Northeastern Vermont Regional Hospital
Northeastern Vermont Regional Hospital in St. Johnsbury, VT publishes cash prices for 465 common procedures listed here, from its own machine-readable price file updated Aug 27, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Vermont median for 286 of 408 procedures and above it for 99. By typical cash price it ranks #2 of 11 Vermont hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.
1315 Hospital Drive, St. Johnsbury, VT, 05819-9210 Collected Sep 22, 2026 Source price file Check a bill from this hospital (802) 748-7400
Critical access hospital (rural, 25 beds or fewer) Nonprofit hospital Emergency department CMS star rating 3 of 5 CCN 471303 · CMS hospital register NPI 1275576704
Financial assistance
Nonprofit hospital: it must offer free or discounted care to patients who qualify. How to apply
Northeastern Vermont Regional Hospital is a nonprofit hospital in the CMS register. Under section 501(r) of the federal tax code it must have a written Financial Assistance Policy with a free application, publish both on its website, and charge patients who qualify no more than the amounts generally billed to insured patients for emergency and other medically necessary care. Who qualifies depends on household income; the policy states the limits.
You can apply up to 240 days after the first bill. Before collection actions such as credit reporting or a lawsuit, the hospital must tell you about the policy and wait at least 120 days after that bill. Ask the billing office for the policy and the application before you pay, or search the hospital's website for “financial assistance”. Letters you can copy.
Source: IRS, section 501(r) requirements for nonprofit hospitals.
Scans and imaging
| Procedure | Cash price | List price | Insurers pay | vs Vermont | Off list |
|---|---|---|---|---|---|
| Abdominal CT scan without and with contrast CPT 74170 CT ABD UPPER W& W/O CONTRAST | $648.00 | $864.00 | $184.39–$820.80 | 78% below | 25% |
| Abdominal CT scan without and with contrast inpatient CPT 74170 CT ABD UPPER W& W/O CONTRAST | $648.00 | $864.00 | $184.39–$820.80 | — | 25% |
| Abdominal X-ray, 2 views CPT 74019 RAD. ABDOMEN 2 VIEW | $785.25 | $1,047.00 | $34.75–$994.65 | 24% above | 25% |
| Abdominal X-ray, 2 views inpatient CPT 74019 RAD. ABDOMEN 2 VIEW | $785.25 | $1,047.00 | $34.75–$994.65 | — | 25% |
| Ankle X-ray, complete, 3 or more views one side CPT 73610 RAD. RT ANKLE COMPL MIN 3 VIEW,Right side | $543.00 | $724.00 | $35.71–$687.80 | at median | 25% |
| Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 RAD. RT ANKLE COMPL MIN 3 VIEW,Right side | $543.00 | $724.00 | $35.71–$687.80 | — | 25% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 EXTREMITY STUDY | $134.25 | $179.00 | $64.91–$170.05 | 52% below | 25% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 EXTREMITY STUDY | $134.25 | $179.00 | $64.91–$170.05 | — | 25% |
| Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 CT UPPER EXT W/O CONTR | $399.75 | $533.00 | $109.91–$506.35 | 81% below | 25% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT RT UPPER EXT W/O CONTRAST,Right side | $399.75 | $533.00 | $109.91–$506.35 | 81% below | 25% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT LT UPPER EXT W/O CONTRAST,Left side | $399.75 | $533.00 | $109.91–$506.35 | 81% below | 25% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 CT UPPER EXT W/O CONTR | $399.75 | $533.00 | $109.91–$506.35 | — | 25% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT RT UPPER EXT W/O CONTRAST,Right side | $399.75 | $533.00 | $109.91–$506.35 | — | 25% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT LT UPPER EXT W/O CONTRAST,Left side | $399.75 | $533.00 | $109.91–$506.35 | — | 25% |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 RF BARIUM SWALLOW SINGLE | $729.75 | $973.00 | $90.94–$924.35 | 15% below | 25% |
| Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 RF BARIUM SWALLOW SINGLE | $729.75 | $973.00 | $90.94–$924.35 | — | 25% |
| Bone scan, whole body (nuclear medicine) CPT 78306 BONE SCAN WHOLE BODY GRP | $3,201.75 | $4,269.00 | $250.48–$4,055.55 | 59% above | 25% |
| Bone scan, whole body (nuclear medicine) inpatient CPT 78306 BONE SCAN WHOLE BODY GRP | $3,201.75 | $4,269.00 | $250.48–$4,055.55 | — | 25% |
| Breast ultrasound, complete, one breast one side CPT 76641 ULTRASOUND BREAST UNILATERAL | $134.25 | $179.00 | $64.91–$170.05 | 77% below | 25% |
| Breast ultrasound, complete, one breast one side CPT 76641 RT BREAST US COMPLETE,Right side | $174.00 | $232.00 | $83.52–$220.40 | 70% below | 25% |
| Breast ultrasound, complete, one breast one side CPT 76641 LT BREAST US COMPLETE,Left side | $174.00 | $232.00 | $83.52–$220.40 | 70% below | 25% |
| Breast ultrasound, complete, one breast inpatient one side CPT 76641 ULTRASOUND BREAST UNILATERAL | $134.25 | $179.00 | $64.91–$170.05 | — | 25% |
| Breast ultrasound, complete, one breast inpatient one side CPT 76641 LT BREAST US COMPLETE,Left side | $174.00 | $232.00 | $83.52–$220.40 | — | 25% |
| Breast ultrasound, complete, one breast inpatient one side CPT 76641 RT BREAST US COMPLETE,Right side | $174.00 | $232.00 | $83.52–$220.40 | — | 25% |
| Breast ultrasound, limited (one breast or one area) CPT 76642 ULTRASOUND LIMITED ~T | $93.00 | $124.00 | $44.64–$117.80 | 84% below | 25% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 UNILATERAL LIMITED BREAST UL~P | $129.75 | $173.00 | $34.72–$164.35 | 77% below | 25% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 UNILATERAL LIMITED BREAST UL | $134.25 | $179.00 | $64.91–$170.05 | 77% below | 25% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 RT BREAST ULTRASOUND LIMITED,Right side | $348.00 | $464.00 | $80.44–$440.80 | 39% below | 25% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 LT BREAST ULTRASOUND LIMITED,Left side | $348.00 | $464.00 | $80.44–$440.80 | 39% below | 25% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 RT AXILLA US,Right side | $348.00 | $464.00 | $80.44–$440.80 | 39% below | 25% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 LT AXILLA US,Left side | $348.00 | $464.00 | $80.44–$440.80 | 39% below | 25% |
| Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 ULTRASOUND LIMITED ~T | $93.00 | $124.00 | $44.64–$117.80 | — | 25% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 UNILATERAL LIMITED BREAST UL~P | $129.75 | $173.00 | $34.72–$164.35 | — | 25% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 UNILATERAL LIMITED BREAST UL | $134.25 | $179.00 | $64.91–$170.05 | — | 25% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 LT BREAST ULTRASOUND LIMITED,Left side | $348.00 | $464.00 | $80.44–$440.80 | — | 25% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 RT BREAST ULTRASOUND LIMITED,Right side | $348.00 | $464.00 | $80.44–$440.80 | — | 25% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 RT AXILLA US,Right side | $348.00 | $464.00 | $80.44–$440.80 | — | 25% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 LT AXILLA US,Left side | $348.00 | $464.00 | $80.44–$440.80 | — | 25% |
| CT angiography (CTA) of the abdomen and pelvis CPT 74174 CTA ABD & PELVIS | $900.00 | $1,200.00 | $365.17–$1,140.00 | 77% below | 25% |
| CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CTA ABD & PELVIS | $900.00 | $1,200.00 | $365.17–$1,140.00 | — | 25% |
| CT angiography (CTA) of the head CPT 70496 CT ANGIOGRAPHY BRAIN | $420.75 | $561.00 | $184.39–$532.95 | 88% below | 25% |
| CT angiography (CTA) of the head inpatient CPT 70496 CT ANGIOGRAPHY BRAIN | $420.75 | $561.00 | $184.39–$532.95 | — | 25% |
| CT angiography (CTA) of the neck CPT 70498 CTA NECK/CAROTID | $420.75 | $561.00 | $184.39–$532.95 | 87% below | 25% |
| CT angiography (CTA) of the neck inpatient CPT 70498 CTA NECK/CAROTID | $420.75 | $561.00 | $184.39–$532.95 | — | 25% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CHEST FOR PE | $558.75 | $745.00 | $184.39–$707.75 | 80% below | 25% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 THORACIC AORTA W | $558.75 | $745.00 | $184.39–$707.75 | 80% below | 25% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CHEST FOR PE | $558.75 | $745.00 | $184.39–$707.75 | — | 25% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 THORACIC AORTA W | $558.75 | $745.00 | $184.39–$707.75 | — | 25% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT RENAL COLIC W/O CONTRAST | $792.00 | $1,056.00 | $176.40–$1,003.20 | 75% below | 25% |
| CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT RENAL COLIC W/O CONTRAST | $792.00 | $1,056.00 | $176.40–$1,003.20 | — | 25% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD & PELVIS WITH CONTRAST | $825.00 | $1,100.00 | $289.84–$1,045.00 | 81% below | 25% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD & PELVIS W ORIN COMB | $825.00 | $1,100.00 | $289.84–$1,045.00 | 81% below | 25% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD & PELVIS W ORIN COMB | $825.00 | $1,100.00 | $289.84–$1,045.00 | — | 25% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD & PELVIS WITH CONTRAST | $825.00 | $1,100.00 | $289.84–$1,045.00 | — | 25% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD/PELVIS WO & W CONTRAST | $1,237.50 | $1,650.00 | $326.21–$1,567.50 | 74% below | 25% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD & PELVIS WO&W ORIN COMB | $1,237.50 | $1,650.00 | $326.21–$1,567.50 | 74% below | 25% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD & PELVIS WO&W ORIN COMB | $1,237.50 | $1,650.00 | $326.21–$1,567.50 | — | 25% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD/PELVIS WO & W CONTRAST | $1,237.50 | $1,650.00 | $326.21–$1,567.50 | — | 25% |
| CT scan of the abdomen with contrast CPT 74160 CT ABD UPPER W/CONTR | $420.75 | $561.00 | $184.39–$532.95 | 85% below | 25% |
| CT scan of the abdomen with contrast inpatient CPT 74160 CT ABD UPPER W/CONTR | $420.75 | $561.00 | $184.39–$532.95 | — | 25% |
| CT scan of the abdomen without contrast CPT 74150 CT ABD UPPER W/O CONTRAST' | $399.75 | $533.00 | $109.91–$506.35 | 83% below | 25% |
| CT scan of the abdomen without contrast inpatient CPT 74150 CT ABD UPPER W/O CONTRAST' | $399.75 | $533.00 | $109.91–$506.35 | — | 25% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 CT SINUS WO CONTRAST | $399.75 | $533.00 | $109.91–$506.35 | 81% below | 25% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAX FACIAL W/O CONTRAST | $399.75 | $533.00 | $109.91–$506.35 | 81% below | 25% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 CT SCAN/HEAD | $2,436.75 | $3,249.00 | $109.91–$3,086.55 | 16% above | 25% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT SINUS WO CONTRAST | $399.75 | $533.00 | $109.91–$506.35 | — | 25% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAX FACIAL W/O CONTRAST | $399.75 | $533.00 | $109.91–$506.35 | — | 25% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT SCAN/HEAD | $2,436.75 | $3,249.00 | $109.91–$3,086.55 | — | 25% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD W/O CONTRAST | $399.75 | $533.00 | $102.69–$506.35 | 79% below | 25% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD W/O CONTRAST | $399.75 | $533.00 | $102.69–$506.35 | — | 25% |
| CT scan of the head with contrast CPT 70460 CT HEAD W/CONTRAST | $420.75 | $561.00 | $142.82–$532.95 | 82% below | 25% |
| CT scan of the head with contrast inpatient CPT 70460 CT HEAD W/CONTRAST | $420.75 | $561.00 | $142.82–$532.95 | — | 25% |
| CT scan of the head without and with contrast CPT 70470 CT HEAD W & W/O CONTRAST | $648.00 | $864.00 | $166.84–$820.80 | 77% below | 25% |
| CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD W & W/O CONTRAST | $648.00 | $864.00 | $166.84–$820.80 | — | 25% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT SPINE W/O CONTR. | $399.75 | $533.00 | $109.91–$506.35 | 82% below | 25% |
| CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT SPINE W/O CONTR. | $399.75 | $533.00 | $109.91–$506.35 | — | 25% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT CERVICAL SPINE W/O CONTRAST | $399.75 | $533.00 | $109.91–$506.35 | 81% below | 25% |
| CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT CERVICAL SPINE W/O CONTRAST | $399.75 | $533.00 | $109.91–$506.35 | — | 25% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT LOWER ABDOMEN W/CONTRAST | $420.75 | $561.00 | $184.39–$532.95 | 84% below | 25% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT LOWER ABDOMEN W/CONTRAST | $420.75 | $561.00 | $184.39–$532.95 | — | 25% |
| Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 EXTRACRANIAL STUDY | $262.50 | $350.00 | $126.91–$332.50 | 61% below | 25% |
| Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 US CAROTID, COMPLETE | $397.50 | $530.00 | $182.08–$503.50 | 41% below | 25% |
| Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 EXTRACRANIAL STUDY | $262.50 | $350.00 | $126.91–$332.50 | — | 25% |
| Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 US CAROTID, COMPLETE | $397.50 | $530.00 | $182.08–$503.50 | — | 25% |
| Chest CT scan without and with contrast CPT 71270 CT CHEST W & W/O CONTRAST | $634.50 | $846.00 | $184.39–$803.70 | 72% below | 25% |
| Chest CT scan without and with contrast inpatient CPT 71270 CT CHEST W & W/O CONTRAST | $634.50 | $846.00 | $184.39–$803.70 | — | 25% |
| Chest X-ray, 2 views CPT 71046 RAD. CHEST 2 VIEW | $730.50 | $974.00 | $31.83–$925.30 | 57% above | 25% |
| Chest X-ray, 2 views inpatient CPT 71046 RAD. CHEST 2 VIEW | $730.50 | $974.00 | $31.83–$925.30 | — | 25% |
| Chest X-ray, single view CPT 71045 RAD. CHEST 2 VIEW | $387.00 | $516.00 | $24.37–$490.20 | 7% above | 25% |
| Chest X-ray, single view inpatient CPT 71045 RAD. CHEST 2 VIEW | $387.00 | $516.00 | $24.37–$490.20 | — | 25% |
| Collarbone (clavicle) X-ray, complete one side CPT 73000 RAD. RT CLAVICLE,Left side | $544.50 | $726.00 | $32.14–$689.70 | 8% above | 25% |
| Collarbone (clavicle) X-ray, complete one side CPT 73000 RAD. LT CLAVICLE,Left side | $544.50 | $726.00 | $32.14–$689.70 | 8% above | 25% |
| Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 RAD. LT CLAVICLE,Left side | $544.50 | $726.00 | $32.14–$689.70 | — | 25% |
| Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 RAD. RT CLAVICLE,Left side | $544.50 | $726.00 | $32.14–$689.70 | — | 25% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RENAL | $174.00 | $232.00 | $83.52–$220.40 | 76% below | 25% |
| Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RENAL | $174.00 | $232.00 | $83.52–$220.40 | — | 25% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 DEXA BONE DENSITY | $648.75 | $865.00 | $37.98–$821.75 | 1% below | 25% |
| DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DEXA BONE DENSITY | $648.75 | $865.00 | $37.98–$821.75 | — | 25% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 DEXA PERIPHERAL SKELETON | $298.50 | $398.00 | $30.54–$378.10 | 16% below | 25% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 DEXA PERIPHERAL SKELETON | $298.50 | $398.00 | $30.54–$378.10 | — | 25% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST W/O | $399.75 | $533.00 | $109.91–$506.35 | 82% below | 25% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST W/O | $399.75 | $533.00 | $109.91–$506.35 | — | 25% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST W/CONTRAST | $420.75 | $561.00 | $160.65–$532.95 | 84% below | 25% |
| Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT CHEST W/CONTRAST | $420.75 | $561.00 | $160.65–$532.95 | — | 25% |
| Diagnostic mammogram, both breasts CPT 77066 DIAGNOSTIC BIL MAMMO | $630.75 | $841.00 | $93.44–$798.95 | — | 25% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 DIAGNOSTIC BIL MAMMO | $630.75 | $841.00 | $93.44–$798.95 | — | 25% |
| Diagnostic mammogram, one breast CPT 77065 DIAGNOSTIC UNI MAMMO | $525.00 | $700.00 | $72.91–$665.00 | 1% below | 25% |
| Diagnostic mammogram, one breast inpatient CPT 77065 DIAGNOSTIC UNI MAMMO | $525.00 | $700.00 | $72.91–$665.00 | — | 25% |
| Duplex ultrasound of the leg arteries, both legs CPT 93925 LOWER EXTREMITY STUDY | $277.50 | $370.00 | $134.16–$351.50 | — | 25% |
| Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 LOWER EXTREMITY STUDY | $277.50 | $370.00 | $134.16–$351.50 | — | 25% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 BILATERAL PERIVASCULAR STUDY | $318.75 | $425.00 | $153.00–$403.75 | — | 25% |
| Duplex ultrasound of the leg veins, both legs CPT 93970 EXTREMITY STUDY | $225.00 | $300.00 | $108.78–$285.00 | 73% below | 25% |
| Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 BILATERAL PERIVASCULAR STUDY | $318.75 | $425.00 | $153.00–$403.75 | — | 25% |
| Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 EXTREMITY STUDY | $225.00 | $300.00 | $108.78–$285.00 | — | 25% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 TTE W/DOPPLER COMPLETE | $360.75 | $481.00 | $165.58–$456.95 | 86% below | 25% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 US HEART ECHO W/COLOR FLOW&DOP | $753.00 | $1,004.00 | $190.06–$953.80 | 71% below | 25% |
| Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 TTE W/DOPPLER COMPLETE | $360.75 | $481.00 | $165.58–$456.95 | — | 25% |
| Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 US HEART ECHO W/COLOR FLOW&DOP | $753.00 | $1,004.00 | $190.06–$953.80 | — | 25% |
| Elbow X-ray, 2 views CPT 73070 ELBOW LTD POST REDUCT 2 VIEWS | $464.25 | $619.00 | $28.25–$588.05 | 15% above | 25% |
| Elbow X-ray, 2 views one side CPT 73070 LEFT ELBOW LTD POST REDU 2 VWS,Left side | $384.00 | $512.00 | $28.25–$486.40 | 5% below | 25% |
| Elbow X-ray, 2 views one side CPT 73070 RIGHT ELBOW LTD POST RED 2 VW,Right side | $464.25 | $619.00 | $28.25–$588.05 | 15% above | 25% |
| Elbow X-ray, 2 views one side CPT 73070 RAD. LT ELBOW LIMIT 2 VIEWS,Left side | $464.25 | $619.00 | $28.25–$588.05 | 15% above | 25% |
| Elbow X-ray, 2 views one side CPT 73070 RAD. RT ELBOW LIMIT 2 VIEWS,Right side | $464.25 | $619.00 | $28.25–$588.05 | 15% above | 25% |
| Elbow X-ray, 2 views inpatient CPT 73070 ELBOW LTD POST REDUCT 2 VIEWS | $464.25 | $619.00 | $28.25–$588.05 | — | 25% |
| Elbow X-ray, 2 views inpatient one side CPT 73070 LEFT ELBOW LTD POST REDU 2 VWS,Left side | $384.00 | $512.00 | $28.25–$486.40 | — | 25% |
| Elbow X-ray, 2 views inpatient one side CPT 73070 RIGHT ELBOW LTD POST RED 2 VW,Right side | $464.25 | $619.00 | $28.25–$588.05 | — | 25% |
| Elbow X-ray, 2 views inpatient one side CPT 73070 RAD. LT ELBOW LIMIT 2 VIEWS,Left side | $464.25 | $619.00 | $28.25–$588.05 | — | 25% |
