Wayne Memorial Hospital
Wayne Memorial Hospital in Honesdale, PA publishes cash prices for 333 common procedures listed here, from its own machine-readable price file updated Sep 16, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Pennsylvania median for 212 of 327 procedures and below it for 111. By typical cash price it ranks #60 of 88 Pennsylvania hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.
601 Park St Honesdale, PA 18431-1445 Collected Sep 27, 2026 Source price file (570) 253-8100
Acute care hospital Emergency department CMS star rating 2 of 5 CCN 390125 · CMS hospital register
Scans and imaging
| Procedure | Cash price | List price | Insurers pay | vs Pennsylvania | Off list |
|---|---|---|---|---|---|
| Ankle X-ray, complete, 3 or more views CPT 73610 ANKLE X-RAY | $319.90 | $457.00 | $182.80–$365.60 | 6% below | 30% |
| Ankle X-ray, complete, 3 or more views inpatient CPT 73610 ANKLE X-RAY | $319.90 | $457.00 | $182.80–$365.60 | — | 30% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 US NI PHYSIO EXTREM ART SGL BI | $269.50 | $385.00 | $154.00–$308.00 | — | 30% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient both sides CPT 93922 US NI PHYSIO EXTREM ART SGL BI | $269.50 | $385.00 | $154.00–$308.00 | — | 30% |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 ESOPHAGUS BA SWALL | $547.40 | $782.00 | $312.80–$625.60 | 28% above | 30% |
| Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 ESOPHAGUS BA SWALL | $547.40 | $782.00 | $312.80–$625.60 | — | 30% |
| Bone scan, whole body (nuclear medicine) CPT 78306 BONE SCAN WHOLE BODY NM | $1,894.20 | $2,706.00 | $1,082.40–$2,164.80 | 54% above | 30% |
| Bone scan, whole body (nuclear medicine) inpatient CPT 78306 BONE SCAN WHOLE BODY NM | $1,894.20 | $2,706.00 | $1,082.40–$2,164.80 | — | 30% |
| Breast ultrasound, complete, one breast one side CPT 76641 US BREAST COMP 4 QUAD UNILAT | $1,034.60 | $1,478.00 | $591.20–$1,182.40 | 100% above | 30% |
| Breast ultrasound, complete, one breast inpatient one side CPT 76641 US BREAST COMP 4 QUAD UNILAT | $1,034.60 | $1,478.00 | $591.20–$1,182.40 | — | 30% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST LIMITED UNILATERAL | $518.00 | $740.00 | $296.00–$592.00 | 31% above | 30% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US BREAST LIMITED UNILATERAL | $518.00 | $740.00 | $296.00–$592.00 | — | 30% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT ANGIO CHEST | $4,517.80 | $6,454.00 | $2,581.60–$5,163.20 | 217% above | 30% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT ANGIO CHEST | $4,517.80 | $6,454.00 | $2,581.60–$5,163.20 | — | 30% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD/PELVIS W/O CONTRAST | $4,938.50 | $7,055.00 | $2,822.00–$5,644.00 | 216% above | 30% |
| CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD/PELVIS W/O CONTRAST | $4,938.50 | $7,055.00 | $2,822.00–$5,644.00 | — | 30% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD/PELVIS W/CONTRAST | $5,711.30 | $8,159.00 | $3,263.60–$6,527.20 | 139% above | 30% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD/PELVIS W/CONTRAST | $5,711.30 | $8,159.00 | $3,263.60–$6,527.20 | — | 30% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD/PELVIS COMBINED | $4,333.00 | $6,190.00 | $2,476.00–$4,952.00 | 62% above | 30% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD/PELVIS COMBINED | $4,333.00 | $6,190.00 | $2,476.00–$4,952.00 | — | 30% |
| CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W/CONTRAST | $3,999.80 | $5,714.00 | $2,285.60–$4,571.20 | 181% above | 30% |
| CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN W/CONTRAST | $3,999.80 | $5,714.00 | $2,285.60–$4,571.20 | — | 30% |
| CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/O CONTRAST | $3,458.00 | $4,940.00 | $1,976.00–$3,952.00 | 221% above | 30% |
| CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN W/O CONTRAST | $3,458.00 | $4,940.00 | $1,976.00–$3,952.00 | — | 30% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 CT SINUSES/FACIAL W/O CONTRAST | $2,961.70 | $4,231.00 | $1,692.40–$3,384.80 | 216% above | 30% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT SINUSES/FACIAL W/O CONTRAST | $2,961.70 | $4,231.00 | $1,692.40–$3,384.80 | — | 30% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD W/O CONTRAST | $2,830.80 | $4,044.00 | $1,617.60–$3,235.20 | 229% above | 30% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD W/O CONTRAST | $2,830.80 | $4,044.00 | $1,617.60–$3,235.20 | — | 30% |
| CT scan of the head with contrast CPT 70460 CT HEAD SCAN W/CONTRAST | $2,966.60 | $4,238.00 | $1,695.20–$3,390.40 | 129% above | 30% |
| CT scan of the head with contrast inpatient CPT 70460 CT HEAD SCAN W/CONTRAST | $2,966.60 | $4,238.00 | $1,695.20–$3,390.40 | — | 30% |
| CT scan of the head without and with contrast CPT 70470 CT HEAD W/&W/O | $3,368.40 | $4,812.00 | $1,924.80–$3,849.60 | 160% above | 30% |
| CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD W/&W/O | $3,368.40 | $4,812.00 | $1,924.80–$3,849.60 | — | 30% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT L-SPINE W/O CONTRAST | $3,458.00 | $4,940.00 | $1,976.00–$3,952.00 | 241% above | 30% |
| CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT L-SPINE W/O CONTRAST | $3,458.00 | $4,940.00 | $1,976.00–$3,952.00 | — | 30% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT C-SPINE W/O CONTRAST | $3,458.00 | $4,940.00 | $1,976.00–$3,952.00 | 256% above | 30% |
| CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT C-SPINE W/O CONTRAST | $3,458.00 | $4,940.00 | $1,976.00–$3,952.00 | — | 30% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/CONTRAST | $3,999.80 | $5,714.00 | $2,285.60–$4,571.20 | 181% above | 30% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/CONTRAST | $3,999.80 | $5,714.00 | $2,285.60–$4,571.20 | — | 30% |
| Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 US CAROTID(ARTERIAL)BILAT | $1,462.30 | $2,089.00 | $835.60–$1,671.20 | — | 30% |
| Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 US CAROTID(ARTERIAL)BILAT | $1,462.30 | $2,089.00 | $835.60–$1,671.20 | — | 30% |
| Chest X-ray, 2 views CPT 71046 CHEST AP & LATERAL X-RAY | $317.10 | $453.00 | $181.20–$362.40 | 37% above | 30% |
| Chest X-ray, 2 views inpatient CPT 71046 CHEST AP & LATERAL X-RAY | $317.10 | $453.00 | $181.20–$362.40 | — | 30% |
| Chest X-ray, single view CPT 71045 CHEST-SINGLE X-RAY | $291.20 | $416.00 | $166.40–$332.80 | 87% above | 30% |
| Chest X-ray, single view CPT 71045 CHEST DECUB OR SPECIAL VW | $406.00 | $580.00 | $232.00–$464.00 | 160% above | 30% |
| Chest X-ray, single view inpatient CPT 71045 CHEST-SINGLE X-RAY | $291.20 | $416.00 | $166.40–$332.80 | — | 30% |
| Chest X-ray, single view inpatient CPT 71045 CHEST DECUB OR SPECIAL VW | $406.00 | $580.00 | $232.00–$464.00 | — | 30% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 RENAL BLADDER ULTRASOUND | $318.50 | $455.00 | $182.00–$364.00 | 53% below | 30% |
| Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 RENAL BLADDER ULTRASOUND | $318.50 | $455.00 | $182.00–$364.00 | — | 30% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 DEXA 1/MORE AXIAL SKELETON | $709.80 | $1,014.00 | $405.60–$811.20 | 170% above | 30% |
| DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DEXA 1/MORE AXIAL SKELETON | $709.80 | $1,014.00 | $405.60–$811.20 | — | 30% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 DEXA 1/MORE APPENDICULAR | $163.80 | $234.00 | $93.60–$187.20 | 8% below | 30% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 DEXA 1/MORE APPENDICULAR | $163.80 | $234.00 | $93.60–$187.20 | — | 30% |
| Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US PREGNANCY COMPLETE SINGLE | $1,323.00 | $1,890.00 | $756.00–$1,512.00 | 61% above | 30% |
| Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US PREGNANCY COMPLETE SINGLE | $1,323.00 | $1,890.00 | $756.00–$1,512.00 | — | 30% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT THORAX W/O CONTRAST | $3,458.00 | $4,940.00 | $1,976.00–$3,952.00 | 226% above | 30% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT THORAX W/O CONTRAST | $3,458.00 | $4,940.00 | $1,976.00–$3,952.00 | — | 30% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT THORAX W/CONTRAST | $3,999.80 | $5,714.00 | $2,285.60–$4,571.20 | 204% above | 30% |
| Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT THORAX W/CONTRAST | $3,999.80 | $5,714.00 | $2,285.60–$4,571.20 | — | 30% |
| Diagnostic mammogram, both breasts both sides CPT 77066 MAMMO DIAGNOSTIC BILAT INC CAD | $345.10 | $493.00 | $101.51–$394.40 | — | 30% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MAMMO DIAGNOSTIC BILAT INC CAD | $345.10 | $493.00 | $197.20–$394.40 | — | 30% |
| Diagnostic mammogram, one breast one side CPT 77065 MAMMO DIAG UNILAT INC CAD | $345.10 | $493.00 | $79.12–$394.40 | 37% above | 30% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MAMMO DIAG UNILAT INC CAD | $345.10 | $493.00 | $197.20–$394.40 | — | 30% |
| Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 US ARTE LOWER EXT BILAT | $522.20 | $746.00 | $298.40–$596.80 | — | 30% |
| Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 US ARTE LOWER EXT BILAT | $522.20 | $746.00 | $298.40–$596.80 | — | 30% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US VENOUS EXTREMITY BILAT | $1,041.60 | $1,488.00 | $595.20–$1,190.40 | — | 30% |
| Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US VENOUS EXTREMITY BILAT | $1,041.60 | $1,488.00 | $595.20–$1,190.40 | — | 30% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHO COMPLETE | $997.50 | $1,425.00 | $570.00–$1,140.00 | 47% below | 30% |
| Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHO COMPLETE | $997.50 | $1,425.00 | $570.00–$1,140.00 | — | 30% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HEPATOBILIARY SCAN NM | $1,008.70 | $1,441.00 | $576.40–$1,152.80 | 18% below | 30% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HIDA SCAN WITH FATTY MEAL | $1,008.70 | $1,441.00 | $576.40–$1,152.80 | 18% below | 30% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HEPATOBILIARY SCAN NM | $1,008.70 | $1,441.00 | $576.40–$1,152.80 | — | 30% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HIDA SCAN WITH FATTY MEAL | $1,008.70 | $1,441.00 | $576.40–$1,152.80 | — | 30% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 SLEEP POLYSOMNOGRAPHY W/CPAP T | $2,865.80 | $4,094.00 | $1,637.60–$3,275.20 | 5% below | 30% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 SLEEP POLYSOMNOGRAPHY W/CPAP T | $2,865.80 | $4,094.00 | $1,637.60–$3,275.20 | — | 30% |
| Knee X-ray, 3 views CPT 73562 KNEE X-RAY | $308.00 | $440.00 | $176.00–$352.00 | 8% below | 30% |
| Knee X-ray, 3 views inpatient CPT 73562 KNEE X-RAY | $308.00 | $440.00 | $176.00–$352.00 | — | 30% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMEN LTD PC | $595.00 | $850.00 | $340.00–$680.00 | 8% above | 30% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ABDOMEN SINGLE ORGAN | $1,101.80 | $1,574.00 | $629.60–$1,259.20 | 100% above | 30% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMEN LTD PC | $595.00 | $850.00 | $340.00–$680.00 | — | 30% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 ABDOMEN SINGLE ORGAN | $1,101.80 | $1,574.00 | $629.60–$1,259.20 | — | 30% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT LOW DOSE FOR LUNG CA SCREEN | $197.40 | $282.00 | $112.80–$225.60 | 22% below | 30% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT LOW DOSE FOR LUNG CA SCREEN | $197.40 | $282.00 | $112.80–$225.60 | — | 30% |
| MRI of both breasts, without and then with contrast dye both sides CPT 77049 MRI BREAST BILATERAL COMBINED | $1,347.50 | $1,925.00 | $770.00–$1,540.00 | — | 30% |
| MRI of both breasts, without and then with contrast dye inpatient both sides CPT 77049 MRI BREAST BILATERAL COMBINED | $1,347.50 | $1,925.00 | $770.00–$1,540.00 | — | 30% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI LOWER EXTREMITY JOINT W/O | $3,037.30 | $4,339.00 | $1,735.60–$3,471.20 | 82% above | 30% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI LOWER EXTREMITY JOINT W/O | $3,037.30 | $4,339.00 | $1,735.60–$3,471.20 | — | 30% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI LOWER EXTREM JOINT COMBINE | $6,461.70 | $9,231.00 | $3,692.40–$7,384.80 | 149% above | 30% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI LOWER EXTREM JOINT COMBINE | $6,461.70 | $9,231.00 | $3,692.40–$7,384.80 | — | 30% |
| MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN W/O CONTRAST | $3,037.30 | $4,339.00 | $1,735.60–$3,471.20 | 80% above | 30% |
| MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN W/O CONTRAST | $3,037.30 | $4,339.00 | $1,735.60–$3,471.20 | — | 30% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN COMBINED | $3,846.50 | $5,495.00 | $2,198.00–$4,396.00 | 42% above | 30% |
| MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABDOMEN COMBINED | $3,846.50 | $5,495.00 | $2,198.00–$4,396.00 | — | 30% |
| MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O CONTRAST | $3,037.30 | $4,339.00 | $1,735.60–$3,471.20 | 128% above | 30% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN W/O CONTRAST | $3,037.30 | $4,339.00 | $1,735.60–$3,471.20 | — | 30% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN COMBINED | $3,846.50 | $5,495.00 | $2,198.00–$4,396.00 | 43% above | 30% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN COMBINED | $3,846.50 | $5,495.00 | $2,198.00–$4,396.00 | — | 30% |
| MRI of the lower back, no contrast dye CPT 72148 MRI L-SPINE W/O CONTRAST | $3,037.30 | $4,339.00 | $1,735.60–$3,471.20 | 79% above | 30% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MRI L-SPINE W/O CONTRAST | $3,037.30 | $4,339.00 | $1,735.60–$3,471.20 | — | 30% |
| MRI of the lower back, without and then with contrast dye CPT 72158 MRI L-SPINE COMBINED | $3,846.50 | $5,495.00 | $2,198.00–$4,396.00 | 42% above | 30% |
| MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI L-SPINE COMBINED | $3,846.50 | $5,495.00 | $2,198.00–$4,396.00 | — | 30% |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI T-SPINE W/O CONTRAST | $3,037.30 | $4,339.00 | $1,735.60–$3,471.20 | 76% above | 30% |
| MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI T-SPINE W/O CONTRAST | $3,037.30 | $4,339.00 | $1,735.60–$3,471.20 | — | 30% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI C-SPINE COMBINED | $3,846.50 | $5,495.00 | $2,198.00–$4,396.00 | 48% above | 30% |
| MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI C-SPINE COMBINED | $3,846.50 | $5,495.00 | $2,198.00–$4,396.00 | — | 30% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI C-SPINE W/O CONTRAST | $3,037.30 | $4,339.00 | $1,735.60–$3,471.20 | 76% above | 30% |
| MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI C-SPINE W/O CONTRAST | $3,037.30 | $4,339.00 | $1,735.60–$3,471.20 | — | 30% |
| MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS COMBINED | $5,555.90 | $7,937.00 | $3,174.80–$6,349.60 | 105% above | 30% |
| MRI of the pelvis without and with contrast CPT 72197 MRI PROSTATE COMBINED | $5,555.90 | $7,937.00 | $3,174.80–$6,349.60 | 105% above | 30% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS COMBINED | $5,555.90 | $7,937.00 | $3,174.80–$6,349.60 | — | 30% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PROSTATE COMBINED | $5,555.90 | $7,937.00 | $3,174.80–$6,349.60 | — | 30% |
| MRI of the pelvis, no contrast dye CPT 72195 MRI PROSTATE W/O CONTRAST | $2,599.80 | $3,714.00 | $1,485.60–$2,971.20 | 50% above | 30% |
| MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS W/O CONTRAST | $2,599.80 | $3,714.00 | $1,485.60–$2,971.20 | 50% above | 30% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PROSTATE W/O CONTRAST | $2,599.80 | $3,714.00 | $1,485.60–$2,971.20 | — | 30% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS W/O CONTRAST | $2,599.80 | $3,714.00 | $1,485.60–$2,971.20 | — | 30% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI UPPER EXTREM JOINT W/O CON | $3,037.30 | $4,339.00 | $1,735.60–$3,471.20 | 49% above | 30% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MRI UPPER EXTREM JOINT W/O CON | $3,037.30 | $4,339.00 | $1,735.60–$3,471.20 | — | 30% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 CARDIAC SPECT MULTI STUDY | $2,921.10 | $4,173.00 | $1,669.20–$3,338.40 | 22% below | 30% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 CARDIAC SPECT MULTI STUDY | $2,921.10 | $4,173.00 | $1,669.20–$3,338.40 | — | 30% |
| PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET/CT SKULL-THIGH 78815 | $7,081.20 | $10,116.00 | $4,046.40–$8,092.80 | 22% above | 30% |
| PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET/CT SKULL-THGH W/PSMA 78815 | $7,081.20 | $10,116.00 | $4,046.40–$8,092.80 | 22% above | 30% |
| PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET/CT SKULL-THIGH 78815 | $7,081.20 | $10,116.00 | $4,046.40–$8,092.80 | — | 30% |
| PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET/CT SKULL-THGH W/PSMA 78815 | $7,081.20 | $10,116.00 | $4,046.40–$8,092.80 | — | 30% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIS LIMITED | $595.00 | $850.00 | $340.00–$680.00 | 48% above | 30% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIS LIMITED | $595.00 | $850.00 | $340.00–$680.00 | — | 30% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 PELVIC NON-PREGNANCY | $1,323.00 | $1,890.00 | $756.00–$1,512.00 | 156% above | 30% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 PELVIC NON-PREGNANCY | $1,323.00 | $1,890.00 | $756.00–$1,512.00 | — | 30% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US PREG >=14 WKS TRANSABD SGL | $318.50 | $455.00 | $182.00–$364.00 | 43% below | 30% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 PELVIC PREGNANCY | $1,260.00 | $1,800.00 | $720.00–$1,440.00 | 125% above | 30% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US PREG >=14 WKS TRANSABD SGL | $318.50 | $455.00 | $182.00–$364.00 | — | 30% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 PELVIC PREGNANCY | $1,260.00 | $1,800.00 | $720.00–$1,440.00 | — | 30% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US PREGNANCY <14WKS TRANSABD,S | $322.00 | $460.00 | $184.00–$368.00 | 32% below | 30% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US PREGNANCY <14WKS TRANSABD,S | $322.00 | $460.00 | $184.00–$368.00 | — | 30% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US PREGNANCY LIMITED | $799.40 | $1,142.00 | $456.80–$913.60 | 85% above | 30% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US PREGNANCY LIMITED | $799.40 | $1,142.00 | $456.80–$913.60 | — | 30% |
| Screening mammogram, both breasts both sides CPT 77067 MAMMO SCREENING BILAT INC CAD | $345.10 | $493.00 | $83.72–$394.40 | — | 30% |
| Screening mammogram, both breasts one side CPT 77067 MAMMO SCREENING UNILAT INC CAD | $345.10 | $493.00 | $83.72–$394.40 | 41% above | 30% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 MAMMO SCREENING BILAT INC CAD | $345.10 | $493.00 | $197.20–$394.40 | — | 30% |
| Screening mammogram, both breasts inpatient one side CPT 77067 MAMMO SCREENING UNILAT INC CAD | $345.10 | $493.00 | $197.20–$394.40 | — | 30% |
| Shoulder X-ray, complete, 2 or more views CPT 73030 SHOULDER X-RAY | $370.30 | $529.00 | $211.60–$423.20 | 12% above | 30% |
| Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 SHOULDER X-RAY | $370.30 | $529.00 | $211.60–$423.20 | — | 30% |
| Sleep study in a lab (polysomnography) CPT 95810 SLEEP POLYSOMNOGRAPHY 4 OR MOR | $2,557.80 | $3,654.00 | $1,461.60–$2,923.20 | 19% below | 30% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 SLEEP POLYSOMNOGRAPHY 4 OR MOR | $2,557.80 | $3,654.00 | $1,461.60–$2,923.20 | — | 30% |
| Stress echocardiogram, complete, including the stress test and supervision CPT 93351 STRESS ECHOCARDIOGRAPHY | $1,381.80 | $1,974.00 | $789.60–$1,579.20 | 4% above | 30% |
| Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 STRESS ECHOCARDIOGRAPHY | $1,381.80 | $1,974.00 | $789.60–$1,579.20 | — | 30% |
| Swallow study (modified barium swallow, video X-ray) CPT 74230 SWALLOWING FUNC.+VIDEO | $858.90 | $1,227.00 | $490.80–$981.60 | 94% above | 30% |
| Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 SWALLOWING FUNC.+VIDEO | $858.90 | $1,227.00 | $490.80–$981.60 | — | 30% |
| Transvaginal pelvic ultrasound CPT 76830 TRANSVAGINAL ULTRASOUND NON-OB | $1,050.00 | $1,500.00 | $600.00–$1,200.00 | 166% above | 30% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 TRANSVAGINAL ULTRASOUND NON-OB | $1,050.00 | $1,500.00 | $600.00–$1,200.00 | — | 30% |
| Transvaginal ultrasound during pregnancy CPT 76817 TRANSVAGINAL OB ULTRASOUND | $999.60 | $1,428.00 | $571.20–$1,142.40 | 101% above | 30% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 TRANSVAGINAL OB ULTRASOUND | $999.60 | $1,428.00 | $571.20–$1,142.40 | — | 30% |
| Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN | $1,194.20 | $1,706.00 | $682.40–$1,364.80 | 82% above | 30% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMEN | $1,194.20 | $1,706.00 | $682.40–$1,364.80 | — | 30% |
| Ultrasound of the scrotum and testicles CPT 76870 ULTRASOUND SCAN OF TESTIC | $1,330.00 | $1,900.00 | $760.00–$1,520.00 | 137% above | 30% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 ULTRASOUND SCAN OF TESTIC | $1,330.00 | $1,900.00 | $760.00–$1,520.00 | — | 30% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 SOFT TISSUE HEAD & NECK | $723.10 | $1,033.00 | $413.20–$826.40 | 78% above | 30% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 SOFT TISSUE HEAD & NECK | $723.10 | $1,033.00 | $413.20–$826.40 | — | 30% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 UGI | $1,148.70 | $1,641.00 | $656.40–$1,312.80 | 104% above | 30% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 UGI +KUB SCOUT | $1,233.40 | $1,762.00 | $704.80–$1,409.60 | 119% above | 30% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 UGI & SMALL BOWEL | $1,302.70 | $1,861.00 | $744.40–$1,488.80 | 131% above | 30% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 UGI | $1,148.70 | $1,641.00 | $656.40–$1,312.80 | — | 30% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 UGI +KUB SCOUT | $1,233.40 | $1,762.00 | $704.80–$1,409.60 | — | 30% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 UGI & SMALL BOWEL | $1,302.70 | $1,861.00 | $744.40–$1,488.80 | — | 30% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 US VENOUS EXTREMITY UNILA | $522.20 | $746.00 | $298.40–$596.80 | 14% below | 30% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 US VENOUS EXTREMITY UNILA | $522.20 | $746.00 | $298.40–$596.80 | — | 30% |
| Wrist X-ray, complete, 3 or more views CPT 73110 WRIST X-RAY | $308.00 | $440.00 | $176.00–$352.00 | 2% below | 30% |
| Wrist X-ray, complete, 3 or more views inpatient CPT 73110 WRIST X-RAY | $308.00 | $440.00 | $176.00–$352.00 | — | 30% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP UNILAT 2-3 VIEWS | $364.00 | $520.00 | $208.00–$416.00 | 9% above | 30% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP UNILAT WITH PELVIS 2-3 VWS | $364.00 | $520.00 | $208.00–$416.00 | 9% above | 30% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP UNILAT WITH PELVIS 2-3 VWS | $364.00 | $520.00 | $208.00–$416.00 | — | 30% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP UNILAT 2-3 VIEWS | $364.00 | $520.00 | $208.00–$416.00 | — | 30% |
| X-ray of the abdomen, 1 view CPT 74018 GASTROGRAFIN CHALLENGE | $172.90 | $247.00 | $98.80–$197.60 | 27% below | 30% |
| X-ray of the abdomen, 1 view CPT 74018 ABDOMEN FLAT PLATE | $291.20 | $416.00 | $166.40–$332.80 | 23% above | 30% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 GASTROGRAFIN CHALLENGE | $172.90 | $247.00 | $98.80–$197.60 | — | 30% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 ABDOMEN FLAT PLATE | $291.20 | $416.00 | $166.40–$332.80 | — | 30% |
| X-ray of the ankle, 2 views CPT 73600 ANKLE LIMITED X-RAY | $211.40 | $302.00 | $120.80–$241.60 | 34% below | 30% |
| X-ray of the ankle, 2 views inpatient CPT 73600 ANKLE LIMITED X-RAY | $211.40 | $302.00 | $120.80–$241.60 | — | 30% |
| X-ray of the finger(s), 2 or more views CPT 73140 FINGER/S X-RAY | $186.90 | $267.00 | $106.80–$213.60 | 3% below | 30% |
| X-ray of the finger(s), 2 or more views inpatient CPT 73140 FINGER/S X-RAY | $186.90 | $267.00 | $106.80–$213.60 | — | 30% |
| X-ray of the foot, 2 views CPT 73620 FOOT LIMITED X-RAY | $211.40 | $302.00 | $120.80–$241.60 | 29% below | 30% |
| X-ray of the foot, 2 views inpatient CPT 73620 FOOT LIMITED X-RAY | $211.40 | $302.00 | $120.80–$241.60 | — | 30% |
| X-ray of the foot, complete, 3 or more views CPT 73630 FOOT X-RAY | $308.00 | $440.00 | $176.00–$352.00 | 11% below | 30% |
| X-ray of the foot, complete, 3 or more views inpatient CPT 73630 FOOT X-RAY | $308.00 | $440.00 | $176.00–$352.00 | — | 30% |
| X-ray of the hand, 3 or more views CPT 73130 HAND X-RAY | $282.10 | $403.00 | $161.20–$322.40 | 5% below | 30% |
| X-ray of the hand, 3 or more views inpatient CPT 73130 HAND X-RAY | $282.10 | $403.00 | $161.20–$322.40 | — | 30% |
| X-ray of the knee, 1 or 2 views CPT 73560 KNEE LIMITED X-RAY | $189.70 | $271.00 | $108.40–$216.80 | 28% below | 30% |
| X-ray of the knee, 1 or 2 views inpatient CPT 73560 KNEE LIMITED X-RAY | $189.70 | $271.00 | $108.40–$216.80 | — | 30% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 SPINE LUMBAR AP& LAT | $501.90 | $717.00 | $286.80–$573.60 | 91% above | 30% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 SPINE LUMBAR AP& LAT | $501.90 | $717.00 | $286.80–$573.60 | — | 30% |
| X-ray of the lower back, 4 or more views CPT 72110 SPINE LUMBAR COMPLETE | $658.00 | $940.00 | $376.00–$752.00 | 91% above | 30% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 SPINE LUMBAR COMPLETE | $658.00 | $940.00 | $376.00–$752.00 | — | 30% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 SPINE THORACIC AP & LAT | $480.90 | $687.00 | $274.80–$549.60 | 35% above | 30% |
| X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 SPINE THORACIC AP & LAT | $480.90 | $687.00 | $274.80–$549.60 | — | 30% |
| X-ray of the nasal bones, 3 or more views CPT 70160 NASAL BONES X-RAY | $349.30 | $499.00 | $199.60–$399.20 | 35% above | 30% |
| X-ray of the nasal bones, 3 or more views inpatient CPT 70160 NASAL BONES X-RAY | $349.30 | $499.00 | $199.60–$399.20 | — | 30% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 SPINE CERVICAL 3 VIEWS OR LESS | $332.50 | $475.00 | $190.00–$380.00 | 18% above | 30% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 SPINE CERVICAL 3 VIEWS OR LESS | $332.50 | $475.00 | $190.00–$380.00 | — | 30% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS X-RAY | $308.00 | $440.00 | $176.00–$352.00 | 17% above | 30% |
| X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PELVIS X-RAY | $308.00 | $440.00 | $176.00–$352.00 | — | 30% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 COCCYX & SACRUM | $513.80 | $734.00 | $293.60–$587.20 | 80% above | 30% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 COCCYX & SACRUM | $513.80 | $734.00 | $293.60–$587.20 | — | 30% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Pennsylvania | Off list |
|---|---|---|---|---|---|
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALT | $41.30 | $59.00 | $5.30–$47.20 | 33% above | 30% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALT | $41.30 | $59.00 | $23.60–$47.20 | — | 30% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 AST | $40.60 | $58.00 | $5.18–$46.40 | 36% above | 30% |
| AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 AST | $40.60 | $58.00 | $23.20–$46.40 | — | 30% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HEPATITIS PANEL, ACUTE | $371.00 | $530.00 | $47.63–$424.00 | 20% above | 30% |
| Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HEPATITIS PANEL, ACUTE | $371.00 | $530.00 | $212.00–$424.00 | — | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 RAST TEST EACH ADDITIONAL | $25.90 | $37.00 | $5.22–$29.60 | 14% below | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 LATEX SPECIFIC IGE | $25.90 | $37.00 | $5.22–$29.60 | 14% below | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGY: SINGLE ALLERGEN | $88.20 | $126.00 | $5.22–$100.80 | 194% above | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 RAST-LATEX | $88.20 | $126.00 | $5.22–$100.80 | 194% above | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 RAST-IGG SPEC-UP 5 ITEMS | $416.50 | $595.00 | $5.22–$476.00 | 1288% above | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGENS(29) | $746.20 | $1,066.00 | $5.22–$852.80 | 2387% above | 30% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RAST TEST EACH ADDITIONAL | $25.90 | $37.00 | $14.80–$29.60 | — | 30% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 LATEX SPECIFIC IGE | $25.90 | $37.00 | $14.80–$29.60 | — | 30% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGY: SINGLE ALLERGEN | $88.20 | $126.00 | $50.40–$100.80 | — | 30% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RAST-LATEX | $88.20 | $126.00 | $50.40–$100.80 | — | 30% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RAST-IGG SPEC-UP 5 ITEMS | $416.50 | $595.00 | $238.00–$476.00 | — | 30% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGENS(29) | $746.20 | $1,066.00 | $426.40–$852.80 | — | 30% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CYCLIC CITROLLINATED PEPTIDE I | $57.40 | $82.00 | $12.95–$65.60 | 21% below | 30% |
| Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CYCLIC CITROLLINATED PEPTIDE I | $57.40 | $82.00 | $32.80–$65.60 | — | 30% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA FLUID | $57.40 | $82.00 | $12.09–$65.60 | 12% below | 30% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODIES ANA* | $77.00 | $110.00 | $12.09–$88.00 | 18% above | 30% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA FLUID | $57.40 | $82.00 | $32.80–$65.60 | — | 30% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR ANTIBODIES ANA* | $77.00 | $110.00 | $44.00–$88.00 | — | 30% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 BRAIN NATRIURETIC PEPTIDE | $231.70 | $331.00 | $39.26–$264.80 | 44% above | 30% |
| BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 BRAIN NATRIURETIC PEPTIDE | $231.70 | $331.00 | $132.40–$264.80 | — | 30% |
| Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL | $142.10 | $203.00 | $8.46–$162.40 | 77% above | 30% |
| Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL | $142.10 | $203.00 | $81.20–$162.40 | — | 30% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 PATHOLOGY,SURGICAL 4 | $247.10 | $353.00 | $141.20–$282.40 | 52% above | 30% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 PATH LEVEL IV TECH FEE | $429.10 | $613.00 | $245.20–$490.40 | 163% above | 30% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 PROSTATE BIOPSY | $677.60 | $968.00 | $387.20–$774.40 | 316% above | 30% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 PATHOLOGY,SURGICAL 4 | $247.10 | $353.00 | $141.20–$282.40 | — | 30% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 PATH LEVEL IV TECH FEE | $429.10 | $613.00 | $245.20–$490.40 | — | 30% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 PROSTATE BIOPSY | $677.60 | $968.00 | $387.20–$774.40 | — | 30% |
| Blood culture for bacteria CPT 87040 BLOOD CULTURE | $143.50 | $205.00 | $10.32–$164.00 | 69% above | 30% |
| Blood culture for bacteria CPT 87040 CULTURE BLOOD 1 | $143.50 | $205.00 | $10.32–$164.00 | 69% above | 30% |
| Blood culture for bacteria inpatient CPT 87040 CULTURE BLOOD 1 | $143.50 | $205.00 | $82.00–$164.00 | — | 30% |
| Blood culture for bacteria inpatient CPT 87040 BLOOD CULTURE | $143.50 | $205.00 | $82.00–$164.00 | — | 30% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE OFFSITE | $14.00 | $20.00 | $8.00–$17.28 | 20% above | 30% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE QUEST | $14.00 | $20.00 | $8.00–$17.28 | 20% above | 30% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE LABCORP | $14.00 | $20.00 | $8.00–$17.28 | 20% above | 30% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE | $14.00 | $20.00 | $8.00–$17.28 | 20% above | 30% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE | $14.00 | $20.00 | $8.00–$16.00 | — | 30% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE QUEST | $14.00 | $20.00 | $8.00–$16.00 | — | 30% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE LABCORP | $14.00 | $20.00 | $8.00–$16.00 | — | 30% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE OFFSITE | $14.00 | $20.00 | $8.00–$16.00 | — | 30% |
| Blood glucose (sugar) test CPT 82947 GLUCOSE | $31.50 | $45.00 | $3.93–$36.00 | 29% above | 30% |
| Blood glucose (sugar) test CPT 82947 GLUCOSE,URINE | $55.30 | $79.00 | $3.93–$63.20 | 127% above | 30% |
| Blood glucose (sugar) test CPT 82947 GLUCOSE, 24 HOUR URINE | $77.00 | $110.00 | $3.93–$88.00 | 216% above | 30% |
| Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE | $31.50 | $45.00 | $18.00–$36.00 | — | 30% |
| Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE,URINE | $55.30 | $79.00 | $31.60–$63.20 | — | 30% |
| Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE, 24 HOUR URINE | $77.00 | $110.00 | $44.00–$88.00 | — | 30% |
| Blood lead test CPT 83655 LEAD BLOOD | $57.40 | $82.00 | $12.11–$65.60 | 10% below | 30% |
| Blood lead test CPT 83655 LEAD,BLOOD | $171.50 | $245.00 | $12.11–$196.00 | 170% above | 30% |
| Blood lead test CPT 83655 LEAD,URINE | $171.50 | $245.00 | $12.11–$196.00 | 170% above | 30% |
| Blood lead test inpatient CPT 83655 LEAD BLOOD | $57.40 | $82.00 | $32.80–$65.60 | — | 30% |
| Blood lead test inpatient CPT 83655 LEAD,BLOOD | $171.50 | $245.00 | $98.00–$196.00 | — | 30% |
| Blood lead test inpatient CPT 83655 LEAD,URINE | $171.50 | $245.00 | $98.00–$196.00 | — | 30% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 PREGNANCY TEST,SERUM | $115.50 | $165.00 | $7.52–$132.00 | 160% above | 30% |
| Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 PREGNANCY TEST,SERUM | $115.50 | $165.00 | $66.00–$132.00 | — | 30% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 CORDBLOOD-ABO | $245.70 | $351.00 | $140.40–$280.80 | 230% above | 30% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPING-ABO | $245.70 | $351.00 | $140.40–$280.80 | 230% above | 30% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPING ABO | $245.70 | $351.00 | $140.40–$280.80 | 230% above | 30% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BLOOD TYPING ABO | $245.70 | $351.00 | $140.40–$280.80 | — | 30% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 CORDBLOOD-ABO | $245.70 | $351.00 | $140.40–$280.80 | — | 30% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BLOOD TYPING-ABO | $245.70 | $351.00 | $140.40–$280.80 | — | 30% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 CRP(C-REACTIVE PROTEIN) | $33.60 | $48.00 | $5.18–$38.40 | at median | 30% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 CARDIO CRP | $33.60 | $48.00 | $5.18–$38.40 | at median | 30% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 CRP(C-REACTIVE PROTEIN) | $33.60 | $48.00 | $19.20–$38.40 | — | 30% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 CARDIO CRP | $33.60 | $48.00 | $19.20–$38.40 | — | 30% |
