHER/PERTUSSIS 5 UNIT/2.5 UNIT/18.5 MCG PER 0.5 ML VIAL	$69.40	$462.67	$59.73–$439.54	10% above	85%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TETANUS/DIPHTHER/PERTUSSIS 5 UNIT/2 UNIT/15.5 MCG PER 0.5 ML SYR	$96.66	$644.37	$83.19–$612.15	53% above	85%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TETANUS/DIPHTHER/PERTUSSIS 5 UNIT/2.5 UNIT/18.5 MCG PER 0.5 ML SYR	$69.40	$462.67	$59.73–$439.54	—	85%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TETANUS/DIPHTHER/PERTUSSIS 5 UNIT/2.5 UNIT/18.5 MCG PER 0.5 ML VIAL	$69.40	$462.67	$59.73–$439.54	—	85%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TETANUS/DIPHTHER/PERTUSSIS 5 UNIT/2 UNIT/15.5 MCG PER 0.5 ML SYR	$96.66	$644.37	$83.19–$612.15	—	85%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 MP-IMMUNIZ. ADMIN-INITIAL VACC	$22.65	$151.00	$19.49–$143.45	71% below	85%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN ONE VACCINE	$22.65	$151.00	$20.85–$151.00	71% below	85%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMINISTRATION	$22.65	$151.00	$19.49–$143.45	71% below	85%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN-INITIAL VACC	$22.65	$151.00	$19.49–$143.45	71% below	85%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 INJ TETANUS ADMINISTRATION	$22.65	$151.00	$20.85–$151.00	71% below	85%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 MP-IMMUNIZ. ADMIN-EACH ADDL.VACC	$21.30	$142.00	$18.33–$134.90	70% below	85%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZ ADMINIS,EACH ADDL VACCINE	$21.30	$142.00	$19.61–$142.00	70% below	85%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMIN-EACH ADDL.VACC	$21.30	$142.00	$18.33–$134.90	70% below	85%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMIN,EACH ADDL.VACC	$21.30	$142.00	$18.33–$134.90	70% below	85%

Source file: https://atlanticare.pt.panaceainc.com/MRFDownload/atlanticare/atlanticare