| Elbow X-ray, 2 views inpatient one side CPT 73070 RAD. RT ELBOW LIMIT 2 VIEWS,Right side | $464.25 | $619.00 | $28.25–$588.05 | — | 25% |
| Elbow X-ray, complete, 3 or more views CPT 73080 ELBOW COMP POST REDUCT MIN 3VW | $571.50 | $762.00 | $31.82–$723.90 | at median | 25% |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 LEFT ELBOW POST REDUCT MIN 3V,Left side | $571.50 | $762.00 | $31.82–$723.90 | at median | 25% |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 RT ELBOW COMP-POST REDT MIN 3V,Right side | $571.50 | $762.00 | $31.82–$723.90 | at median | 25% |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 RAD. RT ELBOW COMPL MIN 3 VIEW,Right side | $571.50 | $762.00 | $31.82–$723.90 | at median | 25% |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 RAD. LT ELBOW COMP MIN 3 VIEWS,Left side | $571.50 | $762.00 | $31.82–$723.90 | at median | 25% |
| Elbow X-ray, complete, 3 or more views inpatient CPT 73080 ELBOW COMP POST REDUCT MIN 3VW | $571.50 | $762.00 | $31.82–$723.90 | — | 25% |
| Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 RAD. RT ELBOW COMPL MIN 3 VIEW,Right side | $571.50 | $762.00 | $31.82–$723.90 | — | 25% |
| Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 LEFT ELBOW POST REDUCT MIN 3V,Left side | $571.50 | $762.00 | $31.82–$723.90 | — | 25% |
| Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 RAD. LT ELBOW COMP MIN 3 VIEWS,Left side | $571.50 | $762.00 | $31.82–$723.90 | — | 25% |
| Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 RT ELBOW COMP-POST REDT MIN 3V,Right side | $571.50 | $762.00 | $31.82–$723.90 | — | 25% |
| Eye socket (orbit) CT scan without contrast CPT 70480 CT SELLA TURCICA WO CONTRAST | $399.75 | $533.00 | $109.91–$506.35 | 82% below | 25% |
| Eye socket (orbit) CT scan without contrast CPT 70480 CT TEMPORAL BONE WO CONTRAST | $399.75 | $533.00 | $109.91–$506.35 | 82% below | 25% |
| Eye socket (orbit) CT scan without contrast CPT 70480 CT ORBITS W/O CONTRAST | $399.75 | $533.00 | $109.91–$506.35 | 82% below | 25% |
| Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT ORBITS W/O CONTRAST | $399.75 | $533.00 | $109.91–$506.35 | — | 25% |
| Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT SELLA TURCICA WO CONTRAST | $399.75 | $533.00 | $109.91–$506.35 | — | 25% |
| Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT TEMPORAL BONE WO CONTRAST | $399.75 | $533.00 | $109.91–$506.35 | — | 25% |
| Facial bones X-ray, complete, 3 or more views CPT 70150 RAD. FACIAL-COMP MIN 3VIEW | $1,044.00 | $1,392.00 | $45.13–$1,322.40 | 68% above | 25% |
| Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 RAD. FACIAL-COMP MIN 3VIEW | $1,044.00 | $1,392.00 | $45.13–$1,322.40 | — | 25% |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 RAD. RT FOREARM 2 VIEWS,Right side | $464.25 | $619.00 | $27.93–$588.05 | at median | 25% |
| Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 RAD. RT FOREARM 2 VIEWS,Right side | $464.25 | $619.00 | $27.93–$588.05 | — | 25% |
| Hand X-ray, 2 views CPT 73120 BIL HAND & WRIST ARTHRITIS STU | $464.25 | $619.00 | $30.19–$588.05 | 3% below | 25% |
| Hand X-ray, 2 views one side CPT 73120 RAD. RT HAND LIMITED 2 VIEWS,Right side | $504.00 | $672.00 | $30.19–$638.40 | 5% above | 25% |
| Hand X-ray, 2 views inpatient CPT 73120 BIL HAND & WRIST ARTHRITIS STU | $464.25 | $619.00 | $30.19–$588.05 | — | 25% |
| Hand X-ray, 2 views inpatient one side CPT 73120 RAD. RT HAND LIMITED 2 VIEWS,Right side | $504.00 | $672.00 | $30.19–$638.40 | — | 25% |
| Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 RAD. LT OC CALCIS HEEL,Left side | $522.75 | $697.00 | $27.28–$662.15 | 34% above | 25% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 RAD. LT OC CALCIS HEEL,Left side | $522.75 | $697.00 | $27.28–$662.15 | — | 25% |
| Knee X-ray, 3 views one side CPT 73562 RT KNEE 3 VIEWS,Right side | $615.00 | $820.00 | $40.90–$779.00 | 4% above | 25% |
| Knee X-ray, 3 views one side CPT 73562 LEFT KNEE 3 VIEWS,Left side | $615.00 | $820.00 | $40.90–$779.00 | 4% above | 25% |
| Knee X-ray, 3 views inpatient one side CPT 73562 RT KNEE 3 VIEWS,Right side | $615.00 | $820.00 | $40.90–$779.00 | — | 25% |
| Knee X-ray, 3 views inpatient one side CPT 73562 LEFT KNEE 3 VIEWS,Left side | $615.00 | $820.00 | $40.90–$779.00 | — | 25% |
| Knee X-ray, complete, 4 or more views CPT 73564 RAD. KNEE COMPLETE MIN 4 VIEWS | $428.25 | $571.00 | $47.72–$542.45 | 37% below | 25% |
| Knee X-ray, complete, 4 or more views one side CPT 73564 RAD. RT KNEE COMPL MIN 4 VIEWS,Right side | $688.50 | $918.00 | $47.72–$872.10 | 1% above | 25% |
| Knee X-ray, complete, 4 or more views inpatient CPT 73564 RAD. KNEE COMPLETE MIN 4 VIEWS | $428.25 | $571.00 | $47.72–$542.45 | — | 25% |
| Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 RAD. RT KNEE COMPL MIN 4 VIEWS,Right side | $688.50 | $918.00 | $47.72–$872.10 | — | 25% |
| Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT EXT. LOWER W/O CONTRAST | $399.75 | $533.00 | $109.91–$506.35 | 81% below | 25% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT RT LOWER EXT W/O CONTRAST,Right side | $399.75 | $533.00 | $109.91–$506.35 | 81% below | 25% |
| Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 CT EXT. LOWER W/O CONTRAST | $399.75 | $533.00 | $109.91–$506.35 | — | 25% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT RT LOWER EXT W/O CONTRAST,Right side | $399.75 | $533.00 | $109.91–$506.35 | — | 25% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ECHO EXAM OF ABDOMEN ~P | $52.50 | $70.00 | $25.38–$70.00 | 92% below | 25% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ECHO EXAM OF ABDOMEN ~T | $108.00 | $144.00 | $51.84–$136.80 | 83% below | 25% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ABD ULTRASOUND-1 ORGAN ~T | $126.75 | $169.00 | $60.84–$160.55 | 81% below | 25% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ECHO EXAM OF ABDOMEN | $142.50 | $190.00 | $68.89–$180.50 | 78% below | 25% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMEN LIMITED/FOLLOW UP | $174.00 | $232.00 | $83.16–$220.40 | 73% below | 25% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ABD ULTRASOUND-1 ORGAN/OR | $307.50 | $410.00 | $83.16–$389.50 | 53% below | 25% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 ECHO EXAM OF ABDOMEN ~P | $52.50 | $70.00 | $25.38–$70.00 | — | 25% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 ECHO EXAM OF ABDOMEN ~T | $108.00 | $144.00 | $51.84–$136.80 | — | 25% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 ABD ULTRASOUND-1 ORGAN ~T | $126.75 | $169.00 | $60.84–$160.55 | — | 25% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 ECHO EXAM OF ABDOMEN | $142.50 | $190.00 | $68.89–$180.50 | — | 25% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMEN LIMITED/FOLLOW UP | $174.00 | $232.00 | $83.16–$220.40 | — | 25% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 ABD ULTRASOUND-1 ORGAN/OR | $307.50 | $410.00 | $83.16–$389.50 | — | 25% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US EXTREMITY NON-VASC REAL-T~P | $48.00 | $64.00 | $23.04–$64.00 | 92% below | 25% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US EXTREMITY NON-VASC REAL-T | $53.25 | $71.00 | $25.74–$71.00 | 91% below | 25% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US EXTREMITY NON-VASC REAL-T~T | $68.25 | $91.00 | $32.76–$91.00 | 88% below | 25% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 SOFT TISSUE EXAM | $312.00 | $416.00 | $61.64–$395.20 | 45% below | 25% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 SOFT TISSUE EXT US LIMITED | $312.00 | $416.00 | $61.64–$395.20 | 45% below | 25% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US EXTREMITY NON-VASC REAL-T~P | $48.00 | $64.00 | $23.04–$64.00 | — | 25% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US EXTREMITY NON-VASC REAL-T | $53.25 | $71.00 | $25.74–$71.00 | — | 25% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US EXTREMITY NON-VASC REAL-T~T | $68.25 | $91.00 | $32.76–$91.00 | — | 25% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 SOFT TISSUE EXAM | $312.00 | $416.00 | $61.64–$395.20 | — | 25% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 SOFT TISSUE EXT US LIMITED | $312.00 | $416.00 | $61.64–$395.20 | — | 25% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT CHEST LUNG CANCER SCREENING | $399.75 | $533.00 | $109.91–$506.35 | 74% below | 25% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT CHEST LUNG CANCER SCREENING | $399.75 | $533.00 | $109.91–$506.35 | — | 25% |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 RAD. RT TIBIA-FIBULA,Right side | $606.75 | $809.00 | $30.19–$768.55 | 28% above | 25% |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 RAD. LT TIBIA-FIBULA,Left side | $606.75 | $809.00 | $30.19–$768.55 | 28% above | 25% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 RAD. RT TIBIA-FIBULA,Right side | $606.75 | $809.00 | $30.19–$768.55 | — | 25% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 RAD. LT TIBIA-FIBULA,Left side | $606.75 | $809.00 | $30.19–$768.55 | — | 25% |
| MR angiography (MRA) of the head without contrast CPT 70544 MRI ANGIOGRAPHY HEAD W/O DYE | $3,004.50 | $4,006.00 | $207.16–$3,805.70 | 14% below | 25% |
| MR angiography (MRA) of the head without contrast CPT 70544 MRI VENOGRAM BRAIN WO | $3,004.50 | $4,006.00 | $207.16–$3,805.70 | 14% below | 25% |
| MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRI ANGIOGRAPHY HEAD W/O DYE | $3,004.50 | $4,006.00 | $207.16–$3,805.70 | — | 25% |
| MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRI VENOGRAM BRAIN WO | $3,004.50 | $4,006.00 | $207.16–$3,805.70 | — | 25% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 RT LOWER JOINT W/O CONTRAST,Right side | $3,254.25 | $4,339.00 | $197.33–$4,122.05 | 3% below | 25% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 LT LOWER JOINT W/O CONTRAST,Left side | $3,254.25 | $4,339.00 | $197.33–$4,122.05 | 3% below | 25% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 LT LOWER JOINT W/O CONTRAST,Left side | $3,254.25 | $4,339.00 | $197.33–$4,122.05 | — | 25% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 RT LOWER JOINT W/O CONTRAST,Right side | $3,254.25 | $4,339.00 | $197.33–$4,122.05 | — | 25% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI RT LOWER JOINT WO/W,Right side | $3,453.00 | $4,604.00 | $366.76–$4,373.80 | 27% below | 25% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI RT LOWER JOINT WO/W,Right side | $3,453.00 | $4,604.00 | $366.76–$4,373.80 | — | 25% |
| MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN W/O CONTRAST | $3,024.00 | $4,032.00 | $186.99–$3,830.40 | 5% above | 25% |
| MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN W/O CONTRAST | $3,024.00 | $4,032.00 | $186.99–$3,830.40 | — | 25% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN W/WO CONTRAST | $3,591.00 | $4,788.00 | $324.16–$4,548.60 | 10% below | 25% |
| MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABDOMEN W/WO CONTRAST | $3,591.00 | $4,788.00 | $324.16–$4,548.60 | — | 25% |
| MRI of the brain, no contrast dye CPT 70551 MRI BRAIN/PITUIT/IAC W/O CONT | $3,003.00 | $4,004.00 | $188.46–$3,803.80 | 8% below | 25% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN/PITUIT/IAC W/O CONT | $3,003.00 | $4,004.00 | $188.46–$3,803.80 | — | 25% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI IAC AND/OR BRAIN | $4,260.00 | $5,680.00 | $305.72–$5,396.00 | 11% below | 25% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI IAC AND/OR BRAIN | $4,260.00 | $5,680.00 | $305.72–$5,396.00 | — | 25% |
| MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR SPINE W/O CONTRAST | $2,907.75 | $3,877.00 | $184.90–$3,683.15 | 19% below | 25% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MRI LUMBAR SPINE W/O CONTRAST | $2,907.75 | $3,877.00 | $184.90–$3,683.15 | — | 25% |
| MRI of the lower back, without and then with contrast dye CPT 72158 MRI LUMBAR SPINE W W/O CONTRAS | $3,564.00 | $4,752.00 | $307.02–$4,514.40 | 24% below | 25% |
| MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI LUMBAR SPINE W W/O CONTRAS | $3,564.00 | $4,752.00 | $307.02–$4,514.40 | — | 25% |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI THORACIC SPINE W/O CONTRAS | $2,996.25 | $3,995.00 | $183.60–$3,795.25 | 16% below | 25% |
| MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI THORACIC SPINE W/O CONTRAS | $2,996.25 | $3,995.00 | $183.60–$3,795.25 | — | 25% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI CERVICAL SPINE W/WO CONTR | $3,453.00 | $4,604.00 | $306.70–$4,373.80 | 28% below | 25% |
| MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI CERVICAL SPINE W/WO CONTR | $3,453.00 | $4,604.00 | $306.70–$4,373.80 | — | 25% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI CERVICAL SPINE W/O CONTRAS | $3,067.50 | $4,090.00 | $183.93–$3,885.50 | 10% below | 25% |
| MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI CERVICAL SPINE W/O CONTRAS | $3,067.50 | $4,090.00 | $183.93–$3,885.50 | — | 25% |
| MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS WO & W | $3,591.00 | $4,788.00 | $322.55–$4,548.60 | 17% below | 25% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS WO & W | $3,591.00 | $4,788.00 | $322.55–$4,548.60 | — | 25% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI RT UPPER JOINT W/O CONTRAS,Right side | $3,254.25 | $4,339.00 | $197.98–$4,122.05 | 1% above | 25% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI LT UPPER JOINT W/O CONTRAS,Left side | $3,254.25 | $4,339.00 | $197.98–$4,122.05 | 1% above | 25% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI RT UPPER JOINT W/O CONTRAS,Right side | $3,254.25 | $4,339.00 | $197.98–$4,122.05 | — | 25% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI LT UPPER JOINT W/O CONTRAS,Left side | $3,254.25 | $4,339.00 | $197.98–$4,122.05 | — | 25% |
| Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 RAD. CERVICAL 4 VIEW | $924.75 | $1,233.00 | $53.08–$1,171.35 | 32% above | 25% |
| Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 RAD. CERVICAL 4 VIEW | $924.75 | $1,233.00 | $53.08–$1,171.35 | — | 25% |
| Neck soft tissue CT scan with contrast CPT 70491 CT NECK W/CONTRAST | $420.75 | $561.00 | $176.92–$532.95 | 82% below | 25% |
| Neck soft tissue CT scan with contrast inpatient CPT 70491 CT NECK W/CONTRAST | $420.75 | $561.00 | $176.92–$532.95 | — | 25% |
| Neck soft tissue CT scan without contrast CPT 70490 CT NECK W/O CONTRAST | $399.75 | $533.00 | $109.91–$506.35 | 81% below | 25% |
| Neck soft tissue CT scan without contrast inpatient CPT 70490 CT NECK W/O CONTRAST | $399.75 | $533.00 | $109.91–$506.35 | — | 25% |
| Neck soft tissue X-ray CPT 70360 RAD. NECK | $408.75 | $545.00 | $29.88–$517.75 | 9% above | 25% |
| Neck soft tissue X-ray inpatient CPT 70360 RAD. NECK | $408.75 | $545.00 | $29.88–$517.75 | — | 25% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 MYOCARDIAL SPECT MULTIPLE STUD | $850.50 | $1,134.00 | $361.10–$1,077.30 | 72% below | 25% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 MPI REST & STRESS NUC | $8,758.50 | $11,678.00 | $413.57–$11,094.10 | 189% above | 25% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 MYOCARDIAL SPECT MULTIPLE STUD | $850.50 | $1,134.00 | $361.10–$1,077.30 | — | 25% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 MPI REST & STRESS NUC | $8,758.50 | $11,678.00 | $413.57–$11,094.10 | — | 25% |
| Pelvic CT scan without contrast CPT 72192 CT PELVIS WO CONTRAST | $399.75 | $533.00 | $109.91–$506.35 | 81% below | 25% |
| Pelvic CT scan without contrast inpatient CPT 72192 CT PELVIS WO CONTRAST | $399.75 | $533.00 | $109.91–$506.35 | — | 25% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US EXAM PELVIC LIMITED ~T | $53.25 | $71.00 | $25.56–$71.00 | 92% below | 25% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US EXAM PELVIS LIMITED | $132.75 | $177.00 | $49.11–$168.15 | 79% below | 25% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US EXAM PELVIC LIMITED ~P | $149.25 | $199.00 | $26.22–$189.05 | 76% below | 25% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US EXAM PELVIC LIMITED | $151.50 | $202.00 | $42.74–$191.90 | 76% below | 25% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US EXAM PELVIC LIMITED ~T | $53.25 | $71.00 | $25.56–$71.00 | — | 25% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US EXAM PELVIS LIMITED | $132.75 | $177.00 | $49.11–$168.15 | — | 25% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US EXAM PELVIC LIMITED ~P | $149.25 | $199.00 | $26.22–$189.05 | — | 25% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US EXAM PELVIC LIMITED | $151.50 | $202.00 | $42.74–$191.90 | — | 25% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIS | $174.00 | $232.00 | $83.52–$220.40 | 74% below | 25% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US EXAM, PELVIC, COMPLETE | $192.00 | $256.00 | $88.60–$243.20 | 72% below | 25% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 PELVIC US/ER | $258.00 | $344.00 | $101.51–$326.80 | 62% below | 25% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 PELVIS US/OR | $258.00 | $344.00 | $101.51–$326.80 | 62% below | 25% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIS | $174.00 | $232.00 | $83.52–$220.40 | — | 25% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US EXAM, PELVIC, COMPLETE | $192.00 | $256.00 | $88.60–$243.20 | — | 25% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 PELVIC US/ER | $258.00 | $344.00 | $101.51–$326.80 | — | 25% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 PELVIS US/OR | $258.00 | $344.00 | $101.51–$326.80 | — | 25% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 FETAL SURVEY SCREENING | $174.00 | $232.00 | $83.52–$220.40 | 75% below | 25% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB | $174.00 | $232.00 | $83.52–$220.40 | 75% below | 25% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OB US >/= 14 WKS, SNGL FETUS | $238.50 | $318.00 | $113.93–$302.10 | 65% below | 25% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB | $174.00 | $232.00 | $83.52–$220.40 | — | 25% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 FETAL SURVEY SCREENING | $174.00 | $232.00 | $83.52–$220.40 | — | 25% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 OB US >/= 14 WKS, SNGL FETUS | $238.50 | $318.00 | $113.93–$302.10 | — | 25% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 FETAL SURVEY SCREENING 1ST TRI | $174.00 | $232.00 | $83.52–$220.40 | 78% below | 25% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 OB US 1ST TRIMESTER TRANSABD | $174.00 | $232.00 | $83.52–$220.40 | 78% below | 25% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 OB US < 14 WKS, SINGLE FETUS | $238.50 | $318.00 | $98.21–$302.10 | 69% below | 25% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 OB US 1ST TRIMESTER TRANSABD | $174.00 | $232.00 | $83.52–$220.40 | — | 25% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 FETAL SURVEY SCREENING 1ST TRI | $174.00 | $232.00 | $83.52–$220.40 | — | 25% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 OB US < 14 WKS, SINGLE FETUS | $238.50 | $318.00 | $98.21–$302.10 | — | 25% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 OB US, LIMITED, FETUS(S) ~T | $60.75 | $81.00 | $29.16–$81.00 | 90% below | 25% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 OB US, LIMITED, FETUS(S) | $161.25 | $215.00 | $68.64–$204.25 | 74% below | 25% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 LIMITED OB | $190.50 | $254.00 | $78.49–$241.30 | 70% below | 25% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 OB US, LIMITED, FETUS(S) ~T | $60.75 | $81.00 | $29.16–$81.00 | — | 25% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 OB US, LIMITED, FETUS(S) | $161.25 | $215.00 | $68.64–$204.25 | — | 25% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 LIMITED OB | $190.50 | $254.00 | $78.49–$241.30 | — | 25% |
