Hospital Detroit-Warren-Dearborn, MI

McLaren Oakland

McLaren Oakland in Pontiac, MI publishes cash prices for 467 common procedures listed here, from its own machine-readable price file updated Dec 31, 2025. Compared with other hospitals in the state, its outpatient cash prices are below the Michigan median for 320 of 459 procedures and above it for 128. By typical cash price it ranks #26 of 97 Michigan hospitals and #11 of 31 hospitals in the Detroit, MI area, cheapest first. Select a procedure to compare it with other hospitals nearby.

50 N PERRY ST, PONTIAC MI, 48342 Collected Sep 23, 2026 Source price file Check a bill from this hospital (248) 338-5000

Acute care hospital Nonprofit hospital Emergency department CMS star rating 2 of 5 CCN 230207 · CMS hospital register NPI 1376564088

Financial assistance

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

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

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

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

CMS price transparency record

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

Oct 9, 2024 Met requirements
May 21, 2025 Met requirements
Jun 16, 2025 Met requirements

Met requirements: CMS reviewed the hospital and found it met the requirements, so no further action was taken.

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

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Michigan	Off list
Abdominal CT scan without and with contrast CPT 74170 CT Abdomen w/ + w/o Contrast	$1,082.10	$2,164.20	$97.38–$1,560.82	31% below	50%
Abdominal CT scan without and with contrast CPT 74170 Add On - CT Abdomen w/ + w/o Contrast	$1,082.10	$2,164.20	$97.38–$1,143.72	31% below	50%
Abdominal CT scan without and with contrast inpatient CPT 74170 CT Abdomen w/ + w/o Contrast	$1,082.10	$2,164.20	$97.38–$1,560.82	—	50%
Abdominal CT scan without and with contrast inpatient CPT 74170 Add On - CT Abdomen w/ + w/o Contrast	$1,082.10	$2,164.20	$97.38–$1,143.72	—	50%
Abdominal X-ray, 2 views CPT 74019 XR Abdomen 2 Views	$114.45	$228.90	$58.17–$177.70	45% below	50%
Abdominal X-ray, 2 views inpatient CPT 74019 XR Abdomen 2 Views	$114.45	$228.90	$58.17–$177.70	—	50%
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR Ankle Complete 3+ Views Right	$106.85	$213.70	$48.16–$165.04	50% below	50%
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR Ankle Complete 3+ Views Left	$106.85	$213.70	$48.16–$163.16	50% below	50%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR Ankle Complete 3+ Views Left	$106.85	$213.70	$48.16–$163.16	—	50%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR Ankle Complete 3+ Views Right	$106.85	$213.70	$48.16–$165.04	—	50%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 US Segmental Pressures U/L 1-2 lvls Bil	$135.15	$270.30	$70.51–$279.65	56% below	50%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 Upr/Lwr Extremity Art Study 2 Level	$135.15	$270.30	$70.51–$279.65	56% below	50%
Ankle-brachial index (ABI), blood pressure test for leg arteries one side CPT 93922 PFT CHARGE -> Right Leg TCOM with ABI 3 or more levels	$135.15	$270.30	$70.51–$279.65	56% below	50%
Ankle-brachial index (ABI), blood pressure test for leg arteries one side CPT 93922 PFT CHARGE -> Left leg TCOM with ABI 3 or more levels	$135.15	$270.30	$70.51–$279.65	56% below	50%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 US Segmental Pressures U/L 1-2 lvls Bil	$135.15	$270.30	$70.51–$279.65	—	50%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 Upr/Lwr Extremity Art Study 2 Level	$135.15	$270.30	$70.51–$279.65	—	50%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient one side CPT 93922 PFT CHARGE -> Right Leg TCOM with ABI 3 or more levels	$135.15	$270.30	$70.51–$279.65	—	50%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient one side CPT 93922 PFT CHARGE -> Left leg TCOM with ABI 3 or more levels	$135.15	$270.30	$70.51–$279.65	—	50%
Arm CT scan without contrast (shoulder to hand, any part) both sides CPT 73200 CT Upper Extremity w/o Contrast Bilat	$899.90	$1,799.80	$58.17–$673.13	—	50%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Shoulder w/o Contrast Right	$899.90	$1,799.80	$58.17–$1,298.02	11% below	50%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Hand w/o Contrast Left	$899.90	$1,799.80	$58.17–$673.13	11% below	50%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Upper Extremity w/o Contrast Right	$899.90	$1,799.80	$58.17–$1,204.97	11% below	50%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Hand w/o Contrast Right	$899.90	$1,799.80	$58.17–$1,298.02	11% below	50%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Wrist w/o Contrast Left	$899.90	$1,799.80	$58.17–$1,298.02	11% below	50%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Shoulder w/o Contrast Left	$899.90	$1,799.80	$58.17–$1,298.02	11% below	50%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Elbow w/o Contrast Right	$899.90	$1,799.80	$58.17–$1,259.86	11% below	50%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 Add On - CT Upper Extrem w/o Cont Right	$899.90	$1,799.80	$58.17–$673.13	11% below	50%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Elbow w/o Contrast Left	$899.90	$1,799.80	$58.17–$1,204.97	11% below	50%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Wrist w/o Contrast Right	$899.90	$1,799.80	$58.17–$709.07	11% below	50%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Upper Extremity w/o Contrast Left	$899.90	$1,799.80	$58.17–$1,204.97	11% below	50%
Arm CT scan without contrast (shoulder to hand, any part) inpatient both sides CPT 73200 CT Upper Extremity w/o Contrast Bilat	$899.90	$1,799.80	$58.17–$673.13	—	50%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Hand w/o Contrast Left	$899.90	$1,799.80	$58.17–$673.13	—	50%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 Add On - CT Upper Extrem w/o Cont Right	$899.90	$1,799.80	$58.17–$673.13	—	50%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Shoulder w/o Contrast Left	$899.90	$1,799.80	$58.17–$1,298.02	—	50%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Hand w/o Contrast Right	$899.90	$1,799.80	$58.17–$1,298.02	—	50%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Wrist w/o Contrast Right	$899.90	$1,799.80	$58.17–$709.07	—	50%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Shoulder w/o Contrast Right	$899.90	$1,799.80	$58.17–$1,298.02	—	50%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Wrist w/o Contrast Left	$899.90	$1,799.80	$58.17–$1,298.02	—	50%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Upper Extremity w/o Contrast Right	$899.90	$1,799.80	$58.17–$1,204.97	—	50%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Upper Extremity w/o Contrast Left	$899.90	$1,799.80	$58.17–$1,204.97	—	50%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Elbow w/o Contrast Left	$899.90	$1,799.80	$58.17–$1,204.97	—	50%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Elbow w/o Contrast Right	$899.90	$1,799.80	$58.17–$1,259.86	—	50%
Barium swallow (esophagus X-ray with contrast) CPT 74220 XR Esophagus	$217.70	$435.40	$97.38–$391.53	23% below	50%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 XR Esophagus	$217.70	$435.40	$97.38–$391.53	—	50%
Bone scan, whole body (nuclear medicine) CPT 78306 NM Bone/Joint Img - Whole Body Delay 1	$636.80	$1,273.60	$219.80–$1,298.02	32% below	50%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM Bone/Joint Img - Whole Body Delay 1	$636.80	$1,273.60	$219.80–$1,298.02	—	50%
Breast ultrasound, complete, one breast both sides CPT 76641 US Breast ABUS Complete Bilateral	$188.30	$376.60	$58.17–$389.62	—	50%
Breast ultrasound, complete, one breast both sides CPT 76641 US Breast Complete Bilateral	$188.30	$376.60	$58.17–$389.62	—	50%
Breast ultrasound, complete, one breast one side CPT 76641 US Breast ABUS Complete Right	$188.30	$376.60	$58.17–$389.62	38% below	50%
Breast ultrasound, complete, one breast one side CPT 76641 ADD ON - US Breast Complete Right	$188.30	$376.60	$58.17–$389.62	38% below	50%
Breast ultrasound, complete, one breast one side CPT 76641 US Breast Complete Right	$188.30	$376.60	$58.17–$389.62	38% below	50%
Breast ultrasound, complete, one breast one side CPT 76641 US Breast Complete Left	$188.30	$376.60	$58.17–$389.62	38% below	50%
Breast ultrasound, complete, one breast one side CPT 76641 US Breast ABUS Complete Left	$188.30	$376.60	$58.17–$389.62	38% below	50%
Breast ultrasound, complete, one breast one side CPT 76641 ADD ON - US Breast ABUS Complete Right	$188.30	$376.60	$58.17–$389.62	38% below	50%
Breast ultrasound, complete, one breast inpatient both sides CPT 76641 US Breast ABUS Complete Bilateral	$188.30	$376.60	$58.17–$389.62	—	50%
Breast ultrasound, complete, one breast inpatient both sides CPT 76641 US Breast Complete Bilateral	$188.30	$376.60	$58.17–$389.62	—	50%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US Breast ABUS Complete Left	$188.30	$376.60	$58.17–$389.62	—	50%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US Breast ABUS Complete Right	$188.30	$376.60	$58.17–$389.62	—	50%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US Breast Complete Left	$188.30	$376.60	$58.17–$389.62	—	50%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 ADD ON - US Breast Complete Right	$188.30	$376.60	$58.17–$389.62	—	50%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US Breast Complete Right	$188.30	$376.60	$58.17–$389.62	—	50%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 ADD ON - US Breast ABUS Complete Right	$188.30	$376.60	$58.17–$389.62	—	50%
Breast ultrasound, limited (one breast or one area) both sides CPT 76642 US Breast Limited Bilateral	$163.90	$327.80	$48.16–$302.81	—	50%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US Breast Limited Right	$163.90	$327.80	$48.16–$302.81	38% below	50%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US Breast Limited Left	$163.90	$327.80	$48.16–$302.81	38% below	50%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 Add On - US Breast Limited RT	$163.90	$327.80	$48.16–$302.81	38% below	50%
Breast ultrasound, limited (one breast or one area) inpatient both sides CPT 76642 US Breast Limited Bilateral	$163.90	$327.80	$48.16–$302.81	—	50%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US Breast Limited Right	$163.90	$327.80	$48.16–$302.81	—	50%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 Add On - US Breast Limited RT	$163.90	$327.80	$48.16–$302.81	—	50%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US Breast Limited Left	$163.90	$327.80	$48.16–$302.81	—	50%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CT Angio Abdomen and Pelvis	$1,130.30	$2,260.60	$195.35–$1,633.60	54% below	50%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CT Venogram Abdomen and Pelvis	$1,130.30	$2,260.60	$195.35–$1,633.60	54% below	50%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 Add On - CT Angio Abdomen and Pelvis	$1,130.30	$2,260.60	$195.35–$1,633.60	54% below	50%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 Add On - CT Angio Abdomen and Pelvis	$1,130.30	$2,260.60	$195.35–$1,633.60	—	50%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CT Angio Abdomen and Pelvis	$1,130.30	$2,260.60	$195.35–$1,633.60	—	50%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CT Venogram Abdomen and Pelvis	$1,130.30	$2,260.60	$195.35–$1,633.60	—	50%
CT angiography (CTA) of the head CPT 70496 CT Venogram Brain/Head	$1,434.50	$2,869.00	$97.38–$2,069.12	7% below	50%
CT angiography (CTA) of the head CPT 70496 CT Angio Brain and Neck	$1,434.50	$2,869.00	$97.38–$2,069.12	7% below	50%
CT angiography (CTA) of the head CPT 70496 CT Angio Brain/Head	$1,434.50	$2,869.00	$97.38–$2,069.12	7% below	50%
CT angiography (CTA) of the head inpatient CPT 70496 CT Angio Brain/Head	$1,434.50	$2,869.00	$97.38–$2,069.12	—	50%
CT angiography (CTA) of the head inpatient CPT 70496 CT Angio Brain and Neck	$1,434.50	$2,869.00	$97.38–$2,069.12	—	50%
CT angiography (CTA) of the head inpatient CPT 70496 CT Venogram Brain/Head	$1,434.50	$2,869.00	$97.38–$2,069.12	—	50%
CT angiography (CTA) of the neck CPT 70498 Add On - CT Angio Neck	$1,269.25	$2,538.50	$97.38–$1,830.77	15% below	50%
CT angiography (CTA) of the neck CPT 70498 CT Angio Neck	$1,436.75	$2,873.50	$97.38–$2,072.37	4% below	50%
CT angiography (CTA) of the neck CPT 70498 CT Venogram Neck	$1,436.75	$2,873.50	$97.38–$1,147.59	4% below	50%
CT angiography (CTA) of the neck inpatient CPT 70498 Add On - CT Angio Neck	$1,269.25	$2,538.50	$97.38–$1,830.77	—	50%
CT angiography (CTA) of the neck inpatient CPT 70498 CT Venogram Neck	$1,436.75	$2,873.50	$97.38–$1,147.59	—	50%
CT angiography (CTA) of the neck inpatient CPT 70498 CT Angio Neck	$1,436.75	$2,873.50	$97.38–$2,072.37	—	50%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT Angio Chest/Abdomen	$1,161.15	$2,322.30	$97.38–$1,161.10	30% below	50%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT Angio Chest/Abdomen/Pelvis	$1,161.15	$2,322.30	$97.38–$1,674.84	30% below	50%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT Angio Chest	$1,161.15	$2,322.30	$97.38–$1,793.51	30% below	50%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT Angio Chest PE Protocol	$1,161.15	$2,322.30	$97.38–$1,674.84	30% below	50%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT Angio TAVR Chest, Abdomen, Pelvis	$1,161.15	$2,322.30	$97.38–$1,161.10	30% below	50%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT Angio TAVR Chest, Abdomen, Pelvis	$1,161.15	$2,322.30	$97.38–$1,161.10	—	50%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT Angio Chest PE Protocol	$1,161.15	$2,322.30	$97.38–$1,674.84	—	50%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT Angio Chest/Abdomen/Pelvis	$1,161.15	$2,322.30	$97.38–$1,674.84	—	50%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT Angio Chest	$1,161.15	$2,322.30	$97.38–$1,793.51	—	50%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT Angio Chest/Abdomen	$1,161.15	$2,322.30	$97.38–$1,161.10	—	50%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CT Angio Coronary Artery Str/Mph/Fnt Cnt	$757.55	$1,515.10	$195.35–$1,247.86	43% below	50%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 CT Angio Coronary Artery Str/Mph/Fnt Cnt	$757.55	$1,515.10	$195.35–$1,247.86	—	50%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT Heart Calcium Scoring	$75.00	$150.00	$48.16–$432.02	50% below	50%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT Heart Calcium Scoring	$75.00	$150.00	$48.16–$432.02	—	50%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Enterography Abd/Pelvis w/o Cont	$1,078.30	$2,156.60	$132.22–$605.63	40% below	50%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 Add On - CT Abd/Pelvis w/o Contrast	$1,078.30	$2,156.60	$132.22–$1,665.54	40% below	50%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Abd/Pelvis w/o Cont Stone Protocol	$1,078.30	$2,156.60	$132.22–$1,555.34	40% below	50%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Abdomen and Pelvis w/o Contrast	$1,078.30	$2,156.60	$132.22–$1,665.54	40% below	50%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 Add On - CT Abd/Pelvis w/o Contrast	$1,078.30	$2,156.60	$132.22–$1,665.54	—	50%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT Abd/Pelvis w/o Cont Stone Protocol	$1,078.30	$2,156.60	$132.22–$1,555.34	—	50%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT Enterography Abd/Pelvis w/o Cont	$1,078.30	$2,156.60	$132.22–$605.63	—	50%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT Abdomen and Pelvis w/o Contrast	$1,078.30	$2,156.60	$132.22–$1,665.54	—	50%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Enterography Abd/Pelvis w/Cont	$1,347.95	$2,695.90	$195.35–$1,887.13	53% below	50%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 Add On - CT Abd/Pelvis w/ Contrast	$1,347.95	$2,695.90	$195.35–$2,082.04	53% below	50%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abdomen and Pelvis w/ Contrast	$1,347.95	$2,695.90	$195.35–$2,082.04	53% below	50%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 Add On - CT Abd/Pelvis w/ Contrast	$1,347.95	$2,695.90	$195.35–$2,082.04	—	50%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Enterography Abd/Pelvis w/Cont	$1,347.95	$2,695.90	$195.35–$1,887.13	—	50%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abdomen and Pelvis w/ Contrast	$1,347.95	$2,695.90	$195.35–$2,082.04	—	50%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 Add On - CT Abd/Pelvis w/ + w/o Contr	$1,347.95	$2,695.90	$195.35–$1,944.28	49% below	50%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT Abdomen w/ + w/o + Pelvis w/ Contrast	$1,347.95	$2,695.90	$195.35–$1,438.81	49% below	50%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT Urogram Abd/Pelvis w/ + w/o Contrast	$1,347.95	$2,695.90	$195.35–$1,944.28	49% below	50%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT Enterography Abd/Pelvis w/+ w/o Cont	$1,347.95	$2,695.90	$195.35–$1,438.81	49% below	50%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT Abdomen and Pelvis w/ + w/o Contrast	$1,347.95	$2,695.90	$195.35–$1,944.28	49% below	50%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT Abd/Pelvis w/ + w/o Contrast Cystogra	$1,347.95	$2,695.90	$195.35–$1,438.81	49% below	50%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT Urogram Abd/Pelvis w/ + w/o Contrast	$1,347.95	$2,695.90	$195.35–$1,944.28	—	50%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT Abd/Pelvis w/ + w/o Contrast Cystogra	$1,347.95	$2,695.90	$195.35–$1,438.81	—	50%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 Add On - CT Abd/Pelvis w/ + w/o Contr	$1,347.95	$2,695.90	$195.35–$1,944.28	—	50%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT Abdomen w/ + w/o + Pelvis w/ Contrast	$1,347.95	$2,695.90	$195.35–$1,438.81	—	50%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT Enterography Abd/Pelvis w/+ w/o Cont	$1,347.95	$2,695.90	$195.35–$1,438.81	—	50%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT Abdomen and Pelvis w/ + w/o Contrast	$1,347.95	$2,695.90	$195.35–$1,944.28	—	50%
CT scan of the abdomen with contrast CPT 74160 Add On - CT Abdomen w/ Contrast	$1,022.65	$2,045.30	$97.38–$1,008.71	30% below	50%
CT scan of the abdomen with contrast CPT 74160 CT Abdomen w/ Contrast	$1,022.65	$2,045.30	$97.38–$1,249.88	30% below	50%
CT scan of the abdomen with contrast inpatient CPT 74160 Add On - CT Abdomen w/ Contrast	$1,022.65	$2,045.30	$97.38–$1,008.71	—	50%
CT scan of the abdomen with contrast inpatient CPT 74160 CT Abdomen w/ Contrast	$1,022.65	$2,045.30	$97.38–$1,249.88	—	50%
CT scan of the abdomen without contrast CPT 74150 Add On - CT Abdomen w/o Contrast	$981.15	$1,962.30	$58.17–$478.30	5% above	50%
CT scan of the abdomen without contrast CPT 74150 CT Abdomen w/o Contrast	$981.15	$1,962.30	$58.17–$1,415.21	5% above	50%
CT scan of the abdomen without contrast inpatient CPT 74150 CT Abdomen w/o Contrast	$981.15	$1,962.30	$58.17–$1,415.21	—	50%
CT scan of the abdomen without contrast inpatient CPT 74150 Add On - CT Abdomen w/o Contrast	$981.15	$1,962.30	$58.17–$478.30	—	50%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT Mandible w/o Contrast	$981.15	$1,962.30	$58.17–$1,199.16	6% below	50%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT TMJ w/o Contrast	$981.15	$1,962.30	$58.17–$518.82	6% below	50%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT Maxillofacial w/o Contrast	$981.15	$1,962.30	$58.17–$1,515.48	6% below	50%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT Sinus w/o Contrast	$981.15	$1,962.30	$58.17–$1,515.48	6% below	50%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT Mandible w/o Contrast	$981.15	$1,962.30	$58.17–$1,199.16	—	50%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT TMJ w/o Contrast	$981.15	$1,962.30	$58.17–$518.82	—	50%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT Sinus w/o Contrast	$981.15	$1,962.30	$58.17–$1,515.48	—	50%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT Maxillofacial w/o Contrast	$981.15	$1,962.30	$58.17–$1,515.48	—	50%
CT scan of the head or brain, no contrast dye CPT 70450 CT Brain/Head w/o Contrast	$983.50	$1,967.00	$58.17–$1,519.11	6% above	50%
CT scan of the head or brain, no contrast dye CPT 70450 CT Brain/Head w/o Cont Stroke Protocol	$983.50	$1,967.00	$58.17–$1,418.60	6% above	50%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Brain/Head w/o Cont Stroke Protocol	$983.50	$1,967.00	$58.17–$1,418.60	—	50%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Brain/Head w/o Contrast	$983.50	$1,967.00	$58.17–$1,519.11	—	50%
CT scan of the head with contrast CPT 70460 CT Brain/Head w/ Contrast	$1,022.65	$2,045.30	$97.38–$565.10	18% below	50%
CT scan of the head with contrast inpatient CPT 70460 CT Brain/Head w/ Contrast	$1,022.65	$2,045.30	$97.38–$565.10	—	50%
CT scan of the head without and with contrast CPT 70470 CT Brain/Head w/ + w/o Contrast	$1,082.10	$2,164.20	$97.38–$1,560.82	31% below	50%
CT scan of the head without and with contrast inpatient CPT 70470 CT Brain/Head w/ + w/o Contrast	$1,082.10	$2,164.20	$97.38–$1,560.82	—	50%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT Spine Lumbar w/o Contrast	$981.15	$1,962.30	$58.17–$1,415.21	10% below	50%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT Spine Lumbar w/o Contrast	$981.15	$1,962.30	$58.17–$1,415.21	—	50%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT Spine Cervical w/o Contrast	$981.15	$1,962.30	$58.17–$1,515.48	12% below	50%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT Spine Cervical w/o Contrast	$981.15	$1,962.30	$58.17–$1,515.48	—	50%
CT scan of the pelvis, with contrast dye CPT 72193 CT Pelvis w/ Contrast	$1,022.65	$2,045.30	$97.38–$1,475.07	24% below	50%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Pelvis w/ Contrast	$1,022.65	$2,045.30	$97.38–$1,475.07	—	50%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 US Carotid Duplex Bilateral	$419.70	$839.40	$132.22–$605.38	—	50%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 US Carotid Duplex Bilateral	$419.70	$839.40	$132.22–$605.38	—	50%
Chest CT scan without and with contrast CPT 71270 CT Chest/Abdomen w/ + w/o Contrast	$1,082.10	$2,164.20	$97.38–$811.97	38% below	50%
Chest CT scan without and with contrast CPT 71270 CT Chest High Resolution w/ + w/o Cont	$1,082.10	$2,164.20	$97.38–$811.97	38% below	50%
Chest CT scan without and with contrast CPT 71270 CT Chest w/ + w/o Contrast	$1,082.10	$2,164.20	$97.38–$1,560.82	38% below	50%
Chest CT scan without and with contrast CPT 71270 CT Chest/Abd/Pelvis w/ + w/o Contrast	$1,082.10	$2,164.20	$97.38–$1,560.82	38% below	50%
Chest CT scan without and with contrast inpatient CPT 71270 CT Chest/Abd/Pelvis w/ + w/o Contrast	$1,082.10	$2,164.20	$97.38–$1,560.82	—	50%
Chest CT scan without and with contrast inpatient CPT 71270 CT Chest w/ + w/o Contrast	$1,082.10	$2,164.20	$97.38–$1,560.82	—	50%
Chest CT scan without and with contrast inpatient CPT 71270 CT Chest/Abdomen w/ + w/o Contrast	$1,082.10	$2,164.20	$97.38–$811.97	—	50%
Chest CT scan without and with contrast inpatient CPT 71270 CT Chest High Resolution w/ + w/o Cont	$1,082.10	$2,164.20	$97.38–$811.97	—	50%
Chest X-ray, 2 views CPT 71046 XR Chest 2 Views	$114.45	$228.90	$48.16–$176.78	36% below	50%
Chest X-ray, 2 views CPT 71046 XR Chest Inspiration /+ Expiration	$114.45	$228.90	$48.16–$153.25	36% below	50%
Chest X-ray, 2 views inpatient CPT 71046 XR Chest 2 Views	$114.45	$228.90	$48.16–$176.78	—	50%
Chest X-ray, 2 views inpatient CPT 71046 XR Chest Inspiration /+ Expiration	$114.45	$228.90	$48.16–$153.25	—	50%
Chest X-ray, single view CPT 71045 XR Chest 1 View Frontal	$106.85	$213.70	$48.16–$163.16	32% below	50%
Chest X-ray, single view CPT 71045 XR Chest 1 View Portable	$106.85	$213.70	$48.16–$165.04	32% below	50%
Chest X-ray, single view CPT 71045 ADD ON - XR Single View Chest	$106.85	$213.70	$48.16–$137.40	32% below	50%
Chest X-ray, single view inpatient CPT 71045 XR Chest 1 View Portable	$106.85	$213.70	$48.16–$165.04	—	50%
Chest X-ray, single view inpatient CPT 71045 XR Chest 1 View Frontal	$106.85	$213.70	$48.16–$163.16	—	50%
Chest X-ray, single view inpatient CPT 71045 ADD ON - XR Single View Chest	$106.85	$213.70	$48.16–$137.40	—	50%
Collarbone (clavicle) X-ray, complete one side CPT 73000 XR Clavicle Right	$106.85	$213.70	$48.16–$165.04	41% below	50%
Collarbone (clavicle) X-ray, complete one side CPT 73000 XR Clavicle Left	$106.85	$213.70	$48.16–$163.16	41% below	50%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 XR Clavicle Left	$106.85	$213.70	$48.16–$163.16	—	50%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 XR Clavicle Right	$106.85	$213.70	$48.16–$165.04	—	50%
Complete ultrasound of the back of the abdomen, such as both kidneys both sides CPT 76770 US Bilat Renal Urinary Bladder Comp	$265.30	$530.60	$58.17–$422.39	—	50%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US Renal Retroperitoneal Comp	$265.30	$530.60	$58.17–$422.39	57% below	50%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US Retroperitoneal Complete	$265.30	$530.60	$58.17–$422.39	57% below	50%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient both sides CPT 76770 US Bilat Renal Urinary Bladder Comp	$265.30	$530.60	$58.17–$422.39	—	50%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US Retroperitoneal Complete	$265.30	$530.60	$58.17–$422.39	—	50%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US Renal Retroperitoneal Comp	$265.30	$530.60	$58.17–$422.39	—	50%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 BD Bone Density DEXA Axial Skeleton	$207.05	$414.10	$58.17–$319.81	33% below	50%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 BD Bone Density DEXA Axial Skeleton	$207.05	$414.10	$58.17–$319.81	—	50%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 BD Bone Density DEXA App Skeleton Periph	$62.90	$125.80	$48.16–$137.40	52% below	50%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 BD Bone Density DEXA App Skeleton Periph	$62.90	$125.80	$48.16–$137.40	—	50%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 WH OB US Detailed, Single	$125.15	$250.30	$132.22–$511.11	82% below	50%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US Pregnancy Complete w/ Detail	$125.15	$250.30	$132.22–$511.11	82% below	50%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 WH OB US Detailed, Single	$125.15	$250.30	$132.22–$511.11	—	50%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US Pregnancy Complete w/ Detail	$125.15	$250.30	$132.22–$511.11	—	50%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Chest w/o Contrast	$981.15	$1,962.30	$58.17–$1,415.21	2% below	50%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Lung Follow-up LOW Dose	$981.15	$1,962.30	$58.17–$1,415.21	2% below	50%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Chest/Abd/Pelvis w/o Contrast	$981.15	$1,962.30	$58.17–$1,515.48	2% below	50%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Chest/Abdomen w/o Contrast	$981.15	$1,962.30	$58.17–$487.97	2% below	50%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Chest High Resolution w/o Contrast	$981.15	$1,962.30	$58.17–$1,199.16	2% below	50%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Chest/Abd/Pelvis w/o Contrast	$981.15	$1,962.30	$58.17–$1,515.48	—	50%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Chest w/o Contrast	$981.15	$1,962.30	$58.17–$1,415.21	—	50%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Chest/Abdomen w/o Contrast	$981.15	$1,962.30	$58.17–$487.97	—	50%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Lung Follow-up LOW Dose	$981.15	$1,962.30	$58.17–$1,415.21	—	50%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Chest High Resolution w/o Contrast	$981.15	$1,962.30	$58.17–$1,199.16	—	50%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Chest w/ + Abd/Pelvis w/+w/o Contrast	$1,022.65	$2,045.30	$97.38–$1,431.71	22% below	50%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Chest w/ Contrast	$1,022.65	$2,045.30	$97.38–$1,475.07	22% below	50%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Chest High Resolution w/ Contrast	$1,022.65	$2,045.30	$97.38–$663.46	22% below	50%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Chest/Abd/Pelvis w/ Contrast	$1,022.65	$2,045.30	$97.38–$1,579.59	22% below	50%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Chest w/ + Abd w/+ w/o + Pelvis w/Con	$1,022.65	$2,045.30	$97.38–$1,431.71	22% below	50%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Chest/Abdomen w/ Contrast	$1,022.65	$2,045.30	$97.38–$805.80	22% below	50%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Chest w/ + Abd w/ + w/o Contrast	$1,022.65	$2,045.30	$97.38–$663.46	22% below	50%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Chest w/ Contrast	$1,022.65	$2,045.30	$97.38–$1,475.07	—	50%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Chest w/ + Abd/Pelvis w/+w/o Contrast	$1,022.65	$2,045.30	$97.38–$1,431.71	—	50%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Chest/Abd/Pelvis w/ Contrast	$1,022.65	$2,045.30	$97.38–$1,579.59	—	50%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Chest/Abdomen w/ Contrast	$1,022.65	$2,045.30	$97.38–$805.80	—	50%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Chest w/ + Abd w/+ w/o + Pelvis w/Con	$1,022.65	$2,045.30	$97.38–$1,431.71	—	50%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Chest w/ + Abd w/ + w/o Contrast	$1,022.65	$2,045.30	$97.38–$663.46	—	50%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Chest High Resolution w/ Contrast	$1,022.65	$2,045.30	$97.38–$663.46	—	50%
Diagnostic mammogram, both breasts both sides CPT 77066 MG Mammo Post Clip/Wire Placement Bilat	$325.65	$651.30	$646.11	—	50%
Diagnostic mammogram, both breasts both sides CPT 77066 MG Mammo Implant Diagnostic Bilateral	$325.65	$651.30	$646.11	—	50%
Diagnostic mammogram, both breasts both sides CPT 77066 Add On - MG Mammo Diagnostic Bilat	$325.65	$651.30	$271.46–$646.11	—	50%
Diagnostic mammogram, both breasts both sides CPT 77066 MG Mammo Diagnostic Bilateral	$325.65	$651.30	$398.01–$646.11	—	50%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MG Mammo Diagnostic Bilateral	$325.65	$651.30	$398.01–$646.11	—	50%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 Add On - MG Mammo Diagnostic Bilat	$325.65	$651.30	$271.46–$646.11	—	50%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MG Mammo Implant Diagnostic Bilateral	$325.65	$651.30	$646.11	—	50%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MG Mammo Post Clip/Wire Placement Bilat	$325.65	$651.30	$646.11	—	50%
Diagnostic mammogram, one breast one side CPT 77065 MG Mammo Diagnostic Left	$263.50	$527.00	$219.65–$507.24	15% below	50%
Diagnostic mammogram, one breast one side CPT 77065 MG Mammo Post Clip/Wire Placement Right	$263.50	$527.00	$322.05–$507.24	15% below	50%
Diagnostic mammogram, one breast one side CPT 77065 MG Mammo Post Clip/Wire Placement Left	$263.50	$527.00	$322.05–$507.24	15% below	50%
Diagnostic mammogram, one breast one side CPT 77065 MG Mammo Implant Diagnostic Right	$263.50	$527.00	$507.24	15% below	50%
Diagnostic mammogram, one breast one side CPT 77065 MG Mammo Implant Diagnostic Left	$263.50	$527.00	$507.24	15% below	50%
Diagnostic mammogram, one breast one side CPT 77065 MG Mammo Diagnostic Right	$263.50	$527.00	$219.65–$507.24	15% below	50%
Diagnostic mammogram, one breast one side CPT 77065 Add On - MG Mammo Diagnostic Right	$263.50	$527.00	$368.90–$507.24	15% below	50%
Diagnostic mammogram, one breast one side CPT 77065 Add On - MG Mammo Diagnostic Left	$263.50	$527.00	$322.05–$507.24	15% below	50%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MG Mammo Implant Diagnostic Left	$263.50	$527.00	$507.24	—	50%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MG Mammo Post Clip/Wire Placement Right	$263.50	$527.00	$322.05–$507.24	—	50%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MG Mammo Implant Diagnostic Right	$263.50	$527.00	$507.24	—	50%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MG Mammo Post Clip/Wire Placement Left	$263.50	$527.00	$322.05–$507.24	—	50%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MG Mammo Diagnostic Left	$263.50	$527.00	$219.65–$507.24	—	50%
Diagnostic mammogram, one breast inpatient one side CPT 77065 Add On - MG Mammo Diagnostic Left	$263.50	$527.00	$322.05–$507.24	—	50%
Diagnostic mammogram, one breast inpatient one side CPT 77065 Add On - MG Mammo Diagnostic Right	$263.50	$527.00	$368.90–$507.24	—	50%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MG Mammo Diagnostic Right	$263.50	$527.00	$219.65–$507.24	—	50%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 US Lower Ext Arterial Duplex Bilateral	$437.65	$875.30	$132.22–$796.29	—	50%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 US Lower Ext Arterial Duplex Bilateral	$437.65	$875.30	$132.22–$796.29	—	50%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US Lower Ext Venous Duplex Bilateral	$348.10	$696.20	$132.22–$608.55	—	50%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US Upper Ext Vein Mapping Bilateral	$348.10	$696.20	$132.22–$608.55	—	50%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US Lower Ext Vein Mapping Bilateral	$348.10	$696.20	$132.22–$608.55	—	50%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US Upper Ext Venous Duplex Bilateral	$348.10	$696.20	$132.22–$608.55	—	50%
Duplex ultrasound of the leg veins, both legs CPT 93970 US Lower Ext Venous Duplex Reflux Bil	$348.10	$696.20	$132.22–$608.55	42% below	50%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US Lower Ext Vein Mapping Bilateral	$348.10	$696.20	$132.22–$608.55	—	50%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US Lower Ext Venous Duplex Bilateral	$348.10	$696.20	$132.22–$608.55	—	50%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US Upper Ext Venous Duplex Bilateral	$348.10	$696.20	$132.22–$608.55	—	50%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US Upper Ext Vein Mapping Bilateral	$348.10	$696.20	$132.22–$608.55	—	50%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 US Lower Ext Venous Duplex Reflux Bil	$348.10	$696.20	$132.22–$608.55	—	50%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 CEC Echocardiogram Complete	$881.45	$1,762.90	$299.92–$855.59	38% below	50%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 CEC Echocardiogram Complete W/Contrast	$1,028.75	$2,057.50	$299.92–$855.59	28% below	50%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 CEC Echocardiogram Complete	$881.45	$1,762.90	$299.92–$855.59	—	50%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 CEC Echocardiogram Complete W/Contrast	$1,028.75	$2,057.50	$299.92–$855.59	—	50%
Elbow X-ray, 2 views one side CPT 73070 XR Elbow 2 Views Right	$106.85	$213.70	$48.16–$163.16	20% below	50%
Elbow X-ray, 2 views one side CPT 73070 XR Elbow 2 Views Left	$106.85	$213.70	$48.16–$163.16	20% below	50%
Elbow X-ray, 2 views inpatient one side CPT 73070 XR Elbow 2 Views Left	$106.85	$213.70	$48.16–$163.16	—	50%
Elbow X-ray, 2 views inpatient one side CPT 73070 XR Elbow 2 Views Right	$106.85	$213.70	$48.16–$163.16	—	50%
Elbow X-ray, complete, 3 or more views one side CPT 73080 XR Elbow Complete 3+ Views Left	$106.85	$213.70	$48.16–$165.04	44% below	50%
Elbow X-ray, complete, 3 or more views one side CPT 73080 XR Elbow Complete 3+ Views Right	$106.85	$213.70	$48.16–$163.16	44% below	50%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 XR Elbow Complete 3+ Views Right	$106.85	$213.70	$48.16–$163.16	—	50%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 XR Elbow Complete 3+ Views Left	$106.85	$213.70	$48.16–$165.04	—	50%
Eye socket (orbit) CT scan without contrast CPT 70480 CT IAC w/o Contrast	$981.15	$1,962.30	$58.17–$1,415.21	2% below	50%
Eye socket (orbit) CT scan without contrast CPT 70480 CT Orbits Sella Ear w/o Contrast	$981.15	$1,962.30	$58.17–$1,373.61	2% below	50%
Eye socket (orbit) CT scan without contrast CPT 70480 CT Temporal Bones w/o Contrast	$981.15	$1,962.30	$58.17–$1,415.21	2% below	50%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT Temporal Bones w/o Contrast	$981.15	$1,962.30	$58.17–$1,415.21	—	50%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT IAC w/o Contrast	$981.15	$1,962.30	$58.17–$1,415.21	—	50%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT Orbits Sella Ear w/o Contrast	$981.15	$1,962.30	$58.17–$1,373.61	—	50%
Facial bones X-ray, complete, 3 or more views CPT 70150 XR Facial Bones 3+ Views	$102.10	$204.20	$58.17–$198.66	61% below	50%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 XR Facial Bones 3+ Views	$102.10	$204.20	$58.17–$198.66	—	50%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 XR Forearm 2 Views Right	$106.85	$213.70	$48.16–$163.16	40% below	50%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 XR Forearm 2 Views Left	$106.85	$213.70	$48.16–$163.16	40% below	50%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 XR Forearm 2 Views Right	$106.85	$213.70	$48.16–$163.16	—	50%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 XR Forearm 2 Views Left	$106.85	$213.70	$48.16–$163.16	—	50%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM Hepatobiliary HIDA Injection/Scan	$1,132.70	$2,265.40	$219.80–$1,585.78	21% above	50%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM Hepatobiliary HIDA Injection/Scan	$1,132.70	$2,265.40	$219.80–$1,585.78	—	50%
Hand X-ray, 2 views one side CPT 73120 XR Hand 2 Views Right	$106.85	$213.70	$58.17–$165.94	27% below	50%
Hand X-ray, 2 views one side CPT 73120 XR Hand 2 Views Left	$106.85	$213.70	$58.17–$165.94	27% below	50%
Hand X-ray, 2 views inpatient one side CPT 73120 XR Hand 2 Views Right	$106.85	$213.70	$58.17–$165.94	—	50%
Hand X-ray, 2 views inpatient one side CPT 73120 XR Hand 2 Views Left	$106.85	$213.70	$58.17–$165.94	—	50%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 XR Calcaneus Left	$106.85	$213.70	$48.16–$154.12	31% below	50%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 XR Calcaneus Right	$106.85	$213.70	$48.16–$149.59	31% below	50%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 XR Calcaneus Right	$106.85	$213.70	$48.16–$149.59	—	50%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 XR Calcaneus Left	$106.85	$213.70	$48.16–$154.12	—	50%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 RT CHARGE Inp Apn Sleep Study Type 3 Dvc -> More than 6 hours	$817.10	$1,634.20	$85.58–$244.15	49% above	50%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 Sleep Study Unatt & Resp Efft	$817.10	$1,634.20	$85.58–$244.15	49% above	50%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 RT CHARGE Inp Apn Sleep Study Type 3 Dvc -> More than 6 hours	$817.10	$1,634.20	$85.58–$244.15	—	50%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 Sleep Study Unatt & Resp Efft	$817.10	$1,634.20	$85.58–$244.15	—	50%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 Polysom 6/> Yrs CPAP 4/> Param	$1,158.80	$2,317.60	$556.51–$1,688.54	67% below	50%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 Polysom 6/> Yrs CPAP 4/> Param	$1,158.80	$2,317.60	$556.51–$1,688.54	—	50%
Knee X-ray, 3 views one side CPT 73562 XR Knee 3 Views Left	$106.85	$213.70	$48.16–$183.24	46% below	50%
Knee X-ray, 3 views one side CPT 73562 XR Knee 3 Views Right	$106.85	$213.70	$48.16–$183.24	46% below	50%
Knee X-ray, 3 views inpatient one side CPT 73562 XR Knee 3 Views Right	$106.85	$213.70	$48.16–$183.24	—	50%
Knee X-ray, 3 views inpatient one side CPT 73562 XR Knee 3 Views Left	$106.85	$213.70	$48.16–$183.24	—	50%
Knee X-ray, complete, 4 or more views one side CPT 73564 XR Knee Complete 4+ Views Left	$110.10	$220.20	$58.17–$210.22	49% below	50%
Knee X-ray, complete, 4 or more views one side CPT 73564 XR Knee Complete 4+ Views Right	$110.10	$220.20	$58.17–$210.22	49% below	50%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 XR Knee Complete 4+ Views Right	$110.10	$220.20	$58.17–$210.22	—	50%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 XR Knee Complete 4+ Views Left	$110.10	$220.20	$58.17–$210.22	—	50%
Leg CT scan without contrast (hip to foot, any part) both sides CPT 73700 CT Lower Extremity w/o Contrast Bilat	$899.90	$1,799.80	$58.17–$491.81	—	50%
Leg CT scan without contrast (hip to foot, any part) both sides CPT 73700 CT Knee w/o Contrast Bilateral	$899.90	$1,799.80	$58.17–$491.81	—	50%
Leg CT scan without contrast (hip to foot, any part) both sides CPT 73700 CT Foot w/o Contrast Bilateral	$899.90	$1,799.80	$58.17–$491.81	—	50%