| C. difficile toxin gene test (stool PCR) CPT 87493 C DIFF TOXIN GENE, NAA | $92.40 | $132.00 | $37.27–$105.60 | 46% below | 30% |
| C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C DIFF TOXIN GENE, NAA | $92.40 | $132.00 | $52.80–$105.60 | — | 30% |
| CA 19-9 blood test (tumor marker) CPT 86301 CA 19-9 | $299.60 | $428.00 | $20.81–$342.40 | 157% above | 30% |
| CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA 19-9 | $299.60 | $428.00 | $171.20–$342.40 | — | 30% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 CA 125 | $299.60 | $428.00 | $20.81–$342.40 | 137% above | 30% |
| CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA 125 | $299.60 | $428.00 | $171.20–$342.40 | — | 30% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-COV-2 COVID 19 AMP PRB | $111.30 | $159.00 | $51.31–$127.20 | 48% above | 30% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-COV-2 COVID 19 AMP PRB | $111.30 | $159.00 | $63.60–$127.20 | — | 30% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA DNA | $88.20 | $126.00 | $35.09–$100.80 | 45% below | 30% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA DNA | $88.20 | $126.00 | $50.40–$100.80 | — | 30% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PROFILE | $171.50 | $245.00 | $13.39–$196.00 | 96% above | 30% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PROFILE | $171.50 | $245.00 | $98.00–$196.00 | — | 30% |
| Complete blood count (CBC) with differential CPT 85025 CBC &PLT | $60.20 | $86.00 | $7.77–$68.80 | 46% above | 30% |
| Complete blood count (CBC) with differential inpatient CPT 85025 CBC &PLT | $60.20 | $86.00 | $34.40–$68.80 | — | 30% |
| Complete blood count (CBC), no differential CPT 85027 CBC(WITHOUT DIFF) | $33.60 | $48.00 | $6.47–$38.40 | 5% below | 30% |
| Complete blood count (CBC), no differential inpatient CPT 85027 CBC(WITHOUT DIFF) | $33.60 | $48.00 | $19.20–$38.40 | — | 30% |
| Comprehensive metabolic panel (blood test) CPT 80053 COMPREHEN METABOLIC PANEL | $231.70 | $331.00 | $10.56–$264.80 | 139% above | 30% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHEN METABOLIC PANEL | $231.70 | $331.00 | $132.40–$264.80 | — | 30% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 DEHYDROEPIANDROSTERONE | $191.10 | $273.00 | $22.23–$218.40 | 69% above | 30% |
| DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DEHYDROEPIANDROSTERONE | $191.10 | $273.00 | $109.20–$218.40 | — | 30% |
| Estradiol blood test CPT 82670 ESTRADIOL,SERUM | $191.10 | $273.00 | $27.94–$218.40 | 34% above | 30% |
| Estradiol blood test CPT 82670 ESTRADIOL CHEMISTRY * | $460.60 | $658.00 | $27.94–$526.40 | 224% above | 30% |
| Estradiol blood test inpatient CPT 82670 ESTRADIOL,SERUM | $191.10 | $273.00 | $109.20–$218.40 | — | 30% |
| Estradiol blood test inpatient CPT 82670 ESTRADIOL CHEMISTRY * | $460.60 | $658.00 | $263.20–$526.40 | — | 30% |
| FSH (follicle-stimulating hormone) test CPT 83001 FSH | $210.70 | $301.00 | $18.58–$240.80 | 110% above | 30% |
| FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH | $210.70 | $301.00 | $120.40–$240.80 | — | 30% |
| Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN, STOOL | $136.50 | $195.00 | $19.63–$156.00 | 32% above | 30% |
| Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CALPROTECTIN, STOOL | $136.50 | $195.00 | $78.00–$156.00 | — | 30% |
| Ferritin blood test (iron stores) CPT 82728 FERRITIN | $165.20 | $236.00 | $13.63–$188.80 | 106% above | 30% |
| Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN | $165.20 | $236.00 | $94.40–$188.80 | — | 30% |
| Folate (folic acid) blood test CPT 82746 FOLIC ACID/SERUM FOLATE | $88.20 | $126.00 | $14.70–$100.80 | 17% above | 30% |
| Folate (folic acid) blood test inpatient CPT 82746 FOLIC ACID/SERUM FOLATE | $88.20 | $126.00 | $50.40–$100.80 | — | 30% |
| Free T3 thyroid hormone test CPT 84481 T3 FREE | $259.00 | $370.00 | $16.94–$296.00 | 171% above | 30% |
| Free T3 thyroid hormone test inpatient CPT 84481 T3 FREE | $259.00 | $370.00 | $148.00–$296.00 | — | 30% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 T4 FREE DIRECT DIALYSIS | $58.80 | $84.00 | $9.02–$67.20 | 12% above | 30% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 T4 FREE | $70.70 | $101.00 | $9.02–$80.80 | 34% above | 30% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 T4 FREE BY DIALYSIS | $284.20 | $406.00 | $9.02–$324.80 | 440% above | 30% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4 FREE DIRECT DIALYSIS | $58.80 | $84.00 | $33.60–$67.20 | — | 30% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4 FREE | $70.70 | $101.00 | $40.40–$80.80 | — | 30% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4 FREE BY DIALYSIS | $284.20 | $406.00 | $162.40–$324.80 | — | 30% |
| Free testosterone test CPT 84402 TESTOSTERONE FREE | $161.00 | $230.00 | $25.47–$184.00 | 25% above | 30% |
| Free testosterone test CPT 84402 TESTOSTERONE,FREE | $261.10 | $373.00 | $25.47–$298.40 | 103% above | 30% |
| Free testosterone test inpatient CPT 84402 TESTOSTERONE FREE | $161.00 | $230.00 | $92.00–$184.00 | — | 30% |
| Free testosterone test inpatient CPT 84402 TESTOSTERONE,FREE | $261.10 | $373.00 | $149.20–$298.40 | — | 30% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE 2 HOUR P.P. | $55.30 | $79.00 | $4.75–$63.20 | 49% above | 30% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE TOLERANCE-1HR. | $102.90 | $147.00 | $4.75–$117.60 | 177% above | 30% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE TOLERANCE-2HR. | $122.50 | $175.00 | $4.75–$140.00 | 230% above | 30% |
| Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE 2 HOUR P.P. | $55.30 | $79.00 | $31.60–$63.20 | — | 30% |
| Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE TOLERANCE-1HR. | $102.90 | $147.00 | $58.80–$117.60 | — | 30% |
| Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE TOLERANCE-2HR. | $122.50 | $175.00 | $70.00–$140.00 | — | 30% |
| Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE 3 SPECIM | $81.90 | $117.00 | $12.87–$93.60 | 7% above | 30% |
| Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE-3HRS. | $158.20 | $226.00 | $12.87–$180.80 | 107% above | 30% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOLERANCE 3 SPECIM | $81.90 | $117.00 | $46.80–$93.60 | — | 30% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOLERANCE-3HRS. | $158.20 | $226.00 | $90.40–$180.80 | — | 30% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 N GON0RRHOEAE DNA | $88.20 | $126.00 | $35.09–$100.80 | 40% below | 30% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 N GON0RRHOEAE DNA | $88.20 | $126.00 | $50.40–$100.80 | — | 30% |
| H. pylori antibody blood test CPT 86677 CLOTEST(FOR H.PYLORI) | $132.30 | $189.00 | $16.85–$151.20 | 31% above | 30% |
| H. pylori antibody blood test CPT 86677 H.PYLORI SEROLOGY | $370.30 | $529.00 | $16.85–$423.20 | 267% above | 30% |
| H. pylori antibody blood test inpatient CPT 86677 CLOTEST(FOR H.PYLORI) | $132.30 | $189.00 | $75.60–$151.20 | — | 30% |
| H. pylori antibody blood test inpatient CPT 86677 H.PYLORI SEROLOGY | $370.30 | $529.00 | $211.60–$423.20 | — | 30% |
| H. pylori stool antigen test CPT 87338 H PYLORI ANTIGEN | $246.40 | $352.00 | $14.38–$281.60 | 199% above | 30% |
| H. pylori stool antigen test inpatient CPT 87338 H PYLORI ANTIGEN | $246.40 | $352.00 | $140.80–$281.60 | — | 30% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV 1 RNA QUANT PCR 2ND G | $524.30 | $749.00 | $85.10–$599.20 | 15% above | 30% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1,RNA QUANT PCR | $525.00 | $750.00 | $85.10–$600.00 | 15% above | 30% |
| HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV 1 RNA QUANT PCR 2ND G | $524.30 | $749.00 | $299.60–$599.20 | — | 30% |
| HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV-1,RNA QUANT PCR | $525.00 | $750.00 | $300.00–$600.00 | — | 30% |
| HIV-1 and HIV-2 antibody test CPT 86703 HIV-1/HIV-2 BY EIA(SCREEN | $107.10 | $153.00 | $13.71–$122.40 | 12% above | 30% |
| HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV-1/HIV-2 BY EIA(SCREEN | $107.10 | $153.00 | $61.20–$122.40 | — | 30% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV-1 AG W/HIV-1 & HIV-2 AB | $51.80 | $74.00 | $24.08–$59.20 | 58% below | 30% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV-1 AG W/HIV-1 & HIV-2 AB | $51.80 | $74.00 | $29.60–$59.20 | — | 30% |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV DNA PROBE | $231.70 | $331.00 | $35.09–$264.80 | 20% above | 30% |
| HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV DNA PROBE | $231.70 | $331.00 | $132.40–$264.80 | — | 30% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 GLYCOSYLATED HEMOGLOBIN | $99.40 | $142.00 | $9.71–$113.60 | 111% above | 30% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 GLYCOSYLATED HEMOGLOBIN | $99.40 | $142.00 | $56.80–$113.60 | — | 30% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURF ANTIIBODY,QUA | $60.20 | $86.00 | $10.74–$68.80 | at median | 30% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURFACE ANTI. | $145.60 | $208.00 | $10.74–$166.40 | 142% above | 30% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B SURF ANTIIBODY,QUA | $60.20 | $86.00 | $34.40–$68.80 | — | 30% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B SURFACE ANTI. | $145.60 | $208.00 | $83.20–$166.40 | — | 30% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURFACE ANTI. | $132.30 | $189.00 | $10.33–$151.20 | 127% above | 30% |
| Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS B SURFACE ANTI. | $132.30 | $189.00 | $75.60–$151.20 | — | 30% |
| Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ANTIBODY | $210.70 | $301.00 | $14.27–$240.80 | 120% above | 30% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C ANTIBODY | $210.70 | $301.00 | $120.40–$240.80 | — | 30% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 HCV VIRAL RNA QUANT PCR | $266.00 | $380.00 | $42.84–$304.00 | 11% above | 30% |
| Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HCV VIRAL RNA QUANT PCR | $266.00 | $380.00 | $152.00–$304.00 | — | 30% |
| Herpes blood test, HSV-1 antibody CPT 86695 HERPES SIMPLEX TYPE 1 | $72.10 | $103.00 | $13.19–$82.40 | 2% below | 30% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 HERPES SIMPLEX TYPE 1 | $72.10 | $103.00 | $41.20–$82.40 | — | 30% |
| Herpes blood test, HSV-2 antibody CPT 86696 HERPES SIMPLEX TYPE 2 | $105.70 | $151.00 | $19.35–$120.80 | 17% above | 30% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 HERPES SIMPLEX TYPE 2 | $105.70 | $151.00 | $60.40–$120.80 | — | 30% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 CRP, HIGH SENSITIVITY | $37.80 | $54.00 | $12.95–$43.20 | 46% below | 30% |
| High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 CRP, HIGH SENSITIVITY | $37.80 | $54.00 | $21.60–$43.20 | — | 30% |
| Homocysteine blood test CPT 83090 HOMOCYSTEINE | $438.20 | $626.00 | $17.92–$500.80 | 343% above | 30% |
| Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINE | $438.20 | $626.00 | $250.40–$500.80 | — | 30% |
| Insulin blood test CPT 83525 INSULIN LEVEL,TOTAL | $208.60 | $298.00 | $11.43–$238.40 | 262% above | 30% |
| Insulin blood test inpatient CPT 83525 INSULIN LEVEL,TOTAL | $208.60 | $298.00 | $119.20–$238.40 | — | 30% |
| Iron blood test (serum iron) CPT 83540 IRON 24 HR URINE | $46.90 | $67.00 | $6.47–$53.60 | 3% above | 30% |
| Iron blood test (serum iron) CPT 83540 IRON | $49.70 | $71.00 | $6.47–$56.80 | 9% above | 30% |
| Iron blood test (serum iron) inpatient CPT 83540 IRON 24 HR URINE | $46.90 | $67.00 | $26.80–$53.60 | — | 30% |
| Iron blood test (serum iron) inpatient CPT 83540 IRON | $49.70 | $71.00 | $28.40–$56.80 | — | 30% |
| Iron-binding capacity (TIBC) test CPT 83550 TIBC | $56.70 | $81.00 | $8.74–$64.80 | 2% below | 30% |
| Iron-binding capacity (TIBC) test CPT 83550 IRON & TIBC,SERUM | $115.50 | $165.00 | $8.74–$132.00 | 100% above | 30% |
| Iron-binding capacity (TIBC) test inpatient CPT 83550 TIBC | $56.70 | $81.00 | $32.40–$64.80 | — | 30% |
| Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON & TIBC,SERUM | $115.50 | $165.00 | $66.00–$132.00 | — | 30% |
| Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL | $145.60 | $208.00 | $8.68–$166.40 | 113% above | 30% |
| Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL | $145.60 | $208.00 | $83.20–$166.40 | — | 30% |
| LH (luteinizing hormone) test CPT 83002 LH(LUTEINIZING HORMONE) | $238.70 | $341.00 | $18.52–$272.80 | 138% above | 30% |
| LH (luteinizing hormone) test inpatient CPT 83002 LH(LUTEINIZING HORMONE) | $238.70 | $341.00 | $136.40–$272.80 | — | 30% |
| Lipase blood test (pancreas enzyme) CPT 83690 LIPASE FLUID | $52.50 | $75.00 | $6.89–$60.00 | 25% above | 30% |
| Lipase blood test (pancreas enzyme) CPT 83690 LIPASE | $55.30 | $79.00 | $6.89–$63.20 | 31% above | 30% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE FLUID | $52.50 | $75.00 | $30.00–$60.00 | — | 30% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE | $55.30 | $79.00 | $31.60–$63.20 | — | 30% |
| Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL | $137.20 | $196.00 | $8.17–$156.80 | 73% above | 30% |
| Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL | $137.20 | $196.00 | $78.40–$156.80 | — | 30% |
| Lyme disease antibody test CPT 86618 LYME C6 ANTIBODIES | $161.00 | $230.00 | $17.03–$184.00 | 91% above | 30% |
| Lyme disease antibody test CPT 86618 LYME ANTI BORRELIA BURGDORFERI | $169.40 | $242.00 | $17.03–$193.60 | 101% above | 30% |
| Lyme disease antibody test inpatient CPT 86618 LYME C6 ANTIBODIES | $161.00 | $230.00 | $92.00–$184.00 | — | 30% |
| Lyme disease antibody test inpatient CPT 86618 LYME ANTI BORRELIA BURGDORFERI | $169.40 | $242.00 | $96.80–$193.60 | — | 30% |
| Magnesium blood test CPT 83735 MAGNESIUM RANDOM STOOL | $49.00 | $70.00 | $6.70–$56.00 | 45% above | 30% |
| Magnesium blood test CPT 83735 MAGNESIUM, URINE | $51.80 | $74.00 | $6.70–$59.20 | 53% above | 30% |
| Magnesium blood test CPT 83735 MAGNESIUM, 24 HOUR URINE | $51.80 | $74.00 | $6.70–$59.20 | 53% above | 30% |
| Magnesium blood test CPT 83735 MAGNESIUM | $51.80 | $74.00 | $6.70–$59.20 | 53% above | 30% |
| Magnesium blood test CPT 83735 MAGNESIUM,RBC | $208.60 | $298.00 | $6.70–$238.40 | 517% above | 30% |
| Magnesium blood test inpatient CPT 83735 MAGNESIUM RANDOM STOOL | $49.00 | $70.00 | $28.00–$56.00 | — | 30% |
| Magnesium blood test inpatient CPT 83735 MAGNESIUM | $51.80 | $74.00 | $29.60–$59.20 | — | 30% |
| Magnesium blood test inpatient CPT 83735 MAGNESIUM, URINE | $51.80 | $74.00 | $29.60–$59.20 | — | 30% |
| Magnesium blood test inpatient CPT 83735 MAGNESIUM, 24 HOUR URINE | $51.80 | $74.00 | $29.60–$59.20 | — | 30% |
| Magnesium blood test inpatient CPT 83735 MAGNESIUM,RBC | $208.60 | $298.00 | $119.20–$238.40 | — | 30% |
| Measles (rubeola) antibody test CPT 86765 RUBEOLA ABS IGM | $54.60 | $78.00 | $12.88–$62.40 | 24% below | 30% |
| Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA ABS IGM | $54.60 | $78.00 | $31.20–$62.40 | — | 30% |
| Mono test (heterophile antibody, Monospot) CPT 86308 HETEROPHILE ANTIBODY SCREEN | $60.20 | $86.00 | $5.18–$68.80 | 57% above | 30% |
| Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HETEROPHILE ANTIBODY SCREEN | $60.20 | $86.00 | $34.40–$68.80 | — | 30% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PSA,FREE | $225.40 | $322.00 | $18.39–$257.60 | 147% above | 30% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA,FREE | $225.40 | $322.00 | $128.80–$257.60 | — | 30% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA HYPERSENSITIVE | $225.40 | $322.00 | $18.39–$257.60 | 153% above | 30% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA, TOTAL | $225.40 | $322.00 | $18.39–$257.60 | 153% above | 30% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATIC SP ANTIGEN TOTAL | $225.40 | $322.00 | $18.39–$257.60 | 153% above | 30% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA HYPERSENSITIVE | $225.40 | $322.00 | $128.80–$257.60 | — | 30% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA, TOTAL | $225.40 | $322.00 | $128.80–$257.60 | — | 30% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROSTATIC SP ANTIGEN TOTAL | $225.40 | $322.00 | $128.80–$257.60 | — | 30% |
| Pap test (liquid-based, automated screening with review) CPT 88175 PAP TLP/AUTO/MAN/REV DIAGNOSTI | $208.60 | $298.00 | $26.61–$238.40 | 167% above | 30% |
| Pap test (liquid-based, automated screening with review) inpatient CPT 88175 PAP TLP/AUTO/MAN/REV DIAGNOSTI | $208.60 | $298.00 | $119.20–$238.40 | — | 30% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 THIN PREP PAP GYN DIAGNOSTIC | $46.90 | $67.00 | $20.26–$53.60 | 23% below | 30% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 THIN PREP PAP SCREENING | $161.70 | $231.00 | $20.26–$184.80 | 164% above | 30% |
| Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 THIN PREP PAP GYN DIAGNOSTIC | $46.90 | $67.00 | $26.80–$53.60 | — | 30% |
| Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 THIN PREP PAP SCREENING | $161.70 | $231.00 | $92.40–$184.80 | — | 30% |
| Parathyroid hormone (PTH) blood test CPT 83970 PTH,C-TERM(MID-MOL)+CALC. | $224.70 | $321.00 | $41.28–$256.80 | 10% above | 30% |
| Parathyroid hormone (PTH) blood test CPT 83970 PTH,INTACT(ICMA)+CALCIUM | $333.20 | $476.00 | $41.28–$380.80 | 64% above | 30% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH,C-TERM(MID-MOL)+CALC. | $224.70 | $321.00 | $128.40–$256.80 | — | 30% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH,INTACT(ICMA)+CALCIUM | $333.20 | $476.00 | $190.40–$380.80 | — | 30% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PTT | $25.20 | $36.00 | $6.01–$28.80 | 39% below | 30% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PTT, PLASMA | $25.20 | $36.00 | $6.01–$28.80 | 39% below | 30% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 LUPUS COMP APTT | $28.70 | $41.00 | $6.01–$32.80 | 30% below | 30% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 APTT | $60.20 | $86.00 | $6.01–$68.80 | 46% above | 30% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT, PLASMA | $25.20 | $36.00 | $14.40–$28.80 | — | 30% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT | $25.20 | $36.00 | $14.40–$28.80 | — | 30% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 LUPUS COMP APTT | $28.70 | $41.00 | $16.40–$32.80 | — | 30% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 APTT | $60.20 | $86.00 | $34.40–$68.80 | — | 30% |
| Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 FETAL CHROMOSOMAL ANEUPLOIDY | $1,561.70 | $2,231.00 | $759.05–$1,784.80 | 25% below | 30% |
| Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 FETAL CHROMOSOMAL ANEUPLOIDY | $1,561.70 | $2,231.00 | $892.40–$1,784.80 | — | 30% |
| Progesterone blood test CPT 84144 PROGESTERONE | $212.80 | $304.00 | $20.86–$243.20 | 82% above | 30% |
| Progesterone blood test inpatient CPT 84144 PROGESTERONE | $212.80 | $304.00 | $121.60–$243.20 | — | 30% |
| Prolactin blood test CPT 84146 MONOMERIC PROLACTIN | $166.60 | $238.00 | $19.38–$190.40 | 58% above | 30% |
| Prolactin blood test CPT 84146 PROLACTIN | $315.00 | $450.00 | $19.38–$360.00 | 198% above | 30% |
| Prolactin blood test inpatient CPT 84146 MONOMERIC PROLACTIN | $166.60 | $238.00 | $95.20–$190.40 | — | 30% |
| Prolactin blood test inpatient CPT 84146 PROLACTIN | $315.00 | $450.00 | $180.00–$360.00 | — | 30% |
| Prothrombin time (PT/INR) clotting test CPT 85610 LUPUS COMPREHENSIVE PROTIME | $21.70 | $31.00 | $4.29–$24.80 | 9% below | 30% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME | $42.00 | $60.00 | $4.29–$48.00 | 76% above | 30% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PT WITH HEPARIN NEUTRAL. | $293.30 | $419.00 | $4.29–$335.20 | 1127% above | 30% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 LUPUS COMPREHENSIVE PROTIME | $21.70 | $31.00 | $12.40–$24.80 | — | 30% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME | $42.00 | $60.00 | $24.00–$48.00 | — | 30% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT WITH HEPARIN NEUTRAL. | $293.30 | $419.00 | $167.60–$335.20 | — | 30% |
| Rapid flu test (influenza antigen) CPT 87804 INFLUENZA B DIRECT AG | $151.90 | $217.00 | $16.55–$173.60 | 335% above | 30% |
| Rapid flu test (influenza antigen) CPT 87804 INFLUENZA A DIRECT AG | $151.90 | $217.00 | $16.55–$173.60 | 335% above | 30% |
| Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA A DIRECT AG | $151.90 | $217.00 | $86.80–$173.60 | — | 30% |
| Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA B DIRECT AG | $151.90 | $217.00 | $86.80–$173.60 | — | 30% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 RAPID STREP,THROAT | $65.80 | $94.00 | $16.53–$75.20 | 26% above | 30% |
| Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 RAPID STREP,THROAT | $65.80 | $94.00 | $37.60–$75.20 | — | 30% |
| Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR FLUID | $28.00 | $40.00 | $5.67–$32.00 | 28% below | 30% |
| Rheumatoid factor (RF) test CPT 86431 RA TITER | $116.90 | $167.00 | $5.67–$133.60 | 200% above | 30% |
| Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR FLUID | $28.00 | $40.00 | $16.00–$32.00 | — | 30% |
| Rheumatoid factor (RF) test inpatient CPT 86431 RA TITER | $116.90 | $167.00 | $66.80–$133.60 | — | 30% |
| Rubella antibody test (immunity check) CPT 86762 RUBELLA TITER | $84.70 | $121.00 | $14.39–$96.80 | 5% above | 30% |
| Rubella antibody test (immunity check) CPT 86762 RUBELLA SCREEN | $84.70 | $121.00 | $14.39–$96.80 | 5% above | 30% |
| Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA SCREEN | $84.70 | $121.00 | $48.40–$96.80 | — | 30% |
| Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA TITER | $84.70 | $121.00 | $48.40–$96.80 | — | 30% |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 RBC SED RATE AUTOMATED | $7.00 | $10.00 | $2.70–$8.00 | 66% below | 30% |
| Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 RBC SED RATE AUTOMATED | $7.00 | $10.00 | $4.00–$8.00 | — | 30% |
| Stool ova and parasites exam CPT 87177 STOOL FOR O&P | $143.50 | $205.00 | $8.90–$164.00 | 192% above | 30% |
| Stool ova and parasites exam inpatient CPT 87177 STOOL FOR O&P | $143.50 | $205.00 | $82.00–$164.00 | — | 30% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLOOD,STOOL | $55.30 | $79.00 | $4.38–$63.20 | 171% above | 30% |
| Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 OCCULT BLOOD,STOOL | $55.30 | $79.00 | $31.60–$63.20 | — | 30% |
| Stool test for hidden blood by immunoassay (FIT) CPT 82274 FECAL OCCULT BLOOD, DIAGNOSTIC | $77.70 | $111.00 | $15.92–$88.80 | 116% above | 30% |
| Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 FECAL OCCULT BLOOD, DIAGNOSTIC | $77.70 | $111.00 | $44.40–$88.80 | — | 30% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR | $42.00 | $60.00 | $4.27–$48.00 | 54% above | 30% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 VDRL | $81.90 | $117.00 | $4.27–$93.60 | 201% above | 30% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR | $42.00 | $60.00 | $24.00–$48.00 | — | 30% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 VDRL | $81.90 | $117.00 | $46.80–$93.60 | — | 30% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB TEST, CELL IMMUNE MEASURE | $144.20 | $206.00 | $61.98–$164.80 | 44% below | 30% |
| TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 TB TEST, CELL IMMUNE MEASURE | $144.20 | $206.00 | $82.40–$164.80 | — | 30% |
| Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TOTAL | $161.00 | $230.00 | $25.81–$184.00 | 9% above | 30% |
| Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE | $339.50 | $485.00 | $25.81–$388.00 | 131% above | 30% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE TOTAL | $161.00 | $230.00 | $92.00–$184.00 | — | 30% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE | $339.50 | $485.00 | $194.00–$388.00 | — | 30% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 ISOENZYMES ALKALINE PHOSPHATAS | $69.30 | $99.00 | $14.55–$79.20 | 1% below | 30% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 ANTI-TPO | $92.40 | $132.00 | $14.55–$105.60 | 32% above | 30% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 LIVER KIDNEY MICROSCAN AB SCRE | $153.30 | $219.00 | $14.55–$175.20 | 118% above | 30% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 MICROSOMAL ANTIBODY | $241.50 | $345.00 | $14.55–$276.00 | 244% above | 30% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 LIVER CYTOSOL PROTEIN-1 LC-1 | $251.30 | $359.00 | $14.55–$287.20 | 258% above | 30% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 ISOENZYMES ALKALINE PHOSPHATAS | $69.30 | $99.00 | $39.60–$79.20 | — | 30% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 ANTI-TPO | $92.40 | $132.00 | $52.80–$105.60 | — | 30% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 LIVER KIDNEY MICROSCAN AB SCRE | $153.30 | $219.00 | $87.60–$175.20 | — | 30% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 MICROSOMAL ANTIBODY | $241.50 | $345.00 | $138.00–$276.00 | — | 30% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 LIVER CYTOSOL PROTEIN-1 LC-1 | $251.30 | $359.00 | $143.60–$287.20 | — | 30% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 SNSCREEN TSH | $33.60 | $48.00 | $16.80–$38.40 | 61% below | 30% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH | $156.80 | $224.00 | $16.80–$179.20 | 81% above | 30% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 SNSCREEN TSH | $33.60 | $48.00 | $19.20–$38.40 | — | 30% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH | $156.80 | $224.00 | $89.60–$179.20 | — | 30% |
| Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAG BY NAA | $136.50 | $195.00 | $35.09–$156.00 | 10% below | 30% |
| Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS VAG BY NAA | $136.50 | $195.00 | $78.00–$156.00 | — | 30% |
| Uric acid blood test CPT 84550 URIC ACID,SERUM | $37.10 | $53.00 | $4.52–$42.40 | 29% above | 30% |
| Uric acid blood test inpatient CPT 84550 URIC ACID,SERUM | $37.10 | $53.00 | $21.20–$42.40 | — | 30% |
| Urinalysis with microscope exam, automated CPT 81001 URINALYSIS-ROUTINE | $43.40 | $62.00 | $3.17–$49.60 | 47% above | 30% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS-ROUTINE | $43.40 | $62.00 | $24.80–$49.60 | — | 30% |
| Urinalysis without microscope exam, automated CPT 81003 URINALYSIS AUTO W/O MICROSCOPY | $33.60 | $48.00 | $2.25–$38.40 | 93% above | 30% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS AUTO W/O MICROSCOPY | $33.60 | $48.00 | $19.20–$38.40 | — | 30% |
| Urinalysis without microscope exam, manual CPT 81002 URINE DIPSTICK ONLY | $26.60 | $38.00 | $3.48–$30.40 | 51% above | 30% |
| Urinalysis without microscope exam, manual CPT 81002 SPECIFIC GRAVITY URINE (NON-AU | $26.60 | $38.00 | $3.48–$30.40 | 51% above | 30% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 SPECIFIC GRAVITY URINE (NON-AU | $26.60 | $38.00 | $15.20–$30.40 | — | 30% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 URINE DIPSTICK ONLY | $26.60 | $38.00 | $15.20–$30.40 | — | 30% |
| Urine culture for bacteria, with colony count CPT 87086 CULTURE URINE VOID | $146.30 | $209.00 | $8.07–$167.20 | 172% above | 30% |
| Urine culture for bacteria, with colony count CPT 87086 CULTURE,URINE C&S CATH | $146.30 | $209.00 | $8.07–$167.20 | 172% above | 30% |
| Urine culture for bacteria, with colony count inpatient CPT 87086 CULTURE URINE VOID | $146.30 | $209.00 | $83.60–$167.20 | — | 30% |
| Urine culture for bacteria, with colony count inpatient CPT 87086 CULTURE,URINE C&S CATH | $146.30 | $209.00 | $83.60–$167.20 | — | 30% |
| Urine pregnancy test, read by color change CPT 81025 PREGNANCY TEST,URINE | $115.50 | $165.00 | $8.61–$132.00 | 253% above | 30% |
| Urine pregnancy test, read by color change inpatient CPT 81025 PREGNANCY TEST,URINE | $115.50 | $165.00 | $66.00–$132.00 | — | 30% |
| Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B12 | $88.20 | $126.00 | $15.08–$100.80 | 15% above | 30% |
| Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B12 | $88.20 | $126.00 | $50.40–$100.80 | — | 30% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D,25-HYDROXY | $214.20 | $306.00 | $29.60–$244.80 | 49% above | 30% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D,25-HYDROXY | $214.20 | $306.00 | $122.40–$244.80 | — | 30% |
| Zinc blood test CPT 84630 ZINC,RBC | $105.70 | $151.00 | $11.39–$120.80 | 84% above | 30% |
| Zinc blood test CPT 84630 ZINC,SERUM OR URINE | $151.90 | $217.00 | $11.39–$173.60 | 164% above | 30% |
| Zinc blood test inpatient CPT 84630 ZINC,RBC | $105.70 | $151.00 | $60.40–$120.80 | — | 30% |
| Zinc blood test inpatient CPT 84630 ZINC,SERUM OR URINE | $151.90 | $217.00 | $86.80–$173.60 | — | 30% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG BETA SUBUNIT | $175.00 | $250.00 | $15.05–$200.00 | 131% above | 30% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCG BETA SUBUNIT | $175.00 | $250.00 | $100.00–$200.00 | — | 30% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Pennsylvania | Off list |
|---|---|---|---|---|---|
| Adenoid removal (adenoidectomy), child under 12 CPT 42830 OR REMOVAL OF ADENOIDS | $5,869.50 | $8,385.00 | $3,354.00–$6,708.00 | 4% below | 30% |
| Adenoid removal (adenoidectomy), child under 12 inpatient CPT 42830 OR REMOVAL OF ADENOIDS | $5,869.50 | $8,385.00 | $3,354.00–$6,708.00 | — | 30% |
| Arthroscopic ACL reconstruction or repair of the knee CPT 29888 OR ARTHRS AIDED ANT CR LIGM RP | $12,932.50 | $18,475.00 | $7,390.00–$14,780.00 | 61% above | 30% |
| Arthroscopic ACL reconstruction or repair of the knee inpatient CPT 29888 OR ARTHRS AIDED ANT CR LIGM RP | $12,932.50 | $18,475.00 | $7,390.00–$14,780.00 | — | 30% |
| Arthroscopic rotator cuff repair of the shoulder CPT 29827 OR SHO ARTHRS SRG RT8TR CUF RP | $12,932.50 | $18,475.00 | $7,390.00–$14,780.00 | 124% above | 30% |
| Arthroscopic rotator cuff repair of the shoulder inpatient CPT 29827 OR SHO ARTHRS SRG RT8TR CUF RP | $12,932.50 | $18,475.00 | $7,390.00–$14,780.00 | — | 30% |
| Balloon dilation of the maxillary sinus opening, one side CPT 31295 OR NSL/SINS NDSC SURG MAX SINS | $12,532.10 | $17,903.00 | $7,161.20–$14,322.40 | at median | 30% |
| Balloon dilation of the maxillary sinus opening, one side inpatient CPT 31295 OR NSL/SINS NDSC SURG MAX SINS | $12,532.10 | $17,903.00 | $7,161.20–$14,322.40 | — | 30% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 STEREOTACTIC BREAST LOC & BX | $2,905.00 | $4,150.00 | $1,660.00–$3,320.00 | 18% below | 30% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 STEREOTACTIC BREAST LOC & BX | $2,905.00 | $4,150.00 | $1,660.00–$3,320.00 | — | 30% |
| Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 TX FX FIB DIST W/O MAN CLSD | $423.50 | $605.00 | $242.00–$484.00 | 27% below | 30% |
| Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 CLSD TX DIS FIB FX (LAT M | $450.10 | $643.00 | $257.20–$514.40 | 22% below | 30% |
| Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 CLSD TX DIS FIB FX (LAT M PC | $612.50 | $875.00 | $350.00–$700.00 | 6% above | 30% |
| Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 TX FX FIB DIST W/O MAN CLSD | $423.50 | $605.00 | $242.00–$484.00 | — | 30% |
| Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 CLSD TX DIS FIB FX (LAT M | $450.10 | $643.00 | $257.20–$514.40 | — | 30% |
| Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 CLSD TX DIS FIB FX (LAT M PC | $612.50 | $875.00 | $350.00–$700.00 | — | 30% |
| Bunion correction with a bone cut near the head of the first metatarsal CPT 28296 OR COR HLX VLGS DSTL MTAR OSTE | $5,873.00 | $8,390.00 | $3,356.00–$6,712.00 | 76% above | 30% |
| Bunion correction with a bone cut near the head of the first metatarsal inpatient CPT 28296 OR COR HLX VLGS DSTL MTAR OSTE | $5,873.00 | $8,390.00 | $3,356.00–$6,712.00 | — | 30% |
| Bunion correction with removal of part of the big toe joint CPT 28292 OR COR HLX VLGS RSC PRX PHLX B | $5,873.00 | $8,390.00 | $3,356.00–$6,712.00 | 76% above | 30% |
| Bunion correction with removal of part of the big toe joint inpatient CPT 28292 OR COR HLX VLGS RSC PRX PHLX B | $5,873.00 | $8,390.00 | $3,356.00–$6,712.00 | — | 30% |
| Cardiac catheterization with coronary angiogram CPT 93458 LT HRT SEL COR LV GRAM W/WO | $18,359.60 | $26,228.00 | $10,491.20–$20,982.40 | 127% above | 30% |
| Cardiac catheterization with coronary angiogram inpatient CPT 93458 LT HRT SEL COR LV GRAM W/WO | $18,359.60 | $26,228.00 | $10,491.20–$20,982.40 | — | 30% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION EXTERNAL PC | $228.90 | $327.00 | $130.80–$261.60 | 82% below | 30% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 OR CARDIOVERSION ELECTRIC EXT | $1,183.70 | $1,691.00 | $676.40–$1,352.80 | 5% below | 30% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION EXTERNAL | $1,183.70 | $1,691.00 | $676.40–$1,352.80 | 5% below | 30% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION EXTERNAL PC | $228.90 | $327.00 | $130.80–$261.60 | — | 30% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION EXTERNAL | $1,183.70 | $1,691.00 | $676.40–$1,352.80 | — | 30% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 OR CARDIOVERSION ELECTRIC EXT | $1,183.70 | $1,691.00 | $676.40–$1,352.80 | — | 30% |
| Carpal tunnel release, open surgery CPT 64721 NEUROPLASTY CARPAL TUNNEL | $3,535.70 | $5,051.00 | $2,020.40–$4,040.80 | 7% below | 30% |
| Carpal tunnel release, open surgery CPT 64721 OR CARPAL TUNNEL SURGERY | $3,535.70 | $5,051.00 | $2,020.40–$4,040.80 | 7% below | 30% |
| Carpal tunnel release, open surgery inpatient CPT 64721 OR CARPAL TUNNEL SURGERY | $3,535.70 | $5,051.00 | $2,020.40–$4,040.80 | — | 30% |
| Carpal tunnel release, open surgery inpatient CPT 64721 NEUROPLASTY CARPAL TUNNEL | $3,535.70 | $5,051.00 | $2,020.40–$4,040.80 | — | 30% |
| Cataract surgery with lens implant CPT 66984 OR XCAPSL CTRC RMVL W/O ECP | $4,130.70 | $5,901.00 | $2,360.40–$4,720.80 | 126% above | 30% |
| Cataract surgery with lens implant inpatient CPT 66984 OR XCAPSL CTRC RMVL W/O ECP | $4,130.70 | $5,901.00 | $2,360.40–$4,720.80 | — | 30% |