| Rib X-ray, one side, 2 views one side CPT 71100 LT/RT RIBS TWO VIEWS | $1,077.75 | $1,437.00 | $34.75–$1,365.15 | 104% above | 25% |
| Rib X-ray, one side, 2 views one side CPT 71100 RAD. RT RIBS,Right side | $1,082.25 | $1,443.00 | $34.75–$1,370.85 | 105% above | 25% |
| Rib X-ray, one side, 2 views one side CPT 71100 RAD. LT RIBS,Left side | $1,082.25 | $1,443.00 | $34.75–$1,370.85 | 105% above | 25% |
| Rib X-ray, one side, 2 views inpatient one side CPT 71100 LT/RT RIBS TWO VIEWS | $1,077.75 | $1,437.00 | $34.75–$1,365.15 | — | 25% |
| Rib X-ray, one side, 2 views inpatient one side CPT 71100 RAD. LT RIBS,Left side | $1,082.25 | $1,443.00 | $34.75–$1,370.85 | — | 25% |
| Rib X-ray, one side, 2 views inpatient one side CPT 71100 RAD. RT RIBS,Right side | $1,082.25 | $1,443.00 | $34.75–$1,370.85 | — | 25% |
| Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 RT RIBS AND PA CXR | $1,447.50 | $1,930.00 | $40.12–$1,833.50 | 123% above | 25% |
| Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 LT/RT RIBS with PA CXR | $1,447.50 | $1,930.00 | $40.12–$1,833.50 | 123% above | 25% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient CPT 71101 RT RIBS AND PA CXR | $1,447.50 | $1,930.00 | $40.12–$1,833.50 | — | 25% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 LT/RT RIBS with PA CXR | $1,447.50 | $1,930.00 | $40.12–$1,833.50 | — | 25% |
| Screening mammogram, both breasts CPT 77067 SCREENING MAMMO | $566.25 | $755.00 | $77.16–$717.25 | 75% above | 25% |
| Screening mammogram, both breasts inpatient CPT 77067 SCREENING MAMMO | $566.25 | $755.00 | $77.16–$717.25 | — | 25% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 RGT SHOULDER CMPLT POST REDUCT,Right side | $620.25 | $827.00 | $34.42–$785.65 | 21% above | 25% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 LEFT SHOULDER CMPT POST REDUCT,Left side | $620.25 | $827.00 | $34.42–$785.65 | 21% above | 25% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 RAD.LT SHOULDER COMP MIN 2VIEW,Left side | $620.25 | $827.00 | $34.42–$785.65 | 21% above | 25% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 RAD.LT SHOULDER COMP MIN 2VIEW,Left side | $620.25 | $827.00 | $34.42–$785.65 | — | 25% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 RGT SHOULDER CMPLT POST REDUCT,Right side | $620.25 | $827.00 | $34.42–$785.65 | — | 25% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 LEFT SHOULDER CMPT POST REDUCT,Left side | $620.25 | $827.00 | $34.42–$785.65 | — | 25% |
| Sinus X-ray, complete, 3 or more views CPT 70220 RAD. PARANASAL MIN 3 VIEW | $846.75 | $1,129.00 | $36.37–$1,072.55 | 82% above | 25% |
| Sinus X-ray, complete, 3 or more views inpatient CPT 70220 RAD. PARANASAL MIN 3 VIEW | $846.75 | $1,129.00 | $36.37–$1,072.55 | — | 25% |
| Skull X-ray, fewer than 4 views CPT 70250 RAD. SKULL LIMITED 4 VIEW | $471.00 | $628.00 | $34.42–$596.60 | 11% below | 25% |
| Skull X-ray, fewer than 4 views inpatient CPT 70250 RAD. SKULL LIMITED 4 VIEW | $471.00 | $628.00 | $34.42–$596.60 | — | 25% |
| Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 RAD. RT FEMUR,Technical Component | $677.25 | $903.00 | $26.09–$857.85 | 60% above | 25% |
| Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 RAD. LT FEMUR,Technical Component | $677.25 | $903.00 | $26.09–$857.85 | 60% above | 25% |
| Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 RAD. LT FEMUR,Technical Component | $677.25 | $903.00 | $26.09–$857.85 | — | 25% |
| Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 RAD. RT FEMUR,Technical Component | $677.25 | $903.00 | $26.09–$857.85 | — | 25% |
| Thoracic spine (mid back) CT scan without contrast CPT 72128 CT THORACIC SPINE W/O CONTRAST | $399.75 | $533.00 | $109.91–$506.35 | 78% below | 25% |
| Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT THORACIC SPINE W/O CONTRAST | $399.75 | $533.00 | $109.91–$506.35 | — | 25% |
| Toe X-ray, 2 or more views one side CPT 73660 LEFT SECOND TOE,Left side | $476.25 | $635.00 | $27.60–$603.25 | 22% above | 25% |
| Toe X-ray, 2 or more views one side CPT 73660 LEFT FOURTH TOE,Left side | $476.25 | $635.00 | $27.60–$603.25 | 22% above | 25% |
| Toe X-ray, 2 or more views one side CPT 73660 RIGHT SECOND TOE,Right side | $476.25 | $635.00 | $27.60–$603.25 | 22% above | 25% |
| Toe X-ray, 2 or more views one side CPT 73660 RT FOURTH TOE,Right side | $476.25 | $635.00 | $27.60–$603.25 | 22% above | 25% |
| Toe X-ray, 2 or more views one side CPT 73660 LEFT GREAT TOE,Left side | $476.25 | $635.00 | $27.60–$603.25 | 22% above | 25% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 LEFT SECOND TOE,Left side | $476.25 | $635.00 | $27.60–$603.25 | — | 25% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 RIGHT SECOND TOE,Right side | $476.25 | $635.00 | $27.60–$603.25 | — | 25% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 LEFT GREAT TOE,Left side | $476.25 | $635.00 | $27.60–$603.25 | — | 25% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 RT FOURTH TOE,Right side | $476.25 | $635.00 | $27.60–$603.25 | — | 25% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 LEFT FOURTH TOE,Left side | $476.25 | $635.00 | $27.60–$603.25 | — | 25% |
| Transvaginal pelvic ultrasound CPT 76830 TRANSVAGINAL US, NON-OB ~T | $51.75 | $69.00 | $24.84–$69.00 | 94% below | 25% |
| Transvaginal pelvic ultrasound CPT 76830 US TRANS VAG | $174.00 | $232.00 | $83.52–$220.40 | 79% below | 25% |
| Transvaginal pelvic ultrasound CPT 76830 TRANSVAGINAL US, NON-OB | $194.25 | $259.00 | $93.91–$246.05 | 76% below | 25% |
| Transvaginal pelvic ultrasound CPT 76830 TRANSVAGINAL US, NON-OB ~P | $207.00 | $276.00 | $35.85–$262.20 | 75% below | 25% |
| Transvaginal pelvic ultrasound CPT 76830 TRANS VAGINAL US/OR | $258.00 | $344.00 | $109.91–$326.80 | 69% below | 25% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 TRANSVAGINAL US, NON-OB ~T | $51.75 | $69.00 | $24.84–$69.00 | — | 25% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANS VAG | $174.00 | $232.00 | $83.52–$220.40 | — | 25% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 TRANSVAGINAL US, NON-OB | $194.25 | $259.00 | $93.91–$246.05 | — | 25% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 TRANSVAGINAL US, NON-OB ~P | $207.00 | $276.00 | $35.85–$262.20 | — | 25% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 TRANS VAGINAL US/OR | $258.00 | $344.00 | $109.91–$326.80 | — | 25% |
| Transvaginal ultrasound during pregnancy CPT 76817 TRANSVAGINAL US, OBSTETRIC ~T | $65.25 | $87.00 | $31.32–$87.00 | 91% below | 25% |
| Transvaginal ultrasound during pregnancy CPT 76817 TRANSVAGINAL US, OBSTETRIC | $174.75 | $233.00 | $77.98–$221.35 | 76% below | 25% |
| Transvaginal ultrasound during pregnancy CPT 76817 FETAL SURVEY TRANS VAG | $190.50 | $254.00 | $89.53–$241.30 | 74% below | 25% |
| Transvaginal ultrasound during pregnancy CPT 76817 TRANS VAG OB US | $190.50 | $254.00 | $89.53–$241.30 | 74% below | 25% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 TRANSVAGINAL US, OBSTETRIC ~T | $65.25 | $87.00 | $31.32–$87.00 | — | 25% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 TRANSVAGINAL US, OBSTETRIC | $174.75 | $233.00 | $77.98–$221.35 | — | 25% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 FETAL SURVEY TRANS VAG | $190.50 | $254.00 | $89.53–$241.30 | — | 25% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 TRANS VAG OB US | $190.50 | $254.00 | $89.53–$241.30 | — | 25% |
| Ultrasound of the abdomen, complete CPT 76700 US ABD. COMPLETE | $174.00 | $232.00 | $83.52–$220.40 | 81% below | 25% |
| Ultrasound of the abdomen, complete CPT 76700 US ABD TWO ORGANS | $174.00 | $232.00 | $83.52–$220.40 | 81% below | 25% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US ABD TWO ORGANS | $174.00 | $232.00 | $83.52–$220.40 | — | 25% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US ABD. COMPLETE | $174.00 | $232.00 | $83.52–$220.40 | — | 25% |
| Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM ~P | $80.25 | $107.00 | $32.83–$107.00 | 88% below | 25% |
| Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM ~T | $151.50 | $202.00 | $72.72–$191.90 | 78% below | 25% |
| Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM | $174.00 | $232.00 | $83.52–$220.40 | 74% below | 25% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM ~P | $80.25 | $107.00 | $32.83–$107.00 | — | 25% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM ~T | $151.50 | $202.00 | $72.72–$191.90 | — | 25% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM | $174.00 | $232.00 | $83.52–$220.40 | — | 25% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US THYROID COMPLETE | $174.00 | $232.00 | $83.52–$220.40 | 80% below | 25% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US THYROID LTD. | $174.00 | $232.00 | $83.52–$220.40 | 80% below | 25% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 SOFT TISSUE HEAD OR NECK | $174.00 | $232.00 | $83.52–$220.40 | 80% below | 25% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US EXAM OF HEAD AND NECK ~T | $180.75 | $241.00 | $86.76–$228.95 | 79% below | 25% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US EXAM OF HEAD AND NECK | $185.25 | $247.00 | $89.56–$234.65 | 79% below | 25% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 THYROID US/OR | $258.00 | $344.00 | $104.86–$326.80 | 70% below | 25% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US THYROID LTD. | $174.00 | $232.00 | $83.52–$220.40 | — | 25% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US THYROID COMPLETE | $174.00 | $232.00 | $83.52–$220.40 | — | 25% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 SOFT TISSUE HEAD OR NECK | $174.00 | $232.00 | $83.52–$220.40 | — | 25% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US EXAM OF HEAD AND NECK ~T | $180.75 | $241.00 | $86.76–$228.95 | — | 25% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US EXAM OF HEAD AND NECK | $185.25 | $247.00 | $89.56–$234.65 | — | 25% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 THYROID US/OR | $258.00 | $344.00 | $104.86–$326.80 | — | 25% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 RAD UPPER GI SINGLE | $1,288.50 | $1,718.00 | $117.75–$1,632.10 | 11% above | 25% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 RAD UPPER GI SINGLE | $1,288.50 | $1,718.00 | $117.75–$1,632.10 | — | 25% |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 RAD. LT HUMERUS MIN 2 VIEWS,Left side | $654.00 | $872.00 | $30.84–$828.40 | 29% above | 25% |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 RAD. RT HUMERUS MIN 2 VIEWS,Right side | $654.00 | $872.00 | $30.84–$828.40 | 29% above | 25% |
| Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 RAD. LT HUMERUS MIN 2 VIEWS,Left side | $654.00 | $872.00 | $30.84–$828.40 | — | 25% |
| Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 RAD. RT HUMERUS MIN 2 VIEWS,Right side | $654.00 | $872.00 | $30.84–$828.40 | — | 25% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 EXTREMITY STUDY | $171.75 | $229.00 | $83.04–$217.55 | 75% below | 25% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 EXTREMITY STUDY ~P | $198.75 | $265.00 | $22.46–$251.75 | 71% below | 25% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 UNILATERAL OR LIMITED STUDY ~T | $138.00 | $184.00 | $66.24–$174.80 | 80% below | 25% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 LT PERIVASCULAR STUDY,Left side | $312.00 | $416.00 | $109.91–$395.20 | 54% below | 25% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 RT PERIVASCULAR STUDY,Right side | $312.00 | $416.00 | $109.91–$395.20 | 54% below | 25% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 EXTREMITY STUDY | $171.75 | $229.00 | $83.04–$217.55 | — | 25% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 EXTREMITY STUDY ~P | $198.75 | $265.00 | $22.46–$251.75 | — | 25% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 UNILATERAL OR LIMITED STUDY ~T | $138.00 | $184.00 | $66.24–$174.80 | — | 25% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 RT PERIVASCULAR STUDY,Right side | $312.00 | $416.00 | $109.91–$395.20 | — | 25% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 LT PERIVASCULAR STUDY,Left side | $312.00 | $416.00 | $109.91–$395.20 | — | 25% |
| Wrist X-ray, 2 views CPT 73100 RT WRIST LIMITED 2 VIEWS,Technical Component | $504.00 | $672.00 | $25.12–$638.40 | 4% above | 25% |
| Wrist X-ray, 2 views one side CPT 73100 RAD. LT WRIST LIMITED 2 VIEWS,Technical Component | $504.00 | $672.00 | $25.12–$638.40 | 4% above | 25% |
| Wrist X-ray, 2 views inpatient CPT 73100 RT WRIST LIMITED 2 VIEWS,Technical Component | $504.00 | $672.00 | $25.12–$638.40 | — | 25% |
| Wrist X-ray, 2 views inpatient one side CPT 73100 RAD. LT WRIST LIMITED 2 VIEWS,Technical Component | $504.00 | $672.00 | $25.12–$638.40 | — | 25% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 RAD.RT WRIST COMPL MIN 3 VIEWS,Right side | $581.25 | $775.00 | $41.22–$736.25 | at median | 25% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 RAD. LT WRIST COMPL MIN 3 VIEW,Left side | $581.25 | $775.00 | $41.22–$736.25 | at median | 25% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 RAD.RT WRIST COMPL MIN 3 VIEWS,Right side | $581.25 | $775.00 | $41.22–$736.25 | — | 25% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 RAD. LT WRIST COMPL MIN 3 VIEW,Left side | $581.25 | $775.00 | $41.22–$736.25 | — | 25% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 RAD. HIP COMPLETE 2 VIEWS | $570.75 | $761.00 | $47.06–$722.95 | at median | 25% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 RAD. LT HIP COMPLETE 2 VIEWS,Left side | $772.50 | $1,030.00 | $47.06–$978.50 | 36% above | 25% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 RAD. HIP COMPLETE 2 VIEWS | $570.75 | $761.00 | $47.06–$722.95 | — | 25% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 RAD. LT HIP COMPLETE 2 VIEWS,Left side | $772.50 | $1,030.00 | $47.06–$978.50 | — | 25% |
| X-ray of the abdomen, 1 view CPT 74018 RAD. ABDOMEN A-P | $592.50 | $790.00 | $28.59–$750.50 | 49% above | 25% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 RAD. ABDOMEN A-P | $592.50 | $790.00 | $28.59–$750.50 | — | 25% |
| X-ray of the ankle, 2 views one side CPT 73600 RAD. RT ANKLE LIMITED 2 VIEWS,Right side | $468.00 | $624.00 | $31.17–$592.80 | at median | 25% |
| X-ray of the ankle, 2 views one side CPT 73600 RAD. LT ANKLE LIMITED 2 VIEWS,Left side | $468.00 | $624.00 | $31.17–$592.80 | at median | 25% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 RAD. LT ANKLE LIMITED 2 VIEWS,Left side | $468.00 | $624.00 | $31.17–$592.80 | — | 25% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 RAD. RT ANKLE LIMITED 2 VIEWS,Right side | $468.00 | $624.00 | $31.17–$592.80 | — | 25% |
| X-ray of the finger(s), 2 or more views CPT 73140 RAD. FINGERS | $175.50 | $234.00 | $37.97–$222.30 | 55% below | 25% |
| X-ray of the finger(s), 2 or more views inpatient CPT 73140 RAD. FINGERS | $175.50 | $234.00 | $37.97–$222.30 | — | 25% |
| X-ray of the foot, 2 views one side CPT 73620 RAD. RT FOOT LIMITED 2 VIEWS,Right side | $475.50 | $634.00 | $27.61–$602.30 | at median | 25% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 RAD. RT FOOT LIMITED 2 VIEWS,Right side | $475.50 | $634.00 | $27.61–$602.30 | — | 25% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 RAD. LT FOOT COMPL MIN 3 VIEWS,Left side | $510.00 | $680.00 | $32.79–$646.00 | at median | 25% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 RAD. RT FOOT COMPL MIN 3 VIEWS,Right side | $510.00 | $680.00 | $32.79–$646.00 | at median | 25% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 RAD. LT FOOT COMPL MIN 3 VIEWS,Left side | $510.00 | $680.00 | $32.79–$646.00 | — | 25% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 RAD. RT FOOT COMPL MIN 3 VIEWS,Right side | $510.00 | $680.00 | $32.79–$646.00 | — | 25% |
| X-ray of the hand, 3 or more views one side CPT 73130 RAD. RT HAND 3 VIEWS,Right side | $504.00 | $672.00 | $36.68–$638.40 | at median | 25% |
| X-ray of the hand, 3 or more views inpatient one side CPT 73130 RAD. RT HAND 3 VIEWS,Right side | $504.00 | $672.00 | $36.68–$638.40 | — | 25% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 RAD. RT KNEE LIMITED,Right side | $500.25 | $667.00 | $33.11–$633.65 | at median | 25% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 RAD. LT KNEE LIMITED,Left side | $500.25 | $667.00 | $33.11–$633.65 | at median | 25% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 RAD. LT KNEE LIMITED,Left side | $500.25 | $667.00 | $33.11–$633.65 | — | 25% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 RAD. RT KNEE LIMITED,Right side | $500.25 | $667.00 | $33.11–$633.65 | — | 25% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 RAD. SPINE LUMBO-SAC | $565.50 | $754.00 | $38.96–$716.30 | 15% below | 25% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 RAD. SPINE LUMBO-SAC | $565.50 | $754.00 | $38.96–$716.30 | — | 25% |
| X-ray of the lower back, 4 or more views CPT 72110 RAD. SPINE COMPLETE | $1,053.00 | $1,404.00 | $51.46–$1,333.80 | 25% above | 25% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 RAD. SPINE COMPLETE | $1,053.00 | $1,404.00 | $51.46–$1,333.80 | — | 25% |
| X-ray of the nasal bones, 3 or more views CPT 70160 RAD. NASAL 3 VIEW | $624.00 | $832.00 | $36.03–$790.40 | 12% above | 25% |