Leg CT scan without contrast (hip to foot, any part) both sides CPT 73700 CT Hip w/o Contrast Bilateral	$899.90	$1,799.80	$58.17–$491.81	—	50%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Foot w/o Contrast Right	$899.90	$1,799.80	$58.17–$1,298.02	18% below	50%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Add On - CT Knee w/o Contrast Right	$899.90	$1,799.80	$58.17–$491.81	18% below	50%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Lower Extremity w/o Contrast Right	$899.90	$1,799.80	$58.17–$1,298.02	18% below	50%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Ankle w/o Contrast Right	$899.90	$1,799.80	$58.17–$1,298.02	18% below	50%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Hip w/o Contrast Left	$899.90	$1,799.80	$58.17–$1,099.86	18% below	50%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Add On - CT Hip w/o Contrast Right	$899.90	$1,799.80	$58.17–$491.81	18% below	50%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Hip w/o Contrast Right	$899.90	$1,799.80	$58.17–$1,298.02	18% below	50%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Lower Extremity w/o Contrast Left	$899.90	$1,799.80	$58.17–$1,298.02	18% below	50%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Knee w/o Contrast Left	$899.90	$1,799.80	$58.17–$1,298.02	18% below	50%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Knee w/o Contrast Right	$899.90	$1,799.80	$58.17–$1,099.86	18% below	50%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Add On - CT Lower Extrem w/o Cont Right	$899.90	$1,799.80	$58.17–$491.81	18% below	50%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Foot w/o Contrast Left	$899.90	$1,799.80	$58.17–$1,259.86	18% below	50%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Ankle w/o Contrast Left	$899.90	$1,799.80	$58.17–$1,298.02	18% below	50%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Add On - CT Foot w/o Contrast Right	$899.90	$1,799.80	$58.17–$491.81	18% below	50%
Leg CT scan without contrast (hip to foot, any part) inpatient both sides CPT 73700 CT Knee w/o Contrast Bilateral	$899.90	$1,799.80	$58.17–$491.81	—	50%
Leg CT scan without contrast (hip to foot, any part) inpatient both sides CPT 73700 CT Foot w/o Contrast Bilateral	$899.90	$1,799.80	$58.17–$491.81	—	50%
Leg CT scan without contrast (hip to foot, any part) inpatient both sides CPT 73700 CT Hip w/o Contrast Bilateral	$899.90	$1,799.80	$58.17–$491.81	—	50%
Leg CT scan without contrast (hip to foot, any part) inpatient both sides CPT 73700 CT Lower Extremity w/o Contrast Bilat	$899.90	$1,799.80	$58.17–$491.81	—	50%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Knee w/o Contrast Left	$899.90	$1,799.80	$58.17–$1,298.02	—	50%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Ankle w/o Contrast Left	$899.90	$1,799.80	$58.17–$1,298.02	—	50%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Ankle w/o Contrast Right	$899.90	$1,799.80	$58.17–$1,298.02	—	50%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Foot w/o Contrast Left	$899.90	$1,799.80	$58.17–$1,259.86	—	50%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Foot w/o Contrast Right	$899.90	$1,799.80	$58.17–$1,298.02	—	50%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Lower Extremity w/o Contrast Right	$899.90	$1,799.80	$58.17–$1,298.02	—	50%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Hip w/o Contrast Left	$899.90	$1,799.80	$58.17–$1,099.86	—	50%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Hip w/o Contrast Right	$899.90	$1,799.80	$58.17–$1,298.02	—	50%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Knee w/o Contrast Right	$899.90	$1,799.80	$58.17–$1,099.86	—	50%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Lower Extremity w/o Contrast Left	$899.90	$1,799.80	$58.17–$1,298.02	—	50%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 Add On - CT Hip w/o Contrast Right	$899.90	$1,799.80	$58.17–$491.81	—	50%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 Add On - CT Lower Extrem w/o Cont Right	$899.90	$1,799.80	$58.17–$491.81	—	50%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 Add On - CT Foot w/o Contrast Right	$899.90	$1,799.80	$58.17–$491.81	—	50%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 Add On - CT Knee w/o Contrast Right	$899.90	$1,799.80	$58.17–$491.81	—	50%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Limited Abdominal US Exam	$200.40	$400.80	$58.17–$341.38	57% below	50%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Abdomen Limited	$200.40	$400.80	$58.17–$341.38	57% below	50%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Ultrasound Abdomen Limited 76705	$200.40	$400.80	$58.17–$341.38	57% below	50%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 Limited Abdominal US Exam	$200.40	$400.80	$58.17–$341.38	—	50%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 Ultrasound Abdomen Limited 76705	$200.40	$400.80	$58.17–$341.38	—	50%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Abdomen Limited	$200.40	$400.80	$58.17–$341.38	—	50%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 IR Limited ultrasound joint/non vascular extremity	$165.30	$330.60	$58.17–$183.24	55% below	50%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US MSK Knee - Tib/Fib Limited Left	$165.30	$330.60	$58.17–$183.24	55% below	50%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US MSK Shoulder - Humerus Limited Right	$165.30	$330.60	$58.17–$238.43	55% below	50%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US Extremity Nonvascular Limited Right	$165.30	$330.60	$58.17–$238.43	55% below	50%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US MSK Shoulder - Humerus Limited Left	$165.30	$330.60	$58.17–$183.24	55% below	50%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US Extremity Nonvascular Limited Left	$165.30	$330.60	$58.17–$238.43	55% below	50%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US MSK Lower Extremity Limited Right	$165.30	$330.60	$58.17–$183.24	55% below	50%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US MSK Lower Extremity Limited Left	$165.30	$330.60	$58.17–$238.43	55% below	50%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US MSK Upper Extremity Limited Right	$165.30	$330.60	$58.17–$231.42	55% below	50%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US Breast Axilla Right	$165.30	$330.60	$58.17–$238.43	55% below	50%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US MSK Upper Extremity Limited Left	$165.30	$330.60	$58.17–$183.24	55% below	50%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US MSK Knee - Tib/Fib Limited Right	$165.30	$330.60	$58.17–$183.24	55% below	50%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US Breast Axilla Left	$165.30	$330.60	$58.17–$231.42	55% below	50%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 IR Limited ultrasound joint/non vascular extremity	$165.30	$330.60	$58.17–$183.24	—	50%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US MSK Knee - Tib/Fib Limited Right	$165.30	$330.60	$58.17–$183.24	—	50%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US MSK Lower Extremity Limited Left	$165.30	$330.60	$58.17–$238.43	—	50%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US MSK Upper Extremity Limited Right	$165.30	$330.60	$58.17–$231.42	—	50%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US MSK Upper Extremity Limited Left	$165.30	$330.60	$58.17–$183.24	—	50%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US MSK Shoulder - Humerus Limited Right	$165.30	$330.60	$58.17–$238.43	—	50%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US MSK Shoulder - Humerus Limited Left	$165.30	$330.60	$58.17–$183.24	—	50%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US MSK Knee - Tib/Fib Limited Left	$165.30	$330.60	$58.17–$183.24	—	50%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US MSK Lower Extremity Limited Right	$165.30	$330.60	$58.17–$183.24	—	50%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US Breast Axilla Left	$165.30	$330.60	$58.17–$231.42	—	50%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US Breast Axilla Right	$165.30	$330.60	$58.17–$238.43	—	50%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US Extremity Nonvascular Limited Left	$165.30	$330.60	$58.17–$238.43	—	50%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US Extremity Nonvascular Limited Right	$165.30	$330.60	$58.17–$238.43	—	50%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT Lung Cancer Screening	$443.45	$886.90	$58.17–$684.95	27% above	50%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT Lung Cancer Screening	$443.45	$886.90	$58.17–$684.95	—	50%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 XR Tibia/Fibula Right	$106.85	$213.70	$48.16–$163.16	42% below	50%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 XR Tibia/Fibula Left	$106.85	$213.70	$48.16–$163.16	42% below	50%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 XR Tibia/Fibula Right	$106.85	$213.70	$48.16–$163.16	—	50%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 XR Tibia/Fibula Left	$106.85	$213.70	$48.16–$163.16	—	50%
MR angiography (MRA) of the head without contrast CPT 70544 MRV Head w/o Contrast	$1,526.40	$3,052.80	$132.22–$941.21	1% below	50%
MR angiography (MRA) of the head without contrast CPT 70544 MRA Brain/Head w/o Contrast	$1,526.40	$3,052.80	$132.22–$2,201.68	1% below	50%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRA Brain/Head w/o Contrast	$1,526.40	$3,052.80	$132.22–$2,201.68	—	50%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRV Head w/o Contrast	$1,526.40	$3,052.80	$132.22–$941.21	—	50%
MRI of both breasts, without and then with contrast dye both sides CPT 77049 MRI Breast w/ + w/o Contrast Bilateral	$2,075.40	$4,150.80	$1,379.03–$2,993.56	—	50%
MRI of both breasts, without and then with contrast dye inpatient both sides CPT 77049 MRI Breast w/ + w/o Contrast Bilateral	$2,075.40	$4,150.80	$1,379.03–$2,993.56	—	50%
MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 MRI Hips w/o Contrast Bilateral	$1,420.25	$2,840.50	$132.22–$825.48	—	50%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Lower Joint w/o Contrast Left	$1,420.25	$2,840.50	$132.22–$825.48	11% below	50%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Lower Joint w/o Contrast Right	$1,420.25	$2,840.50	$132.22–$825.48	11% below	50%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Ankle w/o Contrast Right	$1,420.25	$2,840.50	$132.22–$1,901.71	11% below	50%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Knee w/o Contrast Left	$1,420.25	$2,840.50	$132.22–$2,193.72	11% below	50%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Ankle w/o Contrast Left	$1,420.25	$2,840.50	$132.22–$2,048.57	11% below	50%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Hip w/o Contrast Left	$1,420.25	$2,840.50	$132.22–$2,048.57	11% below	50%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Hip w/o Contrast Right	$1,420.25	$2,840.50	$132.22–$2,048.57	11% below	50%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Knee w/o Contrast Right	$1,420.25	$2,840.50	$132.22–$2,048.57	11% below	50%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 Add On - MRI Hip w/o Contrast Right	$1,420.25	$2,840.50	$132.22–$825.48	11% below	50%
MRI of knee or other lower-limb joint, no contrast dye inpatient both sides CPT 73721 MRI Hips w/o Contrast Bilateral	$1,420.25	$2,840.50	$132.22–$825.48	—	50%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Lower Joint w/o Contrast Right	$1,420.25	$2,840.50	$132.22–$825.48	—	50%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Lower Joint w/o Contrast Left	$1,420.25	$2,840.50	$132.22–$825.48	—	50%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Ankle w/o Contrast Right	$1,420.25	$2,840.50	$132.22–$1,901.71	—	50%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Knee w/o Contrast Left	$1,420.25	$2,840.50	$132.22–$2,193.72	—	50%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Ankle w/o Contrast Left	$1,420.25	$2,840.50	$132.22–$2,048.57	—	50%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Hip w/o Contrast Left	$1,420.25	$2,840.50	$132.22–$2,048.57	—	50%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Hip w/o Contrast Right	$1,420.25	$2,840.50	$132.22–$2,048.57	—	50%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Knee w/o Contrast Right	$1,420.25	$2,840.50	$132.22–$2,048.57	—	50%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 Add On - MRI Hip w/o Contrast Right	$1,420.25	$2,840.50	$132.22–$825.48	—	50%
MRI of knee or other lower-limb joint, without and then with contrast dye both sides CPT 73723 MRI Hips w/ + w/o Contrast Bilateral	$2,727.45	$5,454.90	$195.35–$1,662.54	—	50%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Knee w/ + w/o Contrast Right	$2,727.45	$5,454.90	$195.35–$1,662.54	10% above	50%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Add On - MRI Hip w/ + w/o Contrast RT	$2,727.45	$5,454.90	$195.35–$1,662.54	10% above	50%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Ankle w/ + w/o Contrast Right	$2,727.45	$5,454.90	$195.35–$3,818.43	10% above	50%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Ankle w/ + w/o Contrast Left	$2,727.45	$5,454.90	$195.35–$3,934.07	10% above	50%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Knee w/ + w/o Contrast Left	$2,727.45	$5,454.90	$195.35–$1,662.54	10% above	50%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Hip w/ + w/o Contrast Right	$2,727.45	$5,454.90	$195.35–$1,662.54	10% above	50%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Lower Joint w/ + w/o Contrast Left	$2,727.45	$5,454.90	$195.35–$1,662.54	10% above	50%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Lower Joint w/ + w/o Contrast Right	$2,727.45	$5,454.90	$195.35–$1,662.54	10% above	50%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Hip w/ + w/o Contrast Left	$2,727.45	$5,454.90	$195.35–$1,662.54	10% above	50%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient both sides CPT 73723 MRI Hips w/ + w/o Contrast Bilateral	$2,727.45	$5,454.90	$195.35–$1,662.54	—	50%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Knee w/ + w/o Contrast Left	$2,727.45	$5,454.90	$195.35–$1,662.54	—	50%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Hip w/ + w/o Contrast Left	$2,727.45	$5,454.90	$195.35–$1,662.54	—	50%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Hip w/ + w/o Contrast Right	$2,727.45	$5,454.90	$195.35–$1,662.54	—	50%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Lower Joint w/ + w/o Contrast Right	$2,727.45	$5,454.90	$195.35–$1,662.54	—	50%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Knee w/ + w/o Contrast Right	$2,727.45	$5,454.90	$195.35–$1,662.54	—	50%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 Add On - MRI Hip w/ + w/o Contrast RT	$2,727.45	$5,454.90	$195.35–$1,662.54	—	50%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Ankle w/ + w/o Contrast Right	$2,727.45	$5,454.90	$195.35–$3,818.43	—	50%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Ankle w/ + w/o Contrast Left	$2,727.45	$5,454.90	$195.35–$3,934.07	—	50%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Lower Joint w/ + w/o Contrast Left	$2,727.45	$5,454.90	$195.35–$1,662.54	—	50%
MRI of the abdomen without contrast CPT 74181 MRI Abd/Pelvis w/o Cont Enterography	$1,526.40	$3,052.80	$132.22–$752.18	10% below	50%
MRI of the abdomen without contrast CPT 74181 MRI Abdomen w/o Contrast	$1,526.40	$3,052.80	$132.22–$752.18	10% below	50%
MRI of the abdomen without contrast CPT 74181 MRI MRCP Abdomen w/o Contrast	$1,526.40	$3,052.80	$132.22–$2,201.68	10% below	50%
MRI of the abdomen without contrast CPT 74181 MRI Abd/Pelvis w/o Cnt Urography	$1,526.40	$3,052.80	$132.22–$752.18	10% below	50%
MRI of the abdomen without contrast inpatient CPT 74181 MRI Abdomen w/o Contrast	$1,526.40	$3,052.80	$132.22–$752.18	—	50%
MRI of the abdomen without contrast inpatient CPT 74181 MRI Abd/Pelvis w/o Cont Enterography	$1,526.40	$3,052.80	$132.22–$752.18	—	50%
MRI of the abdomen without contrast inpatient CPT 74181 MRI MRCP Abdomen w/o Contrast	$1,526.40	$3,052.80	$132.22–$2,201.68	—	50%
MRI of the abdomen without contrast inpatient CPT 74181 MRI Abd/Pelvis w/o Cnt Urography	$1,526.40	$3,052.80	$132.22–$752.18	—	50%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI MRCP Abdomen w/ + w/o Contrast	$2,774.10	$5,548.20	$195.35–$1,382.87	11% below	50%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI Abd/Pelvis w/ + w/o Cnt Urography	$2,774.10	$5,548.20	$195.35–$1,382.87	11% below	50%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI Abd/Pelvis w/ + w/o Cont Enterography	$2,774.10	$5,548.20	$195.35–$4,001.36	11% below	50%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI Abdomen w/ + w/o Contrast	$2,774.10	$5,548.20	$195.35–$4,001.36	11% below	50%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI Abd/Pelvis w/ + w/o Cnt Urography	$2,774.10	$5,548.20	$195.35–$1,382.87	—	50%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI Abd/Pelvis w/ + w/o Cont Enterography	$2,774.10	$5,548.20	$195.35–$4,001.36	—	50%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI Abdomen w/ + w/o Contrast	$2,774.10	$5,548.20	$195.35–$4,001.36	—	50%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI MRCP Abdomen w/ + w/o Contrast	$2,774.10	$5,548.20	$195.35–$1,382.87	—	50%
MRI of the brain, no contrast dye CPT 70551 MRI Pituitary w/o Contrast	$1,493.95	$2,987.90	$132.22–$752.18	10% below	50%
MRI of the brain, no contrast dye CPT 70551 MRI Brain w/o Cont Hydrocephalus Screen	$1,493.95	$2,987.90	$132.22–$752.18	10% below	50%
MRI of the brain, no contrast dye CPT 70551 MRI Brain w/o Contrast Stroke Protocol	$1,493.95	$2,987.90	$132.22–$2,154.87	10% below	50%
MRI of the brain, no contrast dye CPT 70551 MRI Brain w/o Contrast	$1,493.95	$2,987.90	$132.22–$2,307.56	10% below	50%
MRI of the brain, no contrast dye CPT 70551 MRI IAC w/o Contrast	$1,493.95	$2,987.90	$132.22–$752.18	10% below	50%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI Brain w/o Contrast Stroke Protocol	$1,493.95	$2,987.90	$132.22–$2,154.87	—	50%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI Brain w/o Contrast	$1,493.95	$2,987.90	$132.22–$2,307.56	—	50%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI Brain w/o Cont Hydrocephalus Screen	$1,493.95	$2,987.90	$132.22–$752.18	—	50%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI Pituitary w/o Contrast	$1,493.95	$2,987.90	$132.22–$752.18	—	50%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI IAC w/o Contrast	$1,493.95	$2,987.90	$132.22–$752.18	—	50%
MRI of the brain, with and without contrast dye CPT 70553 MRI IAC w/ + w/o Contrast	$2,774.10	$5,548.20	$195.35–$4,001.36	2% below	50%
MRI of the brain, with and without contrast dye CPT 70553 MRI Pituitary w/ + w/o Contrast	$2,774.10	$5,548.20	$195.35–$3,714.52	2% below	50%
MRI of the brain, with and without contrast dye CPT 70553 MRI Brain w/ + w/o Contrast	$2,774.10	$5,548.20	$195.35–$4,284.87	2% below	50%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI Pituitary w/ + w/o Contrast	$2,774.10	$5,548.20	$195.35–$3,714.52	—	50%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI IAC w/ + w/o Contrast	$2,774.10	$5,548.20	$195.35–$4,001.36	—	50%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI Brain w/ + w/o Contrast	$2,774.10	$5,548.20	$195.35–$4,284.87	—	50%
MRI of the lower back, no contrast dye CPT 72148 MRI Spine Lumbar w/o Contrast	$1,526.40	$3,052.80	$132.22–$2,357.68	15% below	50%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI Spine Lumbar w/o Contrast	$1,526.40	$3,052.80	$132.22–$2,357.68	—	50%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI Spine Lumbar w/ + w/o Contrast	$2,764.25	$5,528.50	$195.35–$3,987.15	2% above	50%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI Spine Lumbar w/ + w/o Contrast	$2,764.25	$5,528.50	$195.35–$3,987.15	—	50%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI Spine Thoracic w/o Contrast	$1,459.40	$2,918.80	$132.22–$2,105.04	10% below	50%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI Spine Thoracic w/o Contrast	$1,459.40	$2,918.80	$132.22–$2,105.04	—	50%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI Spine Cervical w/ + w/o Contrast	$2,764.25	$5,528.50	$195.35–$3,987.15	2% below	50%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI Spine Cervical w/ + w/o Contrast	$2,764.25	$5,528.50	$195.35–$3,987.15	—	50%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI Spine Cervical w/o Contrast	$1,459.40	$2,918.80	$132.22–$2,105.04	17% below	50%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI Spine Cervical w/o Contrast	$1,459.40	$2,918.80	$132.22–$2,105.04	—	50%
MRI of the pelvis without and with contrast CPT 72197 Add On - MRI Pelvis w/ + w/o Contrast	$2,753.05	$5,506.10	$195.35–$3,971.00	at median	50%
MRI of the pelvis without and with contrast CPT 72197 MRI Prostate w/ + w/o Contrast	$2,753.05	$5,506.10	$195.35–$3,971.00	at median	50%
MRI of the pelvis without and with contrast CPT 72197 MRI Pelvis w/ + w/o Contrast	$2,753.05	$5,506.10	$195.35–$4,252.36	at median	50%
MRI of the pelvis without and with contrast CPT 72197 MRI Sacrum/SI Jts w/ + w/o Contrast	$2,753.05	$5,506.10	$195.35–$1,375.15	at median	50%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI Prostate w/ + w/o Contrast	$2,753.05	$5,506.10	$195.35–$3,971.00	—	50%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI Sacrum/SI Jts w/ + w/o Contrast	$2,753.05	$5,506.10	$195.35–$1,375.15	—	50%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI Pelvis w/ + w/o Contrast	$2,753.05	$5,506.10	$195.35–$4,252.36	—	50%
MRI of the pelvis without and with contrast inpatient CPT 72197 Add On - MRI Pelvis w/ + w/o Contrast	$2,753.05	$5,506.10	$195.35–$3,971.00	—	50%
MRI of the pelvis, no contrast dye CPT 72195 Add On - MRI Pelvis w/o Contrast	$1,459.40	$2,918.80	$132.22–$941.21	14% below	50%
MRI of the pelvis, no contrast dye CPT 72195 MRI Pelvis w/o Contrast	$1,459.40	$2,918.80	$132.22–$2,105.04	14% below	50%
MRI of the pelvis, no contrast dye CPT 72195 MRI Prostate w/o Contrast	$1,459.40	$2,918.80	$132.22–$941.21	14% below	50%
MRI of the pelvis, no contrast dye CPT 72195 MRI Sacrum/SI Jts w/o Contrast	$1,459.40	$2,918.80	$132.22–$2,043.16	14% below	50%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI Sacrum/SI Jts w/o Contrast	$1,459.40	$2,918.80	$132.22–$2,043.16	—	50%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI Prostate w/o Contrast	$1,459.40	$2,918.80	$132.22–$941.21	—	50%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI Pelvis w/o Contrast	$1,459.40	$2,918.80	$132.22–$2,105.04	—	50%
MRI of the pelvis, no contrast dye inpatient CPT 72195 Add On - MRI Pelvis w/o Contrast	$1,459.40	$2,918.80	$132.22–$941.21	—	50%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Elbow w/o Contrast Right	$1,420.25	$2,840.50	$132.22–$2,193.72	24% below	50%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Upper Joint w/o Contrast Right	$1,420.25	$2,840.50	$132.22–$827.43	24% below	50%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Wrist w/o Contrast Left	$1,420.25	$2,840.50	$132.22–$1,735.83	24% below	50%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Shoulder w/o Contrast Left	$1,420.25	$2,840.50	$132.22–$2,048.57	24% below	50%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Elbow w/o Contrast Left	$1,420.25	$2,840.50	$132.22–$2,193.72	24% below	50%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Shoulder w/o Contrast Right	$1,420.25	$2,840.50	$132.22–$2,193.72	24% below	50%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Wrist w/o Contrast Right	$1,420.25	$2,840.50	$132.22–$1,119.08	24% below	50%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Upper Joint w/o Contrast Left	$1,420.25	$2,840.50	$132.22–$827.43	24% below	50%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Wrist w/o Contrast Left	$1,420.25	$2,840.50	$132.22–$1,735.83	—	50%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Upper Joint w/o Contrast Left	$1,420.25	$2,840.50	$132.22–$827.43	—	50%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Upper Joint w/o Contrast Right	$1,420.25	$2,840.50	$132.22–$827.43	—	50%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Shoulder w/o Contrast Left	$1,420.25	$2,840.50	$132.22–$2,048.57	—	50%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Shoulder w/o Contrast Right	$1,420.25	$2,840.50	$132.22–$2,193.72	—	50%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Wrist w/o Contrast Right	$1,420.25	$2,840.50	$132.22–$1,119.08	—	50%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Elbow w/o Contrast Left	$1,420.25	$2,840.50	$132.22–$2,193.72	—	50%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Elbow w/o Contrast Right	$1,420.25	$2,840.50	$132.22–$2,193.72	—	50%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 XR Spine Cervical 4 or 5 Views	$183.70	$367.40	$58.17–$283.74	37% below	50%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 XR Spine Cervical 4 or 5 Views	$183.70	$367.40	$58.17–$283.74	—	50%
Neck soft tissue CT scan with contrast CPT 70491 CT Neck Soft Tissue w/ Contrast	$1,022.65	$2,045.30	$97.38–$1,579.59	22% below	50%
Neck soft tissue CT scan with contrast inpatient CPT 70491 CT Neck Soft Tissue w/ Contrast	$1,022.65	$2,045.30	$97.38–$1,579.59	—	50%
Neck soft tissue CT scan without contrast CPT 70490 CT Neck Soft Tissue w/o Contrast	$971.45	$1,942.90	$58.17–$1,500.50	4% below	50%
Neck soft tissue CT scan without contrast inpatient CPT 70490 CT Neck Soft Tissue w/o Contrast	$971.45	$1,942.90	$58.17–$1,500.50	—	50%
Neck soft tissue X-ray CPT 70360 XR Neck Soft Tissue	$106.85	$213.70	$48.16–$154.12	40% below	50%
Neck soft tissue X-ray inpatient CPT 70360 XR Neck Soft Tissue	$106.85	$213.70	$48.16–$154.12	—	50%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM Myocardial Perf SPECT - Multi Inj	$1,183.95	$2,367.90	$714.10–$2,037.13	60% below	50%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM Myocardial Perf SPECT - Multi Inj	$1,183.95	$2,367.90	$714.10–$2,037.13	—	50%
Pelvic CT scan without contrast CPT 72192 CT Pelvis w/o Contrast	$981.15	$1,962.30	$58.17–$1,373.61	2% below	50%
Pelvic CT scan without contrast CPT 72192 CT Pelvis w/o Cont Cystogram	$981.15	$1,962.30	$58.17–$486.05	2% below	50%
Pelvic CT scan without contrast inpatient CPT 72192 CT Pelvis w/o Contrast	$981.15	$1,962.30	$58.17–$1,373.61	—	50%
Pelvic CT scan without contrast inpatient CPT 72192 CT Pelvis w/o Cont Cystogram	$981.15	$1,962.30	$58.17–$486.05	—	50%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US Urinary Bladder	$212.75	$425.50	$58.17–$297.85	37% below	50%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US Pelvis Limited w/o Transvag	$212.75	$425.50	$58.17–$306.87	37% below	50%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US Pelvis Limited w/ Transvag	$212.75	$425.50	$58.17–$306.87	37% below	50%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 WH US Pelvic, Limited	$212.75	$425.50	$58.17–$165.94	37% below	50%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 WH US Pelvic, Limited	$212.75	$425.50	$58.17–$165.94	—	50%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US Pelvis Limited w/ Transvag	$212.75	$425.50	$58.17–$306.87	—	50%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US Urinary Bladder	$212.75	$425.50	$58.17–$297.85	—	50%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US Pelvis Limited w/o Transvag	$212.75	$425.50	$58.17–$306.87	—	50%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 WH US Pelvic, Complete	$250.65	$501.30	$58.17–$418.51	56% below	50%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US Pelvis Complete w/o Transvag	$250.65	$501.30	$58.17–$418.51	56% below	50%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 WH US Pelvic, Complete w/ Transvaginal	$250.65	$501.30	$58.17–$418.51	56% below	50%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US Pelvis Complete w/ Transvag	$250.65	$501.30	$58.17–$418.51	56% below	50%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 WH US Pelvic, Complete w/ Transvaginal	$250.65	$501.30	$58.17–$418.51	—	50%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US Pelvis Complete w/ Transvag	$250.65	$501.30	$58.17–$418.51	—	50%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US Pelvis Complete w/o Transvag	$250.65	$501.30	$58.17–$418.51	—	50%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 WH US Pelvic, Complete	$250.65	$501.30	$58.17–$418.51	—	50%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 WH OB US Greater Than 14 weeks, Single	$260.15	$520.30	$58.17–$503.40	54% below	50%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB Greater Than 14 Weeks	$260.15	$520.30	$58.17–$503.40	54% below	50%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 WH OB US Greater Than 14 weeks, Single	$260.15	$520.30	$58.17–$503.40	—	50%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB Greater Than 14 Weeks	$260.15	$520.30	$58.17–$503.40	—	50%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB Less Than 14 wks w/ Transvag	$246.50	$493.00	$58.17–$403.09	52% below	50%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB Less Than 14 wks w/o Transvag	$246.50	$493.00	$58.17–$403.09	52% below	50%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 WH OB US, Less Than 14 weeks, Single	$246.50	$493.00	$58.17–$403.09	52% below	50%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OB Less Than 14 wks w/ Transvag	$246.50	$493.00	$58.17–$403.09	—	50%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OB Less Than 14 wks w/o Transvag	$246.50	$493.00	$58.17–$403.09	—	50%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 WH OB US, Less Than 14 weeks, Single	$246.50	$493.00	$58.17–$403.09	—	50%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB Limited	$170.35	$340.70	$58.17–$289.31	47% below	50%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 WH OB US Limited, 1 or More Fetuses	$170.35	$340.70	$58.17–$289.31	47% below	50%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB Limited	$170.35	$340.70	$58.17–$289.31	—	50%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 WH OB US Limited, 1 or More Fetuses	$170.35	$340.70	$58.17–$289.31	—	50%
Rib X-ray, one side, 2 views one side CPT 71100 XR Ribs 2 Views Right	$106.85	$213.70	$48.16–$150.43	46% below	50%
Rib X-ray, one side, 2 views one side CPT 71100 XR Ribs 2 Views Left	$106.85	$213.70	$48.16–$163.16	46% below	50%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 XR Ribs 2 Views Left	$106.85	$213.70	$48.16–$163.16	—	50%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 XR Ribs 2 Views Right	$106.85	$213.70	$48.16–$150.43	—	50%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 XR Ribs w/ PA Chest Left	$110.40	$220.80	$58.17–$171.41	53% below	50%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 XR Ribs w/ PA Chest Right	$110.40	$220.80	$58.17–$171.41	53% below	50%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 XR Ribs w/ PA Chest Right	$110.40	$220.80	$58.17–$171.41	—	50%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 XR Ribs w/ PA Chest Left	$110.40	$220.80	$58.17–$171.41	—	50%
Screening mammogram, both breasts both sides CPT 77067 MG Mammo Screening Bilateral	$286.00	$572.00	$238.41–$534.25	—	50%
Screening mammogram, both breasts both sides CPT 77067 MG Mammo Implant Screening Bilateral	$286.00	$572.00	$534.25	—	50%
Screening mammogram, both breasts both sides CPT 77067 Add On - MG Mammo Screening Bilateral	$286.00	$572.00	$238.41–$534.25	—	50%
Screening mammogram, both breasts inpatient both sides CPT 77067 MG Mammo Screening Bilateral	$286.00	$572.00	$238.41–$534.25	—	50%
Screening mammogram, both breasts inpatient both sides CPT 77067 Add On - MG Mammo Screening Bilateral	$286.00	$572.00	$238.41–$534.25	—	50%
Screening mammogram, both breasts inpatient both sides CPT 77067 MG Mammo Implant Screening Bilateral	$286.00	$572.00	$534.25	—	50%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR Shoulder Complete 2+ Views Right	$106.85	$213.70	$48.16–$163.16	50% below	50%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR Shoulder Complete 2+ Views Left	$106.85	$213.70	$48.16–$163.16	50% below	50%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR Shoulder Complete 2+ Views Left	$106.85	$213.70	$48.16–$163.16	—	50%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR Shoulder Complete 2+ Views Right	$106.85	$213.70	$48.16–$163.16	—	50%
Sinus X-ray, complete, 3 or more views CPT 70220 XR Sinuses Paranasal Complete	$117.45	$234.90	$48.16–$164.43	50% below	50%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 XR Sinuses Paranasal Complete	$117.45	$234.90	$48.16–$164.43	—	50%
Skull X-ray, fewer than 4 views CPT 70250 XR Skull < 4 Views	$106.85	$213.70	$58.17–$165.94	49% below	50%
Skull X-ray, fewer than 4 views CPT 70250 XR Shunt Eval < 4 Skull Vw +Abd/CXR 1 Vw	$106.85	$213.70	$58.17–$165.94	49% below	50%
Skull X-ray, fewer than 4 views inpatient CPT 70250 XR Shunt Eval < 4 Skull Vw +Abd/CXR 1 Vw	$106.85	$213.70	$58.17–$165.94	—	50%
Skull X-ray, fewer than 4 views inpatient CPT 70250 XR Skull < 4 Views	$106.85	$213.70	$58.17–$165.94	—	50%
Sleep study in a lab (polysomnography) CPT 95810 Polysom 6/> Yrs 4/> Param	$1,105.95	$2,211.90	$556.51–$1,610.83	66% below	50%
Sleep study in a lab (polysomnography) inpatient CPT 95810 Polysom 6/> Yrs 4/> Param	$1,105.95	$2,211.90	$556.51–$1,610.83	—	50%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 CSC Treadmill Stress Echo W/O Contrast	$824.35	$1,648.70	$299.92–$855.59	30% below	50%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 CSC Dobutamine Stress Echo W/O Contrast	$824.35	$1,648.70	$299.92–$855.59	30% below	50%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 CSC Dobutamine Stress Echo W/Contrast	$1,340.40	$2,680.80	$299.92–$855.59	13% above	50%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 CSC Treadmill Stress Echo W/ Contrast	$1,340.40	$2,680.80	$299.92–$855.59	13% above	50%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 CSC Dobutamine Stress Echo W/O Contrast	$824.35	$1,648.70	$299.92–$855.59	—	50%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 CSC Treadmill Stress Echo W/O Contrast	$824.35	$1,648.70	$299.92–$855.59	—	50%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 CSC Dobutamine Stress Echo W/Contrast	$1,340.40	$2,680.80	$299.92–$855.59	—	50%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 CSC Treadmill Stress Echo W/ Contrast	$1,340.40	$2,680.80	$299.92–$855.59	—	50%
Swallow study (modified barium swallow, video X-ray) CPT 74230 XR Swallowing Function w/ Speech	$270.35	$540.70	$97.38–$559.31	28% below	50%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 XR Swallowing Function w/ Speech	$270.35	$540.70	$97.38–$559.31	—	50%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 XR Femur 2 Views Right	$106.85	$213.70	$48.16–$163.16	50% below	50%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 XR Femur 2 Views Left	$106.85	$213.70	$48.16–$163.16	50% below	50%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 XR Femur 2 Views Right	$106.85	$213.70	$48.16–$163.16	—	50%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 XR Femur 2 Views Left	$106.85	$213.70	$48.16–$163.16	—	50%
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT Spine Thoracic w/o Contrast	$853.20	$1,706.40	$58.17–$1,230.66	19% below	50%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT Spine Thoracic w/o Contrast	$853.20	$1,706.40	$58.17–$1,230.66	—	50%
Toe X-ray, 2 or more views one side CPT 73660 XR Toe(s) 2+ Views Left	$106.85	$213.70	$48.16–$154.12	15% below	50%
Toe X-ray, 2 or more views one side CPT 73660 XR Toe(s) 2+ Views Right	$106.85	$213.70	$48.16–$163.16	15% below	50%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toe(s) 2+ Views Right	$106.85	$213.70	$48.16–$163.16	—	50%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toe(s) 2+ Views Left	$106.85	$213.70	$48.16–$154.12	—	50%
Transvaginal pelvic ultrasound CPT 76830 ADD ON - US Transvag AMB	$234.50	$469.00	$58.17–$491.81	56% below	50%
Transvaginal pelvic ultrasound CPT 76830 WH US Transvaginal	$243.85	$487.70	$58.17–$491.81	54% below	50%
Transvaginal pelvic ultrasound CPT 76830 US Transvaginal Non-OB	$243.85	$487.70	$58.17–$491.81	54% below	50%
Transvaginal pelvic ultrasound CPT 76830 ADD ON - US Transvag	$243.85	$487.70	$58.17–$491.81	54% below	50%
Transvaginal pelvic ultrasound inpatient CPT 76830 ADD ON - US Transvag AMB	$234.50	$469.00	$58.17–$491.81	—	50%
Transvaginal pelvic ultrasound inpatient CPT 76830 ADD ON - US Transvag	$243.85	$487.70	$58.17–$491.81	—	50%
Transvaginal pelvic ultrasound inpatient CPT 76830 US Transvaginal Non-OB	$243.85	$487.70	$58.17–$491.81	—	50%
Transvaginal pelvic ultrasound inpatient CPT 76830 WH US Transvaginal	$243.85	$487.70	$58.17–$491.81	—	50%
Transvaginal ultrasound during pregnancy CPT 76817 ADD ON - US OB Transvag	$181.05	$362.10	$58.17–$325.95	58% below	50%
Transvaginal ultrasound during pregnancy CPT 76817 US OB Transvaginal	$181.05	$362.10	$58.17–$325.95	58% below	50%
Transvaginal ultrasound during pregnancy CPT 76817 WH OB US Transvaginal	$181.05	$362.10	$58.17–$325.95	58% below	50%
Transvaginal ultrasound during pregnancy CPT 76817 US Transvaginal OB	$181.05	$362.10	$58.17–$325.95	58% below	50%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US OB Transvaginal	$181.05	$362.10	$58.17–$325.95	—	50%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 ADD ON - US OB Transvag	$181.05	$362.10	$58.17–$325.95	—	50%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US Transvaginal OB	$181.05	$362.10	$58.17–$325.95	—	50%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 WH OB US Transvaginal	$181.05	$362.10	$58.17–$325.95	—	50%
Ultrasound of the abdomen, complete CPT 76700 US Abdomen Complete	$270.35	$540.70	$58.17–$447.45	59% below	50%
Ultrasound of the abdomen, complete inpatient CPT 76700 US Abdomen Complete	$270.35	$540.70	$58.17–$447.45	—	50%
Ultrasound of the scrotum and testicles CPT 76870 US Scrotum (Contents) w/ Doppler	$205.55	$411.10	$58.17–$403.09	61% below	50%
Ultrasound of the scrotum and testicles CPT 76870 US Scrotum (Contents) w/o Doppler	$205.55	$411.10	$58.17–$403.09	61% below	50%
Ultrasound of the scrotum and testicles CPT 76870 US Testicular w/ Doppler	$205.55	$411.10	$58.17–$403.09	61% below	50%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US Scrotum (Contents) w/ Doppler	$205.55	$411.10	$58.17–$403.09	—	50%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US Testicular w/ Doppler	$205.55	$411.10	$58.17–$403.09	—	50%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US Scrotum (Contents) w/o Doppler	$205.55	$411.10	$58.17–$403.09	—	50%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Head/Neck Soft Tissue	$231.20	$462.40	$58.17–$478.30	51% below	50%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 IR Ultrasound, soft tissue head and neck	$231.20	$462.40	$58.17–$478.30	51% below	50%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 IR Ultrasound, soft tissue head and neck	$231.20	$462.40	$58.17–$478.30	—	50%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US Head/Neck Soft Tissue	$231.20	$462.40	$58.17–$478.30	—	50%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 XR Upper GI with Small Bowel	$408.65	$817.30	$97.38–$478.30	2% above	50%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 XR Upper GI	$408.65	$817.30	$97.38–$478.30	2% above	50%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 XR Upper GI with Small Bowel	$408.65	$817.30	$97.38–$478.30	—	50%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 XR Upper GI	$408.65	$817.30	$97.38–$478.30	—	50%
Upper arm X-ray (humerus), 2 views one side CPT 73060 XR Humerus Right	$106.85	$213.70	$48.16–$163.16	42% below	50%
Upper arm X-ray (humerus), 2 views one side CPT 73060 XR Humerus Left	$106.85	$213.70	$48.16–$163.16	42% below	50%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 XR Humerus Left	$106.85	$213.70	$48.16–$163.16	—	50%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 XR Humerus Right	$106.85	$213.70	$48.16–$163.16	—	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Lower Ext Venous Duplex Left	$253.40	$506.80	$58.17–$391.40	52% below	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Lower Ext Venous Duplex Right	$253.40	$506.80	$58.17–$391.40	52% below	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Lower Ext Venous Duplex Reflux Right	$253.40	$506.80	$58.17–$388.83	52% below	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Lower Ext Venous Duplex Reflux Left	$253.40	$506.80	$58.17–$388.83	52% below	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Lower Ext Vein Mapping Left	$253.40	$506.80	$58.17–$388.83	52% below	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Lower Ext Vein Mapping Right	$253.40	$506.80	$58.17–$388.83	52% below	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Upper Ext Vein Mapping Left	$253.40	$506.80	$58.17–$388.83	52% below	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Upper Ext Vein Mapping Right	$253.40	$506.80	$58.17–$388.83	52% below	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Upper Ext Venous Duplex Left	$253.40	$506.80	$58.17–$388.83	52% below	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Upper Ext Venous Duplex Right	$253.40	$506.80	$58.17–$388.83	52% below	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Lower Ext Vein Mapping Left	$253.40	$506.80	$58.17–$388.83	—	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Upper Ext Venous Duplex Right	$253.40	$506.80	$58.17–$388.83	—	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Upper Ext Venous Duplex Left	$253.40	$506.80	$58.17–$388.83	—	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Upper Ext Vein Mapping Right	$253.40	$506.80	$58.17–$388.83	—	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Upper Ext Vein Mapping Left	$253.40	$506.80	$58.17–$388.83	—	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Lower Ext Vein Mapping Right	$253.40	$506.80	$58.17–$388.83	—	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Lower Ext Venous Duplex Right	$253.40	$506.80	$58.17–$391.40	—	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Lower Ext Venous Duplex Reflux Right	$253.40	$506.80	$58.17–$388.83	—	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Lower Ext Venous Duplex Reflux Left	$253.40	$506.80	$58.17–$388.83	—	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Lower Ext Venous Duplex Left	$253.40	$506.80	$58.17–$391.40	—	50%