| Cervical biopsy CPT 57500 BIOPSY OF CERVIX | $1,656.20 | $2,366.00 | $946.40–$1,892.80 | at median | 30% |
| Cervical biopsy inpatient CPT 57500 BIOPSY OF CERVIX | $1,656.20 | $2,366.00 | $946.40–$1,892.80 | — | 30% |
| Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 OR CIRCUM 28 DAYS OR OLDER | $3,708.60 | $5,298.00 | $2,119.20–$4,238.40 | 14% below | 30% |
| Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 CIRCUMCISION 28 DAYS OR OLDER | $3,708.60 | $5,298.00 | $2,119.20–$4,238.40 | 14% below | 30% |
| Circumcision by surgical excision, older than 28 days (children and adults) inpatient CPT 54161 OR CIRCUM 28 DAYS OR OLDER | $3,708.60 | $5,298.00 | $2,119.20–$4,238.40 | — | 30% |
| Circumcision by surgical excision, older than 28 days (children and adults) inpatient CPT 54161 CIRCUMCISION 28 DAYS OR OLDER | $3,708.60 | $5,298.00 | $2,119.20–$4,238.40 | — | 30% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 OR CIRCUM W/CLAMP / OTHER DVC | $3,895.50 | $5,565.00 | $2,226.00–$4,452.00 | 220% above | 30% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION W/REGIONL BLOCK | $3,895.50 | $5,565.00 | $2,226.00–$4,452.00 | 220% above | 30% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 OR CIRCUM W/CLAMP / OTHER DVC | $3,895.50 | $5,565.00 | $2,226.00–$4,452.00 | — | 30% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 CIRCUMCISION W/REGIONL BLOCK | $3,895.50 | $5,565.00 | $2,226.00–$4,452.00 | — | 30% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 CLSD TX DIS RAD FX (COLLE | $450.10 | $643.00 | $257.20–$514.40 | 11% below | 30% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 CLSD TX DIS RAD FX (COLLE PC | $686.70 | $981.00 | $392.40–$784.80 | 36% above | 30% |
| Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 CLSD TX DIS RAD FX (COLLE | $450.10 | $643.00 | $257.20–$514.40 | — | 30% |
| Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 CLSD TX DIS RAD FX (COLLE PC | $686.70 | $981.00 | $392.40–$784.80 | — | 30% |
| Colonoscopy with polyp removal CPT 45385 COLONOSCOPY W/LESION REMOVAL | $1,370.60 | $1,958.00 | $783.20–$1,566.40 | 45% below | 30% |
| Colonoscopy with polyp removal CPT 45385 OR COLSC FLX W/RMVL LESION SNA | $2,139.20 | $3,056.00 | $1,222.40–$2,444.80 | 14% below | 30% |
| Colonoscopy with polyp removal inpatient CPT 45385 COLONOSCOPY W/LESION REMOVAL | $1,370.60 | $1,958.00 | $783.20–$1,566.40 | — | 30% |
| Colonoscopy with polyp removal inpatient CPT 45385 OR COLSC FLX W/RMVL LESION SNA | $2,139.20 | $3,056.00 | $1,222.40–$2,444.80 | — | 30% |
| Colonoscopy with tissue sample CPT 45380 COLONOSCOPY AND BIOPSY | $1,507.10 | $2,153.00 | $861.20–$1,722.40 | 24% below | 30% |
| Colonoscopy with tissue sample CPT 45380 OR COLONOSCOPY W/BIOPSY SIN/MU | $2,139.20 | $3,056.00 | $1,222.40–$2,444.80 | 7% above | 30% |
| Colonoscopy with tissue sample inpatient CPT 45380 COLONOSCOPY AND BIOPSY | $1,507.10 | $2,153.00 | $861.20–$1,722.40 | — | 30% |
| Colonoscopy with tissue sample inpatient CPT 45380 OR COLONOSCOPY W/BIOPSY SIN/MU | $2,139.20 | $3,056.00 | $1,222.40–$2,444.80 | — | 30% |
| Colonoscopy, diagnostic CPT 45378 COLONOSCOPY FLX DX WHEN PFRMD | $1,705.20 | $2,436.00 | $974.40–$1,948.80 | 14% above | 30% |
| Colonoscopy, diagnostic CPT 45378 OR COLO FLX DX W/COLLJ SPEC WH | $1,705.20 | $2,436.00 | $974.40–$1,948.80 | 14% above | 30% |
| Colonoscopy, diagnostic inpatient CPT 45378 COLONOSCOPY FLX DX WHEN PFRMD | $1,705.20 | $2,436.00 | $974.40–$1,948.80 | — | 30% |
| Colonoscopy, diagnostic inpatient CPT 45378 OR COLO FLX DX W/COLLJ SPEC WH | $1,705.20 | $2,436.00 | $974.40–$1,948.80 | — | 30% |
| Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 OR COLPOSCOPY W/BX LOOP CERVIX | $5,953.50 | $8,505.00 | $3,402.00–$6,804.00 | 11% above | 30% |
| Colposcopy with LEEP (loop electrosurgical excision) inpatient CPT 57460 OR COLPOSCOPY W/BX LOOP CERVIX | $5,953.50 | $8,505.00 | $3,402.00–$6,804.00 | — | 30% |
| Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 BX/CURETT OF CERVIX W/ SCOPE | $457.80 | $654.00 | $261.60–$523.20 | 30% above | 30% |
| Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 BX/CURETT OF CERVIX W/ SCOPE | $457.80 | $654.00 | $261.60–$523.20 | — | 30% |
| Complex cataract surgery with lens implant CPT 66982 OR XCAPSL CTRC RMVL CPLX WO EC | $4,127.20 | $5,896.00 | $2,358.40–$4,716.80 | 47% above | 30% |
| Complex cataract surgery with lens implant inpatient CPT 66982 OR XCAPSL CTRC RMVL CPLX WO EC | $4,127.20 | $5,896.00 | $2,358.40–$4,716.80 | — | 30% |
| Coronary stent placement, one artery CPT 92928 BMS W/ ANGIOPLASTY, INITIAL | $21,476.70 | $30,681.00 | $12,272.40–$24,544.80 | 30% above | 30% |
| Coronary stent placement, one artery inpatient CPT 92928 BMS W/ ANGIOPLASTY, INITIAL | $21,476.70 | $30,681.00 | $12,272.40–$24,544.80 | — | 30% |
| Cystoscopy with ureteral stent placement CPT 52332 OR CYSTO WITH URETERAL STENT I | $6,244.00 | $8,920.00 | $3,568.00–$7,136.00 | 46% above | 30% |
| Cystoscopy with ureteral stent placement CPT 52332 CYSTO W/INSERT URETERAL STENT | $6,244.00 | $8,920.00 | $3,568.00–$7,136.00 | 46% above | 30% |
| Cystoscopy with ureteral stent placement inpatient CPT 52332 CYSTO W/INSERT URETERAL STENT | $6,244.00 | $8,920.00 | $3,568.00–$7,136.00 | — | 30% |
| Cystoscopy with ureteral stent placement inpatient CPT 52332 OR CYSTO WITH URETERAL STENT I | $6,244.00 | $8,920.00 | $3,568.00–$7,136.00 | — | 30% |
| Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 OR CYSTOURETHROSCOPY | $1,286.60 | $1,838.00 | $735.20–$1,470.40 | 16% below | 30% |
| Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOSCOPY | $1,286.60 | $1,838.00 | $735.20–$1,470.40 | 16% below | 30% |
| Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 OR CYSTOURETHROSCOPY | $1,286.60 | $1,838.00 | $735.20–$1,470.40 | — | 30% |
| Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 CYSTOSCOPY | $1,286.60 | $1,838.00 | $735.20–$1,470.40 | — | 30% |
| D&C (dilation and curettage), not related to pregnancy CPT 58120 OR D&C DX/THPY NON-OB | $5,755.40 | $8,222.00 | $3,288.80–$6,577.60 | 12% above | 30% |
| D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 OR D&C DX/THPY NON-OB | $5,755.40 | $8,222.00 | $3,288.80–$6,577.60 | — | 30% |
| Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 OR TYMPANOSTOMY GENERAL ANESTH | $2,683.10 | $3,833.00 | $1,533.20–$3,066.40 | 11% below | 30% |
| Ear tube placement (tympanostomy) under general anesthesia, one ear inpatient CPT 69436 OR TYMPANOSTOMY GENERAL ANESTH | $2,683.10 | $3,833.00 | $1,533.20–$3,066.40 | — | 30% |
| Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 OR TYMPANOSTOMY W/ANES LOCAL | $1,192.80 | $1,704.00 | $681.60–$1,363.20 | 39% above | 30% |
| Ear tube placement (tympanostomy) with local anesthesia, one ear inpatient CPT 69433 OR TYMPANOSTOMY W/ANES LOCAL | $1,192.80 | $1,704.00 | $681.60–$1,363.20 | — | 30% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVE EAR WAX IRRIGATE PC | $32.90 | $47.00 | $18.80–$37.60 | 72% below | 30% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVE CERUMEN IMPACTED IRRIG | $123.20 | $176.00 | $70.40–$140.80 | 5% above | 30% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVE EAR WAX IRRIGATE | $123.20 | $176.00 | $70.40–$140.80 | 5% above | 30% |
| Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 REMOVE EAR WAX IRRIGATE PC | $32.90 | $47.00 | $18.80–$37.60 | — | 30% |
| Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 REMOVE EAR WAX IRRIGATE | $123.20 | $176.00 | $70.40–$140.80 | — | 30% |
| Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 REMOVE CERUMEN IMPACTED IRRIG | $123.20 | $176.00 | $70.40–$140.80 | — | 30% |
| Earwax removal with instruments, one ear CPT 69210 REMOVAL IMPACTED CERUMEN PC | $71.40 | $102.00 | $40.80–$81.60 | 41% below | 30% |
| Earwax removal with instruments, one ear CPT 69210 REMOVAL IMPACTED CERUMEN | $136.50 | $195.00 | $78.00–$156.00 | 13% above | 30% |
| Earwax removal with instruments, one ear inpatient CPT 69210 REMOVAL IMPACTED CERUMEN PC | $71.40 | $102.00 | $40.80–$81.60 | — | 30% |
| Earwax removal with instruments, one ear inpatient CPT 69210 REMOVAL IMPACTED CERUMEN | $136.50 | $195.00 | $78.00–$156.00 | — | 30% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 BX ENDOMETRIAL SAMPLING W/O | $230.30 | $329.00 | $131.60–$263.20 | 26% below | 30% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 BX ENDOMETRIAL SAMPLING W/O | $230.30 | $329.00 | $131.60–$263.20 | — | 30% |
| Endoscopic sinus surgery: full ethmoid sinus opening CPT 31255 OR NSL/SINS NDSC W/TOT ETHMDCT | $12,532.10 | $17,903.00 | $7,161.20–$14,322.40 | at median | 30% |
| Endoscopic sinus surgery: full ethmoid sinus opening inpatient CPT 31255 OR NSL/SINS NDSC W/TOT ETHMDCT | $12,532.10 | $17,903.00 | $7,161.20–$14,322.40 | — | 30% |
| Endoscopic sinus surgery: opening the frontal sinus CPT 31276 OR NSL/SINS NDSC FRNT TISS RMV | $12,532.10 | $17,903.00 | $7,161.20–$14,322.40 | at median | 30% |
| Endoscopic sinus surgery: opening the frontal sinus inpatient CPT 31276 OR NSL/SINS NDSC FRNT TISS RMV | $12,532.10 | $17,903.00 | $7,161.20–$14,322.40 | — | 30% |
| Endoscopic sinus surgery: opening the maxillary (cheek) sinus CPT 31256 OR ENDO NASAL W/MAXIL ANTROSTO | $6,675.20 | $9,536.00 | $3,814.40–$7,628.80 | 3% above | 30% |
| Endoscopic sinus surgery: opening the maxillary (cheek) sinus inpatient CPT 31256 OR ENDO NASAL W/MAXIL ANTROSTO | $6,675.20 | $9,536.00 | $3,814.40–$7,628.80 | — | 30% |
| Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue CPT 31267 OR ENDO NASAL REM MAXILLARY- | $12,531.40 | $17,902.00 | $7,160.80–$14,321.60 | at median | 30% |
| Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue inpatient CPT 31267 OR ENDO NASAL REM MAXILLARY- | $12,531.40 | $17,902.00 | $7,160.80–$14,321.60 | — | 30% |
| First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 OR RPR AA HRN 1ST 3-10 RDC | $11,293.80 | $16,134.00 | $6,453.60–$12,907.20 | 33% above | 30% |
| First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm inpatient CPT 49593 OR RPR AA HRN 1ST 3-10 RDC | $11,293.80 | $16,134.00 | $6,453.60–$12,907.20 | — | 30% |
| First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 OR RPR AA HRN 1ST < 3 CM RDC | $6,391.00 | $9,130.00 | $3,652.00–$7,304.00 | 7% above | 30% |
| First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm inpatient CPT 49591 OR RPR AA HRN 1ST < 3 CM RDC | $6,391.00 | $9,130.00 | $3,652.00–$7,304.00 | — | 30% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 SIGMOIDOSCOPY DIAG FLEXIBLE | $1,144.50 | $1,635.00 | $654.00–$1,308.00 | 63% above | 30% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 OR SIGMOIDOSCOPY DIAG FLEXIBLE | $1,764.00 | $2,520.00 | $1,008.00–$2,016.00 | 151% above | 30% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 SIGMOIDOSCOPY DIAG FLEXIBLE | $1,144.50 | $1,635.00 | $654.00–$1,308.00 | — | 30% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 OR SIGMOIDOSCOPY DIAG FLEXIBLE | $1,764.00 | $2,520.00 | $1,008.00–$2,016.00 | — | 30% |
| Gallbladder removal, laparoscopic CPT 47562 OR LAPAROSCOPIC CHOLECYSTECTOM | $10,562.30 | $15,089.00 | $6,035.60–$12,071.20 | 39% above | 30% |
| Gallbladder removal, laparoscopic inpatient CPT 47562 OR LAPAROSCOPIC CHOLECYSTECTOM | $10,562.30 | $15,089.00 | $6,035.60–$12,071.20 | — | 30% |
| Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 OR LAPARO CHOLECYSTECTOMY/GRAP | $10,562.30 | $15,089.00 | $6,035.60–$12,071.20 | 17% above | 30% |
| Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery inpatient CPT 47563 OR LAPARO CHOLECYSTECTOMY/GRAP | $10,562.30 | $15,089.00 | $6,035.60–$12,071.20 | — | 30% |
| Hammertoe correction surgery CPT 28285 OR REPAIR OF HAMMERTOE | $5,873.00 | $8,390.00 | $3,356.00–$6,712.00 | 17% above | 30% |
| Hammertoe correction surgery inpatient CPT 28285 OR REPAIR OF HAMMERTOE | $5,873.00 | $8,390.00 | $3,356.00–$6,712.00 | — | 30% |
| Hemorrhoid banding (rubber band ligation) CPT 46221 HEMORRHOIDECTOMY,INTERNAL, RB | $832.30 | $1,189.00 | $475.60–$951.20 | 44% above | 30% |
| Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 HEMORRHOIDECTOMY,INTERNAL, RB | $832.30 | $1,189.00 | $475.60–$951.20 | — | 30% |
| Hemorrhoidectomy (internal and external), one area CPT 46255 HEMORRHOIDECTOMY | $4,412.10 | $6,303.00 | $2,521.20–$5,042.40 | 2% above | 30% |
| Hemorrhoidectomy (internal and external), one area inpatient CPT 46255 HEMORRHOIDECTOMY | $4,412.10 | $6,303.00 | $2,521.20–$5,042.40 | — | 30% |
| Hysterectomy through an abdominal incision (total) CPT 58150 OR HYST ABD TOTAL IPO | $14,700.00 | $21,000.00 | $8,400.00–$16,800.00 | 410% above | 30% |
| Hysterectomy through an abdominal incision (total) inpatient CPT 58150 OR HYST ABD TOTAL IPO | $14,700.00 | $21,000.00 | $8,400.00–$16,800.00 | — | 30% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 INJ. PROCED.HYSTEROSALPIN | $468.30 | $669.00 | $267.60–$535.20 | 42% above | 30% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 CATH/INTRO SALINE/CONTRAST SIS | $468.30 | $669.00 | $267.60–$535.20 | 42% above | 30% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 CATH/INTRO SALINE/CONTRAST SIS | $468.30 | $669.00 | $267.60–$535.20 | — | 30% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 INJ. PROCED.HYSTEROSALPIN | $468.30 | $669.00 | $267.60–$535.20 | — | 30% |
| Hysteroscopy with endometrial ablation CPT 58563 OR HYSTEROSCOPY ABLATION | $8,937.60 | $12,768.00 | $5,107.20–$10,214.40 | 3% above | 30% |
| Hysteroscopy with endometrial ablation inpatient CPT 58563 OR HYSTEROSCOPY ABLATION | $8,937.60 | $12,768.00 | $5,107.20–$10,214.40 | — | 30% |
| Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 HYSTEROSC BX ENDOMETRIAL | $5,755.40 | $8,222.00 | $3,288.80–$6,577.60 | 81% above | 30% |
| Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 OR HYSTEROSCOPY BIOPSY | $5,755.40 | $8,222.00 | $3,288.80–$6,577.60 | 81% above | 30% |
| Hysteroscopy with uterine lining sampling and/or polyp removal inpatient CPT 58558 OR HYSTEROSCOPY BIOPSY | $5,755.40 | $8,222.00 | $3,288.80–$6,577.60 | — | 30% |
| Hysteroscopy with uterine lining sampling and/or polyp removal inpatient CPT 58558 HYSTEROSC BX ENDOMETRIAL | $5,755.40 | $8,222.00 | $3,288.80–$6,577.60 | — | 30% |
| IUD insertion (the device itself billed separately) CPT 58300 OR INSERT INTRAUTERINE DEVICE | $6,652.10 | $9,503.00 | $2,850.90–$7,602.40 | 2515% above | 30% |
| IUD insertion (the device itself billed separately) inpatient CPT 58300 OR INSERT INTRAUTERINE DEVICE | $6,652.10 | $9,503.00 | $3,801.20–$7,602.40 | — | 30% |
| Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS SKIN SIMPLE PC | $219.80 | $314.00 | $125.60–$251.20 | 39% below | 30% |
| Incision and drainage of a simple or single skin abscess CPT 10060 OR I&D ABSC SMP | $375.20 | $536.00 | $214.40–$428.80 | 4% above | 30% |
| Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS SKIN SIMPLE | $375.20 | $536.00 | $214.40–$428.80 | 4% above | 30% |
| Incision and drainage of a simple or single skin abscess CPT 10060 DRAINAGE OF SKIN ABSCESS SIMPL | $375.20 | $536.00 | $214.40–$428.80 | 4% above | 30% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D ABSCESS SKIN SIMPLE PC | $219.80 | $314.00 | $125.60–$251.20 | — | 30% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 OR I&D ABSC SMP | $375.20 | $536.00 | $214.40–$428.80 | — | 30% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 DRAINAGE OF SKIN ABSCESS SIMPL | $375.20 | $536.00 | $214.40–$428.80 | — | 30% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D ABSCESS SKIN SIMPLE | $375.20 | $536.00 | $214.40–$428.80 | — | 30% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 OR PRP I/HERN INIT REDUC >5 YR | $6,391.00 | $9,130.00 | $3,652.00–$7,304.00 | 102% above | 30% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 PRP I/HERN INIT REDUC >5 YR | $6,391.00 | $9,130.00 | $3,652.00–$7,304.00 | 102% above | 30% |
| Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 OR PRP I/HERN INIT REDUC >5 YR | $6,391.00 | $9,130.00 | $3,652.00–$7,304.00 | — | 30% |
| Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 PRP I/HERN INIT REDUC >5 YR | $6,391.00 | $9,130.00 | $3,652.00–$7,304.00 | — | 30% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJECT TNDN/LIGAMENT/CYST PC | $84.00 | $120.00 | $48.00–$96.00 | 88% below | 30% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 OR INJ SINGLE TENDON/LIGAMENT | $569.80 | $814.00 | $325.60–$651.20 | 16% below | 30% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ SINGLE TENDON/LIGAMENT | $569.80 | $814.00 | $325.60–$651.20 | 16% below | 30% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJECT TNDN/LIGAMENT/CYST | $569.80 | $814.00 | $325.60–$651.20 | 16% below | 30% |
| Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJECT TNDN/LIGAMENT/CYST PC | $84.00 | $120.00 | $48.00–$96.00 | — | 30% |
| Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 OR INJ SINGLE TENDON/LIGAMENT | $569.80 | $814.00 | $325.60–$651.20 | — | 30% |
| Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJ SINGLE TENDON/LIGAMENT | $569.80 | $814.00 | $325.60–$651.20 | — | 30% |
| Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJECT TNDN/LIGAMENT/CYST | $569.80 | $814.00 | $325.60–$651.20 | — | 30% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJ JOINT/BURSA PC | $96.60 | $138.00 | $55.20–$110.40 | 79% below | 30% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJ JOINT/BURSA | $533.40 | $762.00 | $304.80–$609.60 | 17% above | 30% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 OR DRAIN/INJ JOINT/BURSA W/O U | $533.40 | $762.00 | $304.80–$609.60 | 17% above | 30% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHROCENT ASP/INJ JT MAJOR | $551.60 | $788.00 | $315.20–$630.40 | 21% above | 30% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRAIN/INJ JOINT/BURSA PC | $96.60 | $138.00 | $55.20–$110.40 | — | 30% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRAIN/INJ JOINT/BURSA | $533.40 | $762.00 | $304.80–$609.60 | — | 30% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 OR DRAIN/INJ JOINT/BURSA W/O U | $533.40 | $762.00 | $304.80–$609.60 | — | 30% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ARTHROCENT ASP/INJ JT MAJOR | $551.60 | $788.00 | $315.20–$630.40 | — | 30% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTOCENT ASP/INJ JT/BRSA IN PC | $79.80 | $114.00 | $45.60–$91.20 | 78% below | 30% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHROCENT ASP/INJ JT/BURSA IN | $416.50 | $595.00 | $238.00–$476.00 | 12% above | 30% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/INJ JOINT/BURSA W/O US | $508.90 | $727.00 | $290.80–$581.60 | 37% above | 30% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ARTOCENT ASP/INJ JT/BRSA IN PC | $79.80 | $114.00 | $45.60–$91.20 | — | 30% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ARTHROCENT ASP/INJ JT/BURSA IN | $416.50 | $595.00 | $238.00–$476.00 | — | 30% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 DRAIN/INJ JOINT/BURSA W/O US | $508.90 | $727.00 | $290.80–$581.60 | — | 30% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAIN/INJ JOINT/BURSA W/O US | $416.50 | $595.00 | $238.00–$476.00 | 4% below | 30% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHRO SM JOINT / BURSA | $416.50 | $595.00 | $238.00–$476.00 | 4% below | 30% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHRO SM JOINT/BURSA/CYS | $416.50 | $595.00 | $238.00–$476.00 | 4% below | 30% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHRO SM JOINT / BURSA | $416.50 | $595.00 | $238.00–$476.00 | — | 30% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHRO SM JOINT/BURSA/CYS | $416.50 | $595.00 | $238.00–$476.00 | — | 30% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 DRAIN/INJ JOINT/BURSA W/O US | $416.50 | $595.00 | $238.00–$476.00 | — | 30% |
| Knee arthroscopy with meniscus trim CPT 29881 OR KNEE ARTHROSCOPY/SURGERY | $5,873.00 | $8,390.00 | $3,356.00–$6,712.00 | 76% above | 30% |
| Knee arthroscopy with meniscus trim inpatient CPT 29881 OR KNEE ARTHROSCOPY/SURGERY | $5,873.00 | $8,390.00 | $3,356.00–$6,712.00 | — | 30% |
| Knee arthroscopy with removal of both torn meniscus parts CPT 29880 OR ARTHRS KNEE W/MENISC MED&LA | $5,873.00 | $8,390.00 | $3,356.00–$6,712.00 | 76% above | 30% |
| Knee arthroscopy with removal of both torn meniscus parts inpatient CPT 29880 OR ARTHRS KNEE W/MENISC MED&LA | $5,873.00 | $8,390.00 | $3,356.00–$6,712.00 | — | 30% |
| Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 OR ARTHR OSC KNEE W/DEBRIDE | $5,873.00 | $8,390.00 | $3,356.00–$6,712.00 | 96% above | 30% |
| Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) inpatient CPT 29877 OR ARTHR OSC KNEE W/DEBRIDE | $5,873.00 | $8,390.00 | $3,356.00–$6,712.00 | — | 30% |
| Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 OR LAPAROSCOPY APPENDECTOMY | $10,562.30 | $15,089.00 | $6,035.60–$12,071.20 | 109% above | 30% |
| Laparoscopic appendectomy (appendix removal through small cuts) inpatient CPT 44970 OR LAPAROSCOPY APPENDECTOMY | $10,562.30 | $15,089.00 | $6,035.60–$12,071.20 | — | 30% |
| Laparoscopic hysterectomy (uterus 250 g or less) CPT 58570 OR TLH UTERUS 250 G OR LESS | $18,845.40 | $26,922.00 | $10,768.80–$21,537.60 | 82% above | 30% |
| Laparoscopic hysterectomy (uterus 250 g or less) inpatient CPT 58570 OR TLH UTERUS 250 G OR LESS | $18,845.40 | $26,922.00 | $10,768.80–$21,537.60 | — | 30% |
| Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries CPT 58571 OR TLH W/T/O 250 G OR LESS | $18,853.10 | $26,933.00 | $10,773.20–$21,546.40 | 273% above | 30% |
| Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries inpatient CPT 58571 OR TLH W/T/O 250 G OR LESS | $18,853.10 | $26,933.00 | $10,773.20–$21,546.40 | — | 30% |
| Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 OR LAP ING HERNIA REPAIR INIT | $10,562.30 | $15,089.00 | $6,035.60–$12,071.20 | 100% above | 30% |
| Laparoscopic inguinal (groin) hernia repair, first repair on that side inpatient CPT 49650 OR LAP ING HERNIA REPAIR INIT | $10,562.30 | $15,089.00 | $6,035.60–$12,071.20 | — | 30% |
| Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 OR LAP ING HERNIA REPAIR RECUR | $10,562.30 | $15,089.00 | $6,035.60–$12,071.20 | 78% above | 30% |
| Laparoscopic inguinal (groin) hernia repair, recurrent hernia inpatient CPT 49651 OR LAP ING HERNIA REPAIR RECUR | $10,562.30 | $15,089.00 | $6,035.60–$12,071.20 | — | 30% |
| Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 OR LAPAROSCOPY REMOVE ADNEXA | $10,562.30 | $15,089.00 | $6,035.60–$12,071.20 | 49% above | 30% |
| Laparoscopic removal of fallopian tubes and/or ovaries inpatient CPT 58661 OR LAPAROSCOPY REMOVE ADNEXA | $10,562.30 | $15,089.00 | $6,035.60–$12,071.20 | — | 30% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 INT REP SCALP/TRUNK <2.5 PC | $139.30 | $199.00 | $79.60–$159.20 | 71% below | 30% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 INT REP SCALP/TRUNK <2.5 | $398.30 | $569.00 | $227.60–$455.20 | 18% below | 30% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 INT REP SCALP/TRUNK <2.5 PC | $139.30 | $199.00 | $79.60–$159.20 | — | 30% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 INT REP SCALP/TRUNK <2.5 | $398.30 | $569.00 | $227.60–$455.20 | — | 30% |
| Left heart catheterization, diagnostic CPT 93452 LV GRAM ONLY | $18,359.60 | $26,228.00 | $10,491.20–$20,982.40 | 224% above | 30% |
| Left heart catheterization, diagnostic inpatient CPT 93452 LV GRAM ONLY | $18,359.60 | $26,228.00 | $10,491.20–$20,982.40 | — | 30% |
| Lower-back epidural injection, without imaging guidance CPT 62322 INJECTION L/S SPINE | $1,021.30 | $1,459.00 | $583.60–$1,167.20 | 42% below | 30% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 INJECTION L/S SPINE | $1,021.30 | $1,459.00 | $583.60–$1,167.20 | — | 30% |
| Lumpectomy (partial mastectomy) CPT 19301 OR PARTIAL MASTECTOMY | $6,931.40 | $9,902.00 | $3,960.80–$7,921.60 | 15% above | 30% |
| Lumpectomy (partial mastectomy) inpatient CPT 19301 OR PARTIAL MASTECTOMY | $6,931.40 | $9,902.00 | $3,960.80–$7,921.60 | — | 30% |
| Miscarriage treatment with D&C, first trimester CPT 59820 OR CARE OF MISCARRIAGE | $5,755.40 | $8,222.00 | $3,288.80–$6,577.60 | 6% above | 30% |
| Miscarriage treatment with D&C, first trimester inpatient CPT 59820 OR CARE OF MISCARRIAGE | $5,755.40 | $8,222.00 | $3,288.80–$6,577.60 | — | 30% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 OR EXC LESN BGN TRUNK/ARM <0.5 | $1,323.00 | $1,890.00 | $756.00–$1,512.00 | 17% above | 30% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 OR EXC LESN BGN TRUNK/ARM <0.5 | $1,323.00 | $1,890.00 | $756.00–$1,512.00 | — | 30% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXC LESN BGN FACE/EAR 0.5CM /< | $1,301.30 | $1,859.00 | $743.60–$1,487.20 | 80% above | 30% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 OR EXC FACE-MM B9+MARG 0.5CM/< | $1,301.30 | $1,859.00 | $743.60–$1,487.20 | 80% above | 30% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 EXC LESN BGN FACE/EAR 0.5CM /< | $1,301.30 | $1,859.00 | $743.60–$1,487.20 | — | 30% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 OR EXC FACE-MM B9+MARG 0.5CM/< | $1,301.30 | $1,859.00 | $743.60–$1,487.20 | — | 30% |
| Nail removal (partial or complete), one nail CPT 11730 AVULSION NAIL PLATE SINGLE PC | $114.10 | $163.00 | $65.20–$130.40 | 63% below | 30% |
| Nail removal (partial or complete), one nail CPT 11730 AVULSION NAIL PLATE SINGLE | $222.60 | $318.00 | $127.20–$254.40 | 28% below | 30% |
| Nail removal (partial or complete), one nail CPT 11730 OR AVULSION NAIL PLATE SINGLE | $392.00 | $560.00 | $224.00–$448.00 | 27% above | 30% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSION NAIL PLATE SINGLE PC | $114.10 | $163.00 | $65.20–$130.40 | — | 30% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSION NAIL PLATE SINGLE | $222.60 | $318.00 | $127.20–$254.40 | — | 30% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 OR AVULSION NAIL PLATE SINGLE | $392.00 | $560.00 | $224.00–$448.00 | — | 30% |
| Occipital nerve block (injection for headaches) CPT 64405 ER INJ ANES/STER GREAT OCC PC | $156.80 | $224.00 | $89.60–$179.20 | 73% below | 30% |
| Occipital nerve block (injection for headaches) CPT 64405 ER INJ ANES/STER GREAT OCCIPIT | $534.80 | $764.00 | $305.60–$611.20 | 9% below | 30% |
| Occipital nerve block (injection for headaches) CPT 64405 NERVE BLOCK OCCIPITAL | $578.90 | $827.00 | $330.80–$661.60 | 1% below | 30% |
| Occipital nerve block (injection for headaches) inpatient CPT 64405 ER INJ ANES/STER GREAT OCC PC | $156.80 | $224.00 | $89.60–$179.20 | — | 30% |
| Occipital nerve block (injection for headaches) inpatient CPT 64405 ER INJ ANES/STER GREAT OCCIPIT | $534.80 | $764.00 | $305.60–$611.20 | — | 30% |
| Occipital nerve block (injection for headaches) inpatient CPT 64405 NERVE BLOCK OCCIPITAL | $578.90 | $827.00 | $330.80–$661.60 | — | 30% |
| Pacemaker implant (dual chamber) CPT 33208 INSERT HEART PM ATRIAL & VENT | $61,357.10 | $87,653.00 | $35,061.20–$70,122.40 | 278% above | 30% |
| Pacemaker implant (dual chamber) CPT 33208 OR INS NEW/ REPL PERM PACEMKR | $61,357.10 | $87,653.00 | $35,061.20–$70,122.40 | 278% above | 30% |
| Pacemaker implant (dual chamber) inpatient CPT 33208 OR INS NEW/ REPL PERM PACEMKR | $61,357.10 | $87,653.00 | $35,061.20–$70,122.40 | — | 30% |
| Pacemaker implant (dual chamber) inpatient CPT 33208 INSERT HEART PM ATRIAL & VENT | $61,357.10 | $87,653.00 | $35,061.20–$70,122.40 | — | 30% |
| Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS WITH IMAGI PC | $546.70 | $781.00 | $312.40–$624.80 | 68% below | 30% |
| Paracentesis with imaging guidance CPT 49083 ABDOMINAL PARACENTESIS | $1,213.10 | $1,733.00 | $693.20–$1,386.40 | 28% below | 30% |
| Paracentesis with imaging guidance CPT 49083 US PARACENTESIS W IMG GUIDE | $1,624.70 | $2,321.00 | $928.40–$1,856.80 | 4% below | 30% |
| Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS WITH IMAGI | $1,707.30 | $2,439.00 | $975.60–$1,951.20 | 1% above | 30% |
| Paracentesis with imaging guidance inpatient CPT 49083 ABD PARACENTESIS WITH IMAGI PC | $546.70 | $781.00 | $312.40–$624.80 | — | 30% |
| Paracentesis with imaging guidance inpatient CPT 49083 ABDOMINAL PARACENTESIS | $1,213.10 | $1,733.00 | $693.20–$1,386.40 | — | 30% |
| Paracentesis with imaging guidance inpatient CPT 49083 US PARACENTESIS W IMG GUIDE | $1,624.70 | $2,321.00 | $928.40–$1,856.80 | — | 30% |
| Paracentesis with imaging guidance inpatient CPT 49083 ABD PARACENTESIS WITH IMAGI | $1,707.30 | $2,439.00 | $975.60–$1,951.20 | — | 30% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 REMOVAL/EXC NAIL PART/COM PC | $213.50 | $305.00 | $122.00–$244.00 | 64% below | 30% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXC NAIL MATRIX PERM REMOVAL | $505.40 | $722.00 | $288.80–$577.60 | 15% below | 30% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 REMOVAL/EXC NAIL PART/COM | $753.20 | $1,076.00 | $430.40–$860.80 | 27% above | 30% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 OR EXC NAIL & MATRIX | $753.20 | $1,076.00 | $430.40–$860.80 | 27% above | 30% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 REMOVAL/EXC NAIL PART/COM PC | $213.50 | $305.00 | $122.00–$244.00 | — | 30% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXC NAIL MATRIX PERM REMOVAL | $505.40 | $722.00 | $288.80–$577.60 | — | 30% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 REMOVAL/EXC NAIL PART/COM | $753.20 | $1,076.00 | $430.40–$860.80 | — | 30% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 OR EXC NAIL & MATRIX | $753.20 | $1,076.00 | $430.40–$860.80 | — | 30% |
| Prostate biopsy CPT 55700 BIOPSY OF PROSTATE | $3,832.50 | $5,475.00 | $1,642.50–$4,380.00 | 33% above | 30% |
| Prostate biopsy inpatient CPT 55700 BIOPSY OF PROSTATE | $3,832.50 | $5,475.00 | $2,190.00–$4,380.00 | — | 30% |
| Prostate removal (prostatectomy), laparoscopic CPT 55866 OR LAPS SURG PRST8ECT RPBIC | $18,926.60 | $27,038.00 | $10,815.20–$21,630.40 | 4% below | 30% |
| Prostate removal (prostatectomy), laparoscopic CPT 55866 LAPS SURG PRST8ECT RPBIC RAD | $18,926.60 | $27,038.00 | $10,815.20–$21,630.40 | 4% below | 30% |
| Prostate removal (prostatectomy), laparoscopic inpatient CPT 55866 LAPS SURG PRST8ECT RPBIC RAD | $18,926.60 | $27,038.00 | $10,815.20–$21,630.40 | — | 30% |
| Prostate removal (prostatectomy), laparoscopic inpatient CPT 55866 OR LAPS SURG PRST8ECT RPBIC | $18,926.60 | $27,038.00 | $10,815.20–$21,630.40 | — | 30% |
| Removal of a breast lump, open surgery CPT 19120 OR EXC CYST/LESN BREAST | $6,931.40 | $9,902.00 | $3,960.80–$7,921.60 | 12% above | 30% |
| Removal of a breast lump, open surgery inpatient CPT 19120 OR EXC CYST/LESN BREAST | $6,931.40 | $9,902.00 | $3,960.80–$7,921.60 | — | 30% |
| Removal of a foreign object under the skin, simple CPT 10120 I&REMOVAL FB SUBCU SIMPLE PC | $216.30 | $309.00 | $123.60–$247.20 | 56% below | 30% |
| Removal of a foreign object under the skin, simple CPT 10120 I&REMOVAL FB SUBCU SIMPLE | $724.50 | $1,035.00 | $414.00–$828.00 | 48% above | 30% |
| Removal of a foreign object under the skin, simple CPT 10120 INCISION/REM FB SUBQ SMP | $724.50 | $1,035.00 | $414.00–$828.00 | 48% above | 30% |
| Removal of a foreign object under the skin, simple CPT 10120 OR INC&RMVL FB SUBQ TISS SMPL | $724.50 | $1,035.00 | $414.00–$828.00 | 48% above | 30% |
| Removal of a foreign object under the skin, simple CPT 10120 REMOVE FOREIGN BODY | $724.50 | $1,035.00 | $414.00–$828.00 | 48% above | 30% |
| Removal of a foreign object under the skin, simple CPT 10120 I&R FB SUBCU SIMPLE | $724.50 | $1,035.00 | $414.00–$828.00 | 48% above | 30% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 I&REMOVAL FB SUBCU SIMPLE PC | $216.30 | $309.00 | $123.60–$247.20 | — | 30% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 REMOVE FOREIGN BODY | $724.50 | $1,035.00 | $414.00–$828.00 | — | 30% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 I&REMOVAL FB SUBCU SIMPLE | $724.50 | $1,035.00 | $414.00–$828.00 | — | 30% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 OR INC&RMVL FB SUBQ TISS SMPL | $724.50 | $1,035.00 | $414.00–$828.00 | — | 30% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 INCISION/REM FB SUBQ SMP | $724.50 | $1,035.00 | $414.00–$828.00 | — | 30% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 I&R FB SUBCU SIMPLE | $724.50 | $1,035.00 | $414.00–$828.00 | — | 30% |
| Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 OR COLON CA SCREENING | $1,759.80 | $2,514.00 | $1,005.60–$2,011.20 | 16% above | 30% |
| Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 COLON CA SCREENING | $1,759.80 | $2,514.00 | $1,005.60–$2,011.20 | 16% above | 30% |
| Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 COLON CA SCREENING | $1,759.80 | $2,514.00 | $1,005.60–$2,011.20 | — | 30% |
| Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 OR COLON CA SCREENING | $1,759.80 | $2,514.00 | $1,005.60–$2,011.20 | — | 30% |
| Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 OR COLORECTAL SCRN; HI RISK IN | $1,759.80 | $2,514.00 | $1,005.60–$2,011.20 | 7% above | 30% |
| Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 COLON CA SCREENING HIGH RISK | $1,759.80 | $2,514.00 | $1,005.60–$2,011.20 | 7% above | 30% |
| Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 OR COLORECTAL SCRN; HI RISK IN | $1,759.80 | $2,514.00 | $1,005.60–$2,011.20 | — | 30% |
| Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 COLON CA SCREENING HIGH RISK | $1,759.80 | $2,514.00 | $1,005.60–$2,011.20 | — | 30% |
| Septoplasty to straighten the nasal septum CPT 30520 OR REPAIR OF NASAL SEPTUM | $5,869.50 | $8,385.00 | $3,354.00–$6,708.00 | 80% above | 30% |
| Septoplasty to straighten the nasal septum inpatient CPT 30520 OR REPAIR OF NASAL SEPTUM | $5,869.50 | $8,385.00 | $3,354.00–$6,708.00 | — | 30% |
| Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 OR FRAGMENTING OF KIDNEY STONE | $6,245.40 | $8,922.00 | $3,568.80–$7,137.60 | 5% below | 30% |
| Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 FRAGMENTING OF KIDNEY STONE | $6,558.30 | $9,369.00 | $3,747.60–$7,495.20 | at median | 30% |
| Shock-wave lithotripsy to break up kidney stones (from outside the body) inpatient CPT 50590 OR FRAGMENTING OF KIDNEY STONE | $6,245.40 | $8,922.00 | $3,568.80–$7,137.60 | — | 30% |
| Shock-wave lithotripsy to break up kidney stones (from outside the body) inpatient CPT 50590 FRAGMENTING OF KIDNEY STONE | $6,558.30 | $9,369.00 | $3,747.60–$7,495.20 | — | 30% |
| Short arm cast (elbow to hand) CPT 29075 APP OF FOREARM CAST | $410.90 | $587.00 | $234.80–$469.60 | 11% above | 30% |