| X-ray of the nasal bones, 3 or more views inpatient CPT 70160 RAD. NASAL 3 VIEW | $624.00 | $832.00 | $36.03–$790.40 | — | 25% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 RAD. SPINE CERVICAL 2 OR 3VIEW | $642.75 | $857.00 | $38.32–$814.15 | 28% above | 25% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 RAD. SPINE CERVICAL 2 OR 3VIEW | $642.75 | $857.00 | $38.32–$814.15 | — | 25% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 RAD. PELVIS, A-P | $431.25 | $575.00 | $26.96–$546.25 | 2% below | 25% |
| X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 RAD. PELVIS, A-P | $431.25 | $575.00 | $26.96–$546.25 | — | 25% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 RAD. SACRUM-COCCYX | $570.75 | $761.00 | $30.85–$722.95 | 13% above | 25% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 RAD. SACRUM-COCCYX | $570.75 | $761.00 | $30.85–$722.95 | — | 25% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Vermont | Off list |
|---|---|---|---|---|---|
| ACTH blood test CPT 82024 ACTH | $635.25 | $847.00 | $37.65–$804.65 | 65% above | 25% |
| ACTH blood test inpatient CPT 82024 ACTH | $635.25 | $847.00 | $37.65–$804.65 | — | 25% |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 MAYO ALT | $39.00 | $52.00 | $5.17–$49.40 | at median | 25% |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALT | $62.25 | $83.00 | $5.17–$78.85 | 59% above | 25% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 MAYO ALT | $39.00 | $52.00 | $5.17–$49.40 | — | 25% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALT | $62.25 | $83.00 | $5.17–$78.85 | — | 25% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 MAYO AST | $63.00 | $84.00 | $5.05–$79.80 | at median | 25% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 SGOT (AST) | $66.75 | $89.00 | $5.05–$84.55 | 6% above | 25% |
| AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 MAYO AST | $63.00 | $84.00 | $5.05–$79.80 | — | 25% |
| AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 SGOT (AST) | $66.75 | $89.00 | $5.05–$84.55 | — | 25% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 MAYO HEPABC PANEL | $407.25 | $543.00 | $46.44–$515.85 | 8% below | 25% |
| Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 MAYO HEPABC PANEL | $407.25 | $543.00 | $46.44–$515.85 | — | 25% |
| Albumin blood test CPT 82040 MAYO MULTIPLE SCLEROSIS PROF | $15.00 | $20.00 | $4.83–$19.00 | 65% below | 25% |
| Albumin blood test CPT 82040 MAYO ALBUMIN | $27.75 | $37.00 | $4.83–$35.15 | 35% below | 25% |
| Albumin blood test CPT 82040 FAHC IgG INDEX CSF | $63.00 | $84.00 | $4.83–$79.80 | 47% above | 25% |
| Albumin blood test CPT 82040 ALBUMIN | $75.75 | $101.00 | $4.83–$95.95 | 77% above | 25% |
| Albumin blood test inpatient CPT 82040 MAYO MULTIPLE SCLEROSIS PROF | $15.00 | $20.00 | $4.83–$19.00 | — | 25% |
| Albumin blood test inpatient CPT 82040 MAYO ALBUMIN | $27.75 | $37.00 | $4.83–$35.15 | — | 25% |
| Albumin blood test inpatient CPT 82040 FAHC IgG INDEX CSF | $63.00 | $84.00 | $4.83–$79.80 | — | 25% |
| Albumin blood test inpatient CPT 82040 ALBUMIN | $75.75 | $101.00 | $4.83–$95.95 | — | 25% |
| Aldosterone blood test CPT 82088 MAYO ALDOSTERONE, P | $31.50 | $42.00 | $15.12–$39.94 | 93% below | 25% |
| Aldosterone blood test CPT 82088 MAYO ALDOSTERONE, 24HR URINE | $67.50 | $90.00 | $32.40–$85.50 | 85% below | 25% |
| Aldosterone blood test CPT 82088 MAYO ALDOSTERONE SODIUM 24HR | $231.75 | $309.00 | $39.73–$293.55 | 47% below | 25% |
| Aldosterone blood test CPT 82088 ALDOSTERONE | $669.75 | $893.00 | $39.73–$848.35 | 53% above | 25% |
| Aldosterone blood test inpatient CPT 82088 MAYO ALDOSTERONE, P | $31.50 | $42.00 | $15.12–$39.94 | — | 25% |
| Aldosterone blood test inpatient CPT 82088 MAYO ALDOSTERONE, 24HR URINE | $67.50 | $90.00 | $32.40–$85.50 | — | 25% |
| Aldosterone blood test inpatient CPT 82088 MAYO ALDOSTERONE SODIUM 24HR | $231.75 | $309.00 | $39.73–$293.55 | — | 25% |
| Aldosterone blood test inpatient CPT 82088 ALDOSTERONE | $669.75 | $893.00 | $39.73–$848.35 | — | 25% |
| Alkaline phosphatase (ALP) blood test CPT 84075 ALK PHOSPHATASE | $68.25 | $91.00 | $5.05–$86.45 | 52% above | 25% |
| Alkaline phosphatase (ALP) blood test CPT 84075 PHOSPHATASE,ALKALINE; | $91.50 | $122.00 | $5.05–$115.90 | 103% above | 25% |
| Alkaline phosphatase (ALP) blood test inpatient CPT 84075 ALK PHOSPHATASE | $68.25 | $91.00 | $5.05–$86.45 | — | 25% |
| Alkaline phosphatase (ALP) blood test inpatient CPT 84075 PHOSPHATASE,ALKALINE; | $91.50 | $122.00 | $5.05–$115.90 | — | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO MOUSE URINE PROTEIN IgE | $5.25 | $7.00 | $2.52–$6.65 | 89% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO RESP PROFILE REG 2,MID-AT | $6.00 | $8.00 | $2.88–$7.60 | 88% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO BUDGERIGAR FEATHERS IgE | $6.00 | $8.00 | $2.88–$7.60 | 88% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO CORIANDER IgE | $6.00 | $8.00 | $2.88–$7.60 | 88% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO TURKEY IgE | $8.25 | $11.00 | $3.96–$10.45 | 83% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO PARSELY IgE | $8.25 | $11.00 | $3.96–$10.45 | 83% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO OLIVE IgE | $8.25 | $11.00 | $3.96–$10.45 | 83% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO BEETS IgE | $8.25 | $11.00 | $3.96–$10.45 | 83% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO LAMB IgE | $8.25 | $11.00 | $3.96–$10.45 | 83% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO SHEEP WOOL, IgE | $9.00 | $12.00 | $4.32–$11.40 | 82% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO CEPHALOSPORIUM ACREMONIUM | $9.00 | $12.00 | $4.32–$11.40 | 82% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO RAT URINE PROTEIN IgE | $9.00 | $12.00 | $4.32–$11.40 | 82% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO RESP PROFILE REG 1N ATLAN | $9.00 | $12.00 | $4.32–$11.40 | 82% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO RAT EPITHELIUM IgE | $9.00 | $12.00 | $4.32–$11.40 | 82% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO PEANUT COMPONENT REFLEX | $10.50 | $14.00 | $5.04–$13.30 | 79% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO CAROB,IgE | $18.75 | $25.00 | $5.09–$23.75 | 62% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO NON-SEAS ALLERGEN PROF | $19.50 | $26.00 | $5.09–$24.70 | 60% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO CLAM, Ige | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO OYSTER, Ige | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO SCALLOP, Ige | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO BANANA,IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO GREEN PEPPER IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO AVOCADO IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO CHESTNUT,SWEET IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO SUNFLOWER SEED, IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO JUNE GRASS IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO GOLDENROD, IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO GIANT RAGWEED IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO COTTONWOOD IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO SYCAMORE IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO EPICOCCUM PURPURAS IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO CURVULARIA LUNATA IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO CORN IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO WALNUT-FOOD IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO FOOD PANEL | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO SOYBEAN IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO CASEIN IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO PINEAPPLE IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO COCKROACH IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO FOOD NUT PANEL #1 | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO WHEAT IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO FOOD-SEAFOOD PANEL | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO PEANUT IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO GLUTEN IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO SPINACH IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO PINE NUT EgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO CRAB IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO LOBSTER IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO FOOD-MEAT PANEL | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO ASPERGILLUS FUMIGATUS | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO FOOD-GRAIN PANEL | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO RABBIT EPITHELIUM | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO FOOD-NUT PANEL #2 | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO FINCH FEATHERS | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO CHOCOLATE ALLERGEN | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO HAMSTER,IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO MACADAMIA NUT IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO HADDOCK IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO MEGRIM IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO ALMOND IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO BRAZIL NUT IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO MILK PROCESSED | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO MILK ALLERGEN | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO SHRIMP ALLERGEN | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO BERMUDA GRASS | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 NAYO HALIBUT IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO HAZELNUT FOOD IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO TUNA IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO SALMON,IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO CODFISH, IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO HOUSE DUST DF | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO JOHNSON GRASS | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO ALTERNARIA TENUIS | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO MEADOW FESCUE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO CLADOSPORIUM | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO RED SORREL | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO DOG | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO ROUGH PIGWEED | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO CAT | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO ENGLISH PLANTAIN | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO SHORT RAGWEED | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO SILVER BIRCH | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO CHILI PEPPER, IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO PAPRIKA,IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO WHITE POTATO, IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO ASPERGILLUS NIGER, IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO FOD PANEL 2, IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO PEDIATRIC ALL SCR 3-8YR | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO COCONUT IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO CASHEW IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO TREE PANEL #1 | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO PECAN-FOOD IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO HONEY IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 NORTHEASTERN ALLERGY SCREEN | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO CEDAR | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO TIMOTHY GRASS | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO MAPLE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO OAK | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO PENICILLIUM | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO LATEX | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO CANDIDA ALBICANS | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO D FARINAE IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO HORSE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO ALTERNARIA TENUIS IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO HOUSE DUST DP | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO CLADOSPORIUM IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO HOUSE DUST H-S | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO DOG DANDER IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO PISTACHIO IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO MOSQUITO IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO CAT EPITHELIUM IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO HOUSE DUST PANEL | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO WEED #1 PANEL | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO CRANBERRY IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO SPRUCE,IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO WHEY IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO CHEESE AMERICAN, IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO LAMB'S QUARTER IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO STRAWBERRY IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO SHORT RAGWEED IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO CHICKEN IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO RICE,IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO BROCCOLI IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO OAT,IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO PORK IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO BAKER'S YEAST IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO COTTAGE CHEESE IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO AUREOBASIDIUM PULLUL IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO BOTRYTIS CINEREA IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO TIMOTHY GRASS IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO CHEESE CHEDDAR | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO OAK IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO STEMPHYLIUM IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO BALD CYPRESS IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO ORANGE IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO GRAPE IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO LEMON IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO GRAPEFRUIT IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO LIME IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO FOOD-FRUIT PANEL | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO CELERY IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO GREEN PEA IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO GREEN STRING BEAN IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO KIDNEY BEAN IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO SWEET POTATO IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO LIMA BEAN IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO MUSTARD IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO MALT IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO RYE IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO CUCUMBER IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO EGGPLANT,IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO HOP FRUIT IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO BLACKBERRY IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO GARLIC IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO CEDAR RED IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO EGG WHOLE IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO BLACK/WHITE PEPPER IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO CURRY IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO LENTIL IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO ELM | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO TETANUS TOXOID IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO AMPICILLIN IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO PAPAYA IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO ROUGH MARSH ELDER IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO COCKLEBUR IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO WORMWOOD IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO MOUSE PROTEIN IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO CHERRY IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO APRICOT IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO WALNUT TREE IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO WHITE ASH | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO PLUM IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO PEAR IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO HELMINTHOSPORUIM HALODES | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO FUSARIUM MONILIFORME | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO RED TOP | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO ORCHARD GRASS | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO RYE GRASS | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO SWEET VERNAL GRASS | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO AMOXICILLIN IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO PENICILLIN G IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO PENICILLIN V IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO MUCOR | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO WHITE HICKORY | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO WHITE PINE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO WILLOW | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO LAMBS QUARTER | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAY MUGWORT | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO BEEF, IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO SESAME SEED, IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO LETTICE, IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO ONION,IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO TOMATO,IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO HONEYBEE VENOM, IGE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO WHT FCD HRNT VENOM, IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO YLW FACED HRNT