Wrist X-ray, 2 views one side CPT 73100 XR Wrist 2 Views Right	$106.85	$213.70	$48.16–$148.51	24% below	50%
Wrist X-ray, 2 views one side CPT 73100 XR Wrist 2 Views Left	$106.85	$213.70	$48.16–$163.16	24% below	50%
Wrist X-ray, 2 views inpatient one side CPT 73100 XR Wrist 2 Views Right	$106.85	$213.70	$48.16–$148.51	—	50%
Wrist X-ray, 2 views inpatient one side CPT 73100 XR Wrist 2 Views Left	$106.85	$213.70	$48.16–$163.16	—	50%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR Wrist Complete 3+ Views Left	$106.85	$213.70	$48.16–$190.95	45% below	50%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR Wrist Complete 3+ Views Right	$106.85	$213.70	$48.16–$190.95	45% below	50%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR Wrist Complete 3+ Views Right	$106.85	$213.70	$48.16–$190.95	—	50%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR Wrist Complete 3+ Views Left	$106.85	$213.70	$48.16–$190.95	—	50%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip 2-3 Views Left	$122.70	$245.40	$48.16–$214.09	41% below	50%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip 2-3 Views Right	$122.70	$245.40	$48.16–$214.09	41% below	50%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip 2-3 Views w/AP Pelvis Right	$122.70	$245.40	$48.16–$214.09	41% below	50%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip 2-3 Views w/AP Pelvis Left	$122.70	$245.40	$48.16–$214.09	41% below	50%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR Hip 2-3 Views Left	$122.70	$245.40	$48.16–$214.09	—	50%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR Hip 2-3 Views Right	$122.70	$245.40	$48.16–$214.09	—	50%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR Hip 2-3 Views w/AP Pelvis Left	$122.70	$245.40	$48.16–$214.09	—	50%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR Hip 2-3 Views w/AP Pelvis Right	$122.70	$245.40	$48.16–$214.09	—	50%
X-ray of the abdomen, 1 view CPT 74018 XR Abdomen 1 View Sitzmark Scan 1	$106.85	$213.70	$48.16–$154.12	33% below	50%
X-ray of the abdomen, 1 view CPT 74018 XR Abdomen KUB 1 View	$106.85	$213.70	$48.16–$163.16	33% below	50%
X-ray of the abdomen, 1 view CPT 74018 XR Abdomen 1 View Upright	$106.85	$213.70	$48.16–$154.12	33% below	50%
X-ray of the abdomen, 1 view CPT 74018 XR Abdomen KUB 1 View Portable	$106.85	$213.70	$48.16–$154.12	33% below	50%
X-ray of the abdomen, 1 view CPT 74018 ADD ON - XR Single View Abdomen	$106.85	$213.70	$48.16–$137.40	33% below	50%
X-ray of the abdomen, 1 view CPT 74018 XR Abdomen 1 View Sitzmark Scan 2	$106.85	$213.70	$48.16–$154.12	33% below	50%
X-ray of the abdomen, 1 view CPT 74018 XR Abdomen 1 View Sitzmark Scan 3	$106.85	$213.70	$48.16–$149.59	33% below	50%
X-ray of the abdomen, 1 view inpatient CPT 74018 XR Abdomen 1 View Sitzmark Scan 3	$106.85	$213.70	$48.16–$149.59	—	50%
X-ray of the abdomen, 1 view inpatient CPT 74018 XR Abdomen KUB 1 View Portable	$106.85	$213.70	$48.16–$154.12	—	50%
X-ray of the abdomen, 1 view inpatient CPT 74018 ADD ON - XR Single View Abdomen	$106.85	$213.70	$48.16–$137.40	—	50%
X-ray of the abdomen, 1 view inpatient CPT 74018 XR Abdomen 1 View Sitzmark Scan 1	$106.85	$213.70	$48.16–$154.12	—	50%
X-ray of the abdomen, 1 view inpatient CPT 74018 XR Abdomen 1 View Sitzmark Scan 2	$106.85	$213.70	$48.16–$154.12	—	50%
X-ray of the abdomen, 1 view inpatient CPT 74018 XR Abdomen KUB 1 View	$106.85	$213.70	$48.16–$163.16	—	50%
X-ray of the abdomen, 1 view inpatient CPT 74018 XR Abdomen 1 View Upright	$106.85	$213.70	$48.16–$154.12	—	50%
X-ray of the ankle, 2 views one side CPT 73600 XR Ankle 2 Views Left	$106.85	$213.70	$48.16–$163.16	39% below	50%
X-ray of the ankle, 2 views one side CPT 73600 XR Ankle 2 Views Right	$106.85	$213.70	$48.16–$163.16	39% below	50%
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR Ankle 2 Views Right	$106.85	$213.70	$48.16–$163.16	—	50%
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR Ankle 2 Views Left	$106.85	$213.70	$48.16–$163.16	—	50%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger(s) 2+ Views Left	$106.85	$213.70	$48.16–$183.24	20% below	50%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger(s) 2+ Views Right	$106.85	$213.70	$48.16–$183.24	20% below	50%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger(s) 2+ Views Right	$106.85	$213.70	$48.16–$183.24	—	50%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger(s) 2+ Views Left	$106.85	$213.70	$48.16–$183.24	—	50%
X-ray of the foot, 2 views one side CPT 73620 XR Foot 2 Views Right	$106.85	$213.70	$48.16–$163.16	33% below	50%
X-ray of the foot, 2 views one side CPT 73620 XR Foot 2 Views Left	$106.85	$213.70	$48.16–$149.59	33% below	50%
X-ray of the foot, 2 views inpatient one side CPT 73620 XR Foot 2 Views Left	$106.85	$213.70	$48.16–$149.59	—	50%
X-ray of the foot, 2 views inpatient one side CPT 73620 XR Foot 2 Views Right	$106.85	$213.70	$48.16–$163.16	—	50%
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR Foot Complete 3+ Views Right	$106.85	$213.70	$48.16–$165.04	41% below	50%
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR Foot Complete 3+ Views Left	$106.85	$213.70	$48.16–$165.04	41% below	50%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR Foot Complete 3+ Views Left	$106.85	$213.70	$48.16–$165.04	—	50%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR Foot Complete 3+ Views Right	$106.85	$213.70	$48.16–$165.04	—	50%
X-ray of the hand, 3 or more views one side CPT 73130 XR Hand Complete 3+ Views Left	$106.85	$213.70	$48.16–$167.81	42% below	50%
X-ray of the hand, 3 or more views one side CPT 73130 XR Hand Complete 3+ Views Right	$106.85	$213.70	$48.16–$167.81	42% below	50%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 XR Hand Complete 3+ Views Left	$106.85	$213.70	$48.16–$167.81	—	50%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 XR Hand Complete 3+ Views Right	$106.85	$213.70	$48.16–$167.81	—	50%
X-ray of the knee, 1 or 2 views one side CPT 73560 XR Knee 1 or 2 Views Right	$106.85	$213.70	$48.16–$163.16	31% below	50%
X-ray of the knee, 1 or 2 views one side CPT 73560 XR Knee 1 or 2 Views Left	$106.85	$213.70	$48.16–$165.04	31% below	50%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR Knee 1 or 2 Views Right	$106.85	$213.70	$48.16–$163.16	—	50%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR Knee 1 or 2 Views Left	$106.85	$213.70	$48.16–$165.04	—	50%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XR Spine Lumbosacral 2 or 3 Views	$106.85	$213.70	$58.17–$167.81	50% below	50%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 XR Spine Lumbosacral 2 or 3 Views	$106.85	$213.70	$58.17–$167.81	—	50%
X-ray of the lower back, 4 or more views CPT 72110 XR Spine Lumbosacral 4+ Views	$183.70	$367.40	$58.17–$283.74	40% below	50%
X-ray of the lower back, 4 or more views inpatient CPT 72110 XR Spine Lumbosacral 4+ Views	$183.70	$367.40	$58.17–$283.74	—	50%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 XR Spine Thoracic 2 Views	$106.85	$213.70	$58.17–$165.94	42% below	50%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 XR Spine Thoracic 2 Views	$106.85	$213.70	$58.17–$165.94	—	50%
X-ray of the nasal bones, 3 or more views CPT 70160 XR Nasal Bones 3+ Views	$92.95	$185.90	$48.16–$169.73	47% below	50%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 XR Nasal Bones 3+ Views	$92.95	$185.90	$48.16–$169.73	—	50%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XR Spine Cervical 2 or 3 Views	$106.85	$213.70	$48.16–$167.81	54% below	50%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 XR Spine Cervical 2 or 3 Views	$106.85	$213.70	$48.16–$167.81	—	50%
X-ray of the pelvis, 1 or 2 views CPT 72170 XR Pelvis 1 or 2 Views	$106.85	$213.70	$58.17–$165.94	35% below	50%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 XR Pelvis 1 or 2 Views	$106.85	$213.70	$58.17–$165.94	—	50%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XR Sacrum/Coccyx 2+ Views	$106.85	$213.70	$48.16–$163.16	39% below	50%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 XR Sacrum/Coccyx 2+ Views	$106.85	$213.70	$48.16–$163.16	—	50%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Michigan	Off list
ACTH blood test CPT 82024 ACTH (Adrenocorticotropic Hormone)	$117.35	$234.70	$21.13–$157.13	25% above	50%
ACTH blood test inpatient CPT 82024 ACTH (Adrenocorticotropic Hormone)	$117.35	$234.70	$21.13–$157.13	—	50%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALT	$15.75	$31.50	$2.90–$24.33	34% below	50%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALT	$15.75	$31.50	$2.90–$24.33	—	50%
AST (aspartate aminotransferase) enzyme test CPT 84450 AST	$15.75	$31.50	$2.83–$24.33	28% below	50%
AST (aspartate aminotransferase) enzyme test CPT 84450 AST Fluid	$15.75	$31.50	$2.83–$8.08	28% below	50%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 AST	$15.75	$31.50	$2.83–$24.33	—	50%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 AST Fluid	$15.75	$31.50	$2.83–$8.08	—	50%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Acute Hepatitis Panel	$164.60	$329.20	$26.05–$237.42	3% below	50%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 Acute Hepatitis Panel	$164.60	$329.20	$26.05–$237.42	—	50%
Albumin blood test CPT 82040 Albumin Level	$15.75	$31.50	$2.71–$22.72	21% below	50%
Albumin blood test inpatient CPT 82040 Albumin Level	$15.75	$31.50	$2.71–$22.72	—	50%
Aldosterone blood test CPT 82088 Aldosterone Lvl	$53.50	$107.00	$22.29–$110.67	3% below	50%
Aldosterone blood test CPT 82088 Aldosterone	$53.50	$107.00	$22.29–$110.67	3% below	50%
Aldosterone blood test inpatient CPT 82088 Aldosterone Lvl	$53.50	$107.00	$22.29–$110.67	—	50%
Aldosterone blood test inpatient CPT 82088 Aldosterone	$53.50	$107.00	$22.29–$110.67	—	50%
Alkaline phosphatase (ALP) blood test CPT 84075 Alkaline Phosphatase	$19.25	$38.50	$2.83–$27.77	8% below	50%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 Alkaline Phosphatase	$19.25	$38.50	$2.83–$27.77	—	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Add-On - Allergen, Insect Panel, IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Box Elder/Maple, IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Alternaria Alternata	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Aspergillus Fumigatus	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Bermuda Grass	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Birch	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Cat Dander	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Cladosporium Herbarum	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Clam	$20.40	$40.80	$2.86–$29.42	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Cockroach	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Cocksfoot (Orchard Grass)	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Codfish	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Common Ragweed	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Corn	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Cow's Milk	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Dermatophagoides Farinae	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Dermatophagoides Pteronyssinus	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Dog Dander	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Egg White	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Elm	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen English Plantain, Ribwort	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Oak	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Peanut	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Penicillium Notatum	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, White Bean IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Tomato IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Rice IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Tuna IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Potato IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Orange IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Oat IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Pigweed	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Redtop (Bentgrass)	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Rough Marsh Elder	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Hazelnut IgE	$20.40	$40.80	$2.86–$24.93	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Green Pepper IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Scallop	$20.40	$40.80	$2.86–$29.42	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Grape IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Crab IgE	$20.40	$40.80	$2.86–$29.42	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Carrot IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Cabbage IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, C. frutescens IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Blue Mussel IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Beef IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Barley IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Pork IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Beef IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Cabbage IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Tuna IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Barley IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Rice IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Potato IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Tomato IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Rye IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Oat IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Rye IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Pecan Nut IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Add-On - GI Distress Pnl, IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Insect Panel IgE - Warde	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Orange IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 White Bean IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Lettuce IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Grape IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Chicken IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Carrot IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Green Pepper IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Hormodendrum hordei IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Candida albicans IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Sesame Seed IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Pork IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Pistachio IgE	$20.40	$40.80	$2.86–$29.42	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Oyster IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Chicken IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Almond IgE	$20.40	$40.80	$2.86–$24.93	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 June Grass, IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Bermuda Grass, IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Maple (Box Elder)	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen June Grass	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Lobster IgE	$20.40	$40.80	$2.86–$29.42	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Lettuce IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Coconut IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Hormodendrum hordei IgE	$20.40	$40.80	$2.86–$29.42	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Candida albicans IgE	$20.40	$40.80	$2.86–$29.42	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Oyster IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Lobster IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Blue Mussel IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Crab IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Sesame Seed IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Almond IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Pecan Nut IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Coconut IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Birch, IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Walnut, IgE	$20.40	$40.80	$2.86–$29.42	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Shrimp, IgE	$20.40	$40.80	$2.86–$29.42	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Scallop, IgE	$20.40	$40.80	$2.86–$29.42	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Corn, IgE	$20.40	$40.80	$2.86–$29.42	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Shrimp	$20.40	$40.80	$2.86–$29.42	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Soybean	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Timothy Grass	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Walnut	$20.40	$40.80	$2.86–$24.93	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Wheat	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Dust Panel	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Cow's Milk, IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 D. farinae, IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Dog Epithelium, IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Codfish, IgE	$20.40	$40.80	$2.86–$29.42	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Clam, IgE	$20.40	$40.80	$2.86–$29.42	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 GI Distress Panel - Warde	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Plantain (English), Ribwort, IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Rough Marsh Elder, IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Redtop (Bentgrass), IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Oak, IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Elm, IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 D. Pternyssinus, IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Common Ragweed, IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Cocksfoot (Grass), IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Cockroach	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Cladosporium herbarum, IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 House Dust Greer, IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Penicillium Notatum, IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Pigweed, IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Timothy Grass, IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Egg White, IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Peanut, IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Cat Epithelium, IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Soybean, IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Wheat, IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Alternaria Alternata, IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen CPT 86003 Aspergillus fumigatus, IgE	$20.40	$40.80	$2.86–$14.20	220% above	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Hormodendrum hordei IgE	$20.40	$40.80	$2.86–$29.42	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Oyster IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Chicken IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Aspergillus fumigatus, IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Almond IgE	$20.40	$40.80	$2.86–$24.93	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Clam, IgE	$20.40	$40.80	$2.86–$29.42	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 June Grass, IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Timothy Grass, IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Bermuda Grass, IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 GI Distress Panel - Warde	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Maple (Box Elder)	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Soybean, IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen June Grass	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Plantain (English), Ribwort, IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Lobster IgE	$20.40	$40.80	$2.86–$29.42	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Lettuce IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Rough Marsh Elder, IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Coconut IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Elm	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Pecan Nut IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Egg White	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Dog Dander	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Almond IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Dermatophagoides Pteronyssinus	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 D. Pternyssinus, IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Dermatophagoides Farinae	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Sesame Seed IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Cow's Milk	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Corn	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Crab IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Common Ragweed	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Elm, IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Codfish	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Blue Mussel IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Cocksfoot (Orchard Grass)	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Cockroach	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Lobster IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Clam	$20.40	$40.80	$2.86–$29.42	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Oak, IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Cladosporium Herbarum	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Oyster IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Cat Dander	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Birch	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Candida albicans IgE	$20.40	$40.80	$2.86–$29.42	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Bermuda Grass	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Redtop (Bentgrass), IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Aspergillus Fumigatus	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Alternaria Alternata	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, White Bean IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cocksfoot (Grass), IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Tomato IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Walnut, IgE	$20.40	$40.80	$2.86–$29.42	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Rice IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Tuna IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Shrimp, IgE	$20.40	$40.80	$2.86–$29.42	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Potato IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cockroach	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Orange IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Scallop, IgE	$20.40	$40.80	$2.86–$29.42	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Peanut	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Birch, IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Oat IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Egg White, IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Oak	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Corn, IgE	$20.40	$40.80	$2.86–$29.42	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Pigweed	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cladosporium herbarum, IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Redtop (Bentgrass)	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Coconut IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen English Plantain, Ribwort	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Codfish, IgE	$20.40	$40.80	$2.86–$29.42	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Hazelnut IgE	$20.40	$40.80	$2.86–$24.93	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Scallop	$20.40	$40.80	$2.86–$29.42	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Green Pepper IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Alternaria Alternata, IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Grape IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Rough Marsh Elder	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Shrimp	$20.40	$40.80	$2.86–$29.42	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cat Epithelium, IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Crab IgE	$20.40	$40.80	$2.86–$29.42	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Soybean	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Carrot IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Dog Epithelium, IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Cabbage IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Timothy Grass	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, C. frutescens IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Wheat, IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Blue Mussel IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Walnut	$20.40	$40.80	$2.86–$24.93	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Beef IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 House Dust Greer, IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Barley IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Wheat	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Pork IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Box Elder/Maple, IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Beef IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Dust Panel	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cabbage IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Penicillium Notatum, IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Tuna IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cow's Milk, IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Barley IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Peanut, IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Rice IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 D. farinae, IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Potato IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Pigweed, IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Tomato IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Rye IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Oat IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Rye IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Pecan Nut IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Add-On - GI Distress Pnl, IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Insect Panel IgE - Warde	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Penicillium Notatum	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Orange IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 White Bean IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Common Ragweed, IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Lettuce IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Grape IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Chicken IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Carrot IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Green Pepper IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Hormodendrum hordei IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Candida albicans IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Sesame Seed IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Pork IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Pistachio IgE	$20.40	$40.80	$2.86–$29.42	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Add-On - Allergen, Insect Panel, IgE	$20.40	$40.80	$2.86–$14.20	—	50%
Alpha-fetoprotein (AFP) blood test CPT 82105 Alpha Fetoprotein Tumor Marker	$73.85	$147.70	$9.17–$114.07	45% above	50%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 Alpha Fetoprotein Tumor Marker	$73.85	$147.70	$9.17–$114.07	—	50%
Ammonia blood test CPT 82140 Ammonia Venous	$67.90	$135.80	$7.97–$97.94	4% above	50%
Ammonia blood test CPT 82140 Ammonia Arterial	$67.90	$135.80	$7.97–$39.58	4% above	50%
Ammonia blood test inpatient CPT 82140 Ammonia Venous	$67.90	$135.80	$7.97–$97.94	—	50%
Ammonia blood test inpatient CPT 82140 Ammonia Arterial	$67.90	$135.80	$7.97–$39.58	—	50%
Amylase blood test CPT 82150 Amylase Urine	$19.75	$39.50	$3.54–$17.60	1% below	50%
Amylase blood test CPT 82150 Amylase Level	$19.75	$39.50	$3.54–$30.51	1% below	50%
Amylase blood test CPT 82150 Amylase Fluid	$19.75	$39.50	$3.54–$17.60	1% below	50%
Amylase blood test CPT 82150 Amylase 24 Hr Urine	$19.75	$39.50	$3.54–$17.60	1% below	50%
Amylase blood test inpatient CPT 82150 Amylase 24 Hr Urine	$19.75	$39.50	$3.54–$17.60	—	50%
Amylase blood test inpatient CPT 82150 Amylase Level	$19.75	$39.50	$3.54–$30.51	—	50%
Amylase blood test inpatient CPT 82150 Amylase Urine	$19.75	$39.50	$3.54–$17.60	—	50%
Amylase blood test inpatient CPT 82150 Amylase Fluid	$19.75	$39.50	$3.54–$17.60	—	50%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Cyclic Citrullinated Pep IgG	$51.35	$102.70	$7.08–$74.07	8% below	50%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 Cyclic Citrullinated Pep IgG	$51.35	$102.70	$7.08–$74.07	—	50%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA Screen w Cascade reflex	$31.40	$62.80	$6.61–$45.29	44% below	50%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Antinuclear Antibody	$31.40	$62.80	$6.61–$48.50	44% below	50%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA Screen w Cascade reflex	$31.40	$62.80	$6.61–$45.29	—	50%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Antinuclear Antibody	$31.40	$62.80	$6.61–$48.50	—	50%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NT-proBNP	$110.25	$220.50	$21.48–$159.02	43% above	50%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NT-proBNP	$110.25	$220.50	$21.48–$159.02	—	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Tissue Aerobic, Anaerobic with Gram Stain	$64.95	$129.90	$4.72–$23.43	23% above	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Body Fluid Aerobic, Anaerobic with Gram Stain	$64.95	$129.90	$4.72–$93.68	23% above	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Sputum Culture with Gram Stain	$64.95	$129.90	$4.72–$93.68	23% above	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Ear Culture with Gram Stain	$64.95	$129.90	$4.72–$23.43	23% above	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Legionella Culture	$64.95	$129.90	$4.72–$93.68	23% above	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Throat Culture	$64.95	$129.90	$4.72–$93.68	23% above	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Eye Culture with Gram Stain	$64.95	$129.90	$4.72–$23.43	23% above	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Tissue Aerobic with Gram Stain	$64.95	$129.90	$4.72–$23.43	23% above	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Genital Culture	$64.95	$129.90	$4.72–$93.68	23% above	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Aerobic, Anaerobic with Gram Stain	$64.95	$129.90	$4.72–$93.68	23% above	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Environmental Culture	$64.95	$129.90	$4.72–$23.43	23% above	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Aerobic with Gram Stain	$64.95	$129.90	$4.72–$93.68	23% above	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Catheter Tip Culture	$64.95	$129.90	$4.72–$23.43	23% above	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Oral Culture	$64.95	$129.90	$4.72–$23.43	23% above	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Bronchoscopy Culture with Gram Stain	$64.95	$129.90	$4.72–$23.43	23% above	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Environmental Culture Spore	$64.95	$129.90	$4.72–$23.43	23% above	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Nasal Culture	$64.95	$129.90	$4.72–$93.68	23% above	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Environmental Water	$64.95	$129.90	$4.72–$23.43	23% above	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Body Fluid Aerobic with Gram Stain	$64.95	$129.90	$4.72–$23.43	23% above	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Foreign Object Culture	$64.95	$129.90	$4.72–$23.43	23% above	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Cerebrospinal Fluid Culture with Gram Stain	$64.95	$129.90	$4.72–$93.68	23% above	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Eye Culture with Gram Stain	$64.95	$129.90	$4.72–$23.43	—	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Genital Culture	$64.95	$129.90	$4.72–$93.68	—	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Foreign Object Culture	$64.95	$129.90	$4.72–$23.43	—	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Nasal Culture	$64.95	$129.90	$4.72–$93.68	—	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Throat Culture	$64.95	$129.90	$4.72–$93.68	—	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture Tissue Aerobic with Gram Stain	$64.95	$129.90	$4.72–$23.43	—	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Catheter Tip Culture	$64.95	$129.90	$4.72–$23.43	—	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture Environmental Water	$64.95	$129.90	$4.72–$23.43	—	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture Body Fluid Aerobic with Gram Stain	$64.95	$129.90	$4.72–$23.43	—	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Cerebrospinal Fluid Culture with Gram Stain	$64.95	$129.90	$4.72–$93.68	—	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture Aerobic with Gram Stain	$64.95	$129.90	$4.72–$93.68	—	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Ear Culture with Gram Stain	$64.95	$129.90	$4.72–$23.43	—	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Sputum Culture with Gram Stain	$64.95	$129.90	$4.72–$93.68	—	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Bronchoscopy Culture with Gram Stain	$64.95	$129.90	$4.72–$23.43	—	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Environmental Culture	$64.95	$129.90	$4.72–$23.43	—	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture Aerobic, Anaerobic with Gram Stain	$64.95	$129.90	$4.72–$93.68	—	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture Body Fluid Aerobic, Anaerobic with Gram Stain	$64.95	$129.90	$4.72–$93.68	—	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture Tissue Aerobic, Anaerobic with Gram Stain	$64.95	$129.90	$4.72–$23.43	—	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Legionella Culture	$64.95	$129.90	$4.72–$93.68	—	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Environmental Culture Spore	$64.95	$129.90	$4.72–$23.43	—	50%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Oral Culture	$64.95	$129.90	$4.72–$23.43	—	50%
Basic metabolic panel (blood test) CPT 80048 Basic Metabolic Panel	$120.55	$241.10	$4.63–$186.20	139% above	50%
Basic metabolic panel (blood test) inpatient CPT 80048 Basic Metabolic Panel	$120.55	$241.10	$4.63–$186.20	—	50%
Bilirubin blood test, total CPT 82247 Bilirubin Total	$15.75	$31.50	$2.75–$22.72	31% below	50%
Bilirubin blood test, total CPT 82247 Bilirubin Level Fluid	$15.75	$31.50	$2.75–$7.83	31% below	50%
Bilirubin blood test, total inpatient CPT 82247 Bilirubin Level Fluid	$15.75	$31.50	$2.75–$7.83	—	50%
Bilirubin blood test, total inpatient CPT 82247 Bilirubin Total	$15.75	$31.50	$2.75–$22.72	—	50%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 88305 Gross Micro Level 4	$131.90	$263.80	$29.23–$203.73	21% above	50%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 G0416 Prostate Bx Path Any Method	$479.30	$958.60	$29.23–$181.17	339% above	50%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 88305 Gross Micro Level 4	$131.90	$263.80	$29.23–$203.73	—	50%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 G0416 Prostate Bx Path Any Method	$479.30	$958.60	$29.23–$181.17	—	50%
Blood culture for bacteria CPT 87040 Bone Marrow Culture	$29.10	$58.20	$5.65–$28.03	54% below	50%
Blood culture for bacteria CPT 87040 Blood Culture	$29.10	$58.20	$5.65–$44.95	54% below	50%
Blood culture for bacteria inpatient CPT 87040 Bone Marrow Culture	$29.10	$58.20	$5.65–$28.03	—	50%
Blood culture for bacteria inpatient CPT 87040 Blood Culture	$29.10	$58.20	$5.65–$44.95	—	50%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 AMB Blood Collection Method -> Venous	$17.30	$34.60	$4.97–$26.72	34% above	50%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Blood Collection Method -> Venous	$17.30	$34.60	$4.97–$24.95	34% above	50%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLLECTION: Venous Draw	$17.30	$34.60	$4.97–$26.72	34% above	50%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Collection of venous blood by venipuncture 36415 ONC	$17.30	$34.60	$4.97–$26.72	34% above	50%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Blood Collection Method -> Venous	$17.30	$34.60	$4.97–$24.95	—	50%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 COLLECTION: Venous Draw	$17.30	$34.60	$4.97–$26.72	—	50%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Collection of venous blood by venipuncture 36415 ONC	$17.30	$34.60	$4.97–$26.72	—	50%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 AMB Blood Collection Method -> Venous	$17.30	$34.60	$4.97–$26.72	—	50%
Blood glucose (sugar) test CPT 82947 .Glucose, Arterial POC	$15.75	$31.50	$2.15–$6.13	34% below	50%
Blood glucose (sugar) test CPT 82947 Glucose POC	$15.75	$31.50	$2.15–$6.13	34% below	50%
Blood glucose (sugar) test CPT 82947 .Glucose, POC	$15.75	$31.50	$2.15–$22.72	34% below	50%
Blood glucose (sugar) test CPT 82947 Whole Blood Glucose POC	$15.75	$31.50	$2.15–$6.13	34% below	50%
Blood glucose (sugar) test CPT 82947 Glucose Level	$25.20	$50.40	$2.15–$38.92	5% above	50%
Blood glucose (sugar) test CPT 82947 Glucose Fasting	$25.20	$50.40	$2.15–$38.92	5% above	50%
Blood glucose (sugar) test CPT 82947 Glucose Level, 2 Hr PP	$25.20	$50.40	$2.15–$6.13	5% above	50%
Blood glucose (sugar) test inpatient CPT 82947 Whole Blood Glucose POC	$15.75	$31.50	$2.15–$6.13	—	50%
Blood glucose (sugar) test inpatient CPT 82947 Glucose POC	$15.75	$31.50	$2.15–$6.13	—	50%
Blood glucose (sugar) test inpatient CPT 82947 .Glucose, POC	$15.75	$31.50	$2.15–$22.72	—	50%
Blood glucose (sugar) test inpatient CPT 82947 .Glucose, Arterial POC	$15.75	$31.50	$2.15–$6.13	—	50%
Blood glucose (sugar) test inpatient CPT 82947 Glucose Level	$25.20	$50.40	$2.15–$38.92	—	50%
Blood glucose (sugar) test inpatient CPT 82947 Glucose Level, 2 Hr PP	$25.20	$50.40	$2.15–$6.13	—	50%
Blood glucose (sugar) test inpatient CPT 82947 Glucose Fasting	$25.20	$50.40	$2.15–$38.92	—	50%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HCG Qualitative Serum	$36.55	$73.10	$4.11–$52.72	1% below	50%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HCG Qualitative Serum	$36.55	$73.10	$4.11–$52.72	—	50%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Neonate ABORh	$22.00	$44.00	$1.64–$5.60	5% above	50%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABORh	$22.00	$44.00	$1.64–$31.73	5% above	50%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Cord ABORh	$22.00	$44.00	$1.64–$5.60	5% above	50%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Cord ABORh	$22.00	$44.00	$1.64–$5.60	—	50%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Neonate ABORh	$22.00	$44.00	$1.64–$5.60	—	50%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABORh	$22.00	$44.00	$1.64–$31.73	—	50%
Blood urea nitrogen (BUN) test CPT 84520 Blood Urea Nitrogen	$15.75	$31.50	$2.16–$22.72	11% below	50%
Blood urea nitrogen (BUN) test inpatient CPT 84520 Blood Urea Nitrogen	$15.75	$31.50	$2.16–$22.72	—	50%
C-peptide blood test CPT 84681 C-Peptide	$51.90	$103.80	$11.38–$74.86	26% below	50%
C-peptide blood test inpatient CPT 84681 C-Peptide	$51.90	$103.80	$11.38–$74.86	—	50%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-Reactive Protein	$31.55	$63.10	$2.83–$48.73	7% below	50%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-Reactive Protein	$31.55	$63.10	$2.83–$48.73	—	50%
C. difficile toxin gene test (stool PCR) CPT 87493 Clostridium Difficile PCR	$84.05	$168.10	$20.39–$121.23	27% below	50%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 Clostridium Difficile PCR	$84.05	$168.10	$20.39–$121.23	—	50%
CA 19-9 blood test (tumor marker) CPT 86301 CA 19 9	$62.40	$124.80	$11.38–$90.01	33% below	50%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA 19 9	$62.40	$124.80	$11.38–$90.01	—	50%
CA-125 blood test (ovarian cancer marker) CPT 86304 CA125	$72.75	$145.50	$11.38–$104.93	28% below	50%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA125	$72.75	$145.50	$11.38–$104.93	—	50%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS CoV-2 (COVID19) by PCR - Cepheid	$122.55	$245.10	$28.07–$253.49	16% above	50%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Coronavirus SARS CoV-2 by PCR - Roche	$122.55	$245.10	$28.07–$253.49	16% above	50%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Rapid Covid POC	$122.55	$245.10	$28.07–$253.49	16% above	50%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 Rapid Covid POC	$122.55	$245.10	$28.07–$253.49	—	50%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 Coronavirus SARS CoV-2 by PCR - Roche	$122.55	$245.10	$28.07–$253.49	—	50%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS CoV-2 (COVID19) by PCR - Cepheid	$122.55	$245.10	$28.07–$253.49	—	50%