| Short arm cast (elbow to hand) CPT 29075 APP OF FOREARM CAST PC | $449.40 | $642.00 | $256.80–$513.60 | 21% above | 30% |
| Short arm cast (elbow to hand) inpatient CPT 29075 APP OF FOREARM CAST | $410.90 | $587.00 | $234.80–$469.60 | — | 30% |
| Short arm cast (elbow to hand) inpatient CPT 29075 APP OF FOREARM CAST PC | $449.40 | $642.00 | $256.80–$513.60 | — | 30% |
| Short arm splint (forearm and hand) CPT 29125 APPL SHORT ARM SPLINT,STA PC | $84.70 | $121.00 | $48.40–$96.80 | 72% below | 30% |
| Short arm splint (forearm and hand) CPT 29125 OT APPL SPLINT ARM SHORT STATC | $232.40 | $332.00 | $132.80–$265.60 | 23% below | 30% |
| Short arm splint (forearm and hand) CPT 29125 APPL SHORT ARM SPLINT,STA | $246.40 | $352.00 | $140.80–$281.60 | 18% below | 30% |
| Short arm splint (forearm and hand) inpatient CPT 29125 APPL SHORT ARM SPLINT,STA PC | $84.70 | $121.00 | $48.40–$96.80 | — | 30% |
| Short arm splint (forearm and hand) inpatient CPT 29125 OT APPL SPLINT ARM SHORT STATC | $232.40 | $332.00 | $132.80–$265.60 | — | 30% |
| Short arm splint (forearm and hand) inpatient CPT 29125 APPL SHORT ARM SPLINT,STA | $246.40 | $352.00 | $140.80–$281.60 | — | 30% |
| Short leg cast (below the knee) CPT 29405 APLICATION SHORT LEG CAST PC | $122.50 | $175.00 | $70.00–$140.00 | 67% below | 30% |
| Short leg cast (below the knee) CPT 29405 APPLICATION SHORT LEG CAST | $375.90 | $537.00 | $214.80–$429.60 | 3% above | 30% |
| Short leg cast (below the knee) CPT 29405 APLICATION SHORT LEG CAST | $525.00 | $750.00 | $300.00–$600.00 | 43% above | 30% |
| Short leg cast (below the knee) inpatient CPT 29405 APLICATION SHORT LEG CAST PC | $122.50 | $175.00 | $70.00–$140.00 | — | 30% |
| Short leg cast (below the knee) inpatient CPT 29405 APPLICATION SHORT LEG CAST | $375.90 | $537.00 | $214.80–$429.60 | — | 30% |
| Short leg cast (below the knee) inpatient CPT 29405 APLICATION SHORT LEG CAST | $525.00 | $750.00 | $300.00–$600.00 | — | 30% |
| Short leg splint (calf to foot) CPT 29515 APPL SHORT LEG SPLINT PC | $105.00 | $150.00 | $60.00–$120.00 | 68% below | 30% |
| Short leg splint (calf to foot) CPT 29515 APPL SHORT LEG SPLINT | $308.00 | $440.00 | $176.00–$352.00 | 5% below | 30% |
| Short leg splint (calf to foot) inpatient CPT 29515 APPL SHORT LEG SPLINT PC | $105.00 | $150.00 | $60.00–$120.00 | — | 30% |
| Short leg splint (calf to foot) inpatient CPT 29515 APPL SHORT LEG SPLINT | $308.00 | $440.00 | $176.00–$352.00 | — | 30% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 OR ARTHROSC SHLDR DECOMP SUBAC | $4,498.20 | $6,426.00 | $2,570.40–$5,140.80 | 158% above | 30% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 OR ARTHROSC SHLDR DECOMP SUBAC | $4,498.20 | $6,426.00 | $2,570.40–$5,140.80 | — | 30% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 SIM REP SCAL/EXT <2.5 PC | $96.60 | $138.00 | $55.20–$110.40 | 80% below | 30% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 REPAIR SUPERFICIAL WOUND | $249.20 | $356.00 | $142.40–$284.80 | 48% below | 30% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 SIM REP SCAL/EXT <2.5 | $392.00 | $560.00 | $224.00–$448.00 | 18% below | 30% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 SIM REP SCAL/EXT <2.5 PC | $96.60 | $138.00 | $55.20–$110.40 | — | 30% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 REPAIR SUPERFICIAL WOUND | $249.20 | $356.00 | $142.40–$284.80 | — | 30% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 SIM REP SCAL/EXT <2.5 | $392.00 | $560.00 | $224.00–$448.00 | — | 30% |
| Skin biopsy, punch, one lesion CPT 11104 OR PUNCH BX SKIN SINGLE LESION | $724.50 | $1,035.00 | $414.00–$828.00 | 5% above | 30% |
| Skin biopsy, punch, one lesion CPT 11104 PUNCH BX SKIN 1ST LESION | $724.50 | $1,035.00 | $414.00–$828.00 | 5% above | 30% |
| Skin biopsy, punch, one lesion CPT 11104 PUNCH BIOPSY SKIN SGL | $724.50 | $1,035.00 | $414.00–$828.00 | 5% above | 30% |
| Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BX SKIN 1ST LESION | $724.50 | $1,035.00 | $414.00–$828.00 | — | 30% |
| Skin biopsy, punch, one lesion inpatient CPT 11104 OR PUNCH BX SKIN SINGLE LESION | $724.50 | $1,035.00 | $414.00–$828.00 | — | 30% |
| Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BIOPSY SKIN SGL | $724.50 | $1,035.00 | $414.00–$828.00 | — | 30% |
| Skin tag removal, up to 15 tags CPT 11200 REM SKINTAG < OR = 15 PC | $180.60 | $258.00 | $103.20–$206.40 | 52% below | 30% |
| Skin tag removal, up to 15 tags CPT 11200 OR REM SKIN TAG < OR =15 | $360.50 | $515.00 | $206.00–$412.00 | 5% below | 30% |
| Skin tag removal, up to 15 tags CPT 11200 RMVL SKIN TAGS UP TO&INC 15 | $360.50 | $515.00 | $206.00–$412.00 | 5% below | 30% |
| Skin tag removal, up to 15 tags CPT 11200 REM SKINTAG < OR = 15 | $360.50 | $515.00 | $206.00–$412.00 | 5% below | 30% |
| Skin tag removal, up to 15 tags inpatient CPT 11200 REM SKINTAG < OR = 15 PC | $180.60 | $258.00 | $103.20–$206.40 | — | 30% |
| Skin tag removal, up to 15 tags inpatient CPT 11200 RMVL SKIN TAGS UP TO&INC 15 | $360.50 | $515.00 | $206.00–$412.00 | — | 30% |
| Skin tag removal, up to 15 tags inpatient CPT 11200 OR REM SKIN TAG < OR =15 | $360.50 | $515.00 | $206.00–$412.00 | — | 30% |
| Skin tag removal, up to 15 tags inpatient CPT 11200 REM SKINTAG < OR = 15 | $360.50 | $515.00 | $206.00–$412.00 | — | 30% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL TAP PC | $132.30 | $189.00 | $75.60–$151.20 | 90% below | 30% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL TAP | $975.10 | $1,393.00 | $557.20–$1,114.40 | 30% below | 30% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL PUNCTURE,LUMBAR | $1,239.70 | $1,771.00 | $708.40–$1,416.80 | 11% below | 30% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL TAP PC | $132.30 | $189.00 | $75.60–$151.20 | — | 30% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL TAP | $975.10 | $1,393.00 | $557.20–$1,114.40 | — | 30% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL PUNCTURE,LUMBAR | $1,239.70 | $1,771.00 | $708.40–$1,416.80 | — | 30% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 SIM REP SCALP/EXT 2.5-7.5 PC | $126.70 | $181.00 | $72.40–$144.80 | 72% below | 30% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 SIM REP SCALP/EXT 2.6-7.5 | $392.00 | $560.00 | $224.00–$448.00 | 13% below | 30% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 SIM REP SCALP/EXT 2.5-7.5 PC | $126.70 | $181.00 | $72.40–$144.80 | — | 30% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 SIM REP SCALP/EXT 2.6-7.5 | $392.00 | $560.00 | $224.00–$448.00 | — | 30% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 RPR FACE/EAR/EYE/NS/LIP<2.5 PC | $119.00 | $170.00 | $68.00–$136.00 | 75% below | 30% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 RPR FACE/EAR/EYEL/NOSE/LIP<2.5 | $392.00 | $560.00 | $224.00–$448.00 | 18% below | 30% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 RPR FACE/EAR/EYE/NS/LIP<2.5 PC | $119.00 | $170.00 | $68.00–$136.00 | — | 30% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 RPR FACE/EAR/EYEL/NOSE/LIP<2.5 | $392.00 | $560.00 | $224.00–$448.00 | — | 30% |
| TURP (transurethral resection of the prostate) CPT 52601 PROSTATECTOMY (TURP) | $9,202.20 | $13,146.00 | $5,258.40–$10,516.80 | 7% above | 30% |
| TURP (transurethral resection of the prostate) CPT 52601 OR PROSTATECTOMY (TURP) | $9,202.20 | $13,146.00 | $5,258.40–$10,516.80 | 7% above | 30% |
| TURP (transurethral resection of the prostate) inpatient CPT 52601 PROSTATECTOMY (TURP) | $9,202.20 | $13,146.00 | $5,258.40–$10,516.80 | — | 30% |
| TURP (transurethral resection of the prostate) inpatient CPT 52601 OR PROSTATECTOMY (TURP) | $9,202.20 | $13,146.00 | $5,258.40–$10,516.80 | — | 30% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 BX TANGENTIAL SKIN SGL | $808.50 | $1,155.00 | $462.00–$924.00 | 47% above | 30% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 SKIN BX SUPERFICIAL SINGLE LES | $808.50 | $1,155.00 | $462.00–$924.00 | 47% above | 30% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 OR BX TANGENTIAL SKIN SGL | $808.50 | $1,155.00 | $462.00–$924.00 | 47% above | 30% |
| Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 OR BX TANGENTIAL SKIN SGL | $808.50 | $1,155.00 | $462.00–$924.00 | — | 30% |
| Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 BX TANGENTIAL SKIN SGL | $808.50 | $1,155.00 | $462.00–$924.00 | — | 30% |
| Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 SKIN BX SUPERFICIAL SINGLE LES | $808.50 | $1,155.00 | $462.00–$924.00 | — | 30% |
| Thoracentesis with imaging guidance CPT 32555 ASPIRATE PLEURA W/ IMAGING | $963.20 | $1,376.00 | $550.40–$1,100.80 | 30% below | 30% |
| Thoracentesis with imaging guidance CPT 32555 US THORACENTESIS W IMG GUIDE | $2,248.40 | $3,212.00 | $1,284.80–$2,569.60 | 63% above | 30% |
| Thoracentesis with imaging guidance inpatient CPT 32555 ASPIRATE PLEURA W/ IMAGING | $963.20 | $1,376.00 | $550.40–$1,100.80 | — | 30% |
| Thoracentesis with imaging guidance inpatient CPT 32555 US THORACENTESIS W IMG GUIDE | $2,248.40 | $3,212.00 | $1,284.80–$2,569.60 | — | 30% |
| Tonsil and adenoid removal, age 12 or older CPT 42821 OR TONSIL & ADENOIDECTOMY 12/> | $5,869.50 | $8,385.00 | $3,354.00–$6,708.00 | 8% below | 30% |
| Tonsil and adenoid removal, age 12 or older inpatient CPT 42821 OR TONSIL & ADENOIDECTOMY 12/> | $5,869.50 | $8,385.00 | $3,354.00–$6,708.00 | — | 30% |
| Tonsil and adenoid removal, child under 12 CPT 42820 OR REMOVE TONSILS AND ADENO<12 | $10,709.30 | $15,299.00 | $6,119.60–$12,239.20 | 12% above | 30% |
| Tonsil and adenoid removal, child under 12 inpatient CPT 42820 OR REMOVE TONSILS AND ADENO<12 | $10,709.30 | $15,299.00 | $6,119.60–$12,239.20 | — | 30% |
| Total hip replacement CPT 27130 OR TOTAL HIP ARTHROPLASTY | $23,292.50 | $33,275.00 | $13,310.00–$26,620.00 | 111% above | 30% |
| Total hip replacement inpatient CPT 27130 OR TOTAL HIP ARTHROPLASTY | $23,292.50 | $33,275.00 | $13,310.00–$26,620.00 | — | 30% |
| Total knee replacement CPT 27447 OR TOTAL KNEE ARTHROPLASTY | $23,292.50 | $33,275.00 | $13,310.00–$26,620.00 | 121% above | 30% |
| Total knee replacement inpatient CPT 27447 OR TOTAL KNEE ARTHROPLASTY | $23,292.50 | $33,275.00 | $13,310.00–$26,620.00 | — | 30% |
| Total shoulder replacement CPT 23472 OR RECONSTRUCT SHOULDER JOINT | $33,288.50 | $47,555.00 | $19,022.00–$38,044.00 | 86% above | 30% |
| Total shoulder replacement inpatient CPT 23472 OR RECONSTRUCT SHOULDER JOINT | $33,288.50 | $47,555.00 | $19,022.00–$38,044.00 | — | 30% |
| Trigger finger release surgery CPT 26055 OR INCISE FINGER TENDON SHEATH | $2,895.90 | $4,137.00 | $1,654.80–$3,309.60 | 20% below | 30% |
| Trigger finger release surgery CPT 26055 INCISION TENDON SHEATH FINGER | $2,895.90 | $4,137.00 | $1,654.80–$3,309.60 | 20% below | 30% |
| Trigger finger release surgery inpatient CPT 26055 INCISION TENDON SHEATH FINGER | $2,895.90 | $4,137.00 | $1,654.80–$3,309.60 | — | 30% |
| Trigger finger release surgery inpatient CPT 26055 OR INCISE FINGER TENDON SHEATH | $2,895.90 | $4,137.00 | $1,654.80–$3,309.60 | — | 30% |
| Trigger point injections, 1 or 2 muscles CPT 20552 INJECT TENDON SNGL/MULT PC | $81.20 | $116.00 | $46.40–$92.80 | 85% below | 30% |
| Trigger point injections, 1 or 2 muscles CPT 20552 INJECT TENDON SINGLE OR MULTIP | $569.10 | $813.00 | $325.20–$650.40 | 4% above | 30% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJECT TENDON SNGL/MULT PC | $81.20 | $116.00 | $46.40–$92.80 | — | 30% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJECT TENDON SINGLE OR MULTIP | $569.10 | $813.00 | $325.20–$650.40 | — | 30% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 US BREAST LOC & BIOPSY | $2,905.00 | $4,150.00 | $1,660.00–$3,320.00 | 8% below | 30% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 US BREAST LOC & BIOPSY | $2,905.00 | $4,150.00 | $1,660.00–$3,320.00 | — | 30% |
| Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 ESOPH EGD DILATION <30 MM | $3,436.30 | $4,909.00 | $1,963.60–$3,927.20 | 1% above | 30% |
| Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 OR ESOPH EGD DILATION <30 MM | $3,436.30 | $4,909.00 | $1,963.60–$3,927.20 | 1% above | 30% |
| Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 ESOPH EGD DILATION <30 MM | $3,436.30 | $4,909.00 | $1,963.60–$3,927.20 | — | 30% |
| Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 OR ESOPH EGD DILATION <30 MM | $3,436.30 | $4,909.00 | $1,963.60–$3,927.20 | — | 30% |
| Upper endoscopy (EGD) with biopsy CPT 43239 EGD FLEX W/BIOPSY | $1,446.90 | $2,067.00 | $826.80–$1,653.60 | 32% below | 30% |
| Upper endoscopy (EGD) with biopsy CPT 43239 OR EGD BIOPSY SINGLE/MULTIPLE | $1,698.20 | $2,426.00 | $970.40–$1,940.80 | 20% below | 30% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 EGD FLEX W/BIOPSY | $1,446.90 | $2,067.00 | $826.80–$1,653.60 | — | 30% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 OR EGD BIOPSY SINGLE/MULTIPLE | $1,698.20 | $2,426.00 | $970.40–$1,940.80 | — | 30% |
| Upper endoscopy (EGD) with injection into the lining CPT 43236 EGD W/SUBMUCOSAL INJECTION | $1,237.60 | $1,768.00 | $707.20–$1,414.40 | 56% below | 30% |
| Upper endoscopy (EGD) with injection into the lining CPT 43236 OR UPPR GI SCOPE W/SUBMUC INJ | $1,698.20 | $2,426.00 | $970.40–$1,940.80 | 39% below | 30% |
| Upper endoscopy (EGD) with injection into the lining inpatient CPT 43236 EGD W/SUBMUCOSAL INJECTION | $1,237.60 | $1,768.00 | $707.20–$1,414.40 | — | 30% |
| Upper endoscopy (EGD) with injection into the lining inpatient CPT 43236 OR UPPR GI SCOPE W/SUBMUC INJ | $1,698.20 | $2,426.00 | $970.40–$1,940.80 | — | 30% |
| Upper endoscopy (EGD) with polyp removal by snare CPT 43251 EGD W/REM TUMOR/POLYP SNARE | $3,709.30 | $5,299.00 | $2,119.60–$4,239.20 | 17% above | 30% |
| Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 EGD W/REM TUMOR/POLYP SNARE | $3,709.30 | $5,299.00 | $2,119.60–$4,239.20 | — | 30% |
| Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 EGD GUIDEWIRE INSERTION | $1,340.50 | $1,915.00 | $766.00–$1,532.00 | 46% below | 30% |
| Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 OR EGD GUIDE WIRE INSERTION | $1,698.20 | $2,426.00 | $970.40–$1,940.80 | 32% below | 30% |
| Upper endoscopy (EGD) with widening of the esophagus over a guide wire inpatient CPT 43248 EGD GUIDEWIRE INSERTION | $1,340.50 | $1,915.00 | $766.00–$1,532.00 | — | 30% |
| Upper endoscopy (EGD) with widening of the esophagus over a guide wire inpatient CPT 43248 OR EGD GUIDE WIRE INSERTION | $1,698.20 | $2,426.00 | $970.40–$1,940.80 | — | 30% |
| Upper endoscopy (EGD), diagnostic CPT 43235 EGD DX W/BRUSHING/WASHING | $1,331.40 | $1,902.00 | $760.80–$1,521.60 | 29% below | 30% |
| Upper endoscopy (EGD), diagnostic CPT 43235 OR EGD DIAGNOSTIC BRUSH WASH | $1,698.20 | $2,426.00 | $970.40–$1,940.80 | 9% below | 30% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 EGD DX W/BRUSHING/WASHING | $1,331.40 | $1,902.00 | $760.80–$1,521.60 | — | 30% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 OR EGD DIAGNOSTIC BRUSH WASH | $1,698.20 | $2,426.00 | $970.40–$1,940.80 | — | 30% |
| Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 CYSTO W/URETEROSCOPY W/LITHO | $9,269.40 | $13,242.00 | $5,296.80–$10,593.60 | 2% below | 30% |
| Ureteroscopy with laser stone breaking (lithotripsy) inpatient CPT 52353 CYSTO W/URETEROSCOPY W/LITHO | $9,269.40 | $13,242.00 | $5,296.80–$10,593.60 | — | 30% |
| Ureteroscopy with laser stone breaking and stent placement CPT 52356 CYSTO/URETERO W/LITHO & INDWEL | $9,269.40 | $13,242.00 | $5,296.80–$10,593.60 | 2% below | 30% |
| Ureteroscopy with laser stone breaking and stent placement CPT 52356 OR CYSTO/URETERO W/LITHO & IND | $9,269.40 | $13,242.00 | $5,296.80–$10,593.60 | 2% below | 30% |
| Ureteroscopy with laser stone breaking and stent placement CPT 52356 CYSTO/PYELOSC INSERT STNT | $9,830.80 | $14,044.00 | $5,617.60–$11,235.20 | 4% above | 30% |
| Ureteroscopy with laser stone breaking and stent placement inpatient CPT 52356 CYSTO/URETERO W/LITHO & INDWEL | $9,269.40 | $13,242.00 | $5,296.80–$10,593.60 | — | 30% |
| Ureteroscopy with laser stone breaking and stent placement inpatient CPT 52356 OR CYSTO/URETERO W/LITHO & IND | $9,269.40 | $13,242.00 | $5,296.80–$10,593.60 | — | 30% |
| Ureteroscopy with laser stone breaking and stent placement inpatient CPT 52356 CYSTO/PYELOSC INSERT STNT | $9,830.80 | $14,044.00 | $5,617.60–$11,235.20 | — | 30% |
| Vasectomy, one or both sides, including follow-up semen testing CPT 55250 OR REMOVAL OF SPERM DUCT(S) | $4,537.40 | $6,482.00 | $2,592.80–$5,185.60 | 76% above | 30% |
| Vasectomy, one or both sides, including follow-up semen testing CPT 55250 VASECTOMY SEMEN EXAM POSTOP | $4,537.40 | $6,482.00 | $2,592.80–$5,185.60 | 76% above | 30% |
| Vasectomy, one or both sides, including follow-up semen testing inpatient CPT 55250 VASECTOMY SEMEN EXAM POSTOP | $4,537.40 | $6,482.00 | $2,592.80–$5,185.60 | — | 30% |
| Vasectomy, one or both sides, including follow-up semen testing inpatient CPT 55250 OR REMOVAL OF SPERM DUCT(S) | $4,537.40 | $6,482.00 | $2,592.80–$5,185.60 | — | 30% |
| Wart removal, up to 14 warts CPT 17110 DESTRUCTION B9 LES UP TO 14 | $343.00 | $490.00 | $196.00–$392.00 | 11% above | 30% |
| Wart removal, up to 14 warts CPT 17110 OR DESTRUCTION B9 LESION 1-14 | $360.50 | $515.00 | $206.00–$412.00 | 16% above | 30% |