VENOM, IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO WASP VENOM, IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO YLW JACKET VENNOM, IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO BLUE MUSSELL, Ige | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO SQUID IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO SWORDFISH IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO MANDARIN IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO CHEESE,MOLD,IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO COFFEE, IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO CUTVULARIA SPICIFERA IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO RHODOTORULA,IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO NUTMEG, IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO CINNAMON, IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO VENOM BUMBLE BEE IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO EGG YOLK | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO ANISE, IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO GINGER IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO BARLEY,IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO BLUEBERRY,IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO WATERMELON IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO MELONS,IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO APPLE ,IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO CHICKEN FEATHER IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO COW EPITHELIUM IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO GOAT IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO WEED PANEL #4 | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO GUINEA PIG EPITHELIUM IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO FALSE RAGWEED | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO INSULIN (HUMAN) IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO ASCARIS IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO POPPY SEED, IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO BEECH | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO WHITE BEAN IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO MOLD PANEL | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO DEER IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO FEATHER PANEL #1 | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Mayo Peach Ige | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO ASPARAGUS IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO BRUSSEL SPROUTS IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO BUCKWHEAT IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO CABBAGE IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO CARROT IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO CAULIFLOWER IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYOALLERGENPROF DAIRY/GRAIN | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO CHICK PEA IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO SQUASH IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO MACKEREL IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO EGG WHITE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO RASPBERRY, IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO TROUT IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO SOLE IgE | $21.00 | $28.00 | $5.09–$26.60 | 57% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO KIWI FRUIT IgE | $28.50 | $38.00 | $5.09–$36.10 | 42% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO FEATHERS PANEL #2 IgE | $36.00 | $48.00 | $5.09–$45.60 | 27% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO MUSHROOM, IgE | $36.00 | $48.00 | $5.09–$45.60 | 27% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO EPITHELIA PANEL #1 | $37.50 | $50.00 | $5.09–$47.50 | 23% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO CATFISH IgE | $38.25 | $51.00 | $5.09–$48.45 | 22% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO PEPPER CAYENNE IgE | $48.75 | $65.00 | $5.09–$61.75 | 1% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO FLOUNDER IgE | $48.75 | $65.00 | $5.09–$61.75 | 1% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO CANARY FEATHERS | $48.75 | $65.00 | $5.09–$61.75 | 1% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO HORSEFLY/STABLEFLY | $48.75 | $65.00 | $5.09–$61.75 | 1% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO PERCH IgE | $48.75 | $65.00 | $5.09–$61.75 | 1% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO FIRE ANT | $48.75 | $65.00 | $5.09–$61.75 | 1% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO GRASS PANEL #2 | $51.75 | $69.00 | $5.09–$65.55 | 6% above | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO BEAN BLACK IgE | $55.50 | $74.00 | $5.09–$70.30 | 13% above | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO JALAPENO/CHIPOTLE IgE | $55.50 | $74.00 | $5.09–$70.30 | 13% above | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO DOCK YELLOW IgE | $56.25 | $75.00 | $5.09–$71.25 | 15% above | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO ASPIRIN,IgE | $62.25 | $83.00 | $5.09–$78.85 | 27% above | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO NECTARINE IgE | $63.75 | $85.00 | $5.09–$80.75 | 30% above | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO GUM CARAGEENAN IgE | $63.75 | $85.00 | $5.09–$80.75 | 30% above | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO ANNATTO SEED, IgE | $69.00 | $92.00 | $5.09–$87.40 | 41% above | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO HOUSE DUST GREER | $70.50 | $94.00 | $5.09–$89.30 | 44% above | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO ANNATTO SEED, IGE | $75.75 | $101.00 | $5.09–$95.95 | 55% above | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO GALACTOSE-ALPHA-1,3-GALAC | $77.25 | $103.00 | $5.09–$97.85 | 58% above | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO CARMINE(RED) DYE IgE | $101.25 | $135.00 | $5.09–$128.25 | 107% above | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MAYO SEASONAL ALLERGEN PANEL | $129.75 | $173.00 | $5.09–$164.35 | 165% above | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO MOUSE URINE PROTEIN IgE | $5.25 | $7.00 | $2.52–$6.65 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO BUDGERIGAR FEATHERS IgE | $6.00 | $8.00 | $2.88–$7.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO CORIANDER IgE | $6.00 | $8.00 | $2.88–$7.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO RESP PROFILE REG 2,MID-AT | $6.00 | $8.00 | $2.88–$7.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO TURKEY IgE | $8.25 | $11.00 | $3.96–$10.45 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO BEETS IgE | $8.25 | $11.00 | $3.96–$10.45 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO OLIVE IgE | $8.25 | $11.00 | $3.96–$10.45 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO LAMB IgE | $8.25 | $11.00 | $3.96–$10.45 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO PARSELY IgE | $8.25 | $11.00 | $3.96–$10.45 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO RESP PROFILE REG 1N ATLAN | $9.00 | $12.00 | $4.32–$11.40 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO RAT EPITHELIUM IgE | $9.00 | $12.00 | $4.32–$11.40 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO SHEEP WOOL, IgE | $9.00 | $12.00 | $4.32–$11.40 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO RAT URINE PROTEIN IgE | $9.00 | $12.00 | $4.32–$11.40 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO CEPHALOSPORIUM ACREMONIUM | $9.00 | $12.00 | $4.32–$11.40 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO PEANUT COMPONENT REFLEX | $10.50 | $14.00 | $5.04–$13.30 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO CAROB,IgE | $18.75 | $25.00 | $5.09–$23.75 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO NON-SEAS ALLERGEN PROF | $19.50 | $26.00 | $5.09–$24.70 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO WHEAT IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO COCKROACH IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO FOOD NUT PANEL #1 | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO FOOD-SEAFOOD PANEL | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO FOOD-MEAT PANEL | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO FOOD-GRAIN PANEL | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO FOOD-NUT PANEL #2 | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO FINCH FEATHERS | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO CHOCOLATE ALLERGEN | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO MILK PROCESSED | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO MILK ALLERGEN | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO SHRIMP ALLERGEN | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO HOUSE DUST DF | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO ALTERNARIA TENUIS | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO CLADOSPORIUM | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO DOG | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO CAT | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO SHORT RAGWEED | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 NORTHEASTERN ALLERGY SCREEN | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO TIMOTHY GRASS | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO OAK | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO LATEX | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO D FARINAE IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO ALTERNARIA TENUIS IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO CLADOSPORIUM IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO DOG DANDER IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO CAT EPITHELIUM IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO LAMB'S QUARTER IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO SHORT RAGWEED IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO TIMOTHY GRASS IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO OAK IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO RASPBERRY, IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO ANISE, IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO GINGER IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO GUINEA PIG EPITHELIUM IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO INSULIN (HUMAN) IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO WHITE BEAN IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO DEER IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Mayo Peach Ige | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO MUSTARD IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO EGGPLANT,IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO LENTIL IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO WALNUT TREE IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO PLUM IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO PEAR IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO APRICOT IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO CHERRY IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO MOUSE PROTEIN IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO WORMWOOD IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO COCKLEBUR IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO ROUGH MARSH ELDER IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO PAPAYA IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO AMPICILLIN IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO TETANUS TOXOID IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO CURRY IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO BLACK/WHITE PEPPER IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO EGG WHOLE IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO CEDAR RED IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO GARLIC IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO BLACKBERRY IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO HOP FRUIT IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO CUCUMBER IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO RYE IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO MALT IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO LIMA BEAN IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO SWEET POTATO IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO KIDNEY BEAN IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO GREEN STRING BEAN IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO GREEN PEA IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO CHICK PEA IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO CELERY IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO CAULIFLOWER IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO CARROT IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO CABBAGE IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO BUCKWHEAT IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO BRUSSEL SPROUTS IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO ASPARAGUS IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO POPPY SEED, IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO ASCARIS IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO GOAT IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO COW EPITHELIUM IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO CHICKEN FEATHER IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO APPLE ,IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO MELONS,IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO WATERMELON IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO BLUEBERRY,IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO BARLEY,IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO VENOM BUMBLE BEE IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO CINNAMON, IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO NUTMEG, IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO RHODOTORULA,IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO CUTVULARIA SPICIFERA IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO COFFEE, IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO CHEESE,MOLD,IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO MANDARIN IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO SWORDFISH IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO SQUID IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO SOLE IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO TROUT IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO MACKEREL IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO SQUASH IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO FOOD-FRUIT PANEL | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO LIME IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO GRAPEFRUIT IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO LEMON IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO GRAPE IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO ORANGE IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO BALD CYPRESS IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO STEMPHYLIUM IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO BOTRYTIS CINEREA IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO AUREOBASIDIUM PULLUL IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO COTTAGE CHEESE IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO BAKER'S YEAST IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO PORK IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO OAT,IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO BROCCOLI IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO RICE,IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO CHEESE AMERICAN, IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO WHEY IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO SPRUCE,IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO WEED #1 PANEL | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO HOUSE DUST PANEL | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO MOSQUITO IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO PISTACHIO IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO HONEY IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO PECAN-FOOD IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO TREE PANEL #1 | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO CASHEW IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO COCONUT IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO PEDIATRIC ALL SCR 3-8YR | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO FOD PANEL 2, IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO ASPERGILLUS NIGER, IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO WHITE POTATO, IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO PAPRIKA,IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO CHILI PEPPER, IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO CODFISH, IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO SALMON,IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO TUNA IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO HAZELNUT FOOD IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 NAYO HALIBUT IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO BRAZIL NUT IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO ALMOND IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO MEGRIM IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO HADDOCK IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO MACADAMIA NUT IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO HAMSTER,IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO LOBSTER IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO CRAB IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO PINE NUT EgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO SPINACH IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO GLUTEN IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO PINEAPPLE IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO CASEIN IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO SOYBEAN IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO FOOD PANEL | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO WALNUT-FOOD IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO CORN IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO CURVULARIA LUNATA IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO EPICOCCUM PURPURAS IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO SYCAMORE IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO COTTONWOOD IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO GIANT RAGWEED IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO GOLDENROD, IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO JUNE GRASS IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO SUNFLOWER SEED, IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO CHESTNUT,SWEET IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO AVOCADO IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO GREEN PEPPER IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO BANANA,IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO SCALLOP, Ige | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO OYSTER, Ige | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO CLAM, Ige | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO BLUE MUSSELL, Ige | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO YLW JACKET VENNOM, IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO WASP VENOM, IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO YLW FACED HRNT VENOM, IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO WHT FCD HRNT VENOM, IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO HONEYBEE VENOM, IGE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO TOMATO,IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO ONION,IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO LETTICE, IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO SESAME SEED, IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO BEEF, IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAY MUGWORT | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO LAMBS QUARTER | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO WILLOW | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO WHITE PINE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO WHITE HICKORY | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO MUCOR | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO PENICILLIN V IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO PENICILLIN G IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO AMOXICILLIN IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO SWEET VERNAL GRASS | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO RYE GRASS | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO ORCHARD GRASS | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO RED TOP | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO FUSARIUM MONILIFORME | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO HELMINTHOSPORUIM HALODES | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO WHITE ASH | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO ELM | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYOALLERGENPROF DAIRY/GRAIN | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO FEATHER PANEL #1 | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO MOLD PANEL | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO BEECH | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO FALSE RAGWEED | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO WEED PANEL #4 | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO EGG YOLK | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO EGG WHITE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO CHEESE CHEDDAR | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO CHICKEN IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO STRAWBERRY IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO CRANBERRY IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO HOUSE DUST H-S | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO HOUSE DUST DP | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO HORSE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO CANDIDA ALBICANS | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO PENICILLIUM | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO MAPLE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO CEDAR | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO SILVER BIRCH | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO ENGLISH PLANTAIN | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO ROUGH PIGWEED | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO RED SORREL | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO MEADOW FESCUE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO JOHNSON GRASS | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO BERMUDA GRASS | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO RABBIT EPITHELIUM | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO ASPERGILLUS FUMIGATUS | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO PEANUT IgE | $21.00 | $28.00 | $5.09–$26.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO KIWI FRUIT IgE | $28.50 | $38.00 | $5.09–$36.10 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO FEATHERS PANEL #2 IgE | $36.00 | $48.00 | $5.09–$45.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO MUSHROOM, IgE | $36.00 | $48.00 | $5.09–$45.60 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO EPITHELIA PANEL #1 | $37.50 | $50.00 | $5.09–$47.50 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO CATFISH IgE | $38.25 | $51.00 | $5.09–$48.45 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO PEPPER CAYENNE IgE | $48.75 | $65.00 | $5.09–$61.75 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO PERCH IgE | $48.75 | $65.00 | $5.09–$61.75 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO FLOUNDER IgE | $48.75 | $65.00 | $5.09–$61.75 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO HORSEFLY/STABLEFLY | $48.75 | $65.00 | $5.09–$61.75 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO FIRE ANT | $48.75 | $65.00 | $5.09–$61.75 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO CANARY FEATHERS | $48.75 | $65.00 | $5.09–$61.75 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO GRASS PANEL #2 | $51.75 | $69.00 | $5.09–$65.55 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO BEAN BLACK IgE | $55.50 | $74.00 | $5.09–$70.30 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO JALAPENO/CHIPOTLE IgE | $55.50 | $74.00 | $5.09–$70.30 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO DOCK YELLOW IgE | $56.25 | $75.00 | $5.09–$71.25 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO ASPIRIN,IgE | $62.25 | $83.00 | $5.09–$78.85 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO GUM CARAGEENAN IgE | $63.75 | $85.00 | $5.09–$80.75 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO NECTARINE IgE | $63.75 | $85.00 | $5.09–$80.75 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO ANNATTO SEED, IgE | $69.00 | $92.00 | $5.09–$87.40 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO HOUSE DUST GREER | $70.50 | $94.00 | $5.09–$89.30 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO ANNATTO SEED, IGE | $75.75 | $101.00 | $5.09–$95.95 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO GALACTOSE-ALPHA-1,3-GALAC | $77.25 | $103.00 | $5.09–$97.85 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO CARMINE(RED) DYE IgE | $101.25 | $135.00 | $5.09–$128.25 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAYO SEASONAL ALLERGEN PANEL | $129.75 | $173.00 | $5.09–$164.35 | — | 25% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 MAYO AFP SINGLE MARKER MATERN | $34.50 | $46.00 | $16.35–$43.70 | 71% below | 25% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 AFP TUMOR MARKER NVRH DHCC | $355.50 | $474.00 | $16.35–$450.30 | 204% above | 25% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 AFP TUMOR MARKE | $355.50 | $474.00 | $16.35–$450.30 | 204% above | 25% |
| Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 MAYO AFP SINGLE MARKER MATERN | $34.50 | $46.00 | $16.35–$43.70 | — | 25% |
| Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 AFP TUMOR MARKE | $355.50 | $474.00 | $16.35–$450.30 | — | 25% |
| Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 AFP TUMOR MARKER NVRH DHCC | $355.50 | $474.00 | $16.35–$450.30 | — | 25% |
| Ammonia blood test CPT 82140 MAYO SUPERSATURATION 24HR URIN | $27.75 | $37.00 | $13.32–$35.15 | 79% below | 25% |
| Ammonia blood test CPT 82140 MAYO AMMONIUM RANDOM URINE | $107.25 | $143.00 | $14.21–$135.85 | 19% below | 25% |
| Ammonia blood test CPT 82140 AMMONIA | $244.50 | $326.00 | $14.21–$309.70 | 84% above | 25% |
| Ammonia blood test inpatient CPT 82140 MAYO SUPERSATURATION 24HR URIN | $27.75 | $37.00 | $13.32–$35.15 | — | 25% |
| Ammonia blood test inpatient CPT 82140 MAYO AMMONIUM RANDOM URINE | $107.25 | $143.00 | $14.21–$135.85 | — | 25% |
| Ammonia blood test inpatient CPT 82140 AMMONIA | $244.50 | $326.00 | $14.21–$309.70 | — | 25% |
| Amylase blood test CPT 82150 MAYO AMYLASE PANCREATIC FLUID | $57.00 | $76.00 | $6.32–$72.20 | 8% above | 25% |
| Amylase blood test CPT 82150 MAYO AMYLASE BODY FLUID | $76.50 | $102.00 | $6.32–$96.90 | 45% above | 25% |
| Amylase blood test CPT 82150 AMYLASE | $101.25 | $135.00 | $6.32–$128.25 | 92% above | 25% |
| Amylase blood test inpatient CPT 82150 MAYO AMYLASE PANCREATIC FLUID | $57.00 | $76.00 | $6.32–$72.20 | — | 25% |
| Amylase blood test inpatient CPT 82150 MAYO AMYLASE BODY FLUID | $76.50 | $102.00 | $6.32–$96.90 | — | 25% |
| Amylase blood test inpatient CPT 82150 AMYLASE | $101.25 | $135.00 | $6.32–$128.25 | — | 25% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 MAYO CONNECTIVE TISS DISEASE | $25.50 | $34.00 | $12.24–$32.30 | 78% below | 25% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 UVM CYCLIC CITRULLINATED PEPTI | $36.00 | $48.00 | $12.63–$45.60 | 69% below | 25% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 MAYO CONNECTIVE TISS DIS CAS | $42.75 | $57.00 | $12.63–$54.15 | 63% below | 25% |
| Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 MAYO CONNECTIVE TISS DISEASE | $25.50 | $34.00 | $12.24–$32.30 | — | 25% |
| Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 UVM CYCLIC CITRULLINATED PEPTI | $36.00 | $48.00 | $12.63–$45.60 | — | 25% |
| Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 MAYO CONNECTIVE TISS DIS CAS | $42.75 | $57.00 | $12.63–$54.15 | — | 25% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 MAYO AUTOIMMUNE LIVER DISEASE | $15.00 | $20.00 | $7.20–$19.00 | 85% below | 25% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 MAYO CONNECTIVE TISS DISEASE | $24.75 | $33.00 | $11.79–$31.35 | 76% below | 25% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 MAYO SCLERODERMA COMP PROFILE | $27.75 | $37.00 | $11.79–$35.15 | 73% below | 25% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA | $204.00 | $272.00 | $11.79–$258.40 | 98% above | 25% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 MAYO AUTOIMMUNE LIVER DISEASE | $15.00 | $20.00 | $7.20–$19.00 | — | 25% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 MAYO CONNECTIVE TISS DISEASE | $24.75 | $33.00 | $11.79–$31.35 | — | 25% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 MAYO SCLERODERMA COMP PROFILE | $27.75 | $37.00 | $11.79–$35.15 | — | 25% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA | $204.00 | $272.00 | $11.79–$258.40 | — | 25% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 B-TYPE NATRIURETIC PEPTIDE | $539.25 | $719.00 | $38.28–$683.05 | 114% above | 25% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 MAYO NT-PRO BNP | $560.25 | $747.00 | $38.28–$709.65 | 122% above | 25% |
| BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 B-TYPE NATRIURETIC PEPTIDE | $539.25 | $719.00 | $38.28–$683.05 | — | 25% |
| BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 MAYO NT-PRO BNP | $560.25 | $747.00 | $38.28–$709.65 | — | 25% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 UVM BACTERIAL CULT,CF RESPIRAT | $9.75 | $13.00 | $4.68–$12.35 | 88% below | 25% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 UVM GROUP B SUSCEPTIBILITY | $32.25 | $43.00 | $8.40–$40.85 | 62% below | 25% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 UVM RESPIRTORY CULTURE&SMEAR | $44.25 | $59.00 | $8.40–$56.05 | 47% below | 25% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 FAHC ANAEROBIC CULTURE | $75.00 | $100.00 | $8.40–$95.00 | 11% below | 25% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 FAHC BACTERIAL CULTURE/SMEAR | $121.50 | $162.00 | $8.40–$153.90 | 44% above | 25% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 FAHC BACTERIAL TISSUE/SMEAR | $149.25 | $199.00 | $8.40–$189.05 | 77% above | 25% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 FAHC BACTERIAL CULTURE OTHER | $149.25 | $199.00 | $8.40–$189.05 | 77% above | 25% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE ROUTINE | $149.25 | $199.00 | $8.40–$189.05 | 77% above | 25% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 MAYO CYSTIC FIBROSIS,CULTURE | $184.50 | $246.00 | $8.40–$233.70 | 119% above | 25% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 UVM BACTERIAL CULT,CF RESPIRAT | $9.75 | $13.00 | $4.68–$12.35 | — | 25% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 UVM GROUP B SUSCEPTIBILITY | $32.25 | $43.00 | $8.40–$40.85 | — | 25% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 UVM RESPIRTORY CULTURE&SMEAR | $44.25 | $59.00 | $8.40–$56.05 | — | 25% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 FAHC ANAEROBIC CULTURE | $75.00 | $100.00 | $8.40–$95.00 | — | 25% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 FAHC BACTERIAL CULTURE/SMEAR | $121.50 | $162.00 | $8.40–$153.90 | — | 25% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 FAHC BACTERIAL CULTURE OTHER | $149.25 | $199.00 | $8.40–$189.05 | — | 25% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 FAHC BACTERIAL TISSUE/SMEAR | $149.25 | $199.00 | $8.40–$189.05 | — | 25% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE ROUTINE | $149.25 | $199.00 | $8.40–$189.05 | — | 25% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 MAYO CYSTIC FIBROSIS,CULTURE | $184.50 | $246.00 | $8.40–$233.70 | — | 25% |
| Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL | $134.25 | $179.00 | $8.25–$170.05 | 44% above | 25% |
| Basic metabolic panel (blood test) CPT 80048 BMP (NVRH DHCC) | $134.25 | $179.00 | $8.25–$170.05 | 44% above | 25% |
| Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL | $134.25 | $179.00 | $8.25–$170.05 | — | 25% |
| Basic metabolic panel (blood test) inpatient CPT 80048 BMP (NVRH DHCC) | $134.25 | $179.00 | $8.25–$170.05 | — | 25% |
| Bilirubin blood test, total CPT 82247 UVM BILIRUBIN, TOTAL | $6.00 | $8.00 | $2.88–$7.60 | 88% below | 25% |
| Bilirubin blood test, total CPT 82247 MAYO TOTAL BILIRUBIN | $52.50 | $70.00 | $4.89–$66.50 | 3% above | 25% |
| Bilirubin blood test, total CPT 82247 NBIL BILIRUBIN NEONATAL | $90.00 | $120.00 | $4.89–$114.00 | 76% above | 25% |
| Bilirubin blood test, total CPT 82247 BILIRUBIN TOTAL | $100.50 | $134.00 | $4.89–$127.30 | 97% above | 25% |
| Bilirubin blood test, total CPT 82247 N BILI TOTAL | $110.25 | $147.00 | $4.89–$139.65 | 116% above | 25% |
| Bilirubin blood test, total CPT 82247 MAYO BILIRUBIN BODY FLUID | $116.25 | $155.00 | $4.89–$147.25 | 128% above | 25% |
| Bilirubin blood test, total inpatient CPT 82247 UVM BILIRUBIN, TOTAL | $6.00 | $8.00 | $2.88–$7.60 | — | 25% |
| Bilirubin blood test, total inpatient CPT 82247 MAYO TOTAL BILIRUBIN | $52.50 | $70.00 | $4.89–$66.50 | — | 25% |
| Bilirubin blood test, total inpatient CPT 82247 NBIL BILIRUBIN NEONATAL | $90.00 | $120.00 | $4.89–$114.00 | — | 25% |
| Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN TOTAL | $100.50 | $134.00 | $4.89–$127.30 | — | 25% |
| Bilirubin blood test, total inpatient CPT 82247 N BILI TOTAL | $110.25 | $147.00 | $4.89–$139.65 | — | 25% |
| Bilirubin blood test, total inpatient CPT 82247 MAYO BILIRUBIN BODY FLUID | $116.25 | $155.00 | $4.89–$147.25 | — | 25% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 CYTOLOGY CELL BLOCK FAHC | $83.25 | $111.00 | $39.96–$105.45 | 68% below | 25% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 LEVEL 4 GROSS&MICRO | $243.75 | $325.00 | $59.14–$308.75 | 7% below | 25% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 SUBSEQ SPECIMEN | $333.75 | $445.00 | $59.14–$422.75 | 28% above | 25% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 SKIN BIOPSY - COMPLEX (SK4) | $337.50 | $450.00 | $59.14–$427.50 | 29% above | 25% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 BONE MARROW NEED BIO | $345.00 | $460.00 | $59.14–$437.00 | 32% above | 25% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 SKIN BIOPSY | $451.50 | $602.00 | $59.14–$571.90 | 73% above | 25% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 CYTOLOGY CELL BLOCK FAHC | $83.25 | $111.00 | $39.96–$105.45 | — | 25% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 LEVEL 4 GROSS&MICRO | $243.75 | $325.00 | $59.14–$308.75 | — | 25% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 SUBSEQ SPECIMEN | $333.75 | $445.00 | $59.14–$422.75 | — | 25% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 SKIN BIOPSY - COMPLEX (SK4) | $337.50 | $450.00 | $59.14–$427.50 | — | 25% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 BONE MARROW NEED BIO | $345.00 | $460.00 | $59.14–$437.00 | — | 25% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 SKIN BIOPSY | $451.50 | $602.00 | $59.14–$571.90 | — | 25% |
| Blood culture for bacteria CPT 87040 BLOOD CULTURE | $132.00 | $176.00 | $10.06–$167.20 | 3% below | 25% |
| Blood culture for bacteria inpatient CPT 87040 BLOOD CULTURE | $132.00 | $176.00 | $10.06–$167.20 | — | 25% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 INSTLJ CH TUBE/CATH AGENT | $14.25 | $19.00 | $6.84–$18.05 | 51% below | 25% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE ROUTINE | $14.25 | $19.00 | $6.27–$18.05 | 51% below | 25% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 ROUTINE VENIPUNCTURE | $45.00 | $60.00 | $8.86–$57.00 | 55% above | 25% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE TEST KIT | $45.00 | $60.00 | $8.86–$57.00 | 55% above | 25% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 BLOOD DRAW | $48.75 | $65.00 | $6.27–$61.75 | 68% above | 25% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE ROUTINE | $14.25 | $19.00 | $6.27–$18.05 | — | 25% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 INSTLJ CH TUBE/CATH AGENT | $14.25 | $19.00 | $6.84–$18.05 | — | 25% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE TEST KIT | $45.00 | $60.00 | $8.86–$57.00 | — | 25% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 ROUTINE VENIPUNCTURE | $45.00 | $60.00 | $8.86–$57.00 | — | 25% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 BLOOD DRAW | $48.75 | $65.00 | $6.27–$61.75 | — | 25% |