Calcium blood test, total CPT 82310 Calcium Level Total	$15.75	$31.50	$2.82–$22.72	21% below	50%
Calcium blood test, total inpatient CPT 82310 Calcium Level Total	$15.75	$31.50	$2.82–$22.72	—	50%
Carcinoembryonic antigen (CEA) test CPT 82378 CEA Fluid	$87.60	$175.20	$10.37–$51.49	6% above	50%
Carcinoembryonic antigen (CEA) test CPT 82378 Carcinoembryonic Antigen	$87.60	$175.20	$10.37–$135.31	6% above	50%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CEA Fluid	$87.60	$175.20	$10.37–$51.49	—	50%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 Carcinoembryonic Antigen	$87.60	$175.20	$10.37–$135.31	—	50%
Chickenpox (varicella) immunity blood test CPT 86787 Varicella Zoster IgG	$31.40	$62.80	$7.05–$45.29	22% below	50%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 Varicella Zoster IgG	$31.40	$62.80	$7.05–$45.29	—	50%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia by PCR	$90.10	$180.20	$19.19–$139.17	22% above	50%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia PCR	$90.10	$180.20	$19.19–$129.96	22% above	50%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia by PCR	$90.10	$180.20	$19.19–$139.17	—	50%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia PCR	$90.10	$180.20	$19.19–$129.96	—	50%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel Calculated	$50.95	$101.90	$7.32–$78.70	at median	50%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel Calculated	$50.95	$101.90	$7.32–$78.70	—	50%
Complete blood count (CBC) with differential CPT 85025 CBC w/ Diff POC	$20.40	$40.80	$4.25–$50.00	49% below	50%
Complete blood count (CBC) with differential CPT 85025 CBC W Differential WBC Count POC 85025 Downtime	$20.40	$40.80	$4.25–$50.00	49% below	50%
Complete blood count (CBC) with differential CPT 85025 CBC w Differential	$43.00	$86.00	$4.25–$66.42	7% above	50%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC W Differential WBC Count POC 85025 Downtime	$20.40	$40.80	$4.25–$50.00	—	50%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC w/ Diff POC	$20.40	$40.80	$4.25–$50.00	—	50%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC w Differential	$43.00	$86.00	$4.25–$66.42	—	50%
Complete blood count (CBC), no differential CPT 85027 CBC No Diff (Hemogram)	$20.50	$41.00	$3.54–$45.00	29% below	50%
Complete blood count (CBC), no differential CPT 85027 White Blood Cell	$20.50	$41.00	$3.54–$45.00	29% below	50%
Complete blood count (CBC), no differential inpatient CPT 85027 CBC No Diff (Hemogram)	$20.50	$41.00	$3.54–$45.00	—	50%
Complete blood count (CBC), no differential inpatient CPT 85027 White Blood Cell	$20.50	$41.00	$3.54–$45.00	—	50%
Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive Metabolic Panel	$213.75	$427.50	$5.78–$330.16	186% above	50%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 Comprehensive Metabolic Panel	$213.75	$427.50	$5.78–$330.16	—	50%
Cortisol blood test, total CPT 82533 Cortisol Baseline	$39.30	$78.60	$8.92–$56.69	16% above	50%
Cortisol blood test, total CPT 82533 Cortisol PM	$39.30	$78.60	$8.92–$44.29	16% above	50%
Cortisol blood test, total CPT 82533 Cortisol AM	$39.30	$78.60	$8.92–$60.70	16% above	50%
Cortisol blood test, total CPT 82533 Cortisol Stim 30 minute	$39.30	$78.60	$8.92–$44.29	16% above	50%
Cortisol blood test, total CPT 82533 Cortisol Stim 60 minute	$39.30	$78.60	$8.92–$44.29	16% above	50%
Cortisol blood test, total CPT 82533 Cortisol	$39.30	$78.60	$8.92–$60.70	16% above	50%
Cortisol blood test, total inpatient CPT 82533 Cortisol AM	$39.30	$78.60	$8.92–$60.70	—	50%
Cortisol blood test, total inpatient CPT 82533 Cortisol PM	$39.30	$78.60	$8.92–$44.29	—	50%
Cortisol blood test, total inpatient CPT 82533 Cortisol Stim 30 minute	$39.30	$78.60	$8.92–$44.29	—	50%
Cortisol blood test, total inpatient CPT 82533 Cortisol Stim 60 minute	$39.30	$78.60	$8.92–$44.29	—	50%
Cortisol blood test, total inpatient CPT 82533 Cortisol Baseline	$39.30	$78.60	$8.92–$56.69	—	50%
Cortisol blood test, total inpatient CPT 82533 Cortisol	$39.30	$78.60	$8.92–$60.70	—	50%
Creatine kinase (CK) blood test, total CPT 82550 Creatine Kinase	$15.75	$31.50	$3.56–$24.33	48% below	50%
Creatine kinase (CK) blood test, total inpatient CPT 82550 Creatine Kinase	$15.75	$31.50	$3.56–$24.33	—	50%
Creatinine blood test CPT 82565 Creatinine Lvl	$15.75	$31.50	$2.80–$24.33	34% below	50%
Creatinine blood test CPT 82565 Fractional Excretion of Sodium	$15.75	$31.50	$2.80–$7.99	34% below	50%
Creatinine blood test CPT 82565 Creatinine	$15.75	$31.50	$2.80–$22.72	34% below	50%
Creatinine blood test inpatient CPT 82565 Creatinine Lvl	$15.75	$31.50	$2.80–$24.33	—	50%
Creatinine blood test inpatient CPT 82565 Creatinine	$15.75	$31.50	$2.80–$22.72	—	50%
Creatinine blood test inpatient CPT 82565 Fractional Excretion of Sodium	$15.75	$31.50	$2.80–$7.99	—	50%
Cytomegalovirus (CMV) antibody test CPT 86644 Cytomegalovirus IgG	$31.85	$63.70	$7.87–$45.94	27% below	50%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 Cytomegalovirus IgG	$31.85	$63.70	$7.87–$45.94	—	50%
D-dimer blood test (blood clot marker) CPT 85379 D Dimer Quantitative	$44.05	$88.10	$5.57–$63.54	2% above	50%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D Dimer Quantitative	$44.05	$88.10	$5.57–$63.54	—	50%
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA Sulfate Serum	$64.45	$128.90	$12.16–$92.96	at median	50%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA Sulfate Serum	$64.45	$128.90	$12.16–$92.96	—	50%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Barbiturates Urine	$89.65	$179.30	$30.00–$168.79	54% above	50%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen 7 Urine	$89.65	$179.30	$30.00–$168.79	54% above	50%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen 10 Urine	$89.65	$179.30	$30.00–$168.79	54% above	50%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Amphetamines Urine	$89.65	$179.30	$30.00–$168.79	54% above	50%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Propoxyphene Urine	$89.65	$179.30	$30.00–$168.79	54% above	50%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Methadone Urine	$89.65	$179.30	$30.00–$168.79	54% above	50%
Drug screen by lab instrument (any number of drug classes) CPT 80307 PCP Urine	$89.65	$179.30	$30.00–$168.79	54% above	50%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Opiates Urine	$89.65	$179.30	$30.00–$168.79	54% above	50%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Oxycodone/Oxymorphone Scrn w/Rflx, Urine	$89.65	$179.30	$30.00–$168.79	54% above	50%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Cocaine Urine	$89.65	$179.30	$30.00–$168.79	54% above	50%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Cannabinoid Urine	$89.65	$179.30	$30.00–$168.79	54% above	50%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Benzodiazepine Urine	$89.65	$179.30	$30.00–$168.79	54% above	50%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Methadone Urine	$89.65	$179.30	$30.00–$168.79	—	50%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Barbiturates Urine	$89.65	$179.30	$30.00–$168.79	—	50%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Opiates Urine	$89.65	$179.30	$30.00–$168.79	—	50%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Benzodiazepine Urine	$89.65	$179.30	$30.00–$168.79	—	50%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Screen 10 Urine	$89.65	$179.30	$30.00–$168.79	—	50%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Cocaine Urine	$89.65	$179.30	$30.00–$168.79	—	50%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 PCP Urine	$89.65	$179.30	$30.00–$168.79	—	50%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Propoxyphene Urine	$89.65	$179.30	$30.00–$168.79	—	50%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Oxycodone/Oxymorphone Scrn w/Rflx, Urine	$89.65	$179.30	$30.00–$168.79	—	50%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Amphetamines Urine	$89.65	$179.30	$30.00–$168.79	—	50%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Screen 7 Urine	$89.65	$179.30	$30.00–$168.79	—	50%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Cannabinoid Urine	$89.65	$179.30	$30.00–$168.79	—	50%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 Electrolyte Panel	$60.75	$121.50	$3.83–$93.83	90% above	50%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 Electrolyte Panel	$60.75	$121.50	$3.83–$93.83	—	50%
Epstein-Barr virus (EBV) antibody test CPT 86665 Epstein Barr VCA IgM	$33.55	$67.10	$9.92–$49.29	47% below	50%
Epstein-Barr virus (EBV) antibody test CPT 86665 EB VCA IgG Unit	$33.55	$67.10	$9.92–$49.29	47% below	50%
Epstein-Barr virus (EBV) antibody test CPT 86665 Epstein Barr VCA IgG	$33.55	$67.10	$9.92–$49.29	47% below	50%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 Epstein Barr VCA IgG	$33.55	$67.10	$9.92–$49.29	—	50%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EB VCA IgG Unit	$33.55	$67.10	$9.92–$49.29	—	50%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 Epstein Barr VCA IgM	$33.55	$67.10	$9.92–$49.29	—	50%
Estradiol blood test CPT 82670 Estradiol Level	$70.80	$141.60	$15.28–$109.36	9% below	50%
Estradiol blood test inpatient CPT 82670 Estradiol Level	$70.80	$141.60	$15.28–$109.36	—	50%
FSH (follicle-stimulating hormone) test CPT 83001 Follicular Stimulating Hormone Level	$37.75	$75.50	$10.16–$58.31	53% below	50%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 Follicular Stimulating Hormone Level	$37.75	$75.50	$10.16–$58.31	—	50%
Fecal calprotectin (stool inflammation test) CPT 83993 Calprotectin, Fecal	$26.40	$52.80	$10.74–$53.31	58% below	50%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 Calprotectin, Fecal	$26.40	$52.80	$10.74–$53.31	—	50%
Ferritin blood test (iron stores) CPT 82728 Ferritin	$78.40	$156.80	$7.46–$121.10	31% above	50%
Ferritin blood test (iron stores) inpatient CPT 82728 Ferritin	$78.40	$156.80	$7.46–$121.10	—	50%
Fibrinogen blood test CPT 85384 Citrated TEG CFFMA	$27.85	$55.70	$5.32–$26.40	4% below	50%
Fibrinogen blood test CPT 85384 Fibrinogen Level	$27.85	$55.70	$5.32–$40.17	4% below	50%
Fibrinogen blood test CPT 85384 Add-On - Fibrogen (factor 1) activity measurement	$27.85	$55.70	$5.32–$26.40	4% below	50%
Fibrinogen blood test CPT 85384 Citrated TEG CFFLEV	$27.85	$55.70	$5.32–$26.40	4% below	50%
Fibrinogen blood test CPT 85384 Trauma TEG CFFMA	$27.85	$55.70	$5.32–$26.40	4% below	50%
Fibrinogen blood test inpatient CPT 85384 Fibrinogen Level	$27.85	$55.70	$5.32–$40.17	—	50%
Fibrinogen blood test inpatient CPT 85384 Trauma TEG CFFMA	$27.85	$55.70	$5.32–$26.40	—	50%
Fibrinogen blood test inpatient CPT 85384 Citrated TEG CFFLEV	$27.85	$55.70	$5.32–$26.40	—	50%
Fibrinogen blood test inpatient CPT 85384 Add-On - Fibrogen (factor 1) activity measurement	$27.85	$55.70	$5.32–$26.40	—	50%
Fibrinogen blood test inpatient CPT 85384 Citrated TEG CFFMA	$27.85	$55.70	$5.32–$26.40	—	50%
Folate (folic acid) blood test CPT 82746 Folate Level	$33.95	$67.90	$8.04–$52.44	54% below	50%
Folate (folic acid) blood test inpatient CPT 82746 Folate Level	$33.95	$67.90	$8.04–$52.44	—	50%
Free T3 thyroid hormone test CPT 84481 T3 Free Level	$42.45	$84.90	$9.27–$61.23	36% below	50%
Free T3 thyroid hormone test inpatient CPT 84481 T3 Free Level	$42.45	$84.90	$9.27–$61.23	—	50%
Free T4 (free thyroxine) thyroid blood test CPT 84439 T4 Free Level	$78.65	$157.30	$4.93–$121.48	158% above	50%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4 Free Level	$78.65	$157.30	$4.93–$121.48	—	50%
Free testosterone test CPT 84402 Testosterone, Free - Warde	$84.95	$169.90	$13.93–$122.53	132% above	50%
Free testosterone test inpatient CPT 84402 Testosterone, Free - Warde	$84.95	$169.90	$13.93–$122.53	—	50%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 Gamma Glutamyl Transferase	$37.30	$74.60	$3.94–$53.80	21% above	50%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 Gamma Glutamyl Transferase	$37.30	$74.60	$3.94–$53.80	—	50%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GTT Glucose Tolerance 1 Hr	$11.40	$22.80	$2.60–$12.89	47% below	50%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose Gestational Screen (1 Hour) OB	$11.80	$23.60	$2.60–$17.02	45% below	50%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GTT Glucose Tolerance 1 Hr	$11.40	$22.80	$2.60–$12.89	—	50%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Glucose Gestational Screen (1 Hour) OB	$11.80	$23.60	$2.60–$17.02	—	50%
Glucose tolerance test, 3 samples CPT 82951 .GTT Glucose Tolerance 2 Hr OB	$41.90	$83.80	$7.04–$34.95	26% below	50%
Glucose tolerance test, 3 samples CPT 82951 .GTT Glucose Tolerance 30 Min OB	$41.90	$83.80	$7.04–$34.95	26% below	50%
Glucose tolerance test, 3 samples CPT 82951 .GTT Glucose Tolerance 90 Min OB	$41.90	$83.80	$7.04–$34.95	26% below	50%
Glucose tolerance test, 3 samples CPT 82951 GTT Glucose Tolerance 2 Hr	$41.90	$83.80	$7.04–$34.95	26% below	50%
Glucose tolerance test, 3 samples inpatient CPT 82951 .GTT Glucose Tolerance 90 Min OB	$41.90	$83.80	$7.04–$34.95	—	50%
Glucose tolerance test, 3 samples inpatient CPT 82951 GTT Glucose Tolerance 2 Hr	$41.90	$83.80	$7.04–$34.95	—	50%
Glucose tolerance test, 3 samples inpatient CPT 82951 .GTT Glucose Tolerance 30 Min OB	$41.90	$83.80	$7.04–$34.95	—	50%
Glucose tolerance test, 3 samples inpatient CPT 82951 .GTT Glucose Tolerance 2 Hr OB	$41.90	$83.80	$7.04–$34.95	—	50%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GC DNA, PCR	$90.10	$180.20	$19.19–$129.96	7% below	50%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GC by PCR	$90.10	$180.20	$19.19–$129.96	7% below	50%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 GC DNA, PCR	$90.10	$180.20	$19.19–$129.96	—	50%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 GC by PCR	$90.10	$180.20	$19.19–$129.96	—	50%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV1QnRNA	$275.25	$550.50	$46.55–$231.15	51% above	50%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 RNA, Quantitative	$275.25	$550.50	$46.55–$397.02	51% above	50%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 EH HIV-1 RNA, Quantitative HCW	$275.25	$550.50	$46.55–$231.15	51% above	50%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 EH HIV-1 RNA, Quantitative HCW	$275.25	$550.50	$46.55–$231.15	—	50%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV1QnRNA	$275.25	$550.50	$46.55–$231.15	—	50%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV-1 RNA, Quantitative	$275.25	$550.50	$46.55–$397.02	—	50%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 Hiv I/II Ab. P24 Ag With Reflex	$31.60	$63.20	$13.17–$65.40	36% below	50%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV Rapid Ab I/II - p24 Ag Qual	$31.60	$63.20	$13.17–$65.40	36% below	50%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 Hiv I/II Ab. P24 Ag With Reflex	$31.60	$63.20	$13.17–$65.40	—	50%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV Rapid Ab I/II - p24 Ag Qual	$31.60	$63.20	$13.17–$65.40	—	50%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV High Risk	$93.25	$186.50	$19.19–$134.50	26% above	50%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV High Risk	$93.25	$186.50	$19.19–$134.50	—	50%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1c POC Amb	$25.15	$50.30	$5.31–$36.28	35% below	50%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1c (Glycosylated)	$47.20	$94.40	$5.31–$72.91	22% above	50%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hemoglobin A1c POC Amb	$25.15	$50.30	$5.31–$36.28	—	50%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hemoglobin A1c (Glycosylated)	$47.20	$94.40	$5.31–$72.91	—	50%
Hemoglobin blood test CPT 85018 Hemoglobin POC	$11.60	$23.20	$1.30–$6.45	28% below	50%
Hemoglobin blood test CPT 85018 Total Hgb	$20.95	$41.90	$1.30–$32.36	31% above	50%
Hemoglobin blood test CPT 85018 Hemoglobin	$20.95	$41.90	$1.30–$30.22	31% above	50%
Hemoglobin blood test inpatient CPT 85018 Hemoglobin POC	$11.60	$23.20	$1.30–$6.45	—	50%
Hemoglobin blood test inpatient CPT 85018 Hemoglobin	$20.95	$41.90	$1.30–$30.22	—	50%
Hemoglobin blood test inpatient CPT 85018 Total Hgb	$20.95	$41.90	$1.30–$32.36	—	50%
Hepatitis B core antibody test (total) CPT 86704 Hepatitis B Core Total (IgM and IgG)	$33.95	$67.90	$6.59–$52.44	23% below	50%
Hepatitis B core antibody test (total) inpatient CPT 86704 Hepatitis B Core Total (IgM and IgG)	$33.95	$67.90	$6.59–$52.44	—	50%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 EH Hepatitis B Surface Antibody HCW	$38.80	$77.60	$5.87–$30.57	8% below	50%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B Surface Antibody	$38.80	$77.60	$5.87–$59.93	8% below	50%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hepatitis B Surface Antibody	$38.80	$77.60	$5.87–$59.93	—	50%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 EH Hepatitis B Surface Antibody HCW	$38.80	$77.60	$5.87–$30.57	—	50%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hepatitis B Surface Antigen	$28.80	$57.60	$5.65–$44.48	38% below	50%
Hepatitis B surface antigen (HBsAg) test CPT 87340 EH Hepatitis B Surface Antigen HCW	$28.80	$57.60	$5.65–$28.07	38% below	50%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hepatitis B Surface Antigen	$28.80	$57.60	$5.65–$44.48	—	50%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 EH Hepatitis B Surface Antigen HCW	$28.80	$57.60	$5.65–$28.07	—	50%
Hepatitis C antibody blood test (screening) CPT 86803 EH Hepatitis C Antibody HCW	$33.90	$67.80	$7.81–$38.75	29% below	50%
Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C Antibody	$33.90	$67.80	$7.81–$52.36	29% below	50%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 Hepatitis C Antibody	$33.90	$67.80	$7.81–$52.36	—	50%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 EH Hepatitis C Antibody HCW	$33.90	$67.80	$7.81–$38.75	—	50%
Hepatitis C viral load (HCV RNA) test CPT 87522 Hepatitis C RNA Qn Viral Load	$195.95	$391.90	$23.43–$282.64	49% above	50%
Hepatitis C viral load (HCV RNA) test CPT 87522 EH Hepatitis C RNA Qn Viral Load HCW	$195.95	$391.90	$23.43–$116.35	49% above	50%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 EH Hepatitis C RNA Qn Viral Load HCW	$195.95	$391.90	$23.43–$116.35	—	50%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Hepatitis C RNA Qn Viral Load	$195.95	$391.90	$23.43–$282.64	—	50%
Herpes blood test, HSV-1 antibody CPT 86695 Herpes Simplex 1 2 IgG	$33.55	$67.10	$7.21–$48.39	19% below	50%
Herpes blood test, HSV-1 antibody CPT 86695 Herpes Simplex 1 IgG	$33.55	$67.10	$7.21–$35.81	19% below	50%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 Herpes Simplex 1 2 IgG	$33.55	$67.10	$7.21–$48.39	—	50%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 Herpes Simplex 1 IgG	$33.55	$67.10	$7.21–$35.81	—	50%
Herpes blood test, HSV-2 antibody CPT 86696 Herpes Simplex 2 IgG	$39.45	$78.90	$10.58–$52.55	23% below	50%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 Herpes Simplex 2 IgG	$39.45	$78.90	$10.58–$52.55	—	50%
High-sensitivity CRP (hs-CRP) test CPT 86141 C-Reactive Protein High Sensitivity (CV Risk)	$57.55	$115.10	$7.08–$88.89	at median	50%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-Reactive Protein High Sensitivity (CV Risk)	$57.55	$115.10	$7.08–$88.89	—	50%
Homocysteine blood test CPT 83090 Homocysteine Level	$94.10	$188.20	$9.80–$135.73	23% above	50%
Homocysteine blood test inpatient CPT 83090 Homocysteine Level	$94.10	$188.20	$9.80–$135.73	—	50%
Insulin blood test CPT 83525 .INSTT Insulin Tolerance 2 Hr	$38.20	$76.40	$6.25–$31.03	4% above	50%
Insulin blood test CPT 83525 .INSTT Insulin Tolerance 4 Hr	$38.20	$76.40	$6.25–$31.03	4% above	50%
Insulin blood test CPT 83525 .INSTT Insulin Tolerance 5 Hr	$38.20	$76.40	$6.25–$31.03	4% above	50%
Insulin blood test CPT 83525 .INSTT Insulin Tolerance Fasting	$38.20	$76.40	$6.25–$31.03	4% above	50%
Insulin blood test CPT 83525 Insulin Level Total	$38.20	$76.40	$6.25–$55.10	4% above	50%
Insulin blood test CPT 83525 .INSTT Insulin Tolerance 1 Hr	$38.20	$76.40	$6.25–$31.03	4% above	50%
Insulin blood test CPT 83525 .INSTT Insulin Tolerance 3 Hr	$38.20	$76.40	$6.25–$31.03	4% above	50%
Insulin blood test inpatient CPT 83525 .INSTT Insulin Tolerance 5 Hr	$38.20	$76.40	$6.25–$31.03	—	50%
Insulin blood test inpatient CPT 83525 .INSTT Insulin Tolerance 4 Hr	$38.20	$76.40	$6.25–$31.03	—	50%
Insulin blood test inpatient CPT 83525 Insulin Level Total	$38.20	$76.40	$6.25–$55.10	—	50%
Insulin blood test inpatient CPT 83525 .INSTT Insulin Tolerance 3 Hr	$38.20	$76.40	$6.25–$31.03	—	50%
Insulin blood test inpatient CPT 83525 .INSTT Insulin Tolerance 1 Hr	$38.20	$76.40	$6.25–$31.03	—	50%
Insulin blood test inpatient CPT 83525 .INSTT Insulin Tolerance 2 Hr	$38.20	$76.40	$6.25–$31.03	—	50%
Insulin blood test inpatient CPT 83525 .INSTT Insulin Tolerance Fasting	$38.20	$76.40	$6.25–$31.03	—	50%
Iron blood test (serum iron) CPT 83540 Iron Level	$34.65	$69.30	$3.54–$53.52	18% above	50%
Iron blood test (serum iron) inpatient CPT 83540 Iron Level	$34.65	$69.30	$3.54–$53.52	—	50%
Iron-binding capacity (TIBC) test CPT 83550 TIBC	$40.90	$81.80	$4.78–$63.17	3% above	50%
Iron-binding capacity (TIBC) test inpatient CPT 83550 TIBC	$40.90	$81.80	$4.78–$63.17	—	50%
Kidney function blood test panel CPT 80069 Renal Function Panel	$150.90	$301.80	$4.75–$217.66	144% above	50%
Kidney function blood test panel inpatient CPT 80069 Renal Function Panel	$150.90	$301.80	$4.75–$217.66	—	50%
LH (luteinizing hormone) test CPT 83002 Luteinizing Hormone	$38.80	$77.60	$10.13–$59.93	49% below	50%
LH (luteinizing hormone) test inpatient CPT 83002 Luteinizing Hormone	$38.80	$77.60	$10.13–$59.93	—	50%
Lactate (lactic acid) blood test CPT 83605 .Lactate Level, POC	$42.80	$85.60	$6.33–$31.43	5% below	50%
Lactate (lactic acid) blood test CPT 83605 Lactate Level POC	$42.80	$85.60	$6.33–$57.31	5% below	50%
Lactate (lactic acid) blood test CPT 83605 Lactic Acid Venous	$42.80	$85.60	$6.33–$66.11	5% below	50%
Lactate (lactic acid) blood test CPT 83605 Lactic Acid Arterial	$42.80	$85.60	$6.33–$31.43	5% below	50%
Lactate (lactic acid) blood test inpatient CPT 83605 .Lactate Level, POC	$42.80	$85.60	$6.33–$31.43	—	50%
Lactate (lactic acid) blood test inpatient CPT 83605 Lactate Level POC	$42.80	$85.60	$6.33–$57.31	—	50%
Lactate (lactic acid) blood test inpatient CPT 83605 Lactic Acid Arterial	$42.80	$85.60	$6.33–$31.43	—	50%
Lactate (lactic acid) blood test inpatient CPT 83605 Lactic Acid Venous	$42.80	$85.60	$6.33–$66.11	—	50%
Lactate dehydrogenase (LDH) blood test CPT 83615 LDH Fluid	$15.75	$31.50	$3.30–$9.43	34% below	50%
Lactate dehydrogenase (LDH) blood test CPT 83615 Lactate Dehydrogenase	$15.75	$31.50	$3.30–$22.72	34% below	50%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH Fluid	$15.75	$31.50	$3.30–$9.43	—	50%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Lactate Dehydrogenase	$15.75	$31.50	$3.30–$22.72	—	50%
Lipase blood test (pancreas enzyme) CPT 83690 Lipase Level	$21.05	$42.10	$3.77–$32.51	30% below	50%
Lipase blood test (pancreas enzyme) CPT 83690 Lipase Fluid	$21.05	$42.10	$3.77–$18.72	30% below	50%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase Fluid	$21.05	$42.10	$3.77–$18.72	—	50%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase Level	$21.05	$42.10	$3.77–$32.51	—	50%
Liver function blood test panel CPT 80076 Hepatic Function Panel	$105.25	$210.50	$4.47–$162.57	124% above	50%
Liver function blood test panel inpatient CPT 80076 Hepatic Function Panel	$105.25	$210.50	$4.47–$162.57	—	50%
Lyme disease antibody test CPT 86618 Lyme Ab Total	$37.25	$74.50	$9.32–$53.73	43% above	50%
Lyme disease antibody test inpatient CPT 86618 Lyme Ab Total	$37.25	$74.50	$9.32–$53.73	—	50%
Magnesium blood test CPT 83735 Magnesium 24 Hr Urine	$16.35	$32.70	$3.66–$18.22	18% below	50%
Magnesium blood test CPT 83735 Magnesium Urine	$16.35	$32.70	$3.66–$18.22	18% below	50%
Magnesium blood test CPT 83735 Magnesium Level	$16.35	$32.70	$3.66–$25.25	18% below	50%
Magnesium blood test inpatient CPT 83735 Magnesium 24 Hr Urine	$16.35	$32.70	$3.66–$18.22	—	50%
Magnesium blood test inpatient CPT 83735 Magnesium Level	$16.35	$32.70	$3.66–$25.25	—	50%
Magnesium blood test inpatient CPT 83735 Magnesium Urine	$16.35	$32.70	$3.66–$18.22	—	50%
Measles (rubeola) antibody test CPT 86765 Rubeola IgG	$28.80	$57.60	$7.05–$41.54	17% above	50%
Measles (rubeola) antibody test inpatient CPT 86765 Rubeola IgG	$28.80	$57.60	$7.05–$41.54	—	50%
Mono test (heterophile antibody, Monospot) CPT 86308 Mononucleosis Screen	$14.45	$28.90	$2.83–$20.84	65% below	50%
Mono test (heterophile antibody, Monospot) CPT 86308 Monospot: Whole Blood POC	$14.45	$28.90	$2.83–$14.09	65% below	50%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 Mononucleosis Screen	$14.45	$28.90	$2.83–$20.84	—	50%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 Monospot: Whole Blood POC	$14.45	$28.90	$2.83–$14.09	—	50%
Mumps immunity blood test CPT 86735 Mumps Screen IgG	$35.55	$71.10	$7.14–$51.28	42% above	50%
Mumps immunity blood test inpatient CPT 86735 Mumps Screen IgG	$35.55	$71.10	$7.14–$51.28	—	50%
Obstetric blood test panel CPT 80055 OB Panel	$92.90	$185.80	$26.15–$156.73	47% below	50%
Obstetric blood test panel inpatient CPT 80055 OB Panel	$92.90	$185.80	$26.15–$156.73	—	50%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA, Free	$58.90	$117.80	$10.06–$84.96	3% above	50%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA Free	$58.90	$117.80	$10.06–$49.94	3% above	50%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA, Free	$58.90	$117.80	$10.06–$84.96	—	50%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA Free	$58.90	$117.80	$10.06–$49.94	—	50%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA, Total	$90.75	$181.50	$10.06–$130.90	80% above	50%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Diagnostic	$90.75	$181.50	$10.06–$130.90	80% above	50%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA, Total	$90.75	$181.50	$10.06–$130.90	—	50%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA Diagnostic	$90.75	$181.50	$10.06–$130.90	—	50%
Pap test (liquid-based, automated screening with review) CPT 88175 88175 Cyto Cerv or Vag Thin Prep Auto/Man	$60.65	$121.30	$14.56–$72.28	18% below	50%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 88175 Cyto Cerv or Vag Thin Prep Auto/Man	$60.65	$121.30	$14.56–$72.28	—	50%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 88142 Cyto Cervical or Vaginal Manual Screen	$77.95	$155.90	$11.08–$55.04	at median	50%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 88142 Cyto Cervical or Vaginal Manual Screen	$77.95	$155.90	$11.08–$55.04	—	50%
Parathyroid hormone (PTH) blood test CPT 83970 PTH Intact	$102.10	$204.20	$22.58–$147.27	24% below	50%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH Intact	$102.10	$204.20	$22.58–$147.27	—	50%
Partial thromboplastin time (PTT) clotting test CPT 85730 Partial Thromboplastin Time	$34.65	$69.30	$3.29–$16.33	12% above	50%
Partial thromboplastin time (PTT) clotting test CPT 85730 Activated PTT	$34.65	$69.30	$3.29–$49.98	12% above	50%
Partial thromboplastin time (PTT) clotting test CPT 85730 Activated Partial Thromboplastin	$34.65	$69.30	$3.29–$53.52	12% above	50%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT With Heparin	$34.65	$69.30	$3.29–$16.33	12% above	50%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Activated PTT	$34.65	$69.30	$3.29–$49.98	—	50%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Activated Partial Thromboplastin	$34.65	$69.30	$3.29–$53.52	—	50%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT With Heparin	$34.65	$69.30	$3.29–$16.33	—	50%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Partial Thromboplastin Time	$34.65	$69.30	$3.29–$16.33	—	50%
Phosphorus (phosphate) blood test CPT 84100 Phosphorus Level	$15.75	$31.50	$2.59–$24.33	25% below	50%
Phosphorus (phosphate) blood test inpatient CPT 84100 Phosphorus Level	$15.75	$31.50	$2.59–$24.33	—	50%
Potassium blood test CPT 84132 Potassium Level POC	$15.75	$31.50	$2.60–$7.43	32% below	50%
Potassium blood test CPT 84132 Potassium Level	$15.75	$31.50	$2.60–$24.33	32% below	50%
Potassium blood test CPT 84132 Potassium Arterial	$15.75	$31.50	$2.60–$7.43	32% below	50%
Potassium blood test inpatient CPT 84132 Potassium Level	$15.75	$31.50	$2.60–$24.33	—	50%
Potassium blood test inpatient CPT 84132 Potassium Arterial	$15.75	$31.50	$2.60–$7.43	—	50%
Potassium blood test inpatient CPT 84132 Potassium Level POC	$15.75	$31.50	$2.60–$7.43	—	50%
Progesterone blood test CPT 84144 Progesterone Level	$51.90	$103.80	$11.41–$74.86	19% below	50%
Progesterone blood test inpatient CPT 84144 Progesterone Level	$51.90	$103.80	$11.41–$74.86	—	50%
Prolactin blood test CPT 84146 Prolactin	$48.70	$97.40	$10.60–$70.24	34% below	50%
Prolactin blood test inpatient CPT 84146 Prolactin	$48.70	$97.40	$10.60–$70.24	—	50%
Prothrombin time (PT/INR) clotting test CPT 85610 INR Level POC	$11.25	$22.50	$2.35–$11.66	42% below	50%
Prothrombin time (PT/INR) clotting test CPT 85610 INR POC	$13.10	$26.20	$2.35–$11.66	32% below	50%
Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time	$29.25	$58.50	$2.35–$11.66	52% above	50%
Prothrombin time (PT/INR) clotting test CPT 85610 .INR POC	$29.25	$58.50	$2.35–$11.66	52% above	50%
Prothrombin time (PT/INR) clotting test CPT 85610 .PT/INR POC	$29.25	$58.50	$2.35–$11.66	52% above	50%
Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time and INR	$29.25	$58.50	$2.35–$45.18	52% above	50%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 INR Level POC	$11.25	$22.50	$2.35–$11.66	—	50%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 INR POC	$13.10	$26.20	$2.35–$11.66	—	50%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 .PT/INR POC	$29.25	$58.50	$2.35–$11.66	—	50%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time	$29.25	$58.50	$2.35–$11.66	—	50%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 .INR POC	$29.25	$58.50	$2.35–$11.66	—	50%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time and INR	$29.25	$58.50	$2.35–$45.18	—	50%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 Drug Screen 12 Urine POC Complete -> Yes	$13.45	$26.90	$6.89–$34.22	65% below	50%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 Drug Screen 12 Urine POC Complete -> Yes	$13.45	$26.90	$6.89–$34.22	—	50%
Rapid flu test (influenza antigen) CPT 87804 Influenza POC	$56.85	$113.70	$9.05–$44.94	18% above	50%
Rapid flu test (influenza antigen) inpatient CPT 87804 Influenza POC	$56.85	$113.70	$9.05–$44.94	—	50%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Rapid Strep	$37.55	$75.10	$9.04–$54.16	30% below	50%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 Rapid Strep	$37.55	$75.10	$9.04–$54.16	—	50%
Renin blood test CPT 84244 Renin Direct	$28.85	$57.70	$12.03–$59.72	31% below	50%
Renin blood test CPT 84244 Renin, Direct	$28.85	$57.70	$12.03–$59.72	31% below	50%
Renin blood test inpatient CPT 84244 Renin, Direct	$28.85	$57.70	$12.03–$59.72	—	50%
Renin blood test inpatient CPT 84244 Renin Direct	$28.85	$57.70	$12.03–$59.72	—	50%
Rh blood typing CPT 86901 Add-On - Rh Type	$19.60	$39.20	$1.64–$28.27	5% below	50%
Rh blood typing CPT 86901 Rh Type Only	$19.60	$39.20	$1.64–$28.27	5% below	50%
Rh blood typing inpatient CPT 86901 Add-On - Rh Type	$19.60	$39.20	$1.64–$28.27	—	50%
Rh blood typing inpatient CPT 86901 Rh Type Only	$19.60	$39.20	$1.64–$28.27	—	50%
Rheumatoid factor (RF) test CPT 86431 Rheumatoid Arthritis Factor Quant	$22.50	$45.00	$3.10–$34.75	35% below	50%
Rheumatoid factor (RF) test inpatient CPT 86431 Rheumatoid Arthritis Factor Quant	$22.50	$45.00	$3.10–$34.75	—	50%
Rubella antibody test (immunity check) CPT 86762 Rubella IgG	$34.60	$69.20	$7.87–$49.91	32% below	50%
Rubella antibody test (immunity check) inpatient CPT 86762 Rubella IgG	$34.60	$69.20	$7.87–$49.91	—	50%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 Sedimentation Rate	$9.40	$18.80	$1.48–$14.52	61% below	50%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 Sedimentation Rate	$9.40	$18.80	$1.48–$14.52	—	50%
Sodium blood test CPT 84295 Sodium Level POC	$15.75	$31.50	$2.63–$7.51	24% below	50%
Sodium blood test CPT 84295 Sodium Arterial	$15.75	$31.50	$2.63–$7.51	24% below	50%
Sodium blood test CPT 84295 Sodium Level	$15.75	$31.50	$2.63–$19.25	24% below	50%
Sodium blood test inpatient CPT 84295 Sodium Level	$15.75	$31.50	$2.63–$19.25	—	50%
Sodium blood test inpatient CPT 84295 Sodium Arterial	$15.75	$31.50	$2.63–$7.51	—	50%
Sodium blood test inpatient CPT 84295 Sodium Level POC	$15.75	$31.50	$2.63–$7.51	—	50%
Stool ova and parasites exam CPT 87177 Pinworm Exam	$30.90	$61.80	$4.87–$24.19	29% below	50%
Stool ova and parasites exam inpatient CPT 87177 Pinworm Exam	$30.90	$61.80	$4.87–$24.19	—	50%
Stool test for hidden blood (guaiac FOBT) CPT 82270 Occult Blood, Stool (POC) AMB	$7.25	$14.50	$2.40–$11.91	59% below	50%
Stool test for hidden blood (guaiac FOBT) CPT 82270 .Occult Blood, Stool, Screen POC	$7.25	$14.50	$2.40–$11.91	59% below	50%
Stool test for hidden blood (guaiac FOBT) CPT 82270 Occult Blood Stool Screen	$7.25	$14.50	$2.40–$11.91	59% below	50%
Stool test for hidden blood (guaiac FOBT) CPT 82270 Occult Blood Fecal Immunochem Screen	$9.05	$18.10	$2.40–$13.98	48% below	50%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Occult Blood Stool Screen	$7.25	$14.50	$2.40–$11.91	—	50%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 .Occult Blood, Stool, Screen POC	$7.25	$14.50	$2.40–$11.91	—	50%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Occult Blood, Stool (POC) AMB	$7.25	$14.50	$2.40–$11.91	—	50%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Occult Blood Fecal Immunochem Screen	$9.05	$18.10	$2.40–$13.98	—	50%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 Occult Blood Fecal Immunochemical Diagnostic	$31.40	$62.80	$8.71–$43.24	31% below	50%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 Fecal Occult Blood Screening Immunoassay 1-3 Determinations	$39.95	$79.90	$8.71–$43.24	13% below	50%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 Occult Blood Fecal Immunochemical Diagnostic	$31.40	$62.80	$8.71–$43.24	—	50%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 Fecal Occult Blood Screening Immunoassay 1-3 Determinations	$39.95	$79.90	$8.71–$43.24	—	50%
Syphilis antibody test (Treponema pallidum) CPT 86780 Treponemal Antibody	$33.35	$66.70	$7.24–$48.10	29% below	50%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 Treponemal Antibody	$33.35	$66.70	$7.24–$48.10	—	50%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR	$11.00	$22.00	$2.34–$15.87	36% below	50%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR	$11.00	$22.00	$2.34–$15.87	—	50%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QuantiFERON-TB Gold Plus	$129.00	$258.00	$33.90–$199.25	2% above	50%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 QuantiFERON-TB Gold Plus	$129.00	$258.00	$33.90–$199.25	—	50%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Total	$63.95	$127.90	$14.12–$92.24	80% above	50%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone Total	$63.95	$127.90	$14.12–$92.24	—	50%
Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroid Peroxidase Antibodies	$37.25	$74.50	$7.96–$57.54	19% below	50%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Thyroid Peroxidase Antibodies	$37.25	$74.50	$7.96–$57.54	—	50%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Stimulating Hormone Reflex Free T4	$83.10	$166.20	$9.19–$128.36	29% above	50%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Stimulating Hormone	$83.10	$166.20	$9.19–$128.36	29% above	50%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Stimulating Hormone	$83.10	$166.20	$9.19–$128.36	—	50%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Stimulating Hormone Reflex Free T4	$83.10	$166.20	$9.19–$128.36	—	50%
Total IgE blood test CPT 82785 Immunoglobulin E	$63.10	$126.20	$9.00–$91.02	42% above	50%
Total IgE blood test inpatient CPT 82785 Immunoglobulin E	$63.10	$126.20	$9.00–$91.02	—	50%
Total cholesterol blood test CPT 82465 Cholesterol Total	$26.05	$52.10	$2.38–$34.88	30% above	50%
Total cholesterol blood test CPT 82465 Cholesterol Fluid	$26.05	$52.10	$2.38–$6.79	30% above	50%
Total cholesterol blood test inpatient CPT 82465 Cholesterol Total	$26.05	$52.10	$2.38–$34.88	—	50%
Total cholesterol blood test inpatient CPT 82465 Cholesterol Fluid	$26.05	$52.10	$2.38–$6.79	—	50%
Total thyroxine (T4) blood test CPT 84436 T4 Total Level	$47.50	$95.00	$3.76–$68.51	43% above	50%
Total thyroxine (T4) blood test CPT 84436 Thyroxine	$47.50	$95.00	$3.76–$18.65	43% above	50%
Total thyroxine (T4) blood test inpatient CPT 84436 T4 Total Level	$47.50	$95.00	$3.76–$68.51	—	50%
Total thyroxine (T4) blood test inpatient CPT 84436 Thyroxine	$47.50	$95.00	$3.76–$18.65	—	50%
Total triiodothyronine (T3) blood test CPT 84480 T3 Total Level	$43.45	$86.90	$7.76–$62.67	6% below	50%
Total triiodothyronine (T3) blood test inpatient CPT 84480 T3 Total Level	$43.45	$86.90	$7.76–$62.67	—	50%
Transferrin blood test CPT 84466 Transferrin	$57.25	$114.50	$6.98–$82.58	at median	50%
Transferrin blood test inpatient CPT 84466 Transferrin	$57.25	$114.50	$6.98–$82.58	—	50%
Trichomonas test (NAAT) CPT 87661 Trichomonas vaginalis by PCR	$46.05	$92.10	$19.19–$95.31	38% below	50%
Trichomonas test (NAAT) inpatient CPT 87661 Trichomonas vaginalis by PCR	$46.05	$92.10	$19.19–$95.31	—	50%
Triglycerides blood test CPT 84478 Triglycerides, Fluid	$46.65	$93.30	$3.14–$8.96	150% above	50%
Triglycerides blood test CPT 84478 Triglycerides	$46.65	$93.30	$3.14–$8.96	150% above	50%
Triglycerides blood test inpatient CPT 84478 Triglycerides	$46.65	$93.30	$3.14–$8.96	—	50%
Triglycerides blood test inpatient CPT 84478 Triglycerides, Fluid	$46.65	$93.30	$3.14–$8.96	—	50%
Troponin test, quantitative CPT 84484 Troponin T High Sensitivity (hs-cTnT)	$54.85	$109.70	$6.82–$84.72	29% above	50%
Troponin test, quantitative CPT 84484 Troponin T High Sensitivity (hs-cTnT) 4 hour	$54.85	$109.70	$6.82–$33.86	29% above	50%
Troponin test, quantitative CPT 84484 .Troponin, POC	$54.85	$109.70	$6.82–$33.86	29% above	50%
Troponin test, quantitative CPT 84484 Troponin T High Sensitivity (hs-cTnT) 2 hour	$54.85	$109.70	$6.82–$33.86	29% above	50%
Troponin test, quantitative CPT 84484 Troponin I	$54.85	$109.70	$6.82–$33.86	29% above	50%
Troponin test, quantitative inpatient CPT 84484 Troponin I	$54.85	$109.70	$6.82–$33.86	—	50%
Troponin test, quantitative inpatient CPT 84484 .Troponin, POC	$54.85	$109.70	$6.82–$33.86	—	50%
Troponin test, quantitative inpatient CPT 84484 Troponin T High Sensitivity (hs-cTnT) 2 hour	$54.85	$109.70	$6.82–$33.86	—	50%
Troponin test, quantitative inpatient CPT 84484 Troponin T High Sensitivity (hs-cTnT) 4 hour	$54.85	$109.70	$6.82–$33.86	—	50%
Troponin test, quantitative inpatient CPT 84484 Troponin T High Sensitivity (hs-cTnT)	$54.85	$109.70	$6.82–$84.72	—	50%
Uric acid blood test CPT 84550 Uric Acid	$15.75	$31.50	$2.47–$24.33	28% below	50%
Uric acid blood test CPT 84550 Uric Acid Urine	$15.75	$31.50	$2.47–$7.05	28% below	50%
Uric acid blood test inpatient CPT 84550 Uric Acid Urine	$15.75	$31.50	$2.47–$7.05	—	50%
Uric acid blood test inpatient CPT 84550 Uric Acid	$15.75	$31.50	$2.47–$24.33	—	50%
Urinalysis with microscope exam, automated CPT 81001 Urine Dipstick POC Amb	$37.75	$75.50	$1.73–$54.45	89% above	50%
Urinalysis with microscope exam, automated CPT 81001 UAWMICR	$37.75	$75.50	$1.73–$58.31	89% above	50%
Urinalysis with microscope exam, automated inpatient CPT 81001 Urine Dipstick POC Amb	$37.75	$75.50	$1.73–$54.45	—	50%
Urinalysis with microscope exam, automated inpatient CPT 81001 UAWMICR	$37.75	$75.50	$1.73–$58.31	—	50%
Urinalysis with microscope exam, manual CPT 81000 Urinalysis Dip Stick Non-Auto w/Microscopy POC 81000	$6.70	$13.40	$2.20–$25.00	55% below	50%
Urinalysis with microscope exam, manual inpatient CPT 81000 Urinalysis Dip Stick Non-Auto w/Microscopy POC 81000	$6.70	$13.40	$2.20–$25.00	—	50%
Urinalysis without microscope exam, automated CPT 81003 UA ONLY	$12.45	$24.90	$1.23–$25.00	4% below	50%
Urinalysis without microscope exam, automated CPT 81003 UAPH	$12.45	$24.90	$1.23–$25.00	4% below	50%
Urinalysis without microscope exam, automated CPT 81003 Urine Dipstick POC Amb	$12.45	$24.90	$1.23–$25.00	4% below	50%
Urinalysis without microscope exam, automated CPT 81003 UACulIf	$12.45	$24.90	$1.23–$25.00	4% below	50%
Urinalysis without microscope exam, automated CPT 81003 UAMicIf	$12.45	$24.90	$1.23–$25.00	4% below	50%
Urinalysis without microscope exam, automated CPT 81003 Ketone Urine	$12.45	$24.90	$1.23–$25.00	4% below	50%
Urinalysis without microscope exam, automated CPT 81003 .Urine Dipstick, POC	$12.45	$24.90	$1.23–$25.00	4% below	50%
Urinalysis without microscope exam, automated inpatient CPT 81003 UAPH	$12.45	$24.90	$1.23–$25.00	—	50%
Urinalysis without microscope exam, automated inpatient CPT 81003 Ketone Urine	$12.45	$24.90	$1.23–$25.00	—	50%
Urinalysis without microscope exam, automated inpatient CPT 81003 UACulIf	$12.45	$24.90	$1.23–$25.00	—	50%
Urinalysis without microscope exam, automated inpatient CPT 81003 Urine Dipstick POC Amb	$12.45	$24.90	$1.23–$25.00	—	50%
Urinalysis without microscope exam, automated inpatient CPT 81003 .Urine Dipstick, POC	$12.45	$24.90	$1.23–$25.00	—	50%