| Wart removal, up to 14 warts inpatient CPT 17110 DESTRUCTION B9 LES UP TO 14 | $343.00 | $490.00 | $196.00–$392.00 | — | 30% |
| Wart removal, up to 14 warts inpatient CPT 17110 OR DESTRUCTION B9 LESION 1-14 | $360.50 | $515.00 | $206.00–$412.00 | — | 30% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDEMENT SKIN SUBCU EX PC | $253.40 | $362.00 | $144.80–$289.60 | 77% below | 30% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDE SKIN/TISSUE | $724.50 | $1,035.00 | $414.00–$828.00 | 35% below | 30% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDEMENT SKIN SUBCU EX | $724.50 | $1,035.00 | $414.00–$828.00 | 35% below | 30% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBR SKIN/SUBQ TISSUE | $724.50 | $1,035.00 | $414.00–$828.00 | 35% below | 30% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 OR DBRDMT SUBQ TIS 1ST 20SQCM/ | $724.50 | $1,035.00 | $414.00–$828.00 | 35% below | 30% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDEMENT SKIN SUBCU EX PC | $253.40 | $362.00 | $144.80–$289.60 | — | 30% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBR SKIN/SUBQ TISSUE | $724.50 | $1,035.00 | $414.00–$828.00 | — | 30% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDE SKIN/TISSUE | $724.50 | $1,035.00 | $414.00–$828.00 | — | 30% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 OR DBRDMT SUBQ TIS 1ST 20SQCM/ | $724.50 | $1,035.00 | $414.00–$828.00 | — | 30% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDEMENT SKIN SUBCU EX | $724.50 | $1,035.00 | $414.00–$828.00 | — | 30% |
| Wrist fracture surgery (plate and screws), distal radius CPT 25607 OR OPTX DST RD XARTC FX/EPI SE | $12,932.50 | $18,475.00 | $7,390.00–$14,780.00 | 78% above | 30% |
| Wrist fracture surgery (plate and screws), distal radius inpatient CPT 25607 OR OPTX DST RD XARTC FX/EPI SE | $12,932.50 | $18,475.00 | $7,390.00–$14,780.00 | — | 30% |
Doctor visits and therapy
| Procedure | Cash price | List price | Insurers pay | vs Pennsylvania | Off list |
|---|---|---|---|---|---|
| Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUS BLOOD/COMP | $816.20 | $1,166.00 | $466.40–$932.80 | 9% below | 30% |
| Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSFUSION DONE IN CHEM | $828.80 | $1,184.00 | $473.60–$947.20 | 7% below | 30% |
| Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSFUSION | $828.80 | $1,184.00 | $473.60–$947.20 | 7% below | 30% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUS BLOOD/COMP | $816.20 | $1,166.00 | $466.40–$932.80 | — | 30% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD TRANSFUSION | $828.80 | $1,184.00 | $473.60–$947.20 | — | 30% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD TRANSFUSION DONE IN CHEM | $828.80 | $1,184.00 | $473.60–$947.20 | — | 30% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NEBULIZER | $387.80 | $554.00 | $221.60–$443.20 | 147% above | 30% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 MINI NEB. SUBSEQUENT | $387.80 | $554.00 | $221.60–$443.20 | 147% above | 30% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 MINI NEB. RX & SET UP | $458.50 | $655.00 | $262.00–$524.00 | 192% above | 30% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 MINI NEB. SUBSEQUENT | $387.80 | $554.00 | $221.60–$443.20 | — | 30% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 NEBULIZER | $387.80 | $554.00 | $221.60–$443.20 | — | 30% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 MINI NEB. RX & SET UP | $458.50 | $655.00 | $262.00–$524.00 | — | 30% |
| Chemotherapy IV infusion, first hour CPT 96413 CHEMO IV INFUSION FIRST HOUR | $595.70 | $851.00 | $340.40–$680.80 | 9% below | 30% |
| Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO IV INFUSION FIRST HOUR | $595.70 | $851.00 | $340.40–$680.80 | — | 30% |
| Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 BASIC COMPREHENSIVE AUDI | $172.90 | $247.00 | $98.80–$197.60 | 39% below | 30% |
| Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 BASIC COMPREHENSIVE AUDI | $172.90 | $247.00 | $98.80–$197.60 | — | 30% |
| Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE PC | $459.20 | $656.00 | $262.40–$524.80 | 74% below | 30% |
| Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE | $1,619.80 | $2,314.00 | $925.60–$1,851.20 | 10% below | 30% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 CRITICAL CARE PC | $459.20 | $656.00 | $262.40–$524.80 | — | 30% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 CRITICAL CARE | $1,619.80 | $2,314.00 | $925.60–$1,851.20 | — | 30% |
| EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG,AWAKE | $1,097.60 | $1,568.00 | $627.20–$1,254.40 | 51% above | 30% |
| EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 EEG,AWAKE | $1,097.60 | $1,568.00 | $627.20–$1,254.40 | — | 30% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ELECTROCARDIOGRAM TRACING | $60.20 | $86.00 | $34.40–$68.80 | 63% below | 30% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ELECTROCARDIOGRAM | $229.60 | $328.00 | $131.20–$262.40 | 42% above | 30% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ELECTROCARDIOGRAM TRACING | $60.20 | $86.00 | $34.40–$68.80 | — | 30% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ELECTROCARDIOGRAM | $229.60 | $328.00 | $131.20–$262.40 | — | 30% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 LEVEL ONE ED PC | $49.70 | $71.00 | $28.40–$56.80 | 79% below | 30% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 LEVEL ONE ED | $159.60 | $228.00 | $91.20–$182.40 | 33% below | 30% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 LEVEL ONE ED PC | $49.70 | $71.00 | $28.40–$56.80 | — | 30% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 LEVEL ONE ED | $159.60 | $228.00 | $91.20–$182.40 | — | 30% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 LEVEL TWO ED PC | $94.50 | $135.00 | $54.00–$108.00 | 77% below | 30% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 LEVEL TWO ED | $287.00 | $410.00 | $164.00–$328.00 | 29% below | 30% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 LEVEL TWO ED PC | $94.50 | $135.00 | $54.00–$108.00 | — | 30% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 LEVEL TWO ED | $287.00 | $410.00 | $164.00–$328.00 | — | 30% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 LEVEL THREE ED PC | $154.70 | $221.00 | $88.40–$176.80 | 73% below | 30% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 LEVEL THREE ED | $504.70 | $721.00 | $288.40–$576.80 | 11% below | 30% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 LEVEL THREE ED PC | $154.70 | $221.00 | $88.40–$176.80 | — | 30% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 LEVEL THREE ED | $504.70 | $721.00 | $288.40–$576.80 | — | 30% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 LEVEL FOUR ED PC | $259.70 | $371.00 | $148.40–$296.80 | 72% below | 30% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 LEVEL FOUR ED | $791.70 | $1,131.00 | $452.40–$904.80 | 15% below | 30% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 LEVEL FOUR ED PC | $259.70 | $371.00 | $148.40–$296.80 | — | 30% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 LEVEL FOUR ED | $791.70 | $1,131.00 | $452.40–$904.80 | — | 30% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 LEVEL FIVE ED PC | $378.00 | $540.00 | $216.00–$432.00 | 71% below | 30% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 LEVEL FIVE ED | $1,136.80 | $1,624.00 | $649.60–$1,299.20 | 12% below | 30% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 LEVEL FIVE ED PC | $378.00 | $540.00 | $216.00–$432.00 | — | 30% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 LEVEL FIVE ED | $1,136.80 | $1,624.00 | $649.60–$1,299.20 | — | 30% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 CARDIOLOGY STRESS TEST | $1,500.80 | $2,144.00 | $857.60–$1,715.20 | 83% above | 30% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CARDIOLOGY STRESS TEST | $1,500.80 | $2,144.00 | $857.60–$1,715.20 | — | 30% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV INFUSION HYDRATION INITIAL | $329.70 | $471.00 | $188.40–$376.80 | 22% below | 30% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRATION IV INFUSION INIT | $385.00 | $550.00 | $220.00–$440.00 | 9% below | 30% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRATION IV INFUSION INITIAL | $434.00 | $620.00 | $248.00–$496.00 | 3% above | 30% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV INFUSION HYDRATION INITIAL | $329.70 | $471.00 | $188.40–$376.80 | — | 30% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HYDRATION IV INFUSION INIT | $385.00 | $550.00 | $220.00–$440.00 | — | 30% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HYDRATION IV INFUSION INITIAL | $434.00 | $620.00 | $248.00–$496.00 | — | 30% |
| IV infusion of a medicine, first hour CPT 96365 THER/PROPH/DIAG IV INF INIT | $385.00 | $550.00 | $220.00–$440.00 | 12% below | 30% |
| IV infusion of a medicine, first hour CPT 96365 THER/PROPH/DIAG IV INF INITIAL | $434.00 | $620.00 | $248.00–$496.00 | at median | 30% |
| IV infusion of a medicine, first hour inpatient CPT 96365 THER/PROPH/DIAG IV INF INIT | $385.00 | $550.00 | $220.00–$440.00 | — | 30% |
| IV infusion of a medicine, first hour inpatient CPT 96365 THER/PROPH/DIAG IV INF INITIAL | $434.00 | $620.00 | $248.00–$496.00 | — | 30% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 THERAPEUTIC /DIAG INJECTION | $127.40 | $182.00 | $72.80–$145.60 | 5% below | 30% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DIAG INJ/SC/IM | $127.40 | $182.00 | $72.80–$145.60 | 5% below | 30% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 THERAP/PRO/DX INJ SQ/IM | $127.40 | $182.00 | $72.80–$145.60 | 5% below | 30% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DIAG INJ SC/IM | $127.40 | $182.00 | $72.80–$145.60 | 5% below | 30% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 THERAPEUTIC/DIAG INJECTION | $127.40 | $182.00 | $72.80–$145.60 | 5% below | 30% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THER/PROPH/DIAG INJ/SC/IM | $127.40 | $182.00 | $72.80–$145.60 | — | 30% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THER/PROPH/DIAG INJ SC/IM | $127.40 | $182.00 | $72.80–$145.60 | — | 30% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THERAPEUTIC /DIAG INJECTION | $127.40 | $182.00 | $72.80–$145.60 | — | 30% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THERAP/PRO/DX INJ SQ/IM | $127.40 | $182.00 | $72.80–$145.60 | — | 30% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THERAPEUTIC/DIAG INJECTION | $127.40 | $182.00 | $72.80–$145.60 | — | 30% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 LEVEL 2 OB NEW | $238.70 | $341.00 | $136.40–$272.80 | 112% above | 30% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 LEVEL 2 OB NEW | $238.70 | $341.00 | $136.40–$272.80 | — | 30% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MNT INITIAL ASSESSMENT 15 MIN | $43.40 | $62.00 | $24.80–$55.33 | at median | 30% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MNT INITIAL ASSESSMENT 15 MIN | $43.40 | $62.00 | $24.80–$49.60 | — | 30% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 SMOKING CESSATION 3-10 MINS | $60.20 | $86.00 | $34.40–$68.80 | 86% above | 30% |
| Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 SMOKING CESSATION 3-10 MINS | $60.20 | $86.00 | $34.40–$68.80 | — | 30% |
| Spirometry (breathing test) CPT 94010 BREATHING CAPACITY TEST | $217.70 | $311.00 | $124.40–$248.80 | 11% below | 30% |
| Spirometry (breathing test) CPT 94010 PULMONARY FUNCTION TEST | $349.30 | $499.00 | $199.60–$399.20 | 43% above | 30% |
| Spirometry (breathing test) inpatient CPT 94010 BREATHING CAPACITY TEST | $217.70 | $311.00 | $124.40–$248.80 | — | 30% |
| Spirometry (breathing test) inpatient CPT 94010 PULMONARY FUNCTION TEST | $349.30 | $499.00 | $199.60–$399.20 | — | 30% |
| Spirometry before and after a bronchodilator CPT 94060 PFT PRE & POST | $652.40 | $932.00 | $372.80–$745.60 | 10% above | 30% |
| Spirometry before and after a bronchodilator inpatient CPT 94060 PFT PRE & POST | $652.40 | $932.00 | $372.80–$745.60 | — | 30% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY | $161.70 | $231.00 | $92.40–$184.80 | 25% below | 30% |
| Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY | $161.70 | $231.00 | $92.40–$184.80 | — | 30% |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs Pennsylvania | Off list |
|---|---|---|---|---|---|
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 INFLUENZA TVS 12-13 VACCINE/PF | $32.90 | $47.00 | $7.05–$37.60 | 24% below | 30% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLUZONE | $34.62 | $49.45 | $7.42–$39.56 | 20% below | 30% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 INFLUENZA VIRUS VACINE | $39.20 | $56.00 | $8.40–$44.80 | 9% below | 30% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 INFLUENZA TVS 12-13 VACCINE/PF | $32.90 | $47.00 | $18.80–$37.60 | — | 30% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLUZONE | $34.62 | $49.45 | $19.78–$39.56 | — | 30% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 INFLUENZA VIRUS VACINE | $39.20 | $56.00 | $22.40–$44.80 | — | 30% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 ADM HEP B VACCINE ADULT | $81.90 | $117.00 | $17.55–$93.60 | 26% above | 30% |
| Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 ADM HEP B VACCINE ADULT | $81.90 | $117.00 | $46.80–$93.60 | — | 30% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL 23 VACC 0.5ML SYR | $204.89 | $292.70 | $43.90–$234.16 | 60% above | 30% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMO 23 | $224.00 | $320.00 | $48.00–$256.00 | 74% above | 30% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL 23 VACC 0.5ML SYR | $204.89 | $292.70 | $117.08–$234.16 | — | 30% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMO 23 | $224.00 | $320.00 | $128.00–$256.00 | — | 30% |
| RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 NIRSEVIMAB-ALIP 50 MG/0.5 ML | $1,041.36 | $1,487.65 | $446.30–$1,190.12 | 16% above | 30% |
| RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 BEYFORTUS 50 MG/1.5 ML SYRINGE | $1,041.36 | $1,487.65 | $446.30–$1,190.12 | 16% above | 30% |
| RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 NIRSEVIMAB-ALIP 50 MG/0.5 ML | $1,041.36 | $1,487.65 | $595.06–$1,190.12 | — | 30% |
| RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 BEYFORTUS 50 MG/1.5 ML SYRINGE | $1,041.36 | $1,487.65 | $595.06–$1,190.12 | — | 30% |
| Rabies vaccine, one dose CPT 90675 RABIES VACCINE | $949.20 | $1,356.00 | $542.40–$1,084.80 | 58% above | 30% |
| Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE | $949.20 | $1,356.00 | $542.40–$1,084.80 | — | 30% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 DT TOXOID PED 0.5ML | $79.63 | $113.75 | $45.50–$91.00 | 43% above | 30% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 49281021515 | $98.00 | $140.00 | $56.00–$112.00 | 76% above | 30% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 DT TOXOID PED 0.5ML | $79.63 | $113.75 | $45.50–$91.00 | — | 30% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 49281021515 | $98.00 | $140.00 | $56.00–$112.00 | — | 30% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 58160084252 - DIPTH - TETANUS | $39.20 | $56.00 | $22.40–$44.80 | 27% below | 30% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDAP | $125.30 | $179.00 | $71.60–$143.20 | 132% above | 30% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 58160084252 - DIPTH - TETANUS | $39.20 | $56.00 | $22.40–$44.80 | — | 30% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TDAP | $125.30 | $179.00 | $71.60–$143.20 | — | 30% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN, ONE PC | $37.10 | $53.00 | $21.20–$42.40 | 12% below | 30% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN | $62.30 | $89.00 | $35.60–$71.20 | 48% above | 30% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN ONE VACCINE | $137.20 | $196.00 | $78.40–$156.80 | 227% above | 30% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN, ONE | $283.50 | $405.00 | $162.00–$324.00 | 575% above | 30% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUN ADMIN ONE VACC | $283.50 | $405.00 | $162.00–$324.00 | 575% above | 30% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMIN, ONE PC | $37.10 | $53.00 | $21.20–$42.40 | — | 30% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMIN | $62.30 | $89.00 | $35.60–$71.20 | — | 30% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMIN ONE VACCINE | $137.20 | $196.00 | $78.40–$156.80 | — | 30% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMIN, ONE | $283.50 | $405.00 | $162.00–$324.00 | — | 30% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUN ADMIN ONE VACC | $283.50 | $405.00 | $162.00–$324.00 | — | 30% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADM EA ADDL PC | $27.30 | $39.00 | $15.60–$31.20 | 39% above | 30% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADM EA ADDL | $69.30 | $99.00 | $39.60–$79.20 | 252% above | 30% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUNIZATION ADM EA ADDL PC | $27.30 | $39.00 | $15.60–$31.20 | — | 30% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUNIZATION ADM EA ADDL | $69.30 | $99.00 | $39.60–$79.20 | — | 30% |
Source file: https://www.wmh.org/wp-content/uploads/2026/09/PricingTransparency-Wayne-Memorial_F-3559-20260916115044.csv