Urinalysis without microscope exam, automated inpatient CPT 81003 UA ONLY	$12.45	$24.90	$1.23–$25.00	—	50%
Urinalysis without microscope exam, automated inpatient CPT 81003 UAMicIf	$12.45	$24.90	$1.23–$25.00	—	50%
Urinalysis without microscope exam, manual CPT 81002 Urine Dipstick POC Amb	$7.65	$15.30	$1.90–$25.00	52% below	50%
Urinalysis without microscope exam, manual CPT 81002 Urinalysis Dip Stick Non-Auto w/o Micro POC 81002 Downtime	$7.65	$15.30	$1.90–$25.00	52% below	50%
Urinalysis without microscope exam, manual inpatient CPT 81002 Urine Dipstick POC Amb	$7.65	$15.30	$1.90–$25.00	—	50%
Urinalysis without microscope exam, manual inpatient CPT 81002 Urinalysis Dip Stick Non-Auto w/o Micro POC 81002 Downtime	$7.65	$15.30	$1.90–$25.00	—	50%
Urine culture for bacteria, with colony count CPT 87086 Urine Culture	$19.25	$38.50	$4.41–$29.73	65% below	50%
Urine culture for bacteria, with colony count inpatient CPT 87086 Urine Culture	$19.25	$38.50	$4.41–$29.73	—	50%
Urine microalbumin (albumin) test CPT 82043 Microalbumin Random Urine	$17.30	$34.60	$3.16–$24.95	33% below	50%
Urine microalbumin (albumin) test CPT 82043 Microalbumin 24 Hr Urine	$17.30	$34.60	$3.16–$15.72	33% below	50%
Urine microalbumin (albumin) test CPT 82043 Microalbumin Ur	$17.30	$34.60	$3.16–$15.72	33% below	50%
Urine microalbumin (albumin) test inpatient CPT 82043 Microalbumin 24 Hr Urine	$17.30	$34.60	$3.16–$15.72	—	50%
Urine microalbumin (albumin) test inpatient CPT 82043 Microalbumin Ur	$17.30	$34.60	$3.16–$15.72	—	50%
Urine microalbumin (albumin) test inpatient CPT 82043 Microalbumin Random Urine	$17.30	$34.60	$3.16–$24.95	—	50%
Urine pregnancy test, read by color change CPT 81025 HCG Qualitative Urine	$19.55	$39.10	$4.71–$30.20	21% below	50%
Urine pregnancy test, read by color change CPT 81025 Urine Pregnancy POC	$19.55	$39.10	$4.71–$30.20	21% below	50%
Urine pregnancy test, read by color change CPT 81025 .HCG Urine (POC)	$19.55	$39.10	$4.71–$30.20	21% below	50%
Urine pregnancy test, read by color change inpatient CPT 81025 .HCG Urine (POC)	$19.55	$39.10	$4.71–$30.20	—	50%
Urine pregnancy test, read by color change inpatient CPT 81025 Urine Pregnancy POC	$19.55	$39.10	$4.71–$30.20	—	50%
Urine pregnancy test, read by color change inpatient CPT 81025 HCG Qualitative Urine	$19.55	$39.10	$4.71–$30.20	—	50%
Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B12 Level	$35.55	$71.10	$8.25–$54.91	41% below	50%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Vitamin B12 Level	$35.55	$71.10	$8.25–$54.91	—	50%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D 25 Hydroxy Level	$125.95	$251.90	$16.19–$194.54	42% above	50%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D 25 Hydroxy Level	$125.95	$251.90	$16.19–$194.54	—	50%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 Vitamin D 1 25 Dihydroxy Level	$50.55	$101.10	$21.06–$104.58	36% below	50%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 Vitamin D 1 25 Dihydroxy Level	$50.55	$101.10	$21.06–$104.58	—	50%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG Beta Quantitative Serum	$78.65	$157.30	$8.23–$121.48	64% above	50%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCG Beta Quantitative Serum	$78.65	$157.30	$8.23–$121.48	—	50%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Michigan	Off list
Appendectomy, open surgery CPT 44950 Appendectomy	$11,905.05	$23,810.09	$3,413.14–$9,736.81	122% above	50%
Appendectomy, open surgery inpatient CPT 44950 Appendectomy	$11,905.05	$23,810.09	$3,413.14–$9,736.81	—	50%
Arthroscopic ACL reconstruction or repair of the knee CPT 29888 KNEE ARTHROSCOPY/SURGERY	$18,532.32	$37,064.64	$3,907.62–$11,891.36	49% above	50%
Arthroscopic ACL reconstruction or repair of the knee inpatient CPT 29888 KNEE ARTHROSCOPY/SURGERY	$18,532.32	$37,064.64	$3,907.62–$11,891.36	—	50%
Botox injections for chronic migraine both sides CPT 64615 BP Chemoden Muscle(s); Facial, Trigeminal, Cerv Spinal, Accessory Nerves, Bilat (eg migraine) 64615	$253.85	$507.70	$161.47–$528.09	—	50%
Botox injections for chronic migraine inpatient both sides CPT 64615 BP Chemoden Muscle(s); Facial, Trigeminal, Cerv Spinal, Accessory Nerves, Bilat (eg migraine) 64615	$253.85	$507.70	$161.47–$528.09	—	50%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 19081-MG Stereo Breast BX 1st Lesion RT	$990.20	$1,980.40	$886.27–$2,528.30	56% below	50%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 19081-MG Stereo Breast BX 1st Lesion LT	$990.20	$1,980.40	$886.27–$2,528.30	56% below	50%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient one side CPT 19081 19081-MG Stereo Breast BX 1st Lesion LT	$990.20	$1,980.40	$886.27–$2,528.30	—	50%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient one side CPT 19081 19081-MG Stereo Breast BX 1st Lesion RT	$990.20	$1,980.40	$886.27–$2,528.30	—	50%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 Cl Tx Dstl Fib Fx Wo Manip	$222.60	$445.20	$131.21–$452.32	40% below	50%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 BP Closed Treatment Distal Fibular Fracture; w/o Manipulation 27786	$222.60	$445.20	$131.21–$452.32	40% below	50%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 Closed Treatment Distal Fibular Fracture; w/o Manipulation 27786	$222.60	$445.20	$131.21–$452.32	40% below	50%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 Closed Treatment Distal Fibular Fracture; w/o Manipulation 27786	$222.60	$445.20	$131.21–$452.32	—	50%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 Cl Tx Dstl Fib Fx Wo Manip	$222.60	$445.20	$131.21–$452.32	—	50%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 BP Closed Treatment Distal Fibular Fracture; w/o Manipulation 27786	$222.60	$445.20	$131.21–$452.32	—	50%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 Cl Tx Metatarsal Fx; Wo Manip	$194.30	$388.60	$131.21–$450.00	48% below	50%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 Closed treatment of metatarsal fracture; w/o manipulation, each 28470	$194.30	$388.60	$131.21–$374.32	48% below	50%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 Hospitalist BP 28470 Closed treatment of metatarsal fracture; w/o manipulation, each	$194.30	$388.60	$131.21–$374.32	48% below	50%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 BP Closed treatment of metatarsal fracture; w/o manipulation, each 28470	$194.30	$388.60	$131.21–$374.32	48% below	50%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 BP Closed treatment of metatarsal fracture; w/o manipulation, each 28470	$194.30	$388.60	$131.21–$374.32	—	50%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 Hospitalist BP 28470 Closed treatment of metatarsal fracture; w/o manipulation, each	$194.30	$388.60	$131.21–$374.32	—	50%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 Closed treatment of metatarsal fracture; w/o manipulation, each 28470	$194.30	$388.60	$131.21–$374.32	—	50%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 Cl Tx Metatarsal Fx; Wo Manip	$194.30	$388.60	$131.21–$450.00	—	50%
Bunion correction with a bone cut near the head of the first metatarsal CPT 28296 CORRECTION HALLUX VALGUS	$6,785.86	$13,571.71	$1,774.80–$5,063.05	51% above	50%
Bunion correction with a bone cut near the head of the first metatarsal inpatient CPT 28296 CORRECTION HALLUX VALGUS	$6,785.86	$13,571.71	$1,774.80–$5,063.05	—	50%
Cardiac catheterization with coronary angiogram one side CPT 93458 CCL Left Heart Cath (W/Wo Lv Gram ) W/ Coronary Angio	$3,847.65	$7,695.30	$1,759.38–$5,019.04	61% below	50%
Cardiac catheterization with coronary angiogram inpatient one side CPT 93458 CCL Left Heart Cath (W/Wo Lv Gram ) W/ Coronary Angio	$3,847.65	$7,695.30	$1,759.38–$5,019.04	—	50%
Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion Electric Ext	$478.60	$957.20	$180.00–$1,085.55	51% below	50%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CCL Cardioversion - No Chargeable Unless Scheduled	$1,069.80	$2,139.60	$357.95–$1,085.55	9% above	50%
Cardioversion, elective (restoring heart rhythm) CPT 92960 BP Cardioversion 92960	$1,069.80	$2,139.60	$357.95–$1,085.55	9% above	50%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Cardioversion Electric Ext	$478.60	$957.20	$180.00–$1,085.55	—	50%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 BP Cardioversion 92960	$1,069.80	$2,139.60	$357.95–$1,085.55	—	50%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CCL Cardioversion - No Chargeable Unless Scheduled	$1,069.80	$2,139.60	$357.95–$1,085.55	—	50%
Carpal tunnel release, open surgery CPT 64721 CARPAL TUNNEL SURGERY	$4,419.76	$8,839.52	$1,068.17–$3,462.69	65% above	50%
Carpal tunnel release, open surgery inpatient CPT 64721 CARPAL TUNNEL SURGERY	$4,419.76	$8,839.52	$1,068.17–$3,462.69	—	50%
Catheter ablation for atrial fibrillation CPT 93656 EP A-FIBRILLATION ABLATION with EP Study	$14,258.30	$28,516.60	$920.15–$38,281.38	60% below	50%
Catheter ablation for atrial fibrillation inpatient CPT 93656 EP A-FIBRILLATION ABLATION with EP Study	$14,258.30	$28,516.60	$920.15–$38,281.38	—	50%
Cervical biopsy CPT 57500 Biopsy Cervix,Single/Multiple 57500	$485.90	$971.80	$476.29–$1,366.35	45% below	50%
Cervical biopsy CPT 57500 BP Biopsy Cervix,Single/Multiple 57500	$485.90	$971.80	$476.29–$1,366.35	45% below	50%
Cervical biopsy inpatient CPT 57500 Biopsy Cervix,Single/Multiple 57500	$485.90	$971.80	$476.29–$1,366.35	—	50%
Cervical biopsy inpatient CPT 57500 BP Biopsy Cervix,Single/Multiple 57500	$485.90	$971.80	$476.29–$1,366.35	—	50%
Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 CIRCUM 28 DAYS OR OLDER	$5,718.21	$11,436.41	$1,120.53–$5,159.53	45% above	50%
Circumcision by surgical excision, older than 28 days (children and adults) inpatient CPT 54161 CIRCUM 28 DAYS OR OLDER	$5,718.21	$11,436.41	$1,120.53–$5,159.53	—	50%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 Circumcision, Clamp/Oth Device with Regional/Ring Block 54150	$2,286.55	$4,573.10	$1,120.53–$3,196.59	36% above	50%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION W/REGIONL BLOCK	$5,017.13	$10,034.25	$1,120.53–$3,196.59	199% above	50%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 Circumcision, Clamp/Oth Device with Regional/Ring Block 54150	$2,286.55	$4,573.10	$1,120.53–$3,196.59	—	50%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 CIRCUMCISION W/REGIONL BLOCK	$5,017.13	$10,034.25	$1,120.53–$3,196.59	—	50%
Circumcision, surgical, older than a newborn CPT 54160 BP Circum, Excision Other Than Clamp/Device/ Or Dorsal Slit; Neonate (28 Days Of Age Or Less) 54160	$2,286.50	$4,573.00	$365.11–$2,582.33	138% above	50%
Circumcision, surgical, older than a newborn inpatient CPT 54160 BP Circum, Excision Other Than Clamp/Device/ Or Dorsal Slit; Neonate (28 Days Of Age Or Less) 54160	$2,286.50	$4,573.00	$365.11–$2,582.33	—	50%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 BP Closed Treatment Distal Radius Fracture/Epiphyseal sep, Inc Ulnar Styloid w/o manipulation 25600	$183.80	$367.60	$131.21–$374.32	52% below	50%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 Closed Treatment Distal Radius Fracture/Epiphyseal sep, Inc Ulnar Styloid without manipulation 25600	$183.80	$367.60	$131.21–$374.32	52% below	50%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 Cltx Dstl Radial Fx/Epiphysl Sep Wo Mnp	$183.80	$367.60	$131.21–$450.00	52% below	50%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 Closed Treatment Distal Radius Fracture/Epiphyseal sep, Inc Ulnar Styloid without manipulation 25600	$183.80	$367.60	$131.21–$374.32	—	50%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 BP Closed Treatment Distal Radius Fracture/Epiphyseal sep, Inc Ulnar Styloid w/o manipulation 25600	$183.80	$367.60	$131.21–$374.32	—	50%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 Cltx Dstl Radial Fx/Epiphysl Sep Wo Mnp	$183.80	$367.60	$131.21–$450.00	—	50%
Colonoscopy with polyp removal CPT 45385 COLONOSCOPY W/LESION REMOVAL	$2,377.57	$4,755.14	$644.96–$1,839.89	37% above	50%
Colonoscopy with polyp removal inpatient CPT 45385 COLONOSCOPY W/LESION REMOVAL	$2,377.57	$4,755.14	$644.96–$1,839.89	—	50%
Colonoscopy with tissue sample CPT 45380 COLONOSCOPY AND BIOPSY	$2,480.19	$4,960.37	$644.96–$1,839.89	33% above	50%
Colonoscopy with tissue sample inpatient CPT 45380 COLONOSCOPY AND BIOPSY	$2,480.19	$4,960.37	$644.96–$1,839.89	—	50%
Colonoscopy, diagnostic CPT 45378 DIAGNOSTIC COLONOSCOPY	$3,254.98	$6,509.95	$498.71–$1,422.68	181% above	50%
Colonoscopy, diagnostic inpatient CPT 45378 DIAGNOSTIC COLONOSCOPY	$3,254.98	$6,509.95	$498.71–$1,422.68	—	50%
Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 Colposcopy Cervix with Loop Electrode Biopsy (s) 57460	$1,841.10	$3,682.20	$1,739.20–$5,491.74	56% below	50%
Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 BX OF CERVIX W/SCOPE LEEP	$4,531.10	$9,062.19	$1,739.20–$5,491.74	8% above	50%
Colposcopy with LEEP (loop electrosurgical excision) inpatient CPT 57460 Colposcopy Cervix with Loop Electrode Biopsy (s) 57460	$1,841.10	$3,682.20	$1,739.20–$5,491.74	—	50%
Colposcopy with LEEP (loop electrosurgical excision) inpatient CPT 57460 BX OF CERVIX W/SCOPE LEEP	$4,531.10	$9,062.19	$1,739.20–$5,491.74	—	50%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 BP Colp Cervix W/Bx & Curett 57454	$225.40	$450.80	$166.39–$474.67	41% below	50%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 Colp Cervix W/Bx & Curett 57454	$225.40	$450.80	$166.39–$474.67	41% below	50%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 BX/CURETT OF CERVIX W/SCOPE	$5,651.73	$11,303.45	$166.39–$474.67	1391% above	50%
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 Colp Cervix W/Bx & Curett 57454	$225.40	$450.80	$166.39–$474.67	—	50%
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 BP Colp Cervix W/Bx & Curett 57454	$225.40	$450.80	$166.39–$474.67	—	50%
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 BX/CURETT OF CERVIX W/SCOPE	$5,651.73	$11,303.45	$166.39–$474.67	—	50%
Cystoscopy with ureteral stent placement CPT 52332 CYSTOSCOPY AND TREATMENT	$7,823.70	$15,647.39	$1,886.59–$5,381.94	80% above	50%
Cystoscopy with ureteral stent placement inpatient CPT 52332 CYSTOSCOPY AND TREATMENT	$7,823.70	$15,647.39	$1,886.59–$5,381.94	—	50%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 Cystoscopy	$680.55	$1,361.10	$180.00–$1,323.46	21% below	50%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 Cystourethroscopy 52000	$680.55	$1,361.10	$365.11–$1,323.46	21% below	50%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 Cystoscopy	$680.55	$1,361.10	$180.00–$1,323.46	—	50%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 Cystourethroscopy 52000	$680.55	$1,361.10	$365.11–$1,323.46	—	50%
D&C (dilation and curettage), not related to pregnancy CPT 58120 Dilation And Curettage, Diagnostic And/Or Therapeutic (Nonobstetrical) 58120	$2,546.30	$5,092.60	$1,739.20–$4,961.49	43% below	50%
D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 Dilation And Curettage, Diagnostic And/Or Therapeutic (Nonobstetrical) 58120	$2,546.30	$5,092.60	$1,739.20–$4,961.49	—	50%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 Destruction Premalignant Lesion 1St	$103.90	$207.80	$108.69–$310.06	47% below	50%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 Premalginant Lesion Destruction;1st Lesion 17000	$103.90	$207.80	$108.69–$310.06	47% below	50%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 Destruction Premalignant Lesion 1St	$103.90	$207.80	$108.69–$310.06	—	50%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 Premalginant Lesion Destruction;1st Lesion 17000	$103.90	$207.80	$108.69–$310.06	—	50%
Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 CREATE EARDRUM OPENING	$2,231.11	$4,462.21	$810.26–$3,170.49	5% above	50%
Ear tube placement (tympanostomy) under general anesthesia, one ear inpatient CPT 69436 CREATE EARDRUM OPENING	$2,231.11	$4,462.21	$810.26–$3,170.49	—	50%
Earwax removal by irrigation (rinsing), one ear CPT 69209 Remove Impacted Ear Wax Irr Uni	$71.90	$143.80	$32.49–$450.00	31% below	50%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 Removal Ear Wax with Irrigation Unilateral 69209	$71.90	$143.80	$32.49–$122.29	31% below	50%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 Removal Impacted Cerumen Irrigation/Lvg Unilat	$83.95	$167.90	$32.49–$122.29	19% below	50%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 Remove Impacted Ear Wax Irr Uni	$71.90	$143.80	$32.49–$450.00	—	50%
Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 Removal Ear Wax with Irrigation Unilateral 69209	$71.90	$143.80	$32.49–$122.29	—	50%
Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 Removal Impacted Cerumen Irrigation/Lvg Unilat	$83.95	$167.90	$32.49–$122.29	—	50%
Earwax removal with instruments, one ear CPT 69210 Remove Impacted Ear Wax Ins Uni	$68.50	$137.00	$32.49–$450.00	29% below	50%
Earwax removal with instruments, one ear one side CPT 69210 BP Removal Impacted Cerumen Requiring Instrumentation, Unilateral 69210	$68.50	$137.00	$32.49–$186.67	29% below	50%
Earwax removal with instruments, one ear one side CPT 69210 Removal Impacted Cerumen Instrumentation Unilat	$68.50	$137.00	$32.49–$186.67	29% below	50%
Earwax removal with instruments, one ear one side CPT 69210 Removal Impacted Cerumen Requiring Instrumentation, Unilateral 69210	$68.50	$137.00	$32.49–$186.67	29% below	50%
Earwax removal with instruments, one ear inpatient CPT 69210 Remove Impacted Ear Wax Ins Uni	$68.50	$137.00	$32.49–$450.00	—	50%
Earwax removal with instruments, one ear inpatient one side CPT 69210 BP Removal Impacted Cerumen Requiring Instrumentation, Unilateral 69210	$68.50	$137.00	$32.49–$186.67	—	50%
Earwax removal with instruments, one ear inpatient one side CPT 69210 Removal Impacted Cerumen Requiring Instrumentation, Unilateral 69210	$68.50	$137.00	$32.49–$186.67	—	50%
Earwax removal with instruments, one ear inpatient one side CPT 69210 Removal Impacted Cerumen Instrumentation Unilat	$68.50	$137.00	$32.49–$186.67	—	50%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 EMB w/wo endocervical biopsy w/o cervical dilation, any method 58100	$225.40	$450.80	$110.04–$313.92	5% below	50%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 BP EMB w/wo endocervical biopsy w/o cervical dilation, any method 58100	$225.40	$450.80	$110.04–$313.92	5% below	50%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 BP EMB w/wo endocervical biopsy w/o cervical dilation, any method 58100	$225.40	$450.80	$110.04–$313.92	—	50%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 EMB w/wo endocervical biopsy w/o cervical dilation, any method 58100	$225.40	$450.80	$110.04–$313.92	—	50%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 62321- IR Inj Epid/Subarac Cer/Thor w/ Img	$970.65	$1,941.30	$378.81–$1,104.16	at median	50%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 62321-XR Injection Cerv/Thor Epidural	$970.65	$1,941.30	$378.81–$1,104.16	at median	50%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 62321- CT Injection Cerv/Thor Epidural	$970.65	$1,941.30	$378.81–$1,104.16	at median	50%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 IR Inj Interlaminar Epidural Cerv/Thorac w/img	$970.65	$1,941.30	$378.81–$1,104.16	at median	50%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 Injection Interlaminar Cervical/Thoracic w/ Guidance 62321	$970.65	$1,941.30	$378.81–$1,104.16	at median	50%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 62321- CT Injection Cerv/Thor Epidural	$970.65	$1,941.30	$378.81–$1,104.16	—	50%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 62321-XR Injection Cerv/Thor Epidural	$970.65	$1,941.30	$378.81–$1,104.16	—	50%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 62321- IR Inj Epid/Subarac Cer/Thor w/ Img	$970.65	$1,941.30	$378.81–$1,104.16	—	50%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 Injection Interlaminar Cervical/Thoracic w/ Guidance 62321	$970.65	$1,941.30	$378.81–$1,104.16	—	50%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 IR Inj Interlaminar Epidural Cerv/Thorac w/img	$970.65	$1,941.30	$378.81–$1,104.16	—	50%
Facet joint injection, lower back, one level, with imaging guidance both sides CPT 64493 64493-XR Facet Injection Lumb/Sacr Bilat	$841.50	$1,683.00	$486.99–$1,771.63	—	50%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 Inj Paravert Facet Jnt Lumbar/Sacral W/Guide Single Lvl 64493	$841.50	$1,683.00	$486.99–$1,771.63	22% below	50%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 INJ PARAVERT F JNT L/S 1 LEV	$1,320.33	$2,640.65	$486.99–$1,771.63	22% above	50%
Facet joint injection, lower back, one level, with imaging guidance one side CPT 64493 64493- IR Inj Paravert F Jnt L/S 1 Level LT	$841.50	$1,683.00	$486.99–$1,771.63	22% below	50%
Facet joint injection, lower back, one level, with imaging guidance one side CPT 64493 64493-XR Facet Injection Lumb/Sacr Right	$841.50	$1,683.00	$486.99–$1,771.63	22% below	50%
Facet joint injection, lower back, one level, with imaging guidance one side CPT 64493 64493-XR Facet Injection Lumb/Sacr Left	$841.50	$1,683.00	$486.99–$1,771.63	22% below	50%
Facet joint injection, lower back, one level, with imaging guidance one side CPT 64493 64493- IR Inj Paravert F Jnt L/S 1 Level RT	$841.50	$1,683.00	$486.99–$1,771.63	22% below	50%
Facet joint injection, lower back, one level, with imaging guidance inpatient both sides CPT 64493 64493-XR Facet Injection Lumb/Sacr Bilat	$841.50	$1,683.00	$486.99–$1,771.63	—	50%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 Inj Paravert Facet Jnt Lumbar/Sacral W/Guide Single Lvl 64493	$841.50	$1,683.00	$486.99–$1,771.63	—	50%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 INJ PARAVERT F JNT L/S 1 LEV	$1,320.33	$2,640.65	$486.99–$1,771.63	—	50%
Facet joint injection, lower back, one level, with imaging guidance inpatient one side CPT 64493 64493- IR Inj Paravert F Jnt L/S 1 Level LT	$841.50	$1,683.00	$486.99–$1,771.63	—	50%
Facet joint injection, lower back, one level, with imaging guidance inpatient one side CPT 64493 64493- IR Inj Paravert F Jnt L/S 1 Level RT	$841.50	$1,683.00	$486.99–$1,771.63	—	50%
Facet joint injection, lower back, one level, with imaging guidance inpatient one side CPT 64493 64493-XR Facet Injection Lumb/Sacr Right	$841.50	$1,683.00	$486.99–$1,771.63	—	50%
Facet joint injection, lower back, one level, with imaging guidance inpatient one side CPT 64493 64493-XR Facet Injection Lumb/Sacr Left	$841.50	$1,683.00	$486.99–$1,771.63	—	50%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 Under Hernia Open Procedures 3-10 cm, reducible	$13,678.91	$27,357.82	$3,413.14–$9,736.81	56% above	50%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm inpatient CPT 49593 Under Hernia Open Procedures 3-10 cm, reducible	$13,678.91	$27,357.82	$3,413.14–$9,736.81	—	50%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 DIAGNOSTIC SIGMOIDOSCOPY	$2,653.61	$5,307.21	$498.71–$1,614.13	11% above	50%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 DIAGNOSTIC SIGMOIDOSCOPY	$2,653.61	$5,307.21	$498.71–$1,614.13	—	50%
Gallbladder removal, laparoscopic CPT 47562 LAPAROSCOPIC CHOLECYSTECTOMY	$14,645.89	$29,291.78	$3,191.39–$9,104.22	78% above	50%
Gallbladder removal, laparoscopic inpatient CPT 47562 LAPAROSCOPIC CHOLECYSTECTOMY	$14,645.89	$29,291.78	$3,191.39–$9,104.22	—	50%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 LAPARO CHOLECYSTECTOMY/GRAPH	$17,648.68	$35,297.36	$3,191.39–$9,508.80	112% above	50%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery inpatient CPT 47563 LAPARO CHOLECYSTECTOMY/GRAPH	$17,648.68	$35,297.36	$3,191.39–$9,508.80	—	50%
Hammertoe correction surgery CPT 28285 Correction Hammertoe	$2,670.70	$5,341.40	$1,774.80–$5,620.86	at median	50%
Hammertoe correction surgery CPT 28285 REPAIR OF HAMMERTOE	$3,772.20	$7,544.39	$1,774.80–$5,620.86	41% above	50%
Hammertoe correction surgery inpatient CPT 28285 Correction Hammertoe	$2,670.70	$5,341.40	$1,774.80–$5,620.86	—	50%
Hammertoe correction surgery inpatient CPT 28285 REPAIR OF HAMMERTOE	$3,772.20	$7,544.39	$1,774.80–$5,620.86	—	50%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 WH US Hysterosonogram w/Saline/Contrast	$371.20	$742.40	$536.60	25% below	50%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 Add On - 58340-US Saline Inj for Hystero	$371.20	$742.40	$536.60	25% below	50%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 Add On - 58340-XR Saline Inj for Hystero	$371.20	$742.40	$536.60	25% below	50%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 WH US Hysterosonogram w/Saline/Contrast	$371.20	$742.40	$536.60	—	50%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 Add On - 58340-XR Saline Inj for Hystero	$371.20	$742.40	$536.60	—	50%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 Add On - 58340-US Saline Inj for Hystero	$371.20	$742.40	$536.60	—	50%
Hysteroscopy with endometrial ablation CPT 58563 HYSTEROSCOPY ABLATION	$4,751.81	$9,503.61	$2,700.24–$7,703.07	at median	50%
Hysteroscopy with endometrial ablation inpatient CPT 58563 HYSTEROSCOPY ABLATION	$4,751.81	$9,503.61	$2,700.24–$7,703.07	—	50%
Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 HYSTEROSCOPY BIOPSY	$5,772.96	$11,545.91	$1,739.20–$5,590.52	30% above	50%
Hysteroscopy with uterine lining sampling and/or polyp removal inpatient CPT 58558 HYSTEROSCOPY BIOPSY	$5,772.96	$11,545.91	$1,739.20–$5,590.52	—	50%
IUD insertion (the device itself billed separately) CPT 58300 Insert Intrauterine Device 58300	$466.30	$932.60	$1,312.80	42% above	50%
IUD insertion (the device itself billed separately) inpatient CPT 58300 Insert Intrauterine Device 58300	$466.30	$932.60	$1,312.80	—	50%
Incision and drainage of a simple or single skin abscess CPT 10060 BP Incision and Drainage of Abscess, Simple/Single 10060	$180.65	$361.30	$108.69–$454.71	34% below	50%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D Absc; Smpl Or Sgl	$180.65	$361.30	$108.69–$454.71	34% below	50%
Incision and drainage of a simple or single skin abscess CPT 10060 Hospitalist BP 10060 Incision & Drainage of Abscess, Simple/Single	$180.65	$361.30	$108.69–$454.71	34% below	50%
Incision and drainage of a simple or single skin abscess CPT 10060 Incision & Drainage Abscess Simple/Single	$180.65	$361.30	$108.69–$454.71	34% below	50%
Incision and drainage of a simple or single skin abscess CPT 10060 Incision & drainage of abscess, simple/single 10060	$180.65	$361.30	$108.69–$454.71	34% below	50%
Incision and drainage of a simple or single skin abscess CPT 10060 DRAINAGE OF SKIN ABSCESS	$5,707.82	$11,415.63	$108.69–$454.71	1991% above	50%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 Incision & drainage of abscess, simple/single 10060	$180.65	$361.30	$108.69–$454.71	—	50%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 Incision & Drainage Abscess Simple/Single	$180.65	$361.30	$108.69–$454.71	—	50%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D Absc; Smpl Or Sgl	$180.65	$361.30	$108.69–$454.71	—	50%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 BP Incision and Drainage of Abscess, Simple/Single 10060	$180.65	$361.30	$108.69–$454.71	—	50%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 Hospitalist BP 10060 Incision & Drainage of Abscess, Simple/Single	$180.65	$361.30	$108.69–$454.71	—	50%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 DRAINAGE OF SKIN ABSCESS	$5,707.82	$11,415.63	$108.69–$454.71	—	50%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 PRP I/HERN INIT REDUC >5 YR	$7,335.12	$14,670.24	$1,930.40–$6,608.38	28% above	50%
Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 PRP I/HERN INIT REDUC >5 YR	$7,335.12	$14,670.24	$1,930.40–$6,608.38	—	50%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 20550- US Injection Sgl Tend Shth or Lig	$213.40	$426.80	$161.47–$528.09	47% below	50%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Inj Sgl Tendon Shth Or Ligament	$213.40	$426.80	$161.47–$528.09	47% below	50%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Hospitalist BP 20550 Injection(s); single tendon sheath, or ligament, aponeurosis	$213.40	$426.80	$161.47–$528.09	47% below	50%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Injection(s); single tendon sheath, or ligament, aponeurosis 20550	$213.40	$426.80	$161.47–$528.09	47% below	50%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 BP Injection(s); single tendon sheath, or ligament, aponeurosis 20550	$213.40	$426.80	$161.47–$528.09	47% below	50%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 20550- IR Inj Sgl Tend Shth or Ligament	$213.40	$426.80	$161.47–$528.09	47% below	50%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 Hospitalist BP 20550 Injection(s); single tendon sheath, or ligament, aponeurosis	$213.40	$426.80	$161.47–$528.09	—	50%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 BP Injection(s); single tendon sheath, or ligament, aponeurosis 20550	$213.40	$426.80	$161.47–$528.09	—	50%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 20550- IR Inj Sgl Tend Shth or Ligament	$213.40	$426.80	$161.47–$528.09	—	50%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 Inj Sgl Tendon Shth Or Ligament	$213.40	$426.80	$161.47–$528.09	—	50%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 20550- US Injection Sgl Tend Shth or Lig	$213.40	$426.80	$161.47–$528.09	—	50%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 Injection(s); single tendon sheath, or ligament, aponeurosis 20550	$213.40	$426.80	$161.47–$528.09	—	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Drain/Inj Major Joint/Bursa W/O Us	$215.05	$430.10	$161.47–$528.09	50% below	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Arthrocentesis/aspiration/inject, major joint/bursa; w/o US guid 20610	$215.05	$430.10	$161.47–$528.09	50% below	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Hospitalist BP 20610 Arthrocentesis/aspiration/inject, major joint/bursa; w/o US guid	$215.05	$430.10	$161.47–$528.09	50% below	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 BP Arthrocentesis, aspiration and/or injection major joint or bursa without U/S Guidance 20610	$215.05	$430.10	$161.47–$528.09	50% below	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJ JOINT/BURSA W/O US	$2,490.70	$4,981.40	$161.47–$528.09	482% above	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 20610-CT Jnt/Bursa Mjr Arthr/Asp/Inj RT	$215.05	$430.10	$161.47–$528.09	50% below	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 20610-XR Jnt/Bursa Major Arth/Asp/Inj LT	$215.05	$430.10	$161.47–$528.09	50% below	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 20610-CT Jnt/Bursa Mjr Arthr/Asp/Inj LT	$215.05	$430.10	$161.47–$528.09	50% below	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 20610-XR Jnt/Bursa Major Arth/Asp/Inj RT	$215.05	$430.10	$161.47–$528.09	50% below	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 IR Arthcntsis, Asp/Inj Maj Brsa w/o U/S - LT	$215.05	$430.10	$161.47–$528.09	50% below	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 IR Arthcntsis, Asp/Inj Maj Brsa w/o U/S - RT	$215.05	$430.10	$161.47–$528.09	50% below	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Drain/Inj Major Joint/Bursa W/O Us	$215.05	$430.10	$161.47–$528.09	—	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Arthrocentesis/aspiration/inject, major joint/bursa; w/o US guid 20610	$215.05	$430.10	$161.47–$528.09	—	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 BP Arthrocentesis, aspiration and/or injection major joint or bursa without U/S Guidance 20610	$215.05	$430.10	$161.47–$528.09	—	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Hospitalist BP 20610 Arthrocentesis/aspiration/inject, major joint/bursa; w/o US guid	$215.05	$430.10	$161.47–$528.09	—	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRAIN/INJ JOINT/BURSA W/O US	$2,490.70	$4,981.40	$161.47–$528.09	—	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 20610-XR Jnt/Bursa Major Arth/Asp/Inj LT	$215.05	$430.10	$161.47–$528.09	—	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 20610-CT Jnt/Bursa Mjr Arthr/Asp/Inj RT	$215.05	$430.10	$161.47–$528.09	—	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 20610-CT Jnt/Bursa Mjr Arthr/Asp/Inj LT	$215.05	$430.10	$161.47–$528.09	—	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 20610-XR Jnt/Bursa Major Arth/Asp/Inj RT	$215.05	$430.10	$161.47–$528.09	—	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 IR Arthcntsis, Asp/Inj Maj Brsa w/o U/S - LT	$215.05	$430.10	$161.47–$528.09	—	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 IR Arthcntsis, Asp/Inj Maj Brsa w/o U/S - RT	$215.05	$430.10	$161.47–$528.09	—	50%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 Insertion Drug Delivry Implant 11981	$148.00	$296.00	$70.51–$225.52	11% below	50%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 BP Insertion Drug Delivry Implant 11981	$148.00	$296.00	$70.51–$225.52	11% below	50%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 BP Insertion Drug Delivry Implant 11981	$148.00	$296.00	$70.51–$225.52	—	50%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 Insertion Drug Delivry Implant 11981	$148.00	$296.00	$70.51–$225.52	—	50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Hospitalist BP 20605 Arthrocentesis/aspiration/inject, intermed joint/bursa; w/o US guid	$208.00	$416.00	$161.47–$528.09	36% below	50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Arthrocentesis Aspir&/Inj Interm Jt/Burs W/O Us	$208.00	$416.00	$161.47–$528.09	36% below	50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 BP Arthrocentesis, aspiration and/or injection intrmediate joint or bursa without U/S Guidance 20605	$208.00	$416.00	$161.47–$528.09	36% below	50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Arthrocentesis/aspiration/inject, intermed joint/bursa; w/o US guid 20605	$208.00	$416.00	$161.47–$528.09	36% below	50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Drain/Inj Inter Joint/Bursa W/O Us	$208.00	$416.00	$161.47–$528.09	36% below	50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 20605-CT Jnt/Bursa Itmd Arthr/Asp/Inj RT	$208.00	$416.00	$161.47–$528.09	36% below	50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 IR Arthcntsis, Asp/Inj Int Brsa w/o U/S - RT	$208.00	$416.00	$161.47–$528.09	36% below	50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 20605-CT Jnt/Bursa Itmd Arthr/Asp/Inj LT	$208.00	$416.00	$161.47–$528.09	36% below	50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 20605-XR Jnt/Bursa Intmd Arth/Asp/Inj LT	$208.00	$416.00	$161.47–$528.09	36% below	50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 IR Arthcntsis, Asp/Inj Int Brsa w/o U/S - LT	$208.00	$416.00	$161.47–$528.09	36% below	50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 20605-XR Jnt/Bursa Intmd Arth/Asp/Inj RT	$208.00	$416.00	$161.47–$528.09	36% below	50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Hospitalist BP 20605 Arthrocentesis/aspiration/inject, intermed joint/bursa; w/o US guid	$208.00	$416.00	$161.47–$528.09	—	50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Arthrocentesis/aspiration/inject, intermed joint/bursa; w/o US guid 20605	$208.00	$416.00	$161.47–$528.09	—	50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Arthrocentesis Aspir&/Inj Interm Jt/Burs W/O Us	$208.00	$416.00	$161.47–$528.09	—	50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 BP Arthrocentesis, aspiration and/or injection intrmediate joint or bursa without U/S Guidance 20605	$208.00	$416.00	$161.47–$528.09	—	50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Drain/Inj Inter Joint/Bursa W/O Us	$208.00	$416.00	$161.47–$528.09	—	50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 IR Arthcntsis, Asp/Inj Int Brsa w/o U/S - LT	$208.00	$416.00	$161.47–$528.09	—	50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 20605-CT Jnt/Bursa Itmd Arthr/Asp/Inj RT	$208.00	$416.00	$161.47–$528.09	—	50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 20605-CT Jnt/Bursa Itmd Arthr/Asp/Inj LT	$208.00	$416.00	$161.47–$528.09	—	50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 20605-XR Jnt/Bursa Intmd Arth/Asp/Inj LT	$208.00	$416.00	$161.47–$528.09	—	50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 20605-XR Jnt/Bursa Intmd Arth/Asp/Inj RT	$208.00	$416.00	$161.47–$528.09	—	50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 IR Arthcntsis, Asp/Inj Int Brsa w/o U/S - RT	$208.00	$416.00	$161.47–$528.09	—	50%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 BP Arthrocentesis, aspiration and/or injection small joint or bursa without U/S Guidance 20600	$208.00	$416.00	$161.47–$528.09	38% below	50%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Arthrocentesis/aspiration/inject, small joint/bursa; w/o US guid 20600	$208.00	$416.00	$161.47–$528.09	38% below	50%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Hospitalist BP 20600 Arthrocentesis/aspiration/inject, small joint/bursa; w/o US guid	$208.00	$416.00	$161.47–$528.09	38% below	50%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Drain/Inj Small Joint/Bursa W/O Us	$208.00	$416.00	$161.47–$528.09	38% below	50%
Joint injection or drainage, small joint (fingers, toes) one side CPT 20600 20600-XR Jnt/Bursa Sml Arthr/Asp/Inj LT	$208.00	$416.00	$161.47–$528.09	38% below	50%
Joint injection or drainage, small joint (fingers, toes) one side CPT 20600 20600-XR Jnt/Bursa Sml Arthr/Asp/Inj RT	$208.00	$416.00	$161.47–$528.09	38% below	50%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 BP Arthrocentesis, aspiration and/or injection small joint or bursa without U/S Guidance 20600	$208.00	$416.00	$161.47–$528.09	—	50%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 Drain/Inj Small Joint/Bursa W/O Us	$208.00	$416.00	$161.47–$528.09	—	50%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 Hospitalist BP 20600 Arthrocentesis/aspiration/inject, small joint/bursa; w/o US guid	$208.00	$416.00	$161.47–$528.09	—	50%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 Arthrocentesis/aspiration/inject, small joint/bursa; w/o US guid 20600	$208.00	$416.00	$161.47–$528.09	—	50%
Joint injection or drainage, small joint (fingers, toes) inpatient one side CPT 20600 20600-XR Jnt/Bursa Sml Arthr/Asp/Inj LT	$208.00	$416.00	$161.47–$528.09	—	50%
Joint injection or drainage, small joint (fingers, toes) inpatient one side CPT 20600 20600-XR Jnt/Bursa Sml Arthr/Asp/Inj RT	$208.00	$416.00	$161.47–$528.09	—	50%
Knee arthroscopy with meniscus repair (one side of the knee) CPT 29882 KNEE ARTHROSCOPY/SURGERY	$11,940.70	$23,881.39	$1,774.80–$8,117.34	72% above	50%
Knee arthroscopy with meniscus repair (one side of the knee) inpatient CPT 29882 KNEE ARTHROSCOPY/SURGERY	$11,940.70	$23,881.39	$1,774.80–$8,117.34	—	50%
Knee arthroscopy with meniscus trim CPT 29881 KNEE ARTHROSCOPY/SURGERY	$6,718.23	$13,436.46	$1,774.80–$5,541.54	42% above	50%
Knee arthroscopy with meniscus trim inpatient CPT 29881 KNEE ARTHROSCOPY/SURGERY	$6,718.23	$13,436.46	$1,774.80–$5,541.54	—	50%
Knee arthroscopy with removal of both torn meniscus parts CPT 29880 KNEE ARTHROSCOPY/SURGERY	$7,286.54	$14,573.07	$1,774.80–$5,962.49	62% above	50%
Knee arthroscopy with removal of both torn meniscus parts inpatient CPT 29880 KNEE ARTHROSCOPY/SURGERY	$7,286.54	$14,573.07	$1,774.80–$5,962.49	—	50%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 KNEE ARTHROSCOPY/SURGERY	$4,821.28	$9,642.56	$1,774.80–$5,271.46	at median	50%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) inpatient CPT 29877 KNEE ARTHROSCOPY/SURGERY	$4,821.28	$9,642.56	$1,774.80–$5,271.46	—	50%
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 LAPAROSCOPY APPENDECTOMY	$12,297.55	$24,595.09	$3,191.39–$9,104.22	45% above	50%
Laparoscopic appendectomy (appendix removal through small cuts) inpatient CPT 44970 LAPAROSCOPY APPENDECTOMY	$12,297.55	$24,595.09	$3,191.39–$9,104.22	—	50%
Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 LAP ING HERNIA REPAIR INIT	$13,687.69	$27,375.37	$3,191.39–$9,657.06	95% above	50%
Laparoscopic inguinal (groin) hernia repair, first repair on that side inpatient CPT 49650 LAP ING HERNIA REPAIR INIT	$13,687.69	$27,375.37	$3,191.39–$9,657.06	—	50%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 LAP ING HERNIA REPAIR RECUR	$15,569.27	$31,138.54	$3,191.39–$10,203.21	87% above	50%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia inpatient CPT 49651 LAP ING HERNIA REPAIR RECUR	$15,569.27	$31,138.54	$3,191.39–$10,203.21	—	50%
Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 LAPAROSCOPY REMOVE ADNEXA	$7,360.03	$14,720.06	$3,191.39–$9,104.22	3% above	50%
Laparoscopic removal of fallopian tubes and/or ovaries inpatient CPT 58661 LAPAROSCOPY REMOVE ADNEXA	$7,360.03	$14,720.06	$3,191.39–$9,104.22	—	50%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Intmd Rpr S/A/T/Ext 2.5 Cm/<	$609.25	$1,218.50	$180.00–$724.61	63% above	50%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Intermediate repair, scalp/axillae/trunk/extem, 2.5cm or less 12031	$609.25	$1,218.50	$218.54–$724.61	63% above	50%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Hospitalist BP 12031 Intermediate repair, scalp/axillae/trunk/extem, 2.5cm or less	$609.25	$1,218.50	$218.54–$724.61	63% above	50%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 BP Intermediate repair, scalp/axillae/trunk/extem, 2.5cm or less 12031	$609.25	$1,218.50	$218.54–$724.61	63% above	50%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 Intermediate repair, scalp/axillae/trunk/extem, 2.5cm or less 12031	$609.25	$1,218.50	$218.54–$724.61	—	50%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 BP Intermediate repair, scalp/axillae/trunk/extem, 2.5cm or less 12031	$609.25	$1,218.50	$218.54–$724.61	—	50%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 Hospitalist BP 12031 Intermediate repair, scalp/axillae/trunk/extem, 2.5cm or less	$609.25	$1,218.50	$218.54–$724.61	—	50%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 Intmd Rpr S/A/T/Ext 2.5 Cm/<	$609.25	$1,218.50	$180.00–$724.61	—	50%
Left heart catheterization, diagnostic CPT 93452 CCL Lv Gram Only	$3,915.10	$7,830.20	$1,759.38–$5,019.04	44% below	50%
Left heart catheterization, diagnostic inpatient CPT 93452 CCL Lv Gram Only	$3,915.10	$7,830.20	$1,759.38–$5,019.04	—	50%
Lower-back epidural injection, with imaging guidance CPT 62323 62323- CT Injection Lmbr/Scrl Epidural	$970.65	$1,941.30	$378.81–$1,080.64	6% below	50%
Lower-back epidural injection, with imaging guidance CPT 62323 IR Inject non-neurolytic intrlaminar L/S	$970.65	$1,941.30	$378.81–$1,080.64	6% below	50%
Lower-back epidural injection, with imaging guidance CPT 62323 62323- IR Inj Epid/Subarac Lum/Sacr w/ Img	$970.65	$1,941.30	$378.81–$1,080.64	6% below	50%
Lower-back epidural injection, with imaging guidance CPT 62323 Injection Interlaminar Lumbar/Sacral w/ Guidance 62323	$970.65	$1,941.30	$378.81–$1,080.64	6% below	50%
Lower-back epidural injection, with imaging guidance CPT 62323 62323-XR Injection Lmbr/Scrl Epidural	$970.65	$1,941.30	$378.81–$1,080.64	6% below	50%
Lower-back epidural injection, with imaging guidance CPT 62323 NJX INTERLAMINAR LMBR/SAC	$7,145.90	$14,291.79	$378.81–$1,080.64	594% above	50%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 62323-XR Injection Lmbr/Scrl Epidural	$970.65	$1,941.30	$378.81–$1,080.64	—	50%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 IR Inject non-neurolytic intrlaminar L/S	$970.65	$1,941.30	$378.81–$1,080.64	—	50%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 62323- CT Injection Lmbr/Scrl Epidural	$970.65	$1,941.30	$378.81–$1,080.64	—	50%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 Injection Interlaminar Lumbar/Sacral w/ Guidance 62323	$970.65	$1,941.30	$378.81–$1,080.64	—	50%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 62323- IR Inj Epid/Subarac Lum/Sacr w/ Img	$970.65	$1,941.30	$378.81–$1,080.64	—	50%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 NJX INTERLAMINAR LMBR/SAC	$7,145.90	$14,291.79	$378.81–$1,080.64	—	50%
Lower-back epidural injection, without imaging guidance CPT 62322 Injection Interlaminar Lumbar/Sacral w/o Guidance 62322	$681.75	$1,363.50	$486.99–$1,389.25	39% below	50%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 Injection Interlaminar Lumbar/Sacral w/o Guidance 62322	$681.75	$1,363.50	$486.99–$1,389.25	—	50%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 64483-XR Inject Lmbr/Scrl Foramina Epid	$1,740.55	$3,481.10	$486.99–$1,444.61	63% above	50%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 64483-CT Inject Lmbr/Scrl Foramina Epid	$1,740.55	$3,481.10	$486.99–$1,444.61	63% above	50%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Injection Anesthetic/Steroid Transforaminal w/Guide Lumbar/Sacral Single Lvl 64483	$1,740.55	$3,481.10	$486.99–$1,444.61	63% above	50%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 IR Inj Foramen Epidural Lum/Sacr	$1,740.55	$3,481.10	$486.99–$1,444.61	63% above	50%
Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 64483- IR Inj Foramen Epid Lum/Sacr RT	$1,740.55	$3,481.10	$486.99–$1,444.61	63% above	50%
Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 64483- IR Inj Foramen Epid Lum/Sacr LT	$1,740.55	$3,481.10	$486.99–$1,444.61	63% above	50%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 64483-XR Inject Lmbr/Scrl Foramina Epid	$1,740.55	$3,481.10	$486.99–$1,444.61	—	50%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 64483-CT Inject Lmbr/Scrl Foramina Epid	$1,740.55	$3,481.10	$486.99–$1,444.61	—	50%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 Injection Anesthetic/Steroid Transforaminal w/Guide Lumbar/Sacral Single Lvl 64483	$1,740.55	$3,481.10	$486.99–$1,444.61	—	50%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 IR Inj Foramen Epidural Lum/Sacr	$1,740.55	$3,481.10	$486.99–$1,444.61	—	50%
Lower-back nerve root steroid injection, with imaging guidance inpatient one side CPT 64483 64483- IR Inj Foramen Epid Lum/Sacr LT	$1,740.55	$3,481.10	$486.99–$1,444.61	—	50%
Lower-back nerve root steroid injection, with imaging guidance inpatient one side CPT 64483 64483- IR Inj Foramen Epid Lum/Sacr RT	$1,740.55	$3,481.10	$486.99–$1,444.61	—	50%
Lumbar interbody fusion (PLIF or TLIF), one level CPT 22630 LUMBAR SPINE FUSION	$38,068.98	$76,137.96	$10,059.36–$50,567.90	2% above	50%
Lumbar interbody fusion (PLIF or TLIF), one level inpatient CPT 22630 LUMBAR SPINE FUSION	$38,068.98	$76,137.96	$10,059.36–$50,567.90	—	50%
Lumpectomy (partial mastectomy) CPT 19301 PARTIAL MASTECTOMY	$7,886.19	$15,772.37	$2,094.62–$6,867.00	46% above	50%
Lumpectomy (partial mastectomy) inpatient CPT 19301 PARTIAL MASTECTOMY	$7,886.19	$15,772.37	$2,094.62–$6,867.00	—	50%
Mastectomy (total removal of the breast) CPT 19303 MAST SIMPLE COMPLETE	$58,686.89	$117,373.78	$3,567.24–$13,317.48	571% above	50%
Mastectomy (total removal of the breast) inpatient CPT 19303 MAST SIMPLE COMPLETE	$58,686.89	$117,373.78	$3,567.24–$13,317.48	—	50%
Miscarriage treatment with D&C, first trimester CPT 59820 CARE OF MISCARRIAGE	$5,471.02	$10,942.04	$1,739.20–$4,961.49	62% above	50%
Miscarriage treatment with D&C, first trimester inpatient CPT 59820 CARE OF MISCARRIAGE	$5,471.02	$10,942.04	$1,739.20–$4,961.49	—	50%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 Exc Tr-Ext B9+Marg 0.5Cm/<	$404.10	$808.20	$180.00–$1,260.49	44% below	50%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 BP Excision benign lesion, trunk/arms/legs; excised 0.5 cm or less 11400	$404.10	$808.20	$384.86–$1,260.49	44% below	50%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 Excision benign lesion, trunk/arms/legs; excised 0.5 cm or less 11400	$404.10	$808.20	$384.86–$1,260.49	44% below	50%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 Excision benign lesion, trunk/arms/legs; excised 0.5 cm or less 11400	$404.10	$808.20	$384.86–$1,260.49	—	50%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 Exc Tr-Ext B9+Marg 0.5Cm/<	$404.10	$808.20	$180.00–$1,260.49	—	50%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 BP Excision benign lesion, trunk/arms/legs; excised 0.5 cm or less 11400	$404.10	$808.20	$384.86–$1,260.49	—	50%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 BP Excision benign lesion face/ears/eyelids/nose/lips/mucous membrane 0.5 cm or less 11440	$270.50	$541.00	$384.86–$1,260.49	63% below	50%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 Excision benign lesion face/ears/eyelids/nose/lips/mucous membrane 0.5 cm or less 11440	$270.50	$541.00	$384.86–$1,260.49	63% below	50%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 Exc Face-Mm B9+Marg 0.5Cm/<	$270.50	$541.00	$180.00–$1,260.49	63% below	50%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 Excision benign lesion face/ears/eyelids/nose/lips/mucous membrane 0.5 cm or less 11440	$270.50	$541.00	$384.86–$1,260.49	—	50%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 BP Excision benign lesion face/ears/eyelids/nose/lips/mucous membrane 0.5 cm or less 11440	$270.50	$541.00	$384.86–$1,260.49	—	50%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 Exc Face-Mm B9+Marg 0.5Cm/<	$270.50	$541.00	$180.00–$1,260.49	—	50%
Nail removal (partial or complete), one nail CPT 11730 Avulsion Nail Plate Partial/Complete Simple 1	$145.80	$291.60	$108.69–$310.06	29% below	50%
Nail removal (partial or complete), one nail CPT 11730 Removal Of nail plate; partial or complete, simple; single 11730	$145.80	$291.60	$108.69–$310.06	29% below	50%
Nail removal (partial or complete), one nail CPT 11730 Hospitalist BP 11730 Removal Of nail plate; partial or complete, simple; single	$145.80	$291.60	$108.69–$310.06	29% below	50%
Nail removal (partial or complete), one nail CPT 11730 Spl Avulse Np; Sgl	$145.80	$291.60	$108.69–$450.00	29% below	50%
Nail removal (partial or complete), one nail CPT 11730 BP Removal Of nail plate; partial or complete, simple; single 11730	$145.80	$291.60	$108.69–$310.06	29% below	50%
Nail removal (partial or complete), one nail inpatient CPT 11730 Hospitalist BP 11730 Removal Of nail plate; partial or complete, simple; single	$145.80	$291.60	$108.69–$310.06	—	50%
Nail removal (partial or complete), one nail inpatient CPT 11730 Removal Of nail plate; partial or complete, simple; single 11730	$145.80	$291.60	$108.69–$310.06	—	50%
Nail removal (partial or complete), one nail inpatient CPT 11730 Avulsion Nail Plate Partial/Complete Simple 1	$145.80	$291.60	$108.69–$310.06	—	50%
Nail removal (partial or complete), one nail inpatient CPT 11730 BP Removal Of nail plate; partial or complete, simple; single 11730	$145.80	$291.60	$108.69–$310.06	—	50%
Nail removal (partial or complete), one nail inpatient CPT 11730 Spl Avulse Np; Sgl	$145.80	$291.60	$108.69–$450.00	—	50%
Occipital nerve block (injection for headaches) CPT 64405 Nerve Block Inj; Occipital 64405	$546.85	$1,093.70	$161.47–$528.09	6% above	50%
Occipital nerve block (injection for headaches) CPT 64405 BP Nerve Block Inj; Occipital 64405	$546.85	$1,093.70	$161.47–$528.09	6% above	50%
Occipital nerve block (injection for headaches) CPT 64405 Inj Anesth ; Greater Occipital Nerve	$546.85	$1,093.70	$161.47–$528.09	6% above	50%
Occipital nerve block (injection for headaches) inpatient CPT 64405 Inj Anesth ; Greater Occipital Nerve	$546.85	$1,093.70	$161.47–$528.09	—	50%
Occipital nerve block (injection for headaches) inpatient CPT 64405 Nerve Block Inj; Occipital 64405	$546.85	$1,093.70	$161.47–$528.09	—	50%
Occipital nerve block (injection for headaches) inpatient CPT 64405 BP Nerve Block Inj; Occipital 64405	$546.85	$1,093.70	$161.47–$528.09	—	50%
Pacemaker implant (dual chamber) both sides CPT 33208 CI Insert or Replace Dual/BI-V Pacer w/Leads	$16,232.10	$32,464.20	$5,724.54–$23,763.42	—	50%
Pacemaker implant (dual chamber) inpatient both sides CPT 33208 CI Insert or Replace Dual/BI-V Pacer w/Leads	$16,232.10	$32,464.20	$5,724.54–$23,763.42	—	50%
Paracentesis with imaging guidance CPT 49083 49083-US Paracentesis	$620.00	$1,240.00	$512.85–$1,463.01	49% below	50%
Paracentesis with imaging guidance CPT 49083 BP Abdominal paracentesis (dx/ther); w imaging guidance 49083	$620.00	$1,240.00	$512.85–$1,463.01	49% below	50%
Paracentesis with imaging guidance CPT 49083 IR Abd paracentesis	$620.00	$1,240.00	$512.85–$1,463.01	49% below	50%
Paracentesis with imaging guidance CPT 49083 49083-CT Paracentesis Abdom w/ CT Guide	$620.00	$1,240.00	$512.85–$1,463.01	49% below	50%
Paracentesis with imaging guidance inpatient CPT 49083 IR Abd paracentesis	$620.00	$1,240.00	$512.85–$1,463.01	—	50%
Paracentesis with imaging guidance inpatient CPT 49083 BP Abdominal paracentesis (dx/ther); w imaging guidance 49083	$620.00	$1,240.00	$512.85–$1,463.01	—	50%
Paracentesis with imaging guidance inpatient CPT 49083 49083-US Paracentesis	$620.00	$1,240.00	$512.85–$1,463.01	—	50%
Paracentesis with imaging guidance inpatient CPT 49083 49083-CT Paracentesis Abdom w/ CT Guide	$620.00	$1,240.00	$512.85–$1,463.01	—	50%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 BP Excision nail & matrix, partl/complt, e.g. ingrown nail, permanent 11750	$372.40	$744.80	$218.54–$724.61	29% below	50%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Excision nail & matrix, partl/complt, e.g. ingrown nail, permanent 11750	$372.40	$744.80	$218.54–$724.61	29% below	50%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Removal Of Nail Bed	$372.40	$744.80	$180.00–$724.61	29% below	50%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Excision Nail Matrix Permanent Removal	$372.40	$744.80	$218.54–$724.61	29% below	50%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Hospitalist BP 11750 Excision nail & matrix, partl/complt, e.g. ingrown nail, permanent	$372.40	$744.80	$218.54–$724.61	29% below	50%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 BP Excision nail & matrix, partl/complt, e.g. ingrown nail, permanent 11750	$372.40	$744.80	$218.54–$724.61	—	50%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Removal Of Nail Bed	$372.40	$744.80	$180.00–$724.61	—	50%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Excision nail & matrix, partl/complt, e.g. ingrown nail, permanent 11750	$372.40	$744.80	$218.54–$724.61	—	50%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Hospitalist BP 11750 Excision nail & matrix, partl/complt, e.g. ingrown nail, permanent	$372.40	$744.80	$218.54–$724.61	—	50%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Excision Nail Matrix Permanent Removal	$372.40	$744.80	$218.54–$724.61	—	50%
Prostate biopsy CPT 55700 55700-US Biopsy Prostate	$1,876.35	$3,752.70	$1,120.53–$3,196.59	23% above	50%
Prostate biopsy CPT 55700 Prostate Biopsy, Needle/Punch-1 or more 55700	$1,876.35	$3,752.70	$1,120.53–$3,196.59	23% above	50%
Prostate biopsy CPT 55700 BP Prostate Biopsy, Needle/Punch-1 or more 55700	$1,876.35	$3,752.70	$1,120.53–$3,196.59	23% above	50%
Prostate biopsy CPT 55700 BIOPSY OF PROSTATE	$3,961.24	$7,922.47	$1,120.53–$3,196.59	159% above	50%
Prostate biopsy inpatient CPT 55700 BP Prostate Biopsy, Needle/Punch-1 or more 55700	$1,876.35	$3,752.70	$1,120.53–$3,196.59	—	50%
Prostate biopsy inpatient CPT 55700 Prostate Biopsy, Needle/Punch-1 or more 55700	$1,876.35	$3,752.70	$1,120.53–$3,196.59	—	50%
Prostate biopsy inpatient CPT 55700 55700-US Biopsy Prostate	$1,876.35	$3,752.70	$1,120.53–$3,196.59	—	50%
Prostate biopsy inpatient CPT 55700 BIOPSY OF PROSTATE	$3,961.24	$7,922.47	$1,120.53–$3,196.59	—	50%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 IR Rhizotomy of the Lumbar Spine/Sacral	$1,962.05	$3,924.10	$1,068.17–$3,047.20	19% below	50%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 64635- IR Destruct Lumb/Sac Facet Jnt Sgl	$1,962.05	$3,924.10	$1,068.17–$3,047.20	19% below	50%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 IR Rhizotomy of the Lumbar Spine/Sacral	$1,962.05	$3,924.10	$1,068.17–$3,047.20	—	50%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 64635- IR Destruct Lumb/Sac Facet Jnt Sgl	$1,962.05	$3,924.10	$1,068.17–$3,047.20	—	50%
Removal of a foreign object under the skin, simple CPT 10120 Inc & Rem Fb Sq; Smpl	$239.30	$478.60	$180.00–$724.61	36% below	50%
Removal of a foreign object under the skin, simple CPT 10120 Incision & removal foreign body; simple 10120	$239.30	$478.60	$218.54–$724.61	36% below	50%
Removal of a foreign object under the skin, simple CPT 10120 BP Incision & removal foreign body; simple 10120	$239.30	$478.60	$218.54–$724.61	36% below	50%
Removal of a foreign object under the skin, simple CPT 10120 Incision & Removal Foreign Body Subq Tiss Simple	$239.30	$478.60	$218.54–$724.61	36% below	50%
Removal of a foreign object under the skin, simple CPT 10120 REMOVE FOREIGN BODY	$1,334.04	$2,668.07	$218.54–$724.61	257% above	50%
Removal of a foreign object under the skin, simple inpatient CPT 10120 Incision & removal foreign body; simple 10120	$239.30	$478.60	$218.54–$724.61	—	50%
Removal of a foreign object under the skin, simple inpatient CPT 10120 BP Incision & removal foreign body; simple 10120	$239.30	$478.60	$218.54–$724.61	—	50%
Removal of a foreign object under the skin, simple inpatient CPT 10120 Incision & Removal Foreign Body Subq Tiss Simple	$239.30	$478.60	$218.54–$724.61	—	50%
Removal of a foreign object under the skin, simple inpatient CPT 10120 Inc & Rem Fb Sq; Smpl	$239.30	$478.60	$180.00–$724.61	—	50%
Removal of a foreign object under the skin, simple inpatient CPT 10120 REMOVE FOREIGN BODY	$1,334.04	$2,668.07	$218.54–$724.61	—	50%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 BP Colorectal Cancer Screening; Colonoscopy, individual not meeting criteria for high risk G0121	$978.15	$1,956.30	$498.71–$1,422.68	5% below	50%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 COLON CA SCRN NOT HI RSK IND	$1,868.58	$3,737.15	$498.71–$1,422.68	81% above	50%
Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 BP Colorectal Cancer Screening; Colonoscopy, individual not meeting criteria for high risk G0121	$978.15	$1,956.30	$498.71–$1,422.68	—	50%
Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 COLON CA SCRN NOT HI RSK IND	$1,868.58	$3,737.15	$498.71–$1,422.68	—	50%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 BP Colorectal cancer screening; colonoscopy on individual at high risk G0105	$975.60	$1,951.20	$498.71–$1,422.68	5% below	50%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 COLORECTAL SCRN; HI RISK IND	$1,946.95	$3,893.89	$498.71–$1,422.68	89% above	50%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 BP Colorectal cancer screening; colonoscopy on individual at high risk G0105	$975.60	$1,951.20	$498.71–$1,422.68	—	50%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 COLORECTAL SCRN; HI RISK IND	$1,946.95	$3,893.89	$498.71–$1,422.68	—	50%
Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 FRAGMENTING OF KIDNEY STONE	$7,563.26	$15,126.51	$1,886.59–$5,381.94	17% above	50%
Shock-wave lithotripsy to break up kidney stones (from outside the body) inpatient CPT 50590 FRAGMENTING OF KIDNEY STONE	$7,563.26	$15,126.51	$1,886.59–$5,381.94	—	50%
Short arm cast (elbow to hand) CPT 29075 Apply Short Arm Cast	$209.55	$419.10	$145.27–$450.00	16% below	50%
Short arm cast (elbow to hand) CPT 29075 Hospitalist BP 29075 Application, cast; elbow to finger (short arm)	$209.55	$419.10	$145.27–$414.42	16% below	50%
Short arm cast (elbow to hand) CPT 29075 Application, cast; elbow to finger (short arm) 29075	$209.55	$419.10	$145.27–$414.42	16% below	50%
Short arm cast (elbow to hand) CPT 29075 BP Application, cast; elbow to finger (short arm) 29075	$209.55	$419.10	$145.27–$414.42	16% below	50%
Short arm cast (elbow to hand) inpatient CPT 29075 BP Application, cast; elbow to finger (short arm) 29075	$209.55	$419.10	$145.27–$414.42	—	50%
Short arm cast (elbow to hand) inpatient CPT 29075 Application, cast; elbow to finger (short arm) 29075	$209.55	$419.10	$145.27–$414.42	—	50%
Short arm cast (elbow to hand) inpatient CPT 29075 Hospitalist BP 29075 Application, cast; elbow to finger (short arm)	$209.55	$419.10	$145.27–$414.42	—	50%
Short arm cast (elbow to hand) inpatient CPT 29075 Apply Short Arm Cast	$209.55	$419.10	$145.27–$450.00	—	50%
Short arm splint (forearm and hand) CPT 29125 Hospitalist BP 29125 Application Short Arm Splint, Static	$225.75	$451.50	$70.51–$201.14	18% above	50%
Short arm splint (forearm and hand) CPT 29125 Application of short arm splint static 29125	$225.75	$451.50	$70.51–$201.14	18% above	50%
Short arm splint (forearm and hand) CPT 29125 BP Application Short Arm Splint,Static 29125	$225.75	$451.50	$70.51–$201.14	18% above	50%
Short arm splint (forearm and hand) CPT 29125 Apply Short Arm Splint; Static	$225.75	$451.50	$70.51–$450.00	18% above	50%
Short arm splint (forearm and hand) inpatient CPT 29125 Hospitalist BP 29125 Application Short Arm Splint, Static	$225.75	$451.50	$70.51–$201.14	—	50%
Short arm splint (forearm and hand) inpatient CPT 29125 Apply Short Arm Splint; Static	$225.75	$451.50	$70.51–$450.00	—	50%
Short arm splint (forearm and hand) inpatient CPT 29125 BP Application Short Arm Splint,Static 29125	$225.75	$451.50	$70.51–$201.14	—	50%
Short arm splint (forearm and hand) inpatient CPT 29125 Application of short arm splint static 29125	$225.75	$451.50	$70.51–$201.14	—	50%
Short leg cast (below the knee) CPT 29405 BP Application Short Leg Cast 29405	$240.95	$481.90	$145.27–$414.42	12% below	50%
Short leg cast (below the knee) CPT 29405 Application Short Leg Cast 29405	$240.95	$481.90	$145.27–$414.42	12% below	50%
Short leg cast (below the knee) CPT 29405 Apply Sh Leg Cast	$240.95	$481.90	$145.27–$450.00	12% below	50%
Short leg cast (below the knee) CPT 29405 Hospitalist BP 29405 Application Short Leg Cast	$240.95	$481.90	$145.27–$414.42	12% below	50%
Short leg cast (below the knee) inpatient CPT 29405 Apply Sh Leg Cast	$240.95	$481.90	$145.27–$450.00	—	50%
Short leg cast (below the knee) inpatient CPT 29405 BP Application Short Leg Cast 29405	$240.95	$481.90	$145.27–$414.42	—	50%
Short leg cast (below the knee) inpatient CPT 29405 Application Short Leg Cast 29405	$240.95	$481.90	$145.27–$414.42	—	50%
Short leg cast (below the knee) inpatient CPT 29405 Hospitalist BP 29405 Application Short Leg Cast	$240.95	$481.90	$145.27–$414.42	—	50%
Short leg splint (calf to foot) CPT 29515 Apply Short Leg Splint	$240.65	$481.30	$86.31–$450.00	47% above	50%
Short leg splint (calf to foot) CPT 29515 Application of short leg splint (calf to foot) 29515	$240.65	$481.30	$86.31–$246.22	47% above	50%
Short leg splint (calf to foot) CPT 29515 BP Application of short leg splint (calf to foot) 29515	$240.65	$481.30	$86.31–$246.22	47% above	50%
Short leg splint (calf to foot) CPT 29515 Hospitalist BP 29515 Application of Short Leg Splint (calf to foot)	$240.65	$481.30	$86.31–$246.22	47% above	50%
Short leg splint (calf to foot) inpatient CPT 29515 Application of short leg splint (calf to foot) 29515	$240.65	$481.30	$86.31–$246.22	—	50%
Short leg splint (calf to foot) inpatient CPT 29515 Hospitalist BP 29515 Application of Short Leg Splint (calf to foot)	$240.65	$481.30	$86.31–$246.22	—	50%
Short leg splint (calf to foot) inpatient CPT 29515 BP Application of short leg splint (calf to foot) 29515	$240.65	$481.30	$86.31–$246.22	—	50%
Short leg splint (calf to foot) inpatient CPT 29515 Apply Short Leg Splint	$240.65	$481.30	$86.31–$450.00	—	50%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 SHOULDER ARTHROSCOPY/SURGERY	$10,435.95	$20,871.90	$1,774.80–$6,418.85	524% above	50%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) inpatient CPT 29824 SHOULDER ARTHROSCOPY/SURGERY	$10,435.95	$20,871.90	$1,774.80–$6,418.85	—	50%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Simple Repair Scalp/Neck/Ax/Genit/Trunk 2.5Cm/<	$323.85	$647.70	$108.69–$310.06	53% above	50%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Srep S/N/A/G/Tr/E; 2.5Cm/<	$323.85	$647.70	$108.69–$467.12	53% above	50%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Simple Lac Repair Ext/Scalp 2.5CM LESS 12001	$323.85	$647.70	$108.69–$310.06	53% above	50%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 BP Simple Lac Repair Ext/Scalp 2.5CM LESS 12001	$323.85	$647.70	$108.69–$310.06	53% above	50%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 RPR S/N/AX/GEN/TRNK 2.5CM/<	$9,815.52	$19,631.03	$108.69–$310.06	4538% above	50%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 Srep S/N/A/G/Tr/E; 2.5Cm/<	$323.85	$647.70	$108.69–$467.12	—	50%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 Simple Repair Scalp/Neck/Ax/Genit/Trunk 2.5Cm/<	$323.85	$647.70	$108.69–$310.06	—	50%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 Simple Lac Repair Ext/Scalp 2.5CM LESS 12001	$323.85	$647.70	$108.69–$310.06	—	50%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 BP Simple Lac Repair Ext/Scalp 2.5CM LESS 12001	$323.85	$647.70	$108.69–$310.06	—	50%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 RPR S/N/AX/GEN/TRNK 2.5CM/<	$9,815.52	$19,631.03	$108.69–$310.06	—	50%
Skin biopsy, punch, one lesion CPT 11104 BP Punch Biopsy of Skin Single Lesion 11104	$237.05	$474.10	$218.54–$623.45	36% below	50%
Skin biopsy, punch, one lesion CPT 11104 Punch Biopsy Skin; Singe Lesion	$237.05	$474.10	$218.54–$623.45	36% below	50%
Skin biopsy, punch, one lesion CPT 11104 Punch BX single lesion 11104	$237.05	$474.10	$218.54–$623.45	36% below	50%
Skin biopsy, punch, one lesion inpatient CPT 11104 Punch Biopsy Skin; Singe Lesion	$237.05	$474.10	$218.54–$623.45	—	50%
Skin biopsy, punch, one lesion inpatient CPT 11104 Punch BX single lesion 11104	$237.05	$474.10	$218.54–$623.45	—	50%
Skin biopsy, punch, one lesion inpatient CPT 11104 BP Punch Biopsy of Skin Single Lesion 11104	$237.05	$474.10	$218.54–$623.45	—	50%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 BP Excision, malignant lesion, trunk/arms/legs 0.5cm or less 11600	$270.50	$541.00	$296.05–$1,097.92	19% below	50%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 Excision, malignant lesion, trunk/arms/legs 0.5cm or less 11600	$270.50	$541.00	$296.05–$1,097.92	19% below	50%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 Excision, malignant lesion, trunk/arms/legs 0.5cm or less 11600	$270.50	$541.00	$296.05–$1,097.92	—	50%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 BP Excision, malignant lesion, trunk/arms/legs 0.5cm or less 11600	$270.50	$541.00	$296.05–$1,097.92	—	50%
Skin tag removal, up to 15 tags CPT 11200 BP Removal of Skin Tags Up To 15 Lesions 11200	$108.95	$217.90	$108.69–$310.06	38% below	50%
Skin tag removal, up to 15 tags CPT 11200 Rem Skin Tags; <=15 Lesions	$108.95	$217.90	$108.69–$450.00	38% below	50%
Skin tag removal, up to 15 tags CPT 11200 Removal of skin tag up to 15 lesions 11200	$108.95	$217.90	$108.69–$310.06	38% below	50%
Skin tag removal, up to 15 tags inpatient CPT 11200 BP Removal of Skin Tags Up To 15 Lesions 11200	$108.95	$217.90	$108.69–$310.06	—	50%
Skin tag removal, up to 15 tags inpatient CPT 11200 Rem Skin Tags; <=15 Lesions	$108.95	$217.90	$108.69–$450.00	—	50%
Skin tag removal, up to 15 tags inpatient CPT 11200 Removal of skin tag up to 15 lesions 11200	$108.95	$217.90	$108.69–$310.06	—	50%
Spinal tap (lumbar puncture), diagnostic CPT 62270 IR Lumbar Puncture Diagnostic	$614.90	$1,229.80	$378.81–$1,647.46	28% below	50%
Spinal tap (lumbar puncture), diagnostic CPT 62270 BP Lumbar Puncture 62270	$639.45	$1,278.90	$378.81–$1,647.46	25% below	50%
Spinal tap (lumbar puncture), diagnostic CPT 62270 Spinal puncture, lumbar, diagnostic 62270	$639.45	$1,278.90	$378.81–$1,647.46	25% below	50%
Spinal tap (lumbar puncture), diagnostic CPT 62270 Spinal Puncture Lumbar Diagnostic	$639.45	$1,278.90	$180.00–$1,647.46	25% below	50%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL FLUID TAP DIAGNOSTIC	$6,595.38	$13,190.75	$378.81–$1,647.46	670% above	50%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 IR Lumbar Puncture Diagnostic	$614.90	$1,229.80	$378.81–$1,647.46	—	50%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 Spinal Puncture Lumbar Diagnostic	$639.45	$1,278.90	$180.00–$1,647.46	—	50%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 Spinal puncture, lumbar, diagnostic 62270	$639.45	$1,278.90	$378.81–$1,647.46	—	50%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 BP Lumbar Puncture 62270	$639.45	$1,278.90	$378.81–$1,647.46	—	50%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL FLUID TAP DIAGNOSTIC	$6,595.38	$13,190.75	$378.81–$1,647.46	—	50%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Simple Repair, scalp/neck/axillae/trunk/genital/extrem, 2.5 - 7.5 cm 12002	$337.80	$675.60	$108.69–$310.06	36% above	50%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 BP Simple Repair, scalp/neck/axillae/trunk/genital/extrem, 2.5 - 7.5 cm 12002	$337.80	$675.60	$108.69–$310.06	36% above	50%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Smpl Repair Scalp/Neck/Ax/Genit/Trunk 2.6-7.5Cm	$337.80	$675.60	$108.69–$310.06	36% above	50%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Sreps/N/A/G/Tr/E; 2.6-7.5Cm	$337.80	$675.60	$108.69–$487.24	36% above	50%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 Simple Repair, scalp/neck/axillae/trunk/genital/extrem, 2.5 - 7.5 cm 12002	$337.80	$675.60	$108.69–$310.06	—	50%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 Sreps/N/A/G/Tr/E; 2.6-7.5Cm	$337.80	$675.60	$108.69–$487.24	—	50%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 Smpl Repair Scalp/Neck/Ax/Genit/Trunk 2.6-7.5Cm	$337.80	$675.60	$108.69–$310.06	—	50%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 BP Simple Repair, scalp/neck/axillae/trunk/genital/extrem, 2.5 - 7.5 cm 12002	$337.80	$675.60	$108.69–$310.06	—	50%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Srep F/E/N/L/Mm; 2.5Cm/<	$323.85	$647.70	$108.69–$500.22	37% above	50%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 BP Simple repair, face/ears/nose/lips/eyelids/muc membr, 2.5cm or less 12011	$323.85	$647.70	$108.69–$310.06	37% above	50%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Simple repair, face/ears/nose/lips/eyelids/muc membr, 2.5cm or less 12011	$323.85	$647.70	$108.69–$310.06	37% above	50%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 Srep F/E/N/L/Mm; 2.5Cm/<	$323.85	$647.70	$108.69–$500.22	—	50%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 Simple repair, face/ears/nose/lips/eyelids/muc membr, 2.5cm or less 12011	$323.85	$647.70	$108.69–$310.06	—	50%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 BP Simple repair, face/ears/nose/lips/eyelids/muc membr, 2.5cm or less 12011	$323.85	$647.70	$108.69–$310.06	—	50%
TURP (transurethral resection of the prostate) CPT 52601 PROSTATECTOMY (TURP)	$8,812.90	$17,625.80	$2,780.74–$7,932.72	41% above	50%
TURP (transurethral resection of the prostate) inpatient CPT 52601 PROSTATECTOMY (TURP)	$8,812.90	$17,625.80	$2,780.74–$7,932.72	—	50%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 Tangential Biopsy Skin; Single Lesion	$237.05	$474.10	$108.69–$310.06	17% below	50%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 Tangential Biopsy Single lesion 11102	$237.05	$474.10	$108.69–$310.06	17% below	50%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 Tangential Biopsy Skin; Single Lesion	$237.05	$474.10	$108.69–$310.06	—	50%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 Tangential Biopsy Single lesion 11102	$237.05	$474.10	$108.69–$310.06	—	50%
Thoracentesis with imaging guidance CPT 32555 32555-US Thoracentesis	$606.90	$1,213.80	$338.19–$1,263.27	46% below	50%
Thoracentesis with imaging guidance CPT 32555 Thoracentesis, needle or catheter, aspiration of the pleural space; w/imaging guidance 32555	$606.90	$1,213.80	$338.19–$1,263.27	46% below	50%
Thoracentesis with imaging guidance CPT 32555 32555-CT Thoracentesis w/ CT Guidance	$606.90	$1,213.80	$338.19–$1,263.27	46% below	50%
Thoracentesis with imaging guidance CPT 32555 Hospitalist BP 32555 Thoracentesis Needle/Cath Pleura w/Image	$606.90	$1,213.80	$338.19–$1,263.27	46% below	50%
Thoracentesis with imaging guidance one side CPT 32555 IR Thoracentesis w/Image guidance - RT	$606.90	$1,213.80	$338.19–$1,263.27	46% below	50%
Thoracentesis with imaging guidance one side CPT 32555 IR Thoracentesis w/Image guidance - LT	$606.90	$1,213.80	$338.19–$1,263.27	46% below	50%
Thoracentesis with imaging guidance inpatient CPT 32555 32555-US Thoracentesis	$606.90	$1,213.80	$338.19–$1,263.27	—	50%
Thoracentesis with imaging guidance inpatient CPT 32555 Thoracentesis, needle or catheter, aspiration of the pleural space; w/imaging guidance 32555	$606.90	$1,213.80	$338.19–$1,263.27	—	50%
Thoracentesis with imaging guidance inpatient CPT 32555 Hospitalist BP 32555 Thoracentesis Needle/Cath Pleura w/Image	$606.90	$1,213.80	$338.19–$1,263.27	—	50%
Thoracentesis with imaging guidance inpatient CPT 32555 32555-CT Thoracentesis w/ CT Guidance	$606.90	$1,213.80	$338.19–$1,263.27	—	50%
Thoracentesis with imaging guidance inpatient one side CPT 32555 IR Thoracentesis w/Image guidance - RT	$606.90	$1,213.80	$338.19–$1,263.27	—	50%
Thoracentesis with imaging guidance inpatient one side CPT 32555 IR Thoracentesis w/Image guidance - LT	$606.90	$1,213.80	$338.19–$1,263.27	—	50%
Tonsil and adenoid removal, child under 12 CPT 42820 REMOVE TONSILS AND ADENOIDS	$4,743.89	$9,487.78	$3,235.87–$9,231.08	45% above	50%
Tonsil and adenoid removal, child under 12 inpatient CPT 42820 REMOVE TONSILS AND ADENOIDS	$4,743.89	$9,487.78	$3,235.87–$9,231.08	—	50%
Tonsil removal (tonsillectomy) only, age 12 or older CPT 42826 REMOVAL OF TONSILS	$5,328.39	$10,656.77	$1,773.96–$5,060.64	30% above	50%
Tonsil removal (tonsillectomy) only, age 12 or older inpatient CPT 42826 REMOVAL OF TONSILS	$5,328.39	$10,656.77	$1,773.96–$5,060.64	—	50%
Total hip replacement CPT 27130 TOTAL HIP ARTHROPLASTY	$29,514.36	$59,028.72	$7,038.15–$31,271.03	39% above	50%
Total hip replacement inpatient CPT 27130 TOTAL HIP ARTHROPLASTY	$29,514.36	$59,028.72	$7,038.15–$31,271.03	—	50%
Total knee replacement CPT 27447 TOTAL KNEE ARTHROPLASTY	$28,720.45	$57,440.90	$7,038.15–$30,494.11	63% above	50%
Total knee replacement inpatient CPT 27447 TOTAL KNEE ARTHROPLASTY	$28,720.45	$57,440.90	$7,038.15–$30,494.11	—	50%
Trigger finger release surgery CPT 26055 INCISE FINGER TENDON SHEATH	$3,543.00	$7,086.00	$875.42–$2,663.15	89% above	50%
Trigger finger release surgery inpatient CPT 26055 INCISE FINGER TENDON SHEATH	$3,543.00	$7,086.00	$875.42–$2,663.15	—	50%
Trigger point injections, 1 or 2 muscles CPT 20552 Injection Single/Mlt Trigger Point 1/2 Muscles w/Guidance 20552	$219.45	$438.90	$161.47–$528.09	40% below	50%
Trigger point injections, 1 or 2 muscles CPT 20552 Inj Trigger Point 1/2 Muscl	$219.45	$438.90	$161.47–$528.09	40% below	50%
Trigger point injections, 1 or 2 muscles CPT 20552 BP Injection Single/Mlt Trigger Point 1/2 Muscles 20552	$219.45	$438.90	$161.47–$528.09	40% below	50%
Trigger point injections, 1 or 2 muscles CPT 20552 BP Injection Single/Mlt Trigger Point 1/2 Muscles With US Guidance 20552	$219.45	$438.90	$161.47–$528.09	40% below	50%
Trigger point injections, 1 or 2 muscles CPT 20552 20552-XR Inj Trigger Pnt 1 or 2 Muscles	$219.45	$438.90	$161.47–$528.09	40% below	50%
Trigger point injections, 1 or 2 muscles CPT 20552 Injection Single/Mlt Trigger Point 1/2 Muscles 20552	$219.45	$438.90	$161.47–$528.09	40% below	50%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Inj Trigger Point 1/2 Muscl	$219.45	$438.90	$161.47–$528.09	—	50%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Injection Single/Mlt Trigger Point 1/2 Muscles 20552	$219.45	$438.90	$161.47–$528.09	—	50%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 20552-XR Inj Trigger Pnt 1 or 2 Muscles	$219.45	$438.90	$161.47–$528.09	—	50%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Injection Single/Mlt Trigger Point 1/2 Muscles w/Guidance 20552	$219.45	$438.90	$161.47–$528.09	—	50%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 BP Injection Single/Mlt Trigger Point 1/2 Muscles 20552	$219.45	$438.90	$161.47–$528.09	—	50%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 BP Injection Single/Mlt Trigger Point 1/2 Muscles With US Guidance 20552	$219.45	$438.90	$161.47–$528.09	—	50%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 19083-US Breast Biopsy 1st Lesion Right	$990.20	$1,980.40	$886.27–$2,528.30	47% below	50%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 19083-US Breast Biopsy 1st Lesion Left	$990.20	$1,980.40	$886.27–$2,528.30	47% below	50%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 19083-US Breast Biopsy 1st Lesion Right	$990.20	$1,980.40	$886.27–$2,528.30	—	50%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 19083-US Breast Biopsy 1st Lesion Left	$990.20	$1,980.40	$886.27–$2,528.30	—	50%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 ESOPH EGD DILATION <30 MM	$3,317.02	$6,634.04	$1,037.65–$2,960.15	38% above	50%
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 ESOPH EGD DILATION <30 MM	$3,317.02	$6,634.04	$1,037.65–$2,960.15	—	50%
Upper endoscopy (EGD) with biopsy CPT 43239 Egd Biopsy Single/Multiple	$2,766.41	$5,532.81	$512.85–$1,463.01	122% above	50%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 Egd Biopsy Single/Multiple	$2,766.41	$5,532.81	$512.85–$1,463.01	—	50%
Upper endoscopy (EGD) with injection into the lining CPT 43236 UPPR GI SCOPE W/SUBMUC INJ	$2,832.17	$5,664.33	$512.85–$3,350.37	104% above	50%
Upper endoscopy (EGD) with injection into the lining inpatient CPT 43236 UPPR GI SCOPE W/SUBMUC INJ	$2,832.17	$5,664.33	$512.85–$3,350.37	—	50%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 EGD REMOVE LESION SNARE	$3,024.39	$6,048.78	$1,037.65–$2,960.15	41% above	50%
Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 EGD REMOVE LESION SNARE	$3,024.39	$6,048.78	$1,037.65–$2,960.15	—	50%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 EGD GUIDE WIRE INSERTION	$1,632.25	$3,264.49	$512.85–$1,463.01	11% above	50%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire inpatient CPT 43248 EGD GUIDE WIRE INSERTION	$1,632.25	$3,264.49	$512.85–$1,463.01	—	50%
Upper endoscopy (EGD), diagnostic CPT 43235 BP EGD flex transoral; diag inc collect specimen brush/wash when performed 43235	$749.25	$1,498.50	$512.85–$1,463.01	16% below	50%
Upper endoscopy (EGD), diagnostic CPT 43235 Egd Diagnostic Brush Wash	$6,925.21	$13,850.42	$512.85–$1,463.01	680% above	50%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 BP EGD flex transoral; diag inc collect specimen brush/wash when performed 43235	$749.25	$1,498.50	$512.85–$1,463.01	—	50%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 Egd Diagnostic Brush Wash	$6,925.21	$13,850.42	$512.85–$1,463.01	—	50%
Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 CYSTOURETERO W/LITHOTRIPSY	$9,382.19	$18,764.38	$2,780.74–$7,932.72	27% above	50%
Ureteroscopy with laser stone breaking (lithotripsy) inpatient CPT 52353 CYSTOURETERO W/LITHOTRIPSY	$9,382.19	$18,764.38	$2,780.74–$7,932.72	—	50%
Ureteroscopy with laser stone breaking and stent placement CPT 52356 CYSTO/URETERO W/LITHOTRIPSY	$10,016.40	$20,032.79	$2,780.74–$7,932.72	1% above	50%
Ureteroscopy with laser stone breaking and stent placement inpatient CPT 52356 CYSTO/URETERO W/LITHOTRIPSY	$10,016.40	$20,032.79	$2,780.74–$7,932.72	—	50%
Vasectomy, one or both sides, including follow-up semen testing both sides CPT 55250 Vasectomy Unilateral or Bilateral 55250	$1,515.50	$3,031.00	$1,120.53–$3,196.59	—	50%
Vasectomy, one or both sides, including follow-up semen testing inpatient both sides CPT 55250 Vasectomy Unilateral or Bilateral 55250	$1,515.50	$3,031.00	$1,120.53–$3,196.59	—	50%
Vein ablation, radiofrequency, first vein CPT 36475 RF Endoven Ablation Thrpy of Incomp Extrem Vein, 1st Vein 36475	$3,723.75	$7,447.50	$1,721.68–$4,911.51	1% below	50%
Vein ablation, radiofrequency, first vein one side CPT 36475 PV Venous Ablation RF First Vein RT	$3,723.75	$7,447.50	$1,721.68–$4,911.51	1% below	50%
Vein ablation, radiofrequency, first vein one side CPT 36475 PV Venous Ablation RF First Vein LT	$3,723.75	$7,447.50	$1,721.68–$4,911.51	1% below	50%
Vein ablation, radiofrequency, first vein inpatient CPT 36475 RF Endoven Ablation Thrpy of Incomp Extrem Vein, 1st Vein 36475	$3,723.75	$7,447.50	$1,721.68–$4,911.51	—	50%
Vein ablation, radiofrequency, first vein inpatient one side CPT 36475 PV Venous Ablation RF First Vein RT	$3,723.75	$7,447.50	$1,721.68–$4,911.51	—	50%
Vein ablation, radiofrequency, first vein inpatient one side CPT 36475 PV Venous Ablation RF First Vein LT	$3,723.75	$7,447.50	$1,721.68–$4,911.51	—	50%
Wart removal, up to 14 warts CPT 17110 Destruct B9 Lesion 1-14	$100.90	$201.80	$108.69–$450.00	50% below	50%
Wart removal, up to 14 warts CPT 17110 BP Benign Lesion Destruction (not skin tag), up to 14 lesions 17110	$100.90	$201.80	$108.69–$310.06	50% below	50%
Wart removal, up to 14 warts CPT 17110 Benign Lesion Destruction (not skin tag), up to 14 lesions 17110	$100.90	$201.80	$108.69–$310.06	50% below	50%
Wart removal, up to 14 warts inpatient CPT 17110 Benign Lesion Destruction (not skin tag), up to 14 lesions 17110	$100.90	$201.80	$108.69–$310.06	—	50%
Wart removal, up to 14 warts inpatient CPT 17110 BP Benign Lesion Destruction (not skin tag), up to 14 lesions 17110	$100.90	$201.80	$108.69–$310.06	—	50%
Wart removal, up to 14 warts inpatient CPT 17110 Destruct B9 Lesion 1-14	$100.90	$201.80	$108.69–$450.00	—	50%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Debridement Subcutaneous Tissue 20 Sq Cm/<	$315.70	$631.40	$218.54–$623.45	43% below	50%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Deb Subq Tissue 20 Sq Cm/<	$315.70	$631.40	$180.00–$623.45	43% below	50%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Debridement, subcutaneous tissue, 1st 20 sq cm or less 11042	$315.70	$631.40	$218.54–$623.45	43% below	50%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Hospitalist BP 11042 Debridement, Subcutaneous Tissue, 1st 20 sq cm or Less	$315.70	$631.40	$218.54–$623.45	43% below	50%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 BP Debridement, Subcutaneous Tissue, 1st 20 sq cm or Less 11042	$315.70	$631.40	$218.54–$623.45	43% below	50%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 BP Debridement, Subcutaneous Tissue, 1st 20 sq cm or Less 11042	$315.70	$631.40	$218.54–$623.45	—	50%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 Debridement, subcutaneous tissue, 1st 20 sq cm or less 11042	$315.70	$631.40	$218.54–$623.45	—	50%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 Deb Subq Tissue 20 Sq Cm/<	$315.70	$631.40	$180.00–$623.45	—	50%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 Hospitalist BP 11042 Debridement, Subcutaneous Tissue, 1st 20 sq cm or Less	$315.70	$631.40	$218.54–$623.45	—	50%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 Debridement Subcutaneous Tissue 20 Sq Cm/<	$315.70	$631.40	$218.54–$623.45	—	50%
Wrist fracture surgery (plate and screws), distal radius CPT 25607 TREAT FX RAD EXTRA-ARTICUL	$16,968.77	$33,937.53	$3,907.62–$11,147.42	75% above	50%
Wrist fracture surgery (plate and screws), distal radius inpatient CPT 25607 TREAT FX RAD EXTRA-ARTICUL	$16,968.77	$33,937.53	$3,907.62–$11,147.42	—	50%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Michigan	Off list
Blood transfusion (giving blood or blood components) CPT 36430 Transfusion Charge	$737.50	$1,475.00	$167.79–$1,032.50	2% below	50%
Blood transfusion (giving blood or blood components) CPT 36430 Transfusion Charge Downtime	$737.50	$1,475.00	$167.79–$682.20	2% below	50%
Blood transfusion (giving blood or blood components) CPT 36430 Transfusion Charge Transformation - 2	$1,475.00	$2,950.00	$167.79–$682.20	96% above	50%
Blood transfusion (giving blood or blood components) CPT 36430 Transfusion Charge Transformation - 3	$2,212.50	$4,425.00	$167.79–$682.20	194% above	50%
Blood transfusion (giving blood or blood components) CPT 36430 Transfusion Charge Transformation - 4	$2,942.50	$5,885.00	$167.79–$682.20	291% above	50%
Blood transfusion (giving blood or blood components) CPT 36430 Transfusion Charge Transformation - 5	$3,678.50	$7,357.00	$167.79–$682.20	389% above	50%
Blood transfusion (giving blood or blood components) CPT 36430 Transfusion Charge Transformation - 6	$4,414.00	$8,828.00	$167.79–$682.20	487% above	50%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Transfusion Charge	$737.50	$1,475.00	$167.79–$1,032.50	—	50%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Transfusion Charge Downtime	$737.50	$1,475.00	$167.79–$682.20	—	50%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Transfusion Charge Transformation - 2	$1,475.00	$2,950.00	$167.79–$682.20	—	50%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Transfusion Charge Transformation - 3	$2,212.50	$4,425.00	$167.79–$682.20	—	50%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Transfusion Charge Transformation - 4	$2,942.50	$5,885.00	$167.79–$682.20	—	50%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Transfusion Charge Transformation - 5	$3,678.50	$7,357.00	$167.79–$682.20	—	50%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Transfusion Charge Transformation - 6	$4,414.00	$8,828.00	$167.79–$682.20	—	50%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Pressure/nonpressurized inhale Tx 94640	$52.35	$104.70	$30.63–$317.38	70% below	50%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT CHARGE Aerosol Med Therapy -> Initial	$68.15	$136.30	$30.63–$317.38	61% below	50%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT CHARGE MDI -> Subsequent	$68.15	$136.30	$30.63–$317.38	61% below	50%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT CHARGE MDI -> Initial	$68.15	$136.30	$30.63–$317.38	61% below	50%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT CHARGE Aerosol Med Therapy -> Subsequent	$68.15	$136.30	$30.63–$317.38	61% below	50%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 PFT CHARGE Aerosol Med Therapy -> Initial	$68.15	$136.30	$30.63–$317.38	61% below	50%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 PFT CHARGE Aerosol Med Therapy -> Subsequent	$68.15	$136.30	$30.63–$317.38	61% below	50%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 PFT CHARGE MDI -> Subsequent	$68.15	$136.30	$30.63–$317.38	61% below	50%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 PFT CHARGE MDI -> Initial	$68.15	$136.30	$30.63–$317.38	61% below	50%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AMB Med Inhalation Tx -> First Airway Inhal Tx 94640	$73.65	$147.30	$30.63–$317.38	58% below	50%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AMB Med Inhalation Tx -> Subs Airway Inhal TX 94640	$73.65	$147.30	$30.63–$317.38	58% below	50%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Pressure/nonpressurized inhale Tx 94640	$52.35	$104.70	$30.63–$317.38	—	50%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RT CHARGE MDI -> Subsequent	$68.15	$136.30	$30.63–$317.38	—	50%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 PFT CHARGE Aerosol Med Therapy -> Subsequent	$68.15	$136.30	$30.63–$317.38	—	50%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RT CHARGE MDI -> Initial	$68.15	$136.30	$30.63–$317.38	—	50%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 PFT CHARGE MDI -> Subsequent	$68.15	$136.30	$30.63–$317.38	—	50%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RT CHARGE Aerosol Med Therapy -> Initial	$68.15	$136.30	$30.63–$317.38	—	50%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RT CHARGE Aerosol Med Therapy -> Subsequent	$68.15	$136.30	$30.63–$317.38	—	50%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 PFT CHARGE MDI -> Initial	$68.15	$136.30	$30.63–$317.38	—	50%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 PFT CHARGE Aerosol Med Therapy -> Initial	$68.15	$136.30	$30.63–$317.38	—	50%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AMB Med Inhalation Tx -> Subs Airway Inhal TX 94640	$73.65	$147.30	$30.63–$317.38	—	50%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AMB Med Inhalation Tx -> First Airway Inhal Tx 94640	$73.65	$147.30	$30.63–$317.38	—	50%
Chemotherapy IV infusion, first hour CPT 96413 INF/C IV Infusion initial/single	$285.00	$570.00	$181.43–$517.58	46% below	50%
Chemotherapy IV infusion, first hour inpatient CPT 96413 INF/C IV Infusion initial/single	$285.00	$570.00	$181.43–$517.58	—	50%
Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 Comp Audiometry Threshold Evaluation & Speech Recognition 92557	$83.45	$166.90	$62.58–$244.15	62% below	50%
Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 Comp Audiometry Threshold Evaluation & Speech Recognition 92557	$83.45	$166.90	$62.58–$244.15	—	50%
Critical care, first 30 to 74 minutes CPT 99291 Critical Care 1St Hour	$1,156.00	$2,312.00	$180.00–$1,785.56	43% below	50%
Critical care, first 30 to 74 minutes inpatient CPT 99291 Critical Care 1St Hour	$1,156.00	$2,312.00	$180.00–$1,785.56	—	50%
EEG (brain wave test), awake and drowsy, routine CPT 95816 CTP EEG Awake and Drowsy	$761.50	$1,523.00	$170.34–$1,326.28	2% below	50%
EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG Awake & Drowsy	$761.50	$1,523.00	$170.34–$1,326.28	2% below	50%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 CTP EEG Awake and Drowsy	$761.50	$1,523.00	$170.34–$1,326.28	—	50%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 EEG Awake & Drowsy	$761.50	$1,523.00	$170.34–$1,326.28	—	50%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Electrocardiogram, Routine With At Least 12 Leads; Tracing Only, W/O Interpret And Report 93005	$49.50	$99.00	$18.90–$92.69	62% below	50%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 CV ECG Acquisition	$49.50	$99.00	$18.90–$92.69	62% below	50%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 CV ECG Acquisition	$49.50	$99.00	$18.90–$92.69	—	50%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 Electrocardiogram, Routine With At Least 12 Leads; Tracing Only, W/O Interpret And Report 93005	$49.50	$99.00	$18.90–$92.69	—	50%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Emergency Dept Visit Level I	$123.00	$246.00	$48.16–$450.00	34% below	50%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 Emergency Dept Visit Level I	$123.00	$246.00	$48.16–$450.00	—	50%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Emergency Dept Visit Level II	$148.50	$297.00	$86.62–$450.00	57% below	50%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 Emergency Dept Visit Level II	$148.50	$297.00	$86.62–$450.00	—	50%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Emergency Dept Visit Level III	$311.00	$622.00	$151.46–$482.86	51% below	50%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 Emergency Dept Visit Level III	$311.00	$622.00	$151.46–$482.86	—	50%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Emergency Dept Visit Level IV	$477.50	$955.00	$180.00–$741.37	55% below	50%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 Emergency Dept Visit Level IV	$477.50	$955.00	$180.00–$741.37	—	50%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Emergency Dept Visit Level V	$759.00	$1,518.00	$180.00–$1,172.35	55% below	50%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 Emergency Dept Visit Level V	$759.00	$1,518.00	$180.00–$1,172.35	—	50%
Exercise stress test, tracing only, the hospital charge CPT 93017 CSC Stress Nuclear Lexi-Scan	$339.10	$678.20	$150.46–$485.92	54% below	50%
Exercise stress test, tracing only, the hospital charge CPT 93017 CSC Stress Nuclear Dobutamine	$339.10	$678.20	$150.46–$485.92	54% below	50%
Exercise stress test, tracing only, the hospital charge CPT 93017 CSC Stress Nuclear Persantine	$339.10	$678.20	$150.46–$485.92	54% below	50%
Exercise stress test, tracing only, the hospital charge CPT 93017 CSC Stress Regular Treadmill	$339.10	$678.20	$150.46–$485.92	54% below	50%
Exercise stress test, tracing only, the hospital charge CPT 93017 CSC Stress Nuclear Treadmill	$339.10	$678.20	$150.46–$485.92	54% below	50%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CSC Stress Nuclear Treadmill	$339.10	$678.20	$150.46–$485.92	—	50%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CSC Stress Regular Treadmill	$339.10	$678.20	$150.46–$485.92	—	50%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CSC Stress Nuclear Dobutamine	$339.10	$678.20	$150.46–$485.92	—	50%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CSC Stress Nuclear Lexi-Scan	$339.10	$678.20	$150.46–$485.92	—	50%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CSC Stress Nuclear Persantine	$339.10	$678.20	$150.46–$485.92	—	50%
Family therapy with the patient, 50 minutes CPT 90847 Family, Couples Psychotherapy With Patient 90847	$100.60	$201.20	$39.90–$250.72	24% below	50%
Family therapy with the patient, 50 minutes inpatient CPT 90847 Family, Couples Psychotherapy With Patient 90847	$100.60	$201.20	$39.90–$250.72	—	50%
Family therapy without the patient, 50 minutes CPT 90846 Family, Couples Psychotherapy W/O Patient 90846	$100.60	$201.20	$47.93–$250.72	32% below	50%
Family therapy without the patient, 50 minutes inpatient CPT 90846 Family, Couples Psychotherapy W/O Patient 90846	$100.60	$201.20	$47.93–$250.72	—	50%
Group psychotherapy session CPT 90853 Group Therapy 90853	$58.45	$116.90	$21.00–$144.34	at median	50%
Group psychotherapy session inpatient CPT 90853 Group Therapy 90853	$58.45	$116.90	$21.00–$144.34	—	50%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Hydration Iv Infusion Init 31-60 Mins	$136.95	$273.90	$86.41–$328.77	48% below	50%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 INF/H IV Inf Initial 31 - 60 min	$136.95	$273.90	$86.41–$328.77	48% below	50%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Iv Infusion Hydration Initial 31 Min-1 Hour	$136.95	$273.90	$86.41–$328.77	48% below	50%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 Iv Infusion Hydration Initial 31 Min-1 Hour	$136.95	$273.90	$86.41–$328.77	—	50%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 INF/H IV Inf Initial 31 - 60 min	$136.95	$273.90	$86.41–$328.77	—	50%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 Hydration Iv Infusion Init 31-60 Mins	$136.95	$273.90	$86.41–$328.77	—	50%
IV infusion of a medicine, first hour CPT 96365 Iv Infusion Therapy/Prophylaxis /Dx 1St To 1 Hr	$171.45	$342.90	$115.25–$328.77	43% below	50%
IV infusion of a medicine, first hour CPT 96365 INF/NC IV Infusion Ther Initial	$171.45	$342.90	$115.25–$328.77	43% below	50%
IV infusion of a medicine, first hour CPT 96365 Ther/Proph/Diag Iv Inf Init =<1 Hr	$171.45	$342.90	$115.25–$328.77	43% below	50%
IV infusion of a medicine, first hour inpatient CPT 96365 Iv Infusion Therapy/Prophylaxis /Dx 1St To 1 Hr	$171.45	$342.90	$115.25–$328.77	—	50%
IV infusion of a medicine, first hour inpatient CPT 96365 Ther/Proph/Diag Iv Inf Init =<1 Hr	$171.45	$342.90	$115.25–$328.77	—	50%
IV infusion of a medicine, first hour inpatient CPT 96365 INF/NC IV Infusion Ther Initial	$171.45	$342.90	$115.25–$328.77	—	50%
IV push of a medicine, first drug CPT 96374 INF/NC IV Push Single/Initial Drug	$92.35	$184.70	$97.56–$328.77	50% below	50%
IV push of a medicine, first drug CPT 96374 Ther/Proph/Diag Inj Iv Push	$92.35	$184.70	$72.77–$328.77	50% below	50%
IV push of a medicine, first drug inpatient CPT 96374 INF/NC IV Push Single/Initial Drug	$92.35	$184.70	$97.56–$328.77	—	50%
IV push of a medicine, first drug inpatient CPT 96374 Ther/Proph/Diag Inj Iv Push	$92.35	$184.70	$72.77–$328.77	—	50%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Amb Med Admin Multiple-IVP -> IM/SQ Inject 96372	$41.10	$82.20	$25.00–$111.06	55% below	50%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Ther/Proph/Diag Inj Sc/Im	$42.55	$85.10	$25.00–$111.06	53% below	50%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INF/NC SQ/IM injection	$42.55	$85.10	$25.00–$111.06	53% below	50%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 AMB Med Admin Multiple pom -> IM/SQ Inject 96372	$42.55	$85.10	$25.00–$111.06	53% below	50%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Amb Med Admin Multiple -> IM/SQ Inject 96372	$42.55	$85.10	$25.00–$111.06	53% below	50%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 AMB Med Admin -> IM/SQ Inject 96372	$42.55	$85.10	$25.00–$111.06	53% below	50%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Therapeutic Prophylactic/Dx Injection Subq/Im	$42.55	$85.10	$25.00–$111.06	53% below	50%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Amb Med Admin Multiple-IVP -> IM/SQ Inject 96372	$41.10	$82.20	$25.00–$111.06	—	50%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Therapeutic Prophylactic/Dx Injection Subq/Im	$42.55	$85.10	$25.00–$111.06	—	50%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Amb Med Admin Multiple -> IM/SQ Inject 96372	$42.55	$85.10	$25.00–$111.06	—	50%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INF/NC SQ/IM injection	$42.55	$85.10	$25.00–$111.06	—	50%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 AMB Med Admin -> IM/SQ Inject 96372	$42.55	$85.10	$25.00–$111.06	—	50%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 AMB Med Admin Multiple pom -> IM/SQ Inject 96372	$42.55	$85.10	$25.00–$111.06	—	50%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Ther/Proph/Diag Inj Sc/Im	$42.55	$85.10	$25.00–$111.06	—	50%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 Psych Diagnostic Eval W/O Med Mgmt 90791	$100.60	$201.20	$79.27–$250.72	55% below	50%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 Psych Diagnostic Eval W/O Med Mgmt 90791	$100.60	$201.20	$79.27–$250.72	—	50%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 Nerve Conduction Studies 7-8 Studies	$288.75	$577.50	$170.34–$485.92	62% below	50%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 BP Nerve Conduction Studies; 7-8 Studies 95910	$288.75	$577.50	$170.34–$485.92	62% below	50%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 BP Nerve Conduction Studies; 7-8 Studies 95910	$288.75	$577.50	$170.34–$485.92	—	50%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 Nerve Conduction Studies 7-8 Studies	$288.75	$577.50	$170.34–$485.92	—	50%
New patient office visit, about 30 minutes CPT 99203 New Patient Visit - Level 3	$88.50	$177.00	$143.34–$225.00	21% below	50%
New patient office visit, about 30 minutes CPT 99203 Office Visit Level 3 New Professional 30-44 Minutes 99203	$89.00	$178.00	$70.13–$225.00	20% below	50%
New patient office visit, about 30 minutes inpatient CPT 99203 New Patient Visit - Level 3	$88.50	$177.00	$143.34–$225.00	—	50%
New patient office visit, about 30 minutes inpatient CPT 99203 Office Visit Level 3 New Professional 30-44 Minutes 99203	$89.00	$178.00	$70.13–$225.00	—	50%
New patient office visit, about 45 minutes CPT 99204 New Patient Visit - Level 4	$95.75	$191.50	$191.74–$250.00	19% below	50%
New patient office visit, about 45 minutes CPT 99204 Office Visit Level 4 New Professional 45-59 Minutes 99204	$96.00	$192.00	$75.64–$250.00	19% below	50%
New patient office visit, about 45 minutes inpatient CPT 99204 New Patient Visit - Level 4	$95.75	$191.50	$191.74–$250.00	—	50%
New patient office visit, about 45 minutes inpatient CPT 99204 Office Visit Level 4 New Professional 45-59 Minutes 99204	$96.00	$192.00	$75.64–$250.00	—	50%
New patient office visit, about 60 minutes CPT 99205 Office Visit Level 5 New Professional 60-74 Minutes 99205	$103.50	$207.00	$86.28–$275.00	24% below	50%
New patient office visit, about 60 minutes CPT 99205 New Patient Visit - Level 5	$103.50	$207.00	$232.39–$275.00	24% below	50%
New patient office visit, about 60 minutes inpatient CPT 99205 Office Visit Level 5 New Professional 60-74 Minutes 99205	$103.50	$207.00	$86.28–$275.00	—	50%
New patient office visit, about 60 minutes inpatient CPT 99205 New Patient Visit - Level 5	$103.50	$207.00	$232.39–$275.00	—	50%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 New Patient Visit - Level 2	$81.75	$163.50	$108.46–$200.00	1% below	50%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 Office Visit Level 2 New Professional 15-29 Minutes 99202	$82.00	$164.00	$108.46–$200.00	1% below	50%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 New Patient Visit - Level 2	$81.75	$163.50	$108.46–$200.00	—	50%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 Office Visit Level 2 New Professional 15-29 Minutes 99202	$82.00	$164.00	$108.46–$200.00	—	50%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MNT Initial Units	$38.10	$76.20	$74.58	17% below	50%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MNT Initial Units	$38.10	$76.20	$74.58	—	50%
Preventive checkup, new patient aged 18–39 CPT 99385 Initial Comp Preventive Med 18 to 39 years New 99385	$106.00	$212.00	$129.55–$163.73	31% below	50%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 Initial Comp Preventive Med 18 to 39 years New 99385	$106.00	$212.00	$129.55–$163.73	—	50%
Preventive checkup, new patient aged 40–64 CPT 99386 Initial Comp Preventive Med 40 to 64 years New 99386	$131.50	$263.00	$109.62–$203.11	29% below	50%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 Initial Comp Preventive Med 40 to 64 years New 99386	$131.50	$263.00	$109.62–$203.11	—	50%
Preventive checkup, new patient aged 65 or older CPT 99387 Initial Preventive Medicine New Patient 65Yrs+Greater than 99387	$144.50	$289.00	$208.43	34% below	50%
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 Initial Preventive Medicine New Patient 65Yrs+Greater than 99387	$144.50	$289.00	$208.43	—	50%
Preventive checkup, returning patient aged 18–39 CPT 99395 Periodic Comp Preventive Med 18 to 39 years Est 99395	$95.50	$191.00	$79.61–$147.51	36% below	50%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 Periodic Comp Preventive Med 18 to 39 years Est 99395	$95.50	$191.00	$79.61–$147.51	—	50%
Preventive checkup, returning patient aged 40–64 CPT 99396 Periodic Comp Preventive Med 40 to 64 years Est 99396	$106.00	$212.00	$88.36–$163.73	37% below	50%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 Periodic Comp Preventive Med 40 to 64 years Est 99396	$106.00	$212.00	$88.36–$163.73	—	50%
Preventive checkup, returning patient aged 65 or older CPT 99397 Periodic Comp Preventive Med 65+ years Est 99397	$120.00	$240.00	$100.03–$173.09	37% below	50%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 Periodic Comp Preventive Med 65+ years Est 99397	$120.00	$240.00	$100.03–$173.09	—	50%
Psychiatric evaluation with medical services CPT 90792 Psych Diagnostic Eval w/Medical Services 90792	$102.40	$204.80	$87.89–$250.72	48% below	50%
Psychiatric evaluation with medical services inpatient CPT 90792 Psych Diagnostic Eval w/Medical Services 90792	$102.40	$204.80	$87.89–$250.72	—	50%
Psychological testing evaluation by a psychologist or physician, first hour CPT 96130 Psychological Eval 1st Hour 96130	$128.20	$256.40	$170.34–$485.92	70% below	50%
Psychological testing evaluation by a psychologist or physician, first hour inpatient CPT 96130 Psychological Eval 1st Hour 96130	$128.20	$256.40	$170.34–$485.92	—	50%
Psychotherapy for crisis, first 60 minutes CPT 90839 Crisis Psychotherapy 90839	$102.10	$204.20	$87.89–$250.72	at median	50%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 Crisis Psychotherapy 90839	$102.10	$204.20	$87.89–$250.72	—	50%
Psychotherapy session, 30 minutes CPT 90832 Psychotherapy, 30 Mins 90832	$100.60	$201.20	$79.27–$250.72	48% below	50%
Psychotherapy session, 30 minutes inpatient CPT 90832 Psychotherapy, 30 Mins 90832	$100.60	$201.20	$79.27–$250.72	—	50%
Psychotherapy session, 45 minutes CPT 90834 Psychotherapy, 45 Mins 90834	$100.60	$201.20	$79.27–$250.72	53% below	50%
Psychotherapy session, 45 minutes inpatient CPT 90834 Psychotherapy, 45 Mins 90834	$100.60	$201.20	$79.27–$250.72	—	50%
Psychotherapy session, 60 minutes CPT 90837 Psychotherapy, 60 Mins 90837	$100.60	$201.20	$87.89–$250.72	56% below	50%
Psychotherapy session, 60 minutes inpatient CPT 90837 Psychotherapy, 60 Mins 90837	$100.60	$201.20	$87.89–$250.72	—	50%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 Tobacco-Use Counsel 3-10 Min	$26.45	$52.90	$16.30–$46.49	35% below	50%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 Tobacco Use Cessation Intermediate 3-10 Minutes 99406	$26.50	$53.00	$16.30–$46.49	35% below	50%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 CM Tobacco Cess Inter 3-10 Min 99406	$26.50	$53.00	$16.30–$46.49	35% below	50%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 Tobacco-Use Counsel 3-10 Min	$26.45	$52.90	$16.30–$46.49	—	50%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 CM Tobacco Cess Inter 3-10 Min 99406	$26.50	$53.00	$16.30–$46.49	—	50%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 Tobacco Use Cessation Intermediate 3-10 Minutes 99406	$26.50	$53.00	$16.30–$46.49	—	50%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Office Visit Level 5 Est Professional 40-54 Minutes 99215	$103.50	$207.00	$86.28–$149.29	37% below	50%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Office Visit Level 5 Est Professional 40-54 Minutes 99215	$103.50	$207.00	$86.28–$149.29	—	50%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Established Patient Visit - Level 3	$88.50	$177.00	$88.50–$177.00	7% below	50%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Office Visit Level 3 Est Professional 20-29 Minutes 99213	$89.00	$178.00	$70.13–$137.47	7% below	50%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Established Patient Visit - Level 3	$88.50	$177.00	$88.50–$177.00	—	50%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Office Visit Level 3 Est Professional 20-29 Minutes 99213	$89.00	$178.00	$70.13–$137.47	—	50%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Established Patient Visit - Level 4	$96.25	$192.50	$96.25–$192.50	19% below	50%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Office Visit Level 4 Est Professional 30-39 Minutes 99214	$96.50	$193.00	$76.04–$149.05	18% below	50%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Established Patient Visit - Level 4	$96.25	$192.50	$96.25–$192.50	—	50%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Office Visit Level 4 Est Professional 30-39 Minutes 99214	$96.50	$193.00	$76.04–$149.05	—	50%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Established Patient Visit - Level 2	$81.75	$163.50	$80.01	11% above	50%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Office Visit Level 2 Est Professional 10-19 Minutes, 99212	$82.00	$164.00	$80.01–$118.28	11% above	50%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Established Patient Visit - Level 2	$81.75	$163.50	$80.01	—	50%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Office Visit Level 2 Est Professional 10-19 Minutes, 99212	$82.00	$164.00	$80.01–$118.28	—	50%
Spirometry (breathing test) CPT 94010 Spirometry POC Amb	$111.90	$223.80	$77.23–$244.15	46% below	50%
Spirometry (breathing test) CPT 94010 PFT CHARGE -> Spirometry	$145.40	$290.80	$77.23–$244.15	29% below	50%
Spirometry (breathing test) CPT 94010 RT CHARGE PFT -> Spirometry	$145.40	$290.80	$77.23–$244.15	29% below	50%
Spirometry (breathing test) inpatient CPT 94010 Spirometry POC Amb	$111.90	$223.80	$77.23–$244.15	—	50%
Spirometry (breathing test) inpatient CPT 94010 RT CHARGE PFT -> Spirometry	$145.40	$290.80	$77.23–$244.15	—	50%
Spirometry (breathing test) inpatient CPT 94010 PFT CHARGE -> Spirometry	$145.40	$290.80	$77.23–$244.15	—	50%
Spirometry before and after a bronchodilator CPT 94060 Bronchodilator Response Spirometry Pre+Post-Bronchodilator Admn 94060	$139.55	$279.10	$115.86–$485.92	66% below	50%
Spirometry before and after a bronchodilator CPT 94060 PFT CHARGE -> Spirometry before & after	$181.50	$363.00	$115.86–$485.92	56% below	50%
Spirometry before and after a bronchodilator CPT 94060 RT CHARGE PFT -> Spirometry before & after	$181.50	$363.00	$115.86–$485.92	56% below	50%
Spirometry before and after a bronchodilator inpatient CPT 94060 Bronchodilator Response Spirometry Pre+Post-Bronchodilator Admn 94060	$139.55	$279.10	$115.86–$485.92	—	50%
Spirometry before and after a bronchodilator inpatient CPT 94060 PFT CHARGE -> Spirometry before & after	$181.50	$363.00	$115.86–$485.92	—	50%
Spirometry before and after a bronchodilator inpatient CPT 94060 RT CHARGE PFT -> Spirometry before & after	$181.50	$363.00	$115.86–$485.92	—	50%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 INF Ther Phlebotomy	$166.60	$333.20	$70.51–$352.88	29% below	50%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 BP Phlebotomy, therapeutic 99195	$166.60	$333.20	$70.51–$352.88	29% below	50%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 BP Phlebotomy, therapeutic 99195	$166.60	$333.20	$70.51–$352.88	—	50%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 INF Ther Phlebotomy	$166.60	$333.20	$70.51–$352.88	—	50%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Michigan	Off list
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 COVID-19 Virus Vial (Spikevax) -> Spikevax PF SYR 0.5mL 91322	$289.05	$578.10	$247.38	4% above	50%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 COVID-19 Virus Vial (Spikevax) -> Spikevax PF SYR 0.5mL 91322	$289.05	$578.10	$247.38	—	50%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 SARS-CoV-2 (COVID-19) mRNA-LNP (12y+) vaccine PF 30 mcg/0.3 mL Susp	$165.47	$330.93	$257.66	23% below	50%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 COVID-19 Virus Vial (Comirnaty) -> Comirnaty PF SYR 0.3mL 91320	$214.25	$428.50	$257.66	at median	50%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 SARS-CoV-2 (COVID-19) mRNA-LNP (12y+) vaccine PF 30 mcg/0.3 mL Susp	$165.47	$330.93	$257.66	—	50%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 COVID-19 Virus Vial (Comirnaty) -> Comirnaty PF SYR 0.3mL 91320	$214.25	$428.50	$257.66	—	50%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 Varicella Virus (Varivax) Vial -> Varicella Virus 90716	$201.95	$403.90	$335.17	at median	50%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 varicella virus vaccine Subcut Inj	$230.15	$460.29	$335.17	14% above	50%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 Varicella Virus (Varivax) Vial -> Varicella Virus 90716	$201.95	$403.90	$335.17	—	50%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 varicella virus vaccine Subcut Inj	$230.15	$460.29	$335.17	—	50%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 DTaP IPV (Age 4-6 Years) Vial -> DTaP IPV 90696	$41.15	$82.30	$109.60	33% below	50%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 NF - diphtheria/tetanus/pertussis,acel/polio IM Susp 0.5 mL	$61.05	$122.10	$109.60	1% below	50%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 DTaP IPV (Age 4-6 Years) Vial -> DTaP IPV 90696	$41.15	$82.30	$109.60	—	50%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 NF - diphtheria/tetanus/pertussis,acel/polio IM Susp 0.5 mL	$61.05	$122.10	$109.60	—	50%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 diphtheria/tetanus/pertussis (DTaP) ped 25 units-10 units-58 mcg/0.5 mL IM Susp 0.5 mL	$28.15	$56.30	$51.62	27% below	50%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 diphtheria/tetanus/pertuss (DTaP) ped 15 units-5 units-23 mcg/0.5 mL IM Susp 0.5 mL	$35.93	$71.86	$51.62	7% below	50%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DTaP Pediatric Under 7 Yrs Vial -> DTaP 90700	$36.55	$73.10	$51.62	6% below	50%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 diphtheria/tetanus/pertussis (DTaP) ped 25 units-10 units-58 mcg/0.5 mL IM Susp 0.5 mL	$28.15	$56.30	$51.62	—	50%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 diphtheria/tetanus/pertuss (DTaP) ped 15 units-5 units-23 mcg/0.5 mL IM Susp 0.5 mL	$35.93	$71.86	$51.62	—	50%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DTaP Pediatric Under 7 Yrs Vial -> DTaP 90700	$36.55	$73.10	$51.62	—	50%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 diphtheria/hepatitis B/pertussis,acellular/polio/tetanus IM Susp 0.5 mL	$83.24	$166.48	$180.78	38% below	50%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 DTaP HepB IPV (Pediarix) Vial -> DTaP HepB IPV 90723	$114.20	$228.40	$180.78	16% below	50%
DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 diphtheria/hepatitis B/pertussis,acellular/polio/tetanus IM Susp 0.5 mL	$83.24	$166.48	$180.78	—	50%
DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 DTaP HepB IPV (Pediarix) Vial -> DTaP HepB IPV 90723	$114.20	$228.40	$180.78	—	50%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 diphtheria/haemophilus/pertussis/tetanus/polio IM Kit	$124.33	$248.65	$209.46	21% below	50%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 DTaP IPV/HIB (Pentacel) Vial -> DTaP IPV/HIB 90698	$182.15	$364.30	$209.46	16% above	50%
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 diphtheria/haemophilus/pertussis/tetanus/polio IM Kit	$124.33	$248.65	$209.46	—	50%
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 DTaP IPV/HIB (Pentacel) Vial -> DTaP IPV/HIB 90698	$182.15	$364.30	$209.46	—	50%
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) CPT 90697 DTaP IPV/HIB/Hep B (Vaxelis) Vial -> DTaP IPV/HIB/Hep B 90697	$438.85	$877.70	$273.24	at median	50%
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) inpatient CPT 90697 DTaP IPV/HIB/Hep B (Vaxelis) Vial -> DTaP IPV/HIB/Hep B 90697	$438.85	$877.70	$273.24	—	50%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 influenza virus vaccine, inactivated PF trivalent IM Susp 0.5 mL	$20.35	$40.70	$35.75	36% below	50%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 Influenza Virus Vial -> IIV3, 0.5ml Inj 90656	$31.70	$63.40	$26.43–$45.72	at median	50%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 influenza virus vaccine, inactivated PF trivalent IM Susp 0.5 mL	$20.35	$40.70	$35.75	—	50%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 Influenza Virus Vial -> IIV3, 0.5ml Inj 90656	$31.70	$63.40	$26.43–$45.72	—	50%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 NF - human papillomavirus vaccine 9-valent Sus	$328.65	$657.30	$574.13	2% below	50%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 Human Papillomavirus Vial -> 9 valent HPV 90651	$403.00	$806.00	$564.20–$581.29	21% above	50%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 NF - human papillomavirus vaccine 9-valent Sus	$328.65	$657.30	$574.13	—	50%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 Human Papillomavirus Vial -> 9 valent HPV 90651	$403.00	$806.00	$564.20–$581.29	—	50%
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 hepatitis A-hepatitis B vaccine 720 units-20 mcg/mL PF IM Susp 1 mL	$127.57	$255.13	$231.04	26% below	50%
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 Hepatitis A Hepatitis B Adult Vial -> Hepatitis A-Hepatitis B Adult 90636	$172.95	$345.90	$231.04	at median	50%
Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 hepatitis A-hepatitis B vaccine 720 units-20 mcg/mL PF IM Susp 1 mL	$127.57	$255.13	$231.04	—	50%
Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 Hepatitis A Hepatitis B Adult Vial -> Hepatitis A-Hepatitis B Adult 90636	$172.95	$345.90	$231.04	—	50%
Hepatitis A vaccine, adult dose CPT 90632 hepatitis A adult vaccine 50 units/mL IM Susp 1 mL	$86.33	$172.66	$146.08	27% below	50%
Hepatitis A vaccine, adult dose CPT 90632 hepatitis A adult vaccine 1440 units/mL PF IM Susp 1 mL	$86.97	$173.94	$146.08	26% below	50%
Hepatitis A vaccine, adult dose CPT 90632 Hepatitis A Adult Vial -> Hepatitis A Adult 90632	$117.80	$235.60	$146.08–$169.91	at median	50%
Hepatitis A vaccine, adult dose inpatient CPT 90632 hepatitis A adult vaccine 50 units/mL IM Susp 1 mL	$86.33	$172.66	$146.08	—	50%
Hepatitis A vaccine, adult dose inpatient CPT 90632 hepatitis A adult vaccine 1440 units/mL PF IM Susp 1 mL	$86.97	$173.94	$146.08	—	50%
Hepatitis A vaccine, adult dose inpatient CPT 90632 Hepatitis A Adult Vial -> Hepatitis A Adult 90632	$117.80	$235.60	$146.08–$169.91	—	50%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 hepatitis A pediatric vaccine 720 units/0.5 mL PF IM Susp 0.5 mL	$36.74	$73.48	$68.27	52% below	50%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 hepatitis A pediatric vaccine 25 units/0.5 mL IM Susp 0.5 mL	$42.93	$85.85	$68.27	44% below	50%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 Hepatitis A Pediatric Adol Vial -> Hepatitis A Pediatric Adol. 90633	$97.60	$195.20	$68.27	27% above	50%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 hepatitis A pediatric vaccine 720 units/0.5 mL PF IM Susp 0.5 mL	$36.74	$73.48	$68.27	—	50%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 hepatitis A pediatric vaccine 25 units/0.5 mL IM Susp 0.5 mL	$42.93	$85.85	$68.27	—	50%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 Hepatitis A Pediatric Adol Vial -> Hepatitis A Pediatric Adol. 90633	$97.60	$195.20	$68.27	—	50%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 hepatitis B adult vaccine 20 mcg/mL IM Susp 1 mL	$58.08	$116.16	$125.98	31% below	50%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 hepatitis B adult vaccine 10 mcg/mL IM Susp 1 mL	$83.85	$167.70	$125.98	at median	50%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 Hepatitis B Adult Vial -> Hep B Adult 20 mcg/mL 90746	$84.00	$168.00	$125.98	at median	50%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 hepatitis B adult vaccine 20 mcg/mL IM Susp 1 mL	$58.08	$116.16	$125.98	—	50%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 hepatitis B adult vaccine 10 mcg/mL IM Susp 1 mL	$83.85	$167.70	$125.98	—	50%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 Hepatitis B Adult Vial -> Hep B Adult 20 mcg/mL 90746	$84.00	$168.00	$125.98	—	50%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) CPT 90739 NF - hepatitis B adult vaccine 20 mcg/0.5 mL IM Susp 0.5 mL	$148.78	$297.55	$271.72	8% above	50%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) CPT 90739 Hepatitis B Adult Vial -> Hep B Adult (Heplisav B) 0.5ml 90739	$223.15	$446.30	$271.72	61% above	50%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) inpatient CPT 90739 NF - hepatitis B adult vaccine 20 mcg/0.5 mL IM Susp 0.5 mL	$148.78	$297.55	$271.72	—	50%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) inpatient CPT 90739 Hepatitis B Adult Vial -> Hep B Adult (Heplisav B) 0.5ml 90739	$223.15	$446.30	$271.72	—	50%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 hepatitis B pediatric/adolescent vaccine 10 mcg/0.5 mL IM Susp 0.5 mL CHG	$24.99	$49.97	$51.03	23% below	50%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 Hepatitis B Pediatric Adol. Vial -> Hep B Recombivax 5 mcg/0.5mL Pediatric Adol. 90744	$26.10	$52.20	$51.03	19% below	50%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 hepatitis B pediatric vaccine 5 mcg/0.5 mL IM Susp 0.5 mL CHG	$34.07	$68.14	$51.03	5% above	50%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 Hepatitis B Pediatric Adol. Vial -> Hep B Engerix 10 mcg/0.5mL Pediatric Adol. 90744	$45.35	$90.70	$51.03	40% above	50%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 hepatitis B pediatric/adolescent vaccine 10 mcg/0.5 mL IM Susp 0.5 mL CHG	$24.99	$49.97	$51.03	—	50%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 Hepatitis B Pediatric Adol. Vial -> Hep B Recombivax 5 mcg/0.5mL Pediatric Adol. 90744	$26.10	$52.20	$51.03	—	50%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 hepatitis B pediatric vaccine 5 mcg/0.5 mL IM Susp 0.5 mL CHG	$34.07	$68.14	$51.03	—	50%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 Hepatitis B Pediatric Adol. Vial -> Hep B Engerix 10 mcg/0.5mL Pediatric Adol. 90744	$45.35	$90.70	$51.03	—	50%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 haemophilus b conjugate (PRP-OMP) vaccine 7.5 mcg-125 mcg/0.5 mL IM Susp 0.5 mL	$35.51	$71.02	$54.90	28% below	50%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 Haemophilus B Conjugate (PRP OMP) Vial -> Hib PRP OMP 90647	$49.20	$98.40	$54.90	at median	50%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) inpatient CPT 90647 haemophilus b conjugate (PRP-OMP) vaccine 7.5 mcg-125 mcg/0.5 mL IM Susp 0.5 mL	$35.51	$71.02	$54.90	—	50%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) inpatient CPT 90647 Haemophilus B Conjugate (PRP OMP) Vial -> Hib PRP OMP 90647	$49.20	$98.40	$54.90	—	50%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 haemophilus b conjugate (PRP-T) vaccine IM Inj	$16.14	$32.27	$22.98	61% below	50%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 Haemophilus B PRP T Vial -> Hib PRP T 90648	$59.95	$119.90	$22.98	43% above	50%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 haemophilus b conjugate (PRP-T) vaccine IM Inj	$16.14	$32.27	$22.98	—	50%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 Haemophilus B PRP T Vial -> Hib PRP T 90648	$59.95	$119.90	$22.98	—	50%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Influenza Virus Vial -> High Dose IIV3, 0.5ml 90662	$67.55	$135.10	$150.44	13% below	50%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Influenza Virus Vial -> High Dose IIV SYR 0.5mL 90662	$67.55	$135.10	$56.31–$150.44	13% below	50%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 NF - influenza virus vaccine, inactivated high-dose PF trivalent IM Susp 0.5 mL	$100.14	$200.28	$150.44	29% above	50%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Influenza Virus Vial -> High Dose IIV Syr 0.7 mL 90662	$119.35	$238.70	$150.44	54% above	50%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 Influenza Virus Vial -> High Dose IIV SYR 0.5mL 90662	$67.55	$135.10	$56.31–$150.44	—	50%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 Influenza Virus Vial -> High Dose IIV3, 0.5ml 90662	$67.55	$135.10	$150.44	—	50%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 NF - influenza virus vaccine, inactivated high-dose PF trivalent IM Susp 0.5 mL	$100.14	$200.28	$150.44	—	50%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 Influenza Virus Vial -> High Dose IIV Syr 0.7 mL 90662	$119.35	$238.70	$150.44	—	50%
Japanese encephalitis vaccine (Ixiaro), 2-dose schedule CPT 90738 Japanese Encephalitis Vial -> Japanese Encephalitis 90738	$441.10	$882.20	$514.80	at median	50%
Japanese encephalitis vaccine (Ixiaro), 2-dose schedule inpatient CPT 90738 Japanese Encephalitis Vial -> Japanese Encephalitis 90738	$441.10	$882.20	$514.80	—	50%
MMR vaccine (measles, mumps and rubella), live CPT 90707 measles/mumps/rubella virus vaccine Subcut Inj	$102.71	$205.42	$166.09	24% below	50%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MMR II Live Vial -> MMR II Live SQ 90707	$135.95	$271.90	$166.09	at median	50%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 measles/mumps/rubella virus vaccine Subcut Inj	$102.71	$205.42	$166.09	—	50%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MMR II Live Vial -> MMR II Live SQ 90707	$135.95	$271.90	$166.09	—	50%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 measles/mumps/rubella/varicella virus vaccine Subcut Inj	$334.91	$669.81	$504.49	6% below	50%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 MMRV Live Vial -> MMRV Live SQ 90710	$355.40	$710.80	$504.49	at median	50%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 measles/mumps/rubella/varicella virus vaccine Subcut Inj	$334.91	$669.81	$504.49	—	50%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 MMRV Live Vial -> MMRV Live SQ 90710	$355.40	$710.80	$504.49	—	50%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 meningococcal conjugate vaccine group ACYW IM Inj	$123.05	$246.10	$290.91	41% below	50%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 NF - meningococcal conjugate vaccine group ACYW IM Soln 0.5 mL	$159.98	$319.95	$290.91	23% below	50%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 Meningococal Conjugate (MCV4 MenACWY) Vial -> MCV4 MenACWY 90734	$207.60	$415.20	$290.91–$299.44	at median	50%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 meningococcal conjugate vaccine group ACYW IM Inj	$123.05	$246.10	$290.91	—	50%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 NF - meningococcal conjugate vaccine group ACYW IM Soln 0.5 mL	$159.98	$319.95	$290.91	—	50%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 Meningococal Conjugate (MCV4 MenACWY) Vial -> MCV4 MenACWY 90734	$207.60	$415.20	$290.91–$299.44	—	50%
Meningococcal ACWY vaccine (MenQuadfi) CPT 90619 Meningoccal Conjugate (MenACWY-TT) Vial -> MenACWY-TT 90619	$236.25	$472.50	$300.02–$340.77	at median	50%
Meningococcal ACWY vaccine (MenQuadfi) inpatient CPT 90619 Meningoccal Conjugate (MenACWY-TT) Vial -> MenACWY-TT 90619	$236.25	$472.50	$300.02–$340.77	—	50%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 meningococcal group B vaccine recombinant, OMV, adjuvanted Sus	$365.93	$731.85	$413.70	9% above	50%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 Meningococcal Group B (MenB 4C) Vial -> MenB 4C 90620	$531.90	$1,063.80	$413.70–$767.21	58% above	50%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 meningococcal group B vaccine recombinant, OMV, adjuvanted Sus	$365.93	$731.85	$413.70	—	50%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 Meningococcal Group B (MenB 4C) Vial -> MenB 4C 90620	$531.90	$1,063.80	$413.70–$767.21	—	50%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 NF - pneumococcal 13-valent conjugate vaccine IM Susp 0.5 mL	$220.38	$440.75	$395.03	16% below	50%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 Pneumococcal conjugate (PCV13) Vial -> PCV13 90670	$296.10	$592.20	$395.03	12% above	50%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 NF - pneumococcal 13-valent conjugate vaccine IM Susp 0.5 mL	$220.38	$440.75	$395.03	—	50%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 Pneumococcal conjugate (PCV13) Vial -> PCV13 90670	$296.10	$592.20	$395.03	—	50%
Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) CPT 90671 Pneumococcal conjugate (PCV15) Vial -> PCV15 90671	$699.45	$1,398.90	$419.79	at median	50%
Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) inpatient CPT 90671 Pneumococcal conjugate (PCV15) Vial -> PCV15 90671	$699.45	$1,398.90	$419.79	—	50%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 pneumococcal 20-valent conjugate vaccine IM Susp 0.5 mL	$296.35	$592.70	$479.07	22% below	50%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 Pneumococcal Conjugate (PCV20) Vial -> PCV20 90677	$381.40	$762.80	$466.15–$550.13	at median	50%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 pneumococcal 20-valent conjugate vaccine IM Susp 0.5 mL	$296.35	$592.70	$479.07	—	50%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 Pneumococcal Conjugate (PCV20) Vial -> PCV20 90677	$381.40	$762.80	$466.15–$550.13	—	50%
Pneumonia vaccine, 21-valent conjugate (Capvaxive) CPT 90684 Pneumococcal conjugate (PCV21) Vial -> PCV21 90684	$486.20	$972.40	$527.04	8% above	50%
Pneumonia vaccine, 21-valent conjugate (Capvaxive) inpatient CPT 90684 Pneumococcal conjugate (PCV21) Vial -> PCV21 90684	$486.20	$972.40	$527.04	—	50%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 pneumococcal 23-polyvalent vaccine Inj Soln 0.5 mL	$126.31	$252.61	$204.26	20% below	50%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Pneumococcal poly (PPSV23) Vial -> PPSV23 90732	$165.65	$331.30	$204.26	5% above	50%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 pneumococcal 23-polyvalent vaccine Inj Soln 0.5 mL	$126.31	$252.61	$204.26	—	50%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 Pneumococcal poly (PPSV23) Vial -> PPSV23 90732	$165.65	$331.30	$204.26	—	50%
Polio vaccine, inactivated (IPV) CPT 90713 poliovirus vaccine, inactivated Inj Susp 0.5 mL	$54.35	$108.69	$78.04	13% below	50%
Polio vaccine, inactivated (IPV) CPT 90713 Poliovirus, Inactivated (IPV) Vial -> Poliovirus, Inactivated (IPV) 90713	$62.75	$125.50	$78.04	at median	50%
Polio vaccine, inactivated (IPV) inpatient CPT 90713 poliovirus vaccine, inactivated Inj Susp 0.5 mL	$54.35	$108.69	$78.04	—	50%
Polio vaccine, inactivated (IPV) inpatient CPT 90713 Poliovirus, Inactivated (IPV) Vial -> Poliovirus, Inactivated (IPV) 90713	$62.75	$125.50	$78.04	—	50%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 Nirsevimab (RSV) 1 mL Vial -> Beyfortus RSV PF 1mL 90381	$750.90	$1,501.80	$970.22	1% above	50%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 Nirsevimab (RSV) 1 mL Vial -> Beyfortus RSV PF 1mL 90381	$750.90	$1,501.80	$970.22	—	50%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 Nirsevimab (RSV) 0.5 mL Vial -> Beyfortus RSV PF 0.5mL 90380	$750.90	$1,501.80	$970.22	1% above	50%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 Nirsevimab (RSV) 0.5 mL Vial -> Beyfortus RSV PF 0.5mL 90380	$750.90	$1,501.80	$970.22	—	50%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 RSV Vial (Abryso) -> Abrysvo RSV preF A-preF B 0.5 mL 90678	$497.10	$994.20	$535.24	4% above	50%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 RSV Vial (Abryso) -> Abrysvo RSV preF A-preF B 0.5 mL 90678	$497.10	$994.20	$535.24	—	50%
RSV vaccine with adjuvant (Arexvy), one dose for older adults CPT 90679 RSV Vial (Arexvy) -> Arexvy RSV preF3 0.5 mL 90679	$497.10	$994.20	$534.46	18% above	50%
RSV vaccine with adjuvant (Arexvy), one dose for older adults inpatient CPT 90679 RSV Vial (Arexvy) -> Arexvy RSV preF3 0.5 mL 90679	$497.10	$994.20	$534.46	—	50%
Rabies vaccine, one dose CPT 90675 rabies vaccine, purified chick embryo cell 2.5 intl units Inj	$433.71	$867.42	$171.58–$758.22	16% below	50%
Rabies vaccine, one dose CPT 90675 rabies vaccine, human diploid cell 2.5 unit IM Inj	$476.57	$953.14	$171.58–$758.22	8% below	50%
Rabies vaccine, one dose CPT 90675 Rabies Vaccine (Rabavert) -> Rabavert 2.5ml 90675	$515.60	$1,031.20	$171.58–$758.22	at median	50%
Rabies vaccine, one dose CPT 90675 Rabies Vial -> Rabies 90675	$528.35	$1,056.70	$171.58–$758.22	2% above	50%
Rabies vaccine, one dose inpatient CPT 90675 rabies vaccine, purified chick embryo cell 2.5 intl units Inj	$433.71	$867.42	$171.58–$758.22	—	50%
Rabies vaccine, one dose inpatient CPT 90675 rabies vaccine, human diploid cell 2.5 unit IM Inj	$476.57	$953.14	$171.58–$758.22	—	50%
Rabies vaccine, one dose inpatient CPT 90675 Rabies Vaccine (Rabavert) -> Rabavert 2.5ml 90675	$515.60	$1,031.20	$171.58–$758.22	—	50%
Rabies vaccine, one dose inpatient CPT 90675 Rabies Vial -> Rabies 90675	$528.35	$1,056.70	$171.58–$758.22	—	50%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) CPT 90681 Rotavirus Vial -> RV1 Oral Rotarix 90681	$214.50	$429.00	$256.49	7% above	50%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) inpatient CPT 90681 Rotavirus Vial -> RV1 Oral Rotarix 90681	$214.50	$429.00	$256.49	—	50%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 rotavirus vaccine pentavalent Oral Susp 2 mL	$61.73	$123.46	$179.24	25% below	50%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 Rotavirus Vial -> RV5 Oral Rotateq 90680	$81.35	$162.70	$179.24	1% below	50%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 rotavirus vaccine pentavalent Oral Susp 2 mL	$61.73	$123.46	$179.24	—	50%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 Rotavirus Vial -> RV5 Oral Rotateq 90680	$81.35	$162.70	$179.24	—	50%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 zoster vaccine, inactivated adjuvanted Inj	$209.25	$418.50	$375.98	6% above	50%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 Zoster Recomb Inactivated (HZV) Vial -> Zoster (HZV) Recomb 90750	$255.85	$511.70	$312.70–$375.98	30% above	50%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 zoster vaccine, inactivated adjuvanted Inj	$209.25	$418.50	$375.98	—	50%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 Zoster Recomb Inactivated (HZV) Vial -> Zoster (HZV) Recomb 90750	$255.85	$511.70	$312.70–$375.98	—	50%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 tetanus-diphtheria toxoids (Td) adult/adolescent 5 units-2 units/0.5 mL IM Susp 0.5 mL	$51.63	$103.25	$73.71	4% below	50%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 Tetanus Diphth 7+ Yrs Vial -> Td PF (2 units/0.5 mL) 90714	$58.90	$117.80	$73.71	9% above	50%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 tetanus-diphtheria toxoids (Td) adult/adolescent 5 units-2 units/0.5 mL IM Susp 0.5 mL	$51.63	$103.25	$73.71	—	50%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 Tetanus Diphth 7+ Yrs Vial -> Td PF (2 units/0.5 mL) 90714	$58.90	$117.80	$73.71	—	50%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 tetanus/diphth/pertussis (Boostrix Tdap) IM Susp 0.5 mL	$46.71	$93.41	$85.05	35% below	50%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 tetanus/diphth/pertussis (Adacel Tdap) IM Susp 0.5 mL	$60.14	$120.27	$85.05	17% below	50%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDaP Age 7 Yrs and Older Vial -> Tdap Vaccine 90715	$66.55	$133.10	$52.44–$102.79	8% below	50%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 tetanus/diphth/pertussis (Boostrix Tdap) IM Susp 0.5 mL	$46.71	$93.41	$85.05	—	50%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 tetanus/diphth/pertussis (Adacel Tdap) IM Susp 0.5 mL	$60.14	$120.27	$85.05	—	50%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TDaP Age 7 Yrs and Older Vial -> Tdap Vaccine 90715	$66.55	$133.10	$52.44–$102.79	—	50%
Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 typhoid vaccine, inactivated IM Soln 0.5 mL	$166.03	$332.05	$268.49	9% above	50%
Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 Typhoid Live Vial -> Typhoid 90691	$191.20	$382.40	$268.49	26% above	50%
Typhoid vaccine, injectable (Vi polysaccharide) inpatient CPT 90691 typhoid vaccine, inactivated IM Soln 0.5 mL	$166.03	$332.05	$268.49	—	50%
Typhoid vaccine, injectable (Vi polysaccharide) inpatient CPT 90691 Typhoid Live Vial -> Typhoid 90691	$191.20	$382.40	$268.49	—	50%
Typhoid vaccine, oral capsules (Vivotif) CPT 90690 NF - typhoid vaccine, live Oral DR Cap	$7.58	$15.16	$204.61	75% below	50%
Typhoid vaccine, oral capsules (Vivotif) inpatient CPT 90690 NF - typhoid vaccine, live Oral DR Cap	$7.58	$15.16	$204.61	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin Pneumo PPSV23 -> VFC Inj Vaccine G0009 (90471) Pneumo	$11.52	$23.03	$38.93–$111.06	50% below	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin Hepatitis A Pediatric Adol. -> VFC First Inj Vaccine (90471)	$11.52	$23.03	$38.93–$111.06	50% below	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin MMR II Live -> VFC First Inj Vaccine (90471)	$11.52	$23.03	$38.93–$111.06	50% below	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin Influenza Virus -> VFC First Inj Vaccine G0008 (90471) Flu	$11.52	$23.03	$38.93–$111.06	50% below	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin DTaP IPV -> VFC First Inj Vaccine (90471)	$11.52	$23.03	$38.93–$111.06	50% below	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin Poliovirus (IPV) -> VFC First Inj Vaccine (90471)	$11.52	$23.03	$38.93–$111.06	50% below	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin DTaP HepB IPV -> VFC First Inj Vaccine (90471)	$11.52	$23.03	$38.93–$111.06	50% below	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin DTaP IPV/HIB -> VFC First Inj Vaccine (90471)	$11.52	$23.03	$38.93–$111.06	50% below	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin Meningococal Conjugate -> VFC First Inj Vaccine (90471)	$11.52	$23.03	$38.93–$111.06	50% below	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin Meningococcal Group B (MenB 4C) -> VFC First Inj Vaccine (90471)	$11.52	$23.03	$38.93–$111.06	50% below	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin MMRV Live -> VFC First Inj Vaccine (90471)	$11.52	$23.03	$38.93–$111.06	50% below	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin Pneumo PCV20 -> VFC Inj Vaccine G0009 (90471) Pneumo	$11.52	$23.03	$38.93–$111.06	50% below	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin RSV -> VFC First Inj Vaccine (90471)	$11.52	$23.03	$38.93–$111.06	50% below	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin Hepatitis B Pediatric Adol. -> VFC First Inj Vaccine (90471)	$11.52	$23.03	$38.93–$111.06	50% below	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin Pneumo PCV 13 -> VFC Inj Vaccine G0009 (90471) Pneumo	$11.52	$23.03	$38.93–$111.06	50% below	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin Tetanus-Diphth -> VFC First Inj Vaccine (90471)	$11.52	$23.03	$38.93–$111.06	50% below	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin DTaP Pediatric Under 7yrs -> VFC First Inj Vaccine (90471)	$11.52	$23.03	$38.93–$111.06	50% below	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin Pneumo PCV 15 -> VFC Inj Vaccine G0009 (90471) Pneumo	$11.52	$23.03	$38.93–$111.06	50% below	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin Hib PRP OMP -> VFC First Inj Vaccine (90471)	$11.52	$23.03	$38.93–$111.06	50% below	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin Varicella Virus (Varivax) -> VFC First Inj Vaccine (90471)	$11.52	$23.03	$38.93–$111.06	50% below	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin Human Papillomavirus -> VFC First Inj Vaccine (90471)	$11.52	$23.03	$38.93–$111.06	50% below	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin DTaP IPV/HIB/Hep B -> VFC First Inj Vaccine (90471)	$11.52	$23.03	$38.93–$111.06	50% below	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin Hib PRP T -> VFC First Inj Vaccine (90471)	$11.52	$23.03	$38.93–$111.06	50% below	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin TDaP 7 Yrs and Older -> VFC First Inj Vaccine (90471)	$11.52	$23.03	$38.93–$111.06	50% below	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Admin Pneumonia Vaccine	$35.55	$71.10	$38.93–$111.06	54% above	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Admin Flu Virus Vaccine	$35.55	$71.10	$38.93–$111.06	54% above	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin Pneumo PCV 13 -> First Inj Vaccine G0009 (90471) Pneumo	$51.95	$103.90	$38.93–$111.06	126% above	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin Poliovirus (IPV) -> First Inj Vaccine (90471)	$51.95	$103.90	$38.93–$111.06	126% above	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin Human Papillomavirus -> First Inj Vaccine (90471)	$51.95	$103.90	$38.93–$111.06	126% above	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin Hib PRP OMP -> First Inj Vaccine (90471)	$51.95	$103.90	$38.93–$111.06	126% above	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin Hib PRP T -> First Inj Vaccine (90471)	$51.95	$103.90	$38.93–$111.06	126% above	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin DTaP HepB IPV -> First Inj Vaccine (90471)	$51.95	$103.90	$38.93–$111.06	126% above	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin Pneumo PCV20 -> First Inj Vaccine G0009 (90471) Pneumo	$51.95	$103.90	$38.93–$111.06	126% above	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin Influenza Virus -> First Inj Vaccine G0008 (90471) Flu	$51.95	$103.90	$38.93–$111.06	126% above	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin TDaP 7 Yrs and Older -> First Inj Vaccine (90471)	$51.95	$103.90	$38.93–$111.06	126% above	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Misc Vaccine Initial Admin Prq Id Subq/Im Inj 90471	$51.95	$103.90	$38.93–$111.06	126% above	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin MMR II Live -> First Inj Vaccine (90471)	$51.95	$103.90	$38.93–$111.06	126% above	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Hep B Admin Prq Id Subq/Im Inj 1 Vaccine Initial G0010 (90471)	$51.95	$103.90	$38.93–$111.06	126% above	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin DTaP IPV/HIB/Hep B -> First Inj Vaccine (90471)	$51.95	$103.90	$38.93–$111.06	126% above	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin Pneumo PCV21 -> First Inj Vaccine G0009 (90471) Pneumo	$51.95	$103.90	$38.93–$111.06	126% above	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin Varicella Virus (Varivax) -> First Inj Vaccine (90471)	$51.95	$103.90	$38.93–$111.06	126% above	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin Pneumo PCV 15 -> First Inj Vaccine G0009 (90471) Pneumo	$51.95	$103.90	$38.93–$111.06	126% above	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin Hepatitis B Pediatric Adol. -> First Inj Vaccine G0010 (90471) Hep B	$51.95	$103.90	$38.93–$111.06	126% above	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin DTaP Pediatric Under 7yrs -> First Inj Vaccine (90471)	$51.95	$103.90	$38.93–$111.06	126% above	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin Hepatitis B Adult -> First Inj Vaccine G0010 (90471) Hep B	$51.95	$103.90	$38.93–$111.06	126% above	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin Tetanus-Diphth -> First Inj Vaccine (90471)	$51.95	$103.90	$38.93–$111.06	126% above	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin Hepatitis A Hepatitis B Adult -> First Inj Vaccine (90471)	$51.95	$103.90	$38.93–$111.06	126% above	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin Misc -> First Inj Vaccine (90471)	$51.95	$103.90	$38.93–$111.06	126% above	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin Pneumo PPSV23 -> First Inj Vaccine G0009 (90471) Pneumo	$51.95	$103.90	$38.93–$111.06	126% above	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin Hepatitis A Pediatric Adol. -> First Inj Vaccine (90471)	$51.95	$103.90	$38.93–$111.06	126% above	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin RSV -> First Inj Vaccine (90471)	$51.95	$103.90	$38.93–$111.06	126% above	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Pneumonia Admin Prq Id Subq/Im Inj 1 Vaccine Initial G0009 (90471)	$51.95	$103.90	$38.93–$111.06	126% above	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin MMRV Live -> First Inj Vaccine (90471)	$51.95	$103.90	$38.93–$111.06	126% above	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin Hepatitis A Adult -> First Inj Vaccine (90471)	$51.95	$103.90	$38.93–$111.06	126% above	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin Meningococcal Group B (MenB 4C) -> First Inj Vaccine (90471)	$51.95	$103.90	$38.93–$111.06	126% above	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 First Inj Vaccine (90471) Ambulatory BCE	$51.95	$103.90	$38.93–$111.06	126% above	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin DTaP IPV/HIB -> First Inj Vaccine (90471)	$51.95	$103.90	$38.93–$111.06	126% above	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin DTaP IPV -> First Inj Vaccine (90471)	$51.95	$103.90	$38.93–$111.06	126% above	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Influenza Admin Prq Id Subq/Im Inj 1 Vaccine Initial G0008 (90471)	$51.95	$103.90	$38.93–$111.06	126% above	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Op Immune Adm 1 Vaccine	$51.95	$103.90	$38.93–$111.06	126% above	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine Admin Meningococal Conjugate -> First Inj Vaccine (90471)	$51.95	$103.90	$38.93–$111.06	126% above	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin MMR II Live -> VFC First Inj Vaccine (90471)	$11.52	$23.03	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin DTaP IPV -> VFC First Inj Vaccine (90471)	$11.52	$23.03	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin Varicella Virus (Varivax) -> VFC First Inj Vaccine (90471)	$11.52	$23.03	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin Pneumo PCV 13 -> VFC Inj Vaccine G0009 (90471) Pneumo	$11.52	$23.03	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin Hepatitis B Pediatric Adol. -> VFC First Inj Vaccine (90471)	$11.52	$23.03	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin Hepatitis A Pediatric Adol. -> VFC First Inj Vaccine (90471)	$11.52	$23.03	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin Pneumo PPSV23 -> VFC Inj Vaccine G0009 (90471) Pneumo	$11.52	$23.03	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin Hib PRP OMP -> VFC First Inj Vaccine (90471)	$11.52	$23.03	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin Pneumo PCV 15 -> VFC Inj Vaccine G0009 (90471) Pneumo	$11.52	$23.03	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin Human Papillomavirus -> VFC First Inj Vaccine (90471)	$11.52	$23.03	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin Hib PRP T -> VFC First Inj Vaccine (90471)	$11.52	$23.03	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin DTaP HepB IPV -> VFC First Inj Vaccine (90471)	$11.52	$23.03	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin Influenza Virus -> VFC First Inj Vaccine G0008 (90471) Flu	$11.52	$23.03	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin Poliovirus (IPV) -> VFC First Inj Vaccine (90471)	$11.52	$23.03	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin Meningococal Conjugate -> VFC First Inj Vaccine (90471)	$11.52	$23.03	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin Meningococcal Group B (MenB 4C) -> VFC First Inj Vaccine (90471)	$11.52	$23.03	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin MMRV Live -> VFC First Inj Vaccine (90471)	$11.52	$23.03	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin Pneumo PCV20 -> VFC Inj Vaccine G0009 (90471) Pneumo	$11.52	$23.03	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin RSV -> VFC First Inj Vaccine (90471)	$11.52	$23.03	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin Tetanus-Diphth -> VFC First Inj Vaccine (90471)	$11.52	$23.03	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin DTaP Pediatric Under 7yrs -> VFC First Inj Vaccine (90471)	$11.52	$23.03	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin TDaP 7 Yrs and Older -> VFC First Inj Vaccine (90471)	$11.52	$23.03	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin DTaP IPV/HIB/Hep B -> VFC First Inj Vaccine (90471)	$11.52	$23.03	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin DTaP IPV/HIB -> VFC First Inj Vaccine (90471)	$11.52	$23.03	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Admin Flu Virus Vaccine	$35.55	$71.10	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Admin Pneumonia Vaccine	$35.55	$71.10	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin Influenza Virus -> First Inj Vaccine G0008 (90471) Flu	$51.95	$103.90	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Misc Vaccine Initial Admin Prq Id Subq/Im Inj 90471	$51.95	$103.90	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin TDaP 7 Yrs and Older -> First Inj Vaccine (90471)	$51.95	$103.90	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin Pneumo PCV 13 -> First Inj Vaccine G0009 (90471) Pneumo	$51.95	$103.90	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin Meningococal Conjugate -> First Inj Vaccine (90471)	$51.95	$103.90	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Hep B Admin Prq Id Subq/Im Inj 1 Vaccine Initial G0010 (90471)	$51.95	$103.90	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 First Inj Vaccine (90471) Ambulatory BCE	$51.95	$103.90	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin Meningococcal Group B (MenB 4C) -> First Inj Vaccine (90471)	$51.95	$103.90	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin Varicella Virus (Varivax) -> First Inj Vaccine (90471)	$51.95	$103.90	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin Hepatitis A Adult -> First Inj Vaccine (90471)	$51.95	$103.90	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin MMRV Live -> First Inj Vaccine (90471)	$51.95	$103.90	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin Pneumo PPSV23 -> First Inj Vaccine G0009 (90471) Pneumo	$51.95	$103.90	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin RSV -> First Inj Vaccine (90471)	$51.95	$103.90	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin Hepatitis A Pediatric Adol. -> First Inj Vaccine (90471)	$51.95	$103.90	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin Misc -> First Inj Vaccine (90471)	$51.95	$103.90	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Op Immune Adm 1 Vaccine	$51.95	$103.90	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin Hepatitis A Hepatitis B Adult -> First Inj Vaccine (90471)	$51.95	$103.90	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin Tetanus-Diphth -> First Inj Vaccine (90471)	$51.95	$103.90	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin Hepatitis B Adult -> First Inj Vaccine G0010 (90471) Hep B	$51.95	$103.90	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin DTaP Pediatric Under 7yrs -> First Inj Vaccine (90471)	$51.95	$103.90	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin DTaP IPV/HIB -> First Inj Vaccine (90471)	$51.95	$103.90	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin Hepatitis B Pediatric Adol. -> First Inj Vaccine G0010 (90471) Hep B	$51.95	$103.90	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin Pneumo PCV 15 -> First Inj Vaccine G0009 (90471) Pneumo	$51.95	$103.90	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin Pneumo PCV21 -> First Inj Vaccine G0009 (90471) Pneumo	$51.95	$103.90	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin DTaP IPV/HIB/Hep B -> First Inj Vaccine (90471)	$51.95	$103.90	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin DTaP IPV -> First Inj Vaccine (90471)	$51.95	$103.90	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin MMR II Live -> First Inj Vaccine (90471)	$51.95	$103.90	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin Pneumo PCV20 -> First Inj Vaccine G0009 (90471) Pneumo	$51.95	$103.90	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Influenza Admin Prq Id Subq/Im Inj 1 Vaccine Initial G0008 (90471)	$51.95	$103.90	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin DTaP HepB IPV -> First Inj Vaccine (90471)	$51.95	$103.90	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin Hib PRP T -> First Inj Vaccine (90471)	$51.95	$103.90	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin Hib PRP OMP -> First Inj Vaccine (90471)	$51.95	$103.90	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin Human Papillomavirus -> First Inj Vaccine (90471)	$51.95	$103.90	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Pneumonia Admin Prq Id Subq/Im Inj 1 Vaccine Initial G0009 (90471)	$51.95	$103.90	$38.93–$111.06	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Vaccine Admin Poliovirus (IPV) -> First Inj Vaccine (90471)	$51.95	$103.90	$38.93–$111.06	—	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin DTaP IPV/HIB/Hep B -> VFC Subs Inj Vaccine (90472)	$11.52	$23.03	$32.24	41% below	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin Pneumo PCV 15 -> VFC Inj Vaccine G0009 (90472) Pneumo	$11.52	$23.03	$32.24	41% below	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin Influenza Virus -> VFC Subs Inj Vaccine G0008 (90472) Flu	$11.52	$23.03	$32.24	41% below	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin DTaP HepB IPV -> VFC Subs Inj Vaccine (90472)	$11.52	$23.03	$32.24	41% below	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin DTaP IPV -> VFC Subs Inj Vaccine (90472)	$11.52	$23.03	$32.24	41% below	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin Pneumo PCV 13 -> VFC Inj Vaccine G0009 (90472) Pneumo	$11.52	$23.03	$32.24	41% below	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin Tetanus-Diphth -> VFC Subs Inj Vaccine (90472)	$11.52	$23.03	$32.24	41% below	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin MMRV Live -> VFC Subs Inj Vaccine (90472)	$11.52	$23.03	$32.24	41% below	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin Varicella Virus (Varivax) -> VFC Subs Inj Vaccine (90472)	$11.52	$23.03	$32.24	41% below	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin TDaP 7 Yrs and Older -> VFC Subs Inj Vaccine (90472)	$11.52	$23.03	$32.24	41% below	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin RSV -> VFC Subs Inj Vaccine (90472)	$11.52	$23.03	$32.24	41% below	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin Meningococal Conjugate -> VFC Subs Inj Vaccine (90472)	$11.52	$23.03	$32.24	41% below	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin Meningococcal Group B (MenB 4C) -> VFC Subs Inj Vaccine (90472)	$11.52	$23.03	$32.24	41% below	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin Pneumo PCV20 -> VFC Inj Vaccine G0009 (90472) Pneumo	$11.52	$23.03	$32.24	41% below	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin MMR II Live -> VFC Subs Inj Vaccine (90472)	$11.52	$23.03	$32.24	41% below	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin DTaP Pediatric Under 7yrs -> VFC Subs Inj Vaccine (90472)	$11.52	$23.03	$32.24	41% below	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin Hib PRP T -> VFC Subs Inj Vaccine (90472)	$11.52	$23.03	$32.24	41% below	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin DTaP IPV/HIB -> VFC Subs Inj Vaccine (90472)	$11.52	$23.03	$32.24	41% below	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin Human Papillomavirus -> VFC Subs Inj Vaccine (90472)	$11.52	$23.03	$32.24	41% below	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin Hib PRP OMP -> VFC Subs Inj Vaccine (90472)	$11.52	$23.03	$32.24	41% below	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin Hepatitis A Pediatric Adol. -> VFC Subs Inj Vaccine (90472)	$11.52	$23.03	$32.24	41% below	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin Poliovirus (IPV) -> VFC Subs Inj Vaccine (90472)	$11.52	$23.03	$32.24	41% below	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin Hepatitis B Pediatric Adol. -> VFC Subs Inj Vaccine (90472)	$11.52	$23.03	$32.24	41% below	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin Pneumo PPSV23 -> VFC Inj Vaccine G0009 (90472) Pneumo	$11.52	$23.03	$32.24	41% below	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin RSV -> Subs Inj Vaccine (90472)	$48.20	$96.40	$32.24	147% above	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin MMRV Live -> Subs Inj Vaccine (90472)	$48.20	$96.40	$32.24	147% above	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin Meningococcal Group B (MenB 4C) -> Subs Inj Vaccine (90472)	$48.20	$96.40	$32.24–$69.52	147% above	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin Prq Id Subq/Im Inj 1 Vaccine Subsequent 90472	$48.20	$96.40	$32.24–$69.52	147% above	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin TDaP 7 Yrs and Older -> Subs Inj Vaccine (90472)	$48.20	$96.40	$32.24–$69.52	147% above	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin DTaP HepB IPV -> Subs Inj Vaccine (90472)	$48.20	$96.40	$32.24	147% above	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin Hib PRP OMP -> Subs Inj Vaccine (90472)	$48.20	$96.40	$32.24	147% above	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin Human Papillomavirus -> Subs Inj Vaccine (90472)	$48.20	$96.40	$32.24–$69.52	147% above	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin Influenza Virus -> Sub Inj Vaccine G0008 (90472) Flu	$48.20	$96.40	$32.24–$69.52	147% above	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin Poliovirus (IPV) -> Subs Inj Vaccine (90472)	$48.20	$96.40	$32.24	147% above	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin Pneumo PPSV23 -> Subs Inj Vaccine G0009 (90472) Pneumo	$48.20	$96.40	$32.24	147% above	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin Pneumo PCV 13 -> Subs Inj Vaccine G0009 (90472) Pneumo	$48.20	$96.40	$32.24	147% above	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin Hib PRP T -> Subs Inj Vaccine (90472)	$48.20	$96.40	$32.24	147% above	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin Hepatitis B Pediatric Adol. -> Subs Inj Vaccine G0010 (90472) Hep B	$48.20	$96.40	$32.24	147% above	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin Pneumo PCV21 -> Subs Inj Vaccine G0009 (90472) Pneumo	$48.20	$96.40	$32.24	147% above	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin Hepatitis B Adult -> Subs Inj Vaccine G0010 (90472) Hep B	$48.20	$96.40	$32.24	147% above	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin Hepatitis A Hepatitis B Adult -> Subs Inj Vaccine (90472)	$48.20	$96.40	$32.24	147% above	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin Hepatitis A Pediatric Adol. -> Subs Inj Vaccine (90472)	$48.20	$96.40	$32.24	147% above	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin Meningococal Conjugate -> Subs Inj Vaccine (90472)	$48.20	$96.40	$32.24	147% above	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin Hepatitis A Adult -> Subs Inj Vaccine (90472)	$48.20	$96.40	$32.24	147% above	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Subs Inj Vaccine (90472) Ambulatory BCE	$48.20	$96.40	$32.24	147% above	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin MMR II Live -> Subs Inj Vaccine (90472)	$48.20	$96.40	$32.24	147% above	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin Misc -> Subs Inj Vaccine (90472)	$48.20	$96.40	$32.24–$69.52	147% above	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin Varicella Virus (Varivax) -> Subs Inj Vaccine (90472)	$48.20	$96.40	$32.24	147% above	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin DTaP IPV -> Subs Inj Vaccine (90472)	$48.20	$96.40	$32.24	147% above	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin DTaP IPV/HIB -> Subs Inj Vaccine (90472)	$48.20	$96.40	$32.24	147% above	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Immunization Adm; Ea Addtl Vaccine	$48.20	$96.40	$32.24–$37.98	147% above	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin Pneumo PCV 15 -> Subs Inj Vaccine G0009 (90472) Pneumo	$48.20	$96.40	$32.24	147% above	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin DTaP IPV/HIB/Hep B -> Subs Inj Vaccine (90472)	$48.20	$96.40	$32.24	147% above	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin Pneumo PCV20 -> Subs Inj Vaccine G0009 (90472) Pneumo	$48.20	$96.40	$32.24–$69.52	147% above	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin DTaP Pediatric Under 7yrs -> Subs Inj Vaccine (90472)	$48.20	$96.40	$32.24	147% above	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Admin Tetanus-Diphth -> Subs Inj Vaccine (90472)	$48.20	$96.40	$32.24	147% above	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin Tetanus-Diphth -> VFC Subs Inj Vaccine (90472)	$11.52	$23.03	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin Varicella Virus (Varivax) -> VFC Subs Inj Vaccine (90472)	$11.52	$23.03	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin Hepatitis B Pediatric Adol. -> VFC Subs Inj Vaccine (90472)	$11.52	$23.03	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin Human Papillomavirus -> VFC Subs Inj Vaccine (90472)	$11.52	$23.03	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin Meningococcal Group B (MenB 4C) -> VFC Subs Inj Vaccine (90472)	$11.52	$23.03	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin DTaP IPV -> VFC Subs Inj Vaccine (90472)	$11.52	$23.03	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin Pneumo PCV 13 -> VFC Inj Vaccine G0009 (90472) Pneumo	$11.52	$23.03	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin Hib PRP T -> VFC Subs Inj Vaccine (90472)	$11.52	$23.03	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin RSV -> VFC Subs Inj Vaccine (90472)	$11.52	$23.03	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin DTaP IPV/HIB -> VFC Subs Inj Vaccine (90472)	$11.52	$23.03	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin Pneumo PCV 15 -> VFC Inj Vaccine G0009 (90472) Pneumo	$11.52	$23.03	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin Meningococal Conjugate -> VFC Subs Inj Vaccine (90472)	$11.52	$23.03	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin DTaP Pediatric Under 7yrs -> VFC Subs Inj Vaccine (90472)	$11.52	$23.03	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin DTaP IPV/HIB/Hep B -> VFC Subs Inj Vaccine (90472)	$11.52	$23.03	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin DTaP HepB IPV -> VFC Subs Inj Vaccine (90472)	$11.52	$23.03	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin MMR II Live -> VFC Subs Inj Vaccine (90472)	$11.52	$23.03	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin Pneumo PCV20 -> VFC Inj Vaccine G0009 (90472) Pneumo	$11.52	$23.03	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin Pneumo PPSV23 -> VFC Inj Vaccine G0009 (90472) Pneumo	$11.52	$23.03	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin Hepatitis A Pediatric Adol. -> VFC Subs Inj Vaccine (90472)	$11.52	$23.03	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin Poliovirus (IPV) -> VFC Subs Inj Vaccine (90472)	$11.52	$23.03	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin TDaP 7 Yrs and Older -> VFC Subs Inj Vaccine (90472)	$11.52	$23.03	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin Influenza Virus -> VFC Subs Inj Vaccine G0008 (90472) Flu	$11.52	$23.03	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin MMRV Live -> VFC Subs Inj Vaccine (90472)	$11.52	$23.03	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin Hib PRP OMP -> VFC Subs Inj Vaccine (90472)	$11.52	$23.03	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin Hepatitis A Hepatitis B Adult -> Subs Inj Vaccine (90472)	$48.20	$96.40	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin Hepatitis A Pediatric Adol. -> Subs Inj Vaccine (90472)	$48.20	$96.40	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin DTaP Pediatric Under 7yrs -> Subs Inj Vaccine (90472)	$48.20	$96.40	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin MMRV Live -> Subs Inj Vaccine (90472)	$48.20	$96.40	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin Hepatitis A Adult -> Subs Inj Vaccine (90472)	$48.20	$96.40	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Subs Inj Vaccine (90472) Ambulatory BCE	$48.20	$96.40	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin Meningococal Conjugate -> Subs Inj Vaccine (90472)	$48.20	$96.40	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin MMR II Live -> Subs Inj Vaccine (90472)	$48.20	$96.40	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin Tetanus-Diphth -> Subs Inj Vaccine (90472)	$48.20	$96.40	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin Misc -> Subs Inj Vaccine (90472)	$48.20	$96.40	$32.24–$69.52	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin RSV -> Subs Inj Vaccine (90472)	$48.20	$96.40	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin Varicella Virus (Varivax) -> Subs Inj Vaccine (90472)	$48.20	$96.40	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin Human Papillomavirus -> Subs Inj Vaccine (90472)	$48.20	$96.40	$32.24–$69.52	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin DTaP IPV -> Subs Inj Vaccine (90472)	$48.20	$96.40	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin Hib PRP OMP -> Subs Inj Vaccine (90472)	$48.20	$96.40	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin DTaP IPV/HIB -> Subs Inj Vaccine (90472)	$48.20	$96.40	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin DTaP HepB IPV -> Subs Inj Vaccine (90472)	$48.20	$96.40	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Immunization Adm; Ea Addtl Vaccine	$48.20	$96.40	$32.24–$37.98	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin Meningococcal Group B (MenB 4C) -> Subs Inj Vaccine (90472)	$48.20	$96.40	$32.24–$69.52	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin Pneumo PCV 15 -> Subs Inj Vaccine G0009 (90472) Pneumo	$48.20	$96.40	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin DTaP IPV/HIB/Hep B -> Subs Inj Vaccine (90472)	$48.20	$96.40	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin Poliovirus (IPV) -> Subs Inj Vaccine (90472)	$48.20	$96.40	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin Influenza Virus -> Sub Inj Vaccine G0008 (90472) Flu	$48.20	$96.40	$32.24–$69.52	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin Pneumo PPSV23 -> Subs Inj Vaccine G0009 (90472) Pneumo	$48.20	$96.40	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin Pneumo PCV 13 -> Subs Inj Vaccine G0009 (90472) Pneumo	$48.20	$96.40	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin Pneumo PCV20 -> Subs Inj Vaccine G0009 (90472) Pneumo	$48.20	$96.40	$32.24–$69.52	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin Hib PRP T -> Subs Inj Vaccine (90472)	$48.20	$96.40	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin Hepatitis B Pediatric Adol. -> Subs Inj Vaccine G0010 (90472) Hep B	$48.20	$96.40	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin Pneumo PCV21 -> Subs Inj Vaccine G0009 (90472) Pneumo	$48.20	$96.40	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin TDaP 7 Yrs and Older -> Subs Inj Vaccine (90472)	$48.20	$96.40	$32.24–$69.52	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin Hepatitis B Adult -> Subs Inj Vaccine G0010 (90472) Hep B	$48.20	$96.40	$32.24	—	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Vaccine Admin Prq Id Subq/Im Inj 1 Vaccine Subsequent 90472	$48.20	$96.40	$32.24–$69.52	—	50%
Yellow fever vaccine, live CPT 90717 Yellow Fever Vial -> Yellow Fever 90717	$234.60	$469.20	$410.26	at median	50%
Yellow fever vaccine, live inpatient CPT 90717 Yellow Fever Vial -> Yellow Fever 90717	$234.60	$469.20	$410.26	—	50%

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

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

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

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

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

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

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

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

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

Source file: https://www.mclaren.org/Uploads/Public/Documents/corporate/ChargeMasterFile/2026/38-1428164_McLarenOakland_standardcharges.csv