| Blood glucose (sugar) test CPT 82947 GLUCOSE SERUM | $44.25 | $59.00 | $3.83–$56.05 | 8% above | 25% |
| Blood glucose (sugar) test CPT 82947 GLUCOSE 1-2 HR PP | $44.25 | $59.00 | $3.83–$56.05 | 8% above | 25% |
| Blood glucose (sugar) test CPT 82947 MAYO GLUCOSE | $46.50 | $62.00 | $3.83–$58.90 | 13% above | 25% |
| Blood glucose (sugar) test CPT 82947 FASTING GLUCOSE | $72.75 | $97.00 | $3.83–$92.15 | 77% above | 25% |
| Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE 1-2 HR PP | $44.25 | $59.00 | $3.83–$56.05 | — | 25% |
| Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE SERUM | $44.25 | $59.00 | $3.83–$56.05 | — | 25% |
| Blood glucose (sugar) test inpatient CPT 82947 MAYO GLUCOSE | $46.50 | $62.00 | $3.83–$58.90 | — | 25% |
| Blood glucose (sugar) test inpatient CPT 82947 FASTING GLUCOSE | $72.75 | $97.00 | $3.83–$92.15 | — | 25% |
| Blood lead test CPT 83655 LEAD | $12.75 | $17.00 | $6.12–$16.15 | 80% below | 25% |
| Blood lead test CPT 83655 MAYO LEAD/CREAT RATIO, URINE | $22.50 | $30.00 | $10.80–$28.50 | 65% below | 25% |
| Blood lead test CPT 83655 LEAD TEST | $24.75 | $33.00 | $11.81–$31.35 | 61% below | 25% |
| Blood lead test CPT 83655 MAYO LEAD 24 HR URINE | $45.00 | $60.00 | $11.81–$57.00 | 30% below | 25% |
| Blood lead test CPT 83655 MAYO HEAVY METALS SCR OCC | $63.75 | $85.00 | $11.81–$80.75 | 1% below | 25% |
| Blood lead test CPT 83655 MAYO HEAVY METALS SCREEN BLOOD | $196.50 | $262.00 | $11.81–$248.90 | 206% above | 25% |
| Blood lead test CPT 83655 LEAD, BLOOD | $204.00 | $272.00 | $11.81–$258.40 | 217% above | 25% |
| Blood lead test CPT 83655 LEAD 24 HR URINE | $303.75 | $405.00 | $11.81–$384.75 | 373% above | 25% |
| Blood lead test inpatient CPT 83655 LEAD | $12.75 | $17.00 | $6.12–$16.15 | — | 25% |
| Blood lead test inpatient CPT 83655 MAYO LEAD/CREAT RATIO, URINE | $22.50 | $30.00 | $10.80–$28.50 | — | 25% |
| Blood lead test inpatient CPT 83655 LEAD TEST | $24.75 | $33.00 | $11.81–$31.35 | — | 25% |
| Blood lead test inpatient CPT 83655 MAYO LEAD 24 HR URINE | $45.00 | $60.00 | $11.81–$57.00 | — | 25% |
| Blood lead test inpatient CPT 83655 MAYO HEAVY METALS SCR OCC | $63.75 | $85.00 | $11.81–$80.75 | — | 25% |
| Blood lead test inpatient CPT 83655 MAYO HEAVY METALS SCREEN BLOOD | $196.50 | $262.00 | $11.81–$248.90 | — | 25% |
| Blood lead test inpatient CPT 83655 LEAD, BLOOD | $204.00 | $272.00 | $11.81–$258.40 | — | 25% |
| Blood lead test inpatient CPT 83655 LEAD 24 HR URINE | $303.75 | $405.00 | $11.81–$384.75 | — | 25% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HCG BETA SER QUAL | $99.00 | $132.00 | $7.33–$125.40 | 18% above | 25% |
| Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HCG BETA SER QUAL | $99.00 | $132.00 | $7.33–$125.40 | — | 25% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ARC ABO | $116.25 | $155.00 | $2.92–$147.25 | 37% above | 25% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 GROUP ONLY | $116.25 | $155.00 | $2.92–$147.25 | 37% above | 25% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 UVM ISOHEMAGGLUTININS QT | $116.25 | $155.00 | $2.92–$147.25 | 37% above | 25% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 UVM ISOHEMAGGLUTININS QT | $116.25 | $155.00 | $2.92–$147.25 | — | 25% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 GROUP ONLY | $116.25 | $155.00 | $2.92–$147.25 | — | 25% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ARC ABO | $116.25 | $155.00 | $2.92–$147.25 | — | 25% |
| Blood urea nitrogen (BUN) test CPT 84520 UREA NITROGEN | $48.00 | $64.00 | $3.85–$60.80 | 14% above | 25% |
| Blood urea nitrogen (BUN) test CPT 84520 BUN NVRH DHCC | $48.00 | $64.00 | $3.85–$60.80 | 14% above | 25% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 BUN NVRH DHCC | $48.00 | $64.00 | $3.85–$60.80 | — | 25% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 UREA NITROGEN | $48.00 | $64.00 | $3.85–$60.80 | — | 25% |
| C-peptide blood test CPT 84681 MAYO C-PEPTIDE, 24HR URINE | $54.00 | $72.00 | $20.29–$68.40 | 71% below | 25% |
| C-peptide blood test CPT 84681 C PEPTIDE SERUM | $345.75 | $461.00 | $20.29–$437.95 | 85% above | 25% |
| C-peptide blood test CPT 84681 C PEPTIDE URIN | $472.50 | $630.00 | $20.29–$598.50 | 153% above | 25% |
| C-peptide blood test inpatient CPT 84681 MAYO C-PEPTIDE, 24HR URINE | $54.00 | $72.00 | $20.29–$68.40 | — | 25% |
| C-peptide blood test inpatient CPT 84681 C PEPTIDE SERUM | $345.75 | $461.00 | $20.29–$437.95 | — | 25% |
| C-peptide blood test inpatient CPT 84681 C PEPTIDE URIN | $472.50 | $630.00 | $20.29–$598.50 | — | 25% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN NVRH DHCC | $62.25 | $83.00 | $5.05–$78.85 | 2% above | 25% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 CRP QUANTITATIVE | $62.25 | $83.00 | $5.05–$78.85 | 2% above | 25% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN NVRH DHCC | $62.25 | $83.00 | $5.05–$78.85 | — | 25% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 CRP QUANTITATIVE | $62.25 | $83.00 | $5.05–$78.85 | — | 25% |
| C. difficile toxin gene test (stool PCR) CPT 87493 XPERT C. DIFFICILE | $93.00 | $124.00 | $36.34–$117.80 | 60% below | 25% |
| C. difficile toxin gene test (stool PCR) inpatient CPT 87493 XPERT C. DIFFICILE | $93.00 | $124.00 | $36.34–$117.80 | — | 25% |
| CA 19-9 blood test (tumor marker) CPT 86301 CA19-9 | $345.75 | $461.00 | $20.29–$437.95 | 57% above | 25% |
| CA 19-9 blood test (tumor marker) CPT 86301 CA 19-9 NVRH DHCC | $345.75 | $461.00 | $20.29–$437.95 | 57% above | 25% |
| CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA19-9 | $345.75 | $461.00 | $20.29–$437.95 | — | 25% |
| CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA 19-9 NVRH DHCC | $345.75 | $461.00 | $20.29–$437.95 | — | 25% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 CA125 | $345.75 | $461.00 | $20.29–$437.95 | 85% above | 25% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 CA 125 NVRH DHCC | $345.75 | $461.00 | $20.29–$437.95 | 85% above | 25% |
| CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA125 | $345.75 | $461.00 | $20.29–$437.95 | — | 25% |
| CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA 125 NVRH DHCC | $345.75 | $461.00 | $20.29–$437.95 | — | 25% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID-19 PCR (NVRH) | $124.50 | $166.00 | $50.03–$157.70 | 19% above | 25% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COVID-19 PCR (NVRH) | $124.50 | $166.00 | $50.03–$157.70 | — | 25% |
| Calcium blood test, total CPT 82310 UVM CALCULATED CALCIUM | $23.25 | $31.00 | $5.03–$29.45 | 33% below | 25% |
| Calcium blood test, total CPT 82310 MAYO CALCIUM, RANDON UR | $31.50 | $42.00 | $5.03–$39.90 | 9% below | 25% |
| Calcium blood test, total CPT 82310 CALCIUM | $53.25 | $71.00 | $5.03–$67.45 | 53% above | 25% |
| Calcium blood test, total inpatient CPT 82310 UVM CALCULATED CALCIUM | $23.25 | $31.00 | $5.03–$29.45 | — | 25% |
| Calcium blood test, total inpatient CPT 82310 MAYO CALCIUM, RANDON UR | $31.50 | $42.00 | $5.03–$39.90 | — | 25% |
| Calcium blood test, total inpatient CPT 82310 CALCIUM | $53.25 | $71.00 | $5.03–$67.45 | — | 25% |
| Carcinoembryonic antigen (CEA) test CPT 82378 MAYO CEA PANCREATIC CYST FLUID | $181.50 | $242.00 | $18.49–$229.90 | 3% below | 25% |
| Carcinoembryonic antigen (CEA) test CPT 82378 MAYO CEA, PLEURAL FLUID | $216.75 | $289.00 | $18.49–$274.55 | 15% above | 25% |
| Carcinoembryonic antigen (CEA) test CPT 82378 MAYO CEA PERITONEAL FLUID | $216.75 | $289.00 | $18.49–$274.55 | 15% above | 25% |
| Carcinoembryonic antigen (CEA) test CPT 82378 CEA | $303.75 | $405.00 | $18.49–$384.75 | 62% above | 25% |
| Carcinoembryonic antigen (CEA) test CPT 82378 CEA NVRH DHCC | $303.75 | $405.00 | $18.49–$384.75 | 62% above | 25% |
| Carcinoembryonic antigen (CEA) test inpatient CPT 82378 MAYO CEA PANCREATIC CYST FLUID | $181.50 | $242.00 | $18.49–$229.90 | — | 25% |
| Carcinoembryonic antigen (CEA) test inpatient CPT 82378 MAYO CEA, PLEURAL FLUID | $216.75 | $289.00 | $18.49–$274.55 | — | 25% |
| Carcinoembryonic antigen (CEA) test inpatient CPT 82378 MAYO CEA PERITONEAL FLUID | $216.75 | $289.00 | $18.49–$274.55 | — | 25% |
| Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CEA NVRH DHCC | $303.75 | $405.00 | $18.49–$384.75 | — | 25% |
| Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CEA | $303.75 | $405.00 | $18.49–$384.75 | — | 25% |
| Chickenpox (varicella) immunity blood test CPT 86787 UVM VARICELLA IgG | $116.25 | $155.00 | $12.56–$147.25 | 22% above | 25% |
| Chickenpox (varicella) immunity blood test CPT 86787 MAYO VZV IgG Ab | $116.25 | $155.00 | $12.56–$147.25 | 22% above | 25% |
| Chickenpox (varicella) immunity blood test CPT 86787 MAYO VZV IgM Ab | $218.25 | $291.00 | $12.56–$276.45 | 130% above | 25% |
| Chickenpox (varicella) immunity blood test inpatient CPT 86787 UVM VARICELLA IgG | $116.25 | $155.00 | $12.56–$147.25 | — | 25% |
| Chickenpox (varicella) immunity blood test inpatient CPT 86787 MAYO VZV IgG Ab | $116.25 | $155.00 | $12.56–$147.25 | — | 25% |
| Chickenpox (varicella) immunity blood test inpatient CPT 86787 MAYO VZV IgM Ab | $218.25 | $291.00 | $12.56–$276.45 | — | 25% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 UVM CHLAMYDIA PROBE | $174.75 | $233.00 | $34.21–$221.35 | 44% above | 25% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 MAYO C.TRACH,MISC RNA | $174.75 | $233.00 | $34.21–$221.35 | 44% above | 25% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 UVM CHLAMYDIA TRACHOMATIS | $174.75 | $233.00 | $34.21–$221.35 | 44% above | 25% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 UVM CHLAMYDIA TRACHOMATIS | $174.75 | $233.00 | $34.21–$221.35 | — | 25% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 MAYO C.TRACH,MISC RNA | $174.75 | $233.00 | $34.21–$221.35 | — | 25% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 UVM CHLAMYDIA PROBE | $174.75 | $233.00 | $34.21–$221.35 | — | 25% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL | $32.25 | $43.00 | $13.06–$40.85 | 67% below | 25% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 MAYO LIPOPROTEIN METB PROFIL | $60.75 | $81.00 | $13.06–$76.95 | 38% below | 25% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID 2 NVRH DHCC | $148.50 | $198.00 | $13.06–$188.10 | 52% above | 25% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID2A | $148.50 | $198.00 | $13.06–$188.10 | 52% above | 25% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL | $32.25 | $43.00 | $13.06–$40.85 | — | 25% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 MAYO LIPOPROTEIN METB PROFIL | $60.75 | $81.00 | $13.06–$76.95 | — | 25% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID 2 NVRH DHCC | $148.50 | $198.00 | $13.06–$188.10 | — | 25% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID2A | $148.50 | $198.00 | $13.06–$188.10 | — | 25% |
| Complete blood count (CBC) with differential CPT 85025 V-CBC W/DIFFERENTIAL | $63.75 | $85.00 | $7.58–$80.75 | 8% below | 25% |
| Complete blood count (CBC) with differential CPT 85025 CBCW/DIFF (NVRH DHCC) | $117.00 | $156.00 | $7.58–$148.20 | 68% above | 25% |
| Complete blood count (CBC) with differential CPT 85025 CBC/DIFF | $117.00 | $156.00 | $7.58–$148.20 | 68% above | 25% |
| Complete blood count (CBC) with differential inpatient CPT 85025 V-CBC W/DIFFERENTIAL | $63.75 | $85.00 | $7.58–$80.75 | — | 25% |
| Complete blood count (CBC) with differential inpatient CPT 85025 CBC/DIFF | $117.00 | $156.00 | $7.58–$148.20 | — | 25% |
| Complete blood count (CBC) with differential inpatient CPT 85025 CBCW/DIFF (NVRH DHCC) | $117.00 | $156.00 | $7.58–$148.20 | — | 25% |
| Complete blood count (CBC), no differential CPT 85027 UVM CBC W/PLT CLUMPS BLUE TOP | $10.50 | $14.00 | $5.04–$13.30 | 82% below | 25% |
| Complete blood count (CBC), no differential CPT 85027 FAHC CBC (HEMAGRAM) | $27.75 | $37.00 | $6.31–$35.15 | 53% below | 25% |
| Complete blood count (CBC), no differential CPT 85027 CBC | $112.50 | $150.00 | $6.31–$142.50 | 91% above | 25% |
| Complete blood count (CBC), no differential inpatient CPT 85027 UVM CBC W/PLT CLUMPS BLUE TOP | $10.50 | $14.00 | $5.04–$13.30 | — | 25% |
| Complete blood count (CBC), no differential inpatient CPT 85027 FAHC CBC (HEMAGRAM) | $27.75 | $37.00 | $6.31–$35.15 | — | 25% |
| Complete blood count (CBC), no differential inpatient CPT 85027 CBC | $112.50 | $150.00 | $6.31–$142.50 | — | 25% |
| Comprehensive metabolic panel (blood test) CPT 80053 CMP (NVRH DHCC) | $168.75 | $225.00 | $10.30–$213.75 | 20% above | 25% |
| Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL | $168.75 | $225.00 | $10.30–$213.75 | 20% above | 25% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 CMP (NVRH DHCC) | $168.75 | $225.00 | $10.30–$213.75 | — | 25% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL | $168.75 | $225.00 | $10.30–$213.75 | — | 25% |
| Cortisol blood test, total CPT 82533 UVM CORTISOL OR CORTISOL 60MIN | $34.50 | $46.00 | $15.89–$43.70 | 72% below | 25% |
| Cortisol blood test, total CPT 82533 MAYO CORTISOL | $35.25 | $47.00 | $15.89–$44.65 | 71% below | 25% |
| Cortisol blood test, total CPT 82533 MAYO CORTISOL FREE&TOTAL | $120.75 | $161.00 | $15.89–$152.95 | 1% below | 25% |
| Cortisol blood test, total CPT 82533 FAHC DEXAMETHASONE SUPPRESSION | $272.25 | $363.00 | $15.89–$344.85 | 123% above | 25% |
| Cortisol blood test, total inpatient CPT 82533 UVM CORTISOL OR CORTISOL 60MIN | $34.50 | $46.00 | $15.89–$43.70 | — | 25% |
| Cortisol blood test, total inpatient CPT 82533 MAYO CORTISOL | $35.25 | $47.00 | $15.89–$44.65 | — | 25% |
| Cortisol blood test, total inpatient CPT 82533 MAYO CORTISOL FREE&TOTAL | $120.75 | $161.00 | $15.89–$152.95 | — | 25% |
| Cortisol blood test, total inpatient CPT 82533 FAHC DEXAMETHASONE SUPPRESSION | $272.25 | $363.00 | $15.89–$344.85 | — | 25% |
| Creatine kinase (CK) blood test, total CPT 82550 MAYO CK TOTAL | $35.25 | $47.00 | $6.35–$44.65 | 52% below | 25% |
| Creatine kinase (CK) blood test, total CPT 82550 CREATININE KINASE NVRH DHCC | $97.50 | $130.00 | $6.35–$123.50 | 32% above | 25% |
| Creatine kinase (CK) blood test, total CPT 82550 CK | $97.50 | $130.00 | $6.35–$123.50 | 32% above | 25% |
| Creatine kinase (CK) blood test, total inpatient CPT 82550 MAYO CK TOTAL | $35.25 | $47.00 | $6.35–$44.65 | — | 25% |
| Creatine kinase (CK) blood test, total inpatient CPT 82550 CREATININE KINASE NVRH DHCC | $97.50 | $130.00 | $6.35–$123.50 | — | 25% |
| Creatine kinase (CK) blood test, total inpatient CPT 82550 CK | $97.50 | $130.00 | $6.35–$123.50 | — | 25% |
| Creatinine blood test CPT 82565 CREATININE,SERUM | $72.00 | $96.00 | $4.99–$91.20 | 60% above | 25% |
| Creatinine blood test CPT 82565 CREATININE NVRH DHCC | $72.00 | $96.00 | $4.99–$91.20 | 60% above | 25% |
| Creatinine blood test CPT 82565 FAHC CREATININE RANDOM URINE | $102.75 | $137.00 | $4.99–$130.15 | 128% above | 25% |
| Creatinine blood test inpatient CPT 82565 CREATININE NVRH DHCC | $72.00 | $96.00 | $4.99–$91.20 | — | 25% |
| Creatinine blood test inpatient CPT 82565 CREATININE,SERUM | $72.00 | $96.00 | $4.99–$91.20 | — | 25% |
| Creatinine blood test inpatient CPT 82565 FAHC CREATININE RANDOM URINE | $102.75 | $137.00 | $4.99–$130.15 | — | 25% |
| Cytomegalovirus (CMV) antibody test CPT 86644 CMV IGG (SCBL6731) | $76.50 | $102.00 | $14.03–$96.90 | 4% below | 25% |
| Cytomegalovirus (CMV) antibody test CPT 86644 CMV NEGATIVE CHARGE | $242.25 | $323.00 | $14.03–$306.85 | 203% above | 25% |
| Cytomegalovirus (CMV) antibody test CPT 86644 MAYO CMV IgG Ab | $242.25 | $323.00 | $14.03–$306.85 | 203% above | 25% |
| Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CMV IGG (SCBL6731) | $76.50 | $102.00 | $14.03–$96.90 | — | 25% |
| Cytomegalovirus (CMV) antibody test inpatient CPT 86644 MAYO CMV IgG Ab | $242.25 | $323.00 | $14.03–$306.85 | — | 25% |
| Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CMV NEGATIVE CHARGE | $242.25 | $323.00 | $14.03–$306.85 | — | 25% |
| D-dimer blood test (blood clot marker) CPT 85379 MAYO D-DIMER | $38.25 | $51.00 | $9.93–$48.45 | 60% below | 25% |
| D-dimer blood test (blood clot marker) CPT 85379 D-DIMER | $123.75 | $165.00 | $9.93–$156.75 | 31% above | 25% |
| D-dimer blood test (blood clot marker) CPT 85379 MAYO PROLONGED CLOT TIME PRO | $174.75 | $233.00 | $9.93–$221.35 | 85% above | 25% |
| D-dimer blood test (blood clot marker) CPT 85379 FAHC THROMBOSIS PANEL/ NO COUM | $270.00 | $360.00 | $9.93–$342.00 | 186% above | 25% |
| D-dimer blood test (blood clot marker) inpatient CPT 85379 MAYO D-DIMER | $38.25 | $51.00 | $9.93–$48.45 | — | 25% |
| D-dimer blood test (blood clot marker) inpatient CPT 85379 D-DIMER | $123.75 | $165.00 | $9.93–$156.75 | — | 25% |
| D-dimer blood test (blood clot marker) inpatient CPT 85379 MAYO PROLONGED CLOT TIME PRO | $174.75 | $233.00 | $9.93–$221.35 | — | 25% |
| D-dimer blood test (blood clot marker) inpatient CPT 85379 FAHC THROMBOSIS PANEL/ NO COUM | $270.00 | $360.00 | $9.93–$342.00 | — | 25% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA-S | $355.50 | $474.00 | $21.67–$450.30 | 36% above | 25% |
| DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA-S | $355.50 | $474.00 | $21.67–$450.30 | — | 25% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 UVM FENTANYL SCR W/REFLEX CONF | $24.75 | $33.00 | $11.88–$33.00 | 85% below | 25% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 FENTANYL SCR W/RFLX TO CON URI | $30.00 | $40.00 | $14.40–$40.00 | 82% below | 25% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 MAYO OXYCODONE SCREEN URINE | $48.00 | $64.00 | $23.04–$60.90 | 71% below | 25% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 MAYO CONTROLLED SUBSTANCE URIN | $63.75 | $85.00 | $30.60–$80.75 | 62% below | 25% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 MAYO ALCOHOL BIOMARKERS URINE | $76.50 | $102.00 | $36.72–$96.90 | 54% below | 25% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 URINE DRUG SCREEN | $83.25 | $111.00 | $40.25–$105.45 | 50% below | 25% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 MAYO ACETAMINOPHEN,URINE | $102.00 | $136.00 | $48.96–$129.20 | 39% below | 25% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 MAYO BENZODIAZEPINES SERUM | $123.75 | $165.00 | $59.40–$156.75 | 26% below | 25% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 MAYO GHB SCREEN | $132.75 | $177.00 | $60.59–$168.15 | 20% below | 25% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 MAYO DRUG SCREEN 9 PANEL SP | $180.00 | $240.00 | $60.59–$228.00 | 8% above | 25% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 MAYO FLUNITRAZEPAM (ROHYPNOL) | $183.00 | $244.00 | $60.59–$231.80 | 10% above | 25% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 MAYO GABAPENTIN,URINE | $185.25 | $247.00 | $60.59–$234.65 | 11% above | 25% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG SCREEN URINE (NVRH) | $244.50 | $326.00 | $60.59–$309.70 | 47% above | 25% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 MAYO HYPOGLYCEMIC AGENT SCREEN | $247.50 | $330.00 | $60.59–$313.50 | 49% above | 25% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 MAYO MECONIUM DRUG SCREEN | $247.50 | $330.00 | $60.59–$313.50 | 49% above | 25% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 MAYO ETHYL GLUCURONIDE SCR,U | $247.50 | $330.00 | $60.59–$313.50 | 49% above | 25% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 MAYO DRUG SCREEN PRESCRIPTION | $247.50 | $330.00 | $60.59–$313.50 | 49% above | 25% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 MAYO DRUG SCREEN, PRESCRIP/OTC | $247.50 | $330.00 | $60.59–$313.50 | 49% above | 25% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 MAYO NALOXONE SCR TOTAL URINE | $270.00 | $360.00 | $60.59–$342.00 | 62% above | 25% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 MAYO DRUG ABUSE SCREEN #9446 | $343.50 | $458.00 | $60.59–$435.10 | 106% above | 25% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 MAYO SEDATIVE HYPNOT PAN UR | $382.50 | $510.00 | $60.59–$484.50 | 130% above | 25% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 MAYO DRUG SCREEN (HAIR) | $644.25 | $859.00 | $60.59–$816.05 | 287% above | 25% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 UVM FENTANYL SCR W/REFLEX CONF | $24.75 | $33.00 | $11.88–$33.00 | — | 25% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 FENTANYL SCR W/RFLX TO CON URI | $30.00 | $40.00 | $14.40–$40.00 | — | 25% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 MAYO OXYCODONE SCREEN URINE | $48.00 | $64.00 | $23.04–$60.90 | — | 25% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 MAYO CONTROLLED SUBSTANCE URIN | $63.75 | $85.00 | $30.60–$80.75 | — | 25% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 MAYO ALCOHOL BIOMARKERS URINE | $76.50 | $102.00 | $36.72–$96.90 | — | 25% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 URINE DRUG SCREEN | $83.25 | $111.00 | $40.25–$105.45 | — | 25% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 MAYO ACETAMINOPHEN,URINE | $102.00 | $136.00 | $48.96–$129.20 | — | 25% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 MAYO BENZODIAZEPINES SERUM | $123.75 | $165.00 | $59.40–$156.75 | — | 25% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 MAYO GHB SCREEN | $132.75 | $177.00 | $60.59–$168.15 | — | 25% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 MAYO DRUG SCREEN 9 PANEL SP | $180.00 | $240.00 | $60.59–$228.00 | — | 25% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 MAYO FLUNITRAZEPAM (ROHYPNOL) | $183.00 | $244.00 | $60.59–$231.80 | — | 25% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 MAYO GABAPENTIN,URINE | $185.25 | $247.00 | $60.59–$234.65 | — | 25% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG SCREEN URINE (NVRH) | $244.50 | $326.00 | $60.59–$309.70 | — | 25% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 MAYO HYPOGLYCEMIC AGENT SCREEN | $247.50 | $330.00 | $60.59–$313.50 | — | 25% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 MAYO ETHYL GLUCURONIDE SCR,U | $247.50 | $330.00 | $60.59–$313.50 | — | 25% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 MAYO DRUG SCREEN PRESCRIPTION | $247.50 | $330.00 | $60.59–$313.50 | — | 25% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 MAYO MECONIUM DRUG SCREEN | $247.50 | $330.00 | $60.59–$313.50 | — | 25% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 MAYO DRUG SCREEN, PRESCRIP/OTC | $247.50 | $330.00 | $60.59–$313.50 | — | 25% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 MAYO NALOXONE SCR TOTAL URINE | $270.00 | $360.00 | $60.59–$342.00 | — | 25% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 MAYO DRUG ABUSE SCREEN #9446 | $343.50 | $458.00 | $60.59–$435.10 | — | 25% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 MAYO SEDATIVE HYPNOT PAN UR | $382.50 | $510.00 | $60.59–$484.50 | — | 25% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 MAYO DRUG SCREEN (HAIR) | $644.25 | $859.00 | $60.59–$816.05 | — | 25% |
| Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 LYTES (ELECTROLYTES) | $81.00 | $108.00 | $6.83–$102.60 | at median | 25% |
| Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 LYTES (ELECTROLYTES) | $81.00 | $108.00 | $6.83–$102.60 | — | 25% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 VCA(EB) | $240.75 | $321.00 | $17.69–$304.95 | 115% above | 25% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 VCA(EB) [2] | $240.75 | $321.00 | $17.69–$304.95 | 115% above | 25% |
| Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 VCA(EB) | $240.75 | $321.00 | $17.69–$304.95 | — | 25% |
| Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 VCA(EB) [2] | $240.75 | $321.00 | $17.69–$304.95 | — | 25% |
| Estradiol blood test CPT 82670 MAYO ESTROGENS E1&E2 FRACTI | $45.00 | $60.00 | $21.60–$57.00 | 74% below | 25% |
| Estradiol blood test CPT 82670 ESTRADIOL NVRH DHCC | $276.00 | $368.00 | $27.24–$349.60 | 58% above | 25% |
| Estradiol blood test CPT 82670 ESTRADIOL | $276.00 | $368.00 | $27.24–$349.60 | 58% above | 25% |
| Estradiol blood test CPT 82670 MAYO ESTRADIOL RAPID | $279.00 | $372.00 | $27.24–$353.40 | 60% above | 25% |
| Estradiol blood test inpatient CPT 82670 MAYO ESTROGENS E1&E2 FRACTI | $45.00 | $60.00 | $21.60–$57.00 | — | 25% |
| Estradiol blood test inpatient CPT 82670 ESTRADIOL | $276.00 | $368.00 | $27.24–$349.60 | — | 25% |
| Estradiol blood test inpatient CPT 82670 ESTRADIOL NVRH DHCC | $276.00 | $368.00 | $27.24–$349.60 | — | 25% |
| Estradiol blood test inpatient CPT 82670 MAYO ESTRADIOL RAPID | $279.00 | $372.00 | $27.24–$353.40 | — | 25% |
| FSH (follicle-stimulating hormone) test CPT 83001 FSH NVRH DHCC | $312.00 | $416.00 | $18.12–$395.20 | 60% above | 25% |
| FSH (follicle-stimulating hormone) test CPT 83001 FSH | $312.00 | $416.00 | $18.12–$395.20 | 60% above | 25% |
| FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH | $312.00 | $416.00 | $18.12–$395.20 | — | 25% |
| FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH NVRH DHCC | $312.00 | $416.00 | $18.12–$395.20 | — | 25% |
| Fecal calprotectin (stool inflammation test) CPT 83993 MAYO CALPROTECTIN | $326.25 | $435.00 | $19.14–$413.25 | at median | 25% |
| Fecal calprotectin (stool inflammation test) inpatient CPT 83993 MAYO CALPROTECTIN | $326.25 | $435.00 | $19.14–$413.25 | — | 25% |
| Ferritin blood test (iron stores) CPT 82728 FAHC FERRITIN | $124.50 | $166.00 | $13.29–$157.70 | at median | 25% |
| Ferritin blood test (iron stores) CPT 82728 FERRITIN (NVRH DHCC) | $125.25 | $167.00 | $13.29–$158.65 | 1% above | 25% |
| Ferritin blood test (iron stores) CPT 82728 FERRITIN | $125.25 | $167.00 | $13.29–$158.65 | 1% above | 25% |
| Ferritin blood test (iron stores) inpatient CPT 82728 FAHC FERRITIN | $124.50 | $166.00 | $13.29–$157.70 | — | 25% |
| Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN | $125.25 | $167.00 | $13.29–$158.65 | — | 25% |
| Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN (NVRH DHCC) | $125.25 | $167.00 | $13.29–$158.65 | — | 25% |
| Fibrinogen blood test CPT 85384 MAYO FIBRINOGEN CLAUSS | $36.75 | $49.00 | $9.48–$46.55 | 45% below | 25% |
| Fibrinogen blood test CPT 85384 MAYO PROLONGED CLOT TIME PRO | $145.50 | $194.00 | $9.48–$184.30 | 119% above | 25% |
| Fibrinogen blood test CPT 85384 LRH FIBRINOGEN | $163.50 | $218.00 | $9.48–$207.10 | 146% above | 25% |
| Fibrinogen blood test inpatient CPT 85384 MAYO FIBRINOGEN CLAUSS | $36.75 | $49.00 | $9.48–$46.55 | — | 25% |
| Fibrinogen blood test inpatient CPT 85384 MAYO PROLONGED CLOT TIME PRO | $145.50 | $194.00 | $9.48–$184.30 | — | 25% |
| Fibrinogen blood test inpatient CPT 85384 LRH FIBRINOGEN | $163.50 | $218.00 | $9.48–$207.10 | — | 25% |
| Folate (folic acid) blood test CPT 82746 FOLATE | $228.00 | $304.00 | $14.33–$288.80 | 100% above | 25% |
| Folate (folic acid) blood test CPT 82746 FOLATE,SERUM NVRH DHCC | $228.00 | $304.00 | $14.33–$288.80 | 100% above | 25% |
| Folate (folic acid) blood test CPT 82746 FOLATE (Serum) | $228.00 | $304.00 | $14.33–$288.80 | 100% above | 25% |
| Folate (folic acid) blood test inpatient CPT 82746 FOLATE,SERUM NVRH DHCC | $228.00 | $304.00 | $14.33–$288.80 | — | 25% |
| Folate (folic acid) blood test inpatient CPT 82746 FOLATE | $228.00 | $304.00 | $14.33–$288.80 | — | 25% |
| Folate (folic acid) blood test inpatient CPT 82746 FOLATE (Serum) | $228.00 | $304.00 | $14.33–$288.80 | — | 25% |
| Free T3 thyroid hormone test CPT 84481 T3 FREE | $222.75 | $297.00 | $16.52–$282.15 | 46% above | 25% |
| Free T3 thyroid hormone test inpatient CPT 84481 T3 FREE | $222.75 | $297.00 | $16.52–$282.15 | — | 25% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 MAYO T4, FREE, DIRECT DIALYSIS | $26.25 | $35.00 | $8.79–$33.25 | 74% below | 25% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 FREE T4 (NVRH) | $122.25 | $163.00 | $8.79–$154.85 | 20% above | 25% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 FREE T4 (NVRH DHCC) | $122.25 | $163.00 | $8.79–$154.85 | 20% above | 25% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 FAHC FREE T4 | $125.25 | $167.00 | $8.79–$158.65 | 23% above | 25% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 MAYO T4, FREE, DIRECT DIALYSIS | $26.25 | $35.00 | $8.79–$33.25 | — | 25% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 FREE T4 (NVRH DHCC) | $122.25 | $163.00 | $8.79–$154.85 | — | 25% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 FREE T4 (NVRH) | $122.25 | $163.00 | $8.79–$154.85 | — | 25% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 FAHC FREE T4 | $125.25 | $167.00 | $8.79–$158.65 | — | 25% |
| Free testosterone test CPT 84402 MAYO FREE TESTOSTERONE | $24.75 | $33.00 | $11.88–$31.35 | 73% below | 25% |
| Free testosterone test CPT 84402 MAYO TESTOSTERONE T,BIO FREE | $45.75 | $61.00 | $21.96–$57.95 | 50% below | 25% |
| Free testosterone test CPT 84402 MAYO TESTOSTERONE T,BIO,FREE | $85.50 | $114.00 | $24.83–$108.30 | 7% below | 25% |
| Free testosterone test CPT 84402 MAYO TESTOSTERONE,FREE | $154.50 | $206.00 | $24.83–$195.70 | 68% above | 25% |
| Free testosterone test CPT 84402 MAYO TESTOSTERONE FREE | $419.25 | $559.00 | $24.83–$531.05 | 356% above | 25% |
| Free testosterone test inpatient CPT 84402 MAYO FREE TESTOSTERONE | $24.75 | $33.00 | $11.88–$31.35 | — | 25% |
| Free testosterone test inpatient CPT 84402 MAYO TESTOSTERONE T,BIO FREE | $45.75 | $61.00 | $21.96–$57.95 | — | 25% |
| Free testosterone test inpatient CPT 84402 MAYO TESTOSTERONE T,BIO,FREE | $85.50 | $114.00 | $24.83–$108.30 | — | 25% |
| Free testosterone test inpatient CPT 84402 MAYO TESTOSTERONE,FREE | $154.50 | $206.00 | $24.83–$195.70 | — | 25% |
| Free testosterone test inpatient CPT 84402 MAYO TESTOSTERONE FREE | $419.25 | $559.00 | $24.83–$531.05 | — | 25% |
| Gamma-glutamyl transferase (GGT) blood test CPT 82977 MAYO GGT | $40.50 | $54.00 | $7.02–$51.30 | 12% below | 25% |
| Gamma-glutamyl transferase (GGT) blood test CPT 82977 GGT | $72.75 | $97.00 | $7.02–$92.15 | 58% above | 25% |
| Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 MAYO GGT | $40.50 | $54.00 | $7.02–$51.30 | — | 25% |
| Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 GGT | $72.75 | $97.00 | $7.02–$92.15 | — | 25% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE 1-2 H W/GLUC | $84.00 | $112.00 | $4.63–$106.40 | 55% above | 25% |
| Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE 1-2 H W/GLUC | $84.00 | $112.00 | $4.63–$106.40 | — | 25% |
| Glucose tolerance test, 3 samples CPT 82951 GLUCOSE - 2 HR GTT | $151.50 | $202.00 | $12.55–$191.90 | 1% above | 25% |
| Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERAN 3 HR | $216.75 | $289.00 | $12.55–$274.55 | 44% above | 25% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE - 2 HR GTT | $151.50 | $202.00 | $12.55–$191.90 | — | 25% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOLERAN 3 HR | $216.75 | $289.00 | $12.55–$274.55 | — | 25% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 MAYO N.GONORR,MISC,RNA | $174.75 | $233.00 | $34.21–$221.35 | 11% above | 25% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 UVM GC PROBE | $174.75 | $233.00 | $34.21–$221.35 | 11% above | 25% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 UVM NEISSERIA GONORRHOEA | $174.75 | $233.00 | $34.21–$221.35 | 11% above | 25% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 MAYO N.GONORR,MISC,RNA | $174.75 | $233.00 | $34.21–$221.35 | — | 25% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 UVM GC PROBE | $174.75 | $233.00 | $34.21–$221.35 | — | 25% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 UVM NEISSERIA GONORRHOEA | $174.75 | $233.00 | $34.21–$221.35 | — | 25% |
| H. pylori antibody blood test CPT 86677 MAYO HELICOBACTER PYLORI IgA | $52.50 | $70.00 | $16.43–$66.50 | 6% below | 25% |
| H. pylori antibody blood test CPT 86677 H-PYLORIC QL | $407.25 | $543.00 | $16.43–$515.85 | 630% above | 25% |
| H. pylori antibody blood test inpatient CPT 86677 MAYO HELICOBACTER PYLORI IgA | $52.50 | $70.00 | $16.43–$66.50 | — | 25% |
| H. pylori antibody blood test inpatient CPT 86677 H-PYLORIC QL | $407.25 | $543.00 | $16.43–$515.85 | — | 25% |
| H. pylori stool antigen test CPT 87338 UVM H.PYLORI Ag STOOL | $62.25 | $83.00 | $14.02–$78.85 | 71% below | 25% |
| H. pylori stool antigen test inpatient CPT 87338 UVM H.PYLORI Ag STOOL | $62.25 | $83.00 | $14.02–$78.85 | — | 25% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 UVM HIV 1 RNA QUANTITATION | $106.50 | $142.00 | $51.12–$134.90 | 71% below | 25% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 FAHC HIV ULTRASENSITIVE | $458.25 | $611.00 | $82.97–$580.45 | 24% above | 25% |
| HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 UVM HIV 1 RNA QUANTITATION | $106.50 | $142.00 | $51.12–$134.90 | — | 25% |
| HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 FAHC HIV ULTRASENSITIVE | $458.25 | $611.00 | $82.97–$580.45 | — | 25% |
| HIV-1 and HIV-2 antibody test CPT 86703 MAYO HIV-1/2 AB EVALUATION | $147.75 | $197.00 | $13.37–$187.15 | 38% above | 25% |
| HIV-1 and HIV-2 antibody test CPT 86703 MAYO HIV-1/2 AB EVAL | $147.75 | $197.00 | $13.37–$187.15 | 38% above | 25% |
| HIV-1 and HIV-2 antibody test inpatient CPT 86703 MAYO HIV-1/2 AB EVALUATION | $147.75 | $197.00 | $13.37–$187.15 | — | 25% |
| HIV-1 and HIV-2 antibody test inpatient CPT 86703 MAYO HIV-1/2 AB EVAL | $147.75 | $197.00 | $13.37–$187.15 | — | 25% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 MAYO HIV-1/2 Ag&Ab SCREEN | $38.25 | $51.00 | $18.36–$48.45 | 58% below | 25% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV 1/2 AB&AB SCR NVRH DHCC | $38.25 | $51.00 | $18.36–$48.45 | 58% below | 25% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV 1/2 AB&AB SCR NVRH DHCC | $38.25 | $51.00 | $18.36–$48.45 | — | 25% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 MAYO HIV-1/2 Ag&Ab SCREEN | $38.25 | $51.00 | $18.36–$48.45 | — | 25% |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 MAYO HPV PCR (VAG) | $162.75 | $217.00 | $34.21–$206.15 | 6% above | 25% |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV DNA AMP PROBE | $162.75 | $217.00 | $34.21–$206.15 | 6% above | 25% |
| HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV DNA AMP PROBE | $162.75 | $217.00 | $34.21–$206.15 | — | 25% |
| HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 MAYO HPV PCR (VAG) | $162.75 | $217.00 | $34.21–$206.15 | — | 25% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 GLYCOSYLATED HEMOGLOBIN TEST | $21.00 | $28.00 | $9.47–$26.60 | 76% below | 25% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 GLYCOSYLATED HEMOGLOGIN TEST | $21.75 | $29.00 | $9.47–$27.55 | 75% below | 25% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HGB A1C | $111.75 | $149.00 | $9.47–$141.55 | 28% above | 25% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN AIC | $175.50 | $234.00 | $9.47–$222.30 | 100% above | 25% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 GLYCOSYLATED HEMOGLOBIN TEST | $21.00 | $28.00 | $9.47–$26.60 | — | 25% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 GLYCOSYLATED HEMOGLOGIN TEST | $21.75 | $29.00 | $9.47–$27.55 | — | 25% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HGB A1C | $111.75 | $149.00 | $9.47–$141.55 | — | 25% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HEMOGLOBIN AIC | $175.50 | $234.00 | $9.47–$222.30 | — | 25% |
| Hemoglobin blood test CPT 85018 HEMOBLOBIN | $12.00 | $16.00 | $2.31–$15.20 | 47% below | 25% |
| Hemoglobin blood test CPT 85018 HEMOGLOBIN | $45.00 | $60.00 | $2.31–$57.00 | 100% above | 25% |
| Hemoglobin blood test CPT 85018 BODY FLUID HEMOGLOBIN (BFHGB) | $51.75 | $69.00 | $2.31–$65.55 | 130% above | 25% |
| Hemoglobin blood test inpatient CPT 85018 HEMOBLOBIN | $12.00 | $16.00 | $2.31–$15.20 | — | 25% |
| Hemoglobin blood test inpatient CPT 85018 HEMOGLOBIN | $45.00 | $60.00 | $2.31–$57.00 | — | 25% |
| Hemoglobin blood test inpatient CPT 85018 BODY FLUID HEMOGLOBIN (BFHGB) | $51.75 | $69.00 | $2.31–$65.55 | — | 25% |
| Hepatitis B core antibody test (total) CPT 86704 UVM HEPATITIS B CORE ANTIBODY" | $25.50 | $34.00 | $11.75–$32.30 | 74% below | 25% |
| Hepatitis B core antibody test (total) CPT 86704 HEPATITIS B CORE AB NVRH DHCC | $25.50 | $34.00 | $11.75–$32.30 | 74% below | 25% |
| Hepatitis B core antibody test (total) CPT 86704 MAYO HEPATITIS B CORE IgG&IgM | $203.25 | $271.00 | $11.75–$257.45 | 103% above | 25% |
| Hepatitis B core antibody test (total) inpatient CPT 86704 UVM HEPATITIS B CORE ANTIBODY" | $25.50 | $34.00 | $11.75–$32.30 | — | 25% |
| Hepatitis B core antibody test (total) inpatient CPT 86704 HEPATITIS B CORE AB NVRH DHCC | $25.50 | $34.00 | $11.75–$32.30 | — | 25% |
| Hepatitis B core antibody test (total) inpatient CPT 86704 MAYO HEPATITIS B CORE IgG&IgM | $203.25 | $271.00 | $11.75–$257.45 | — | 25% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 UVM HEP B SURFACE ANTIBODY | $42.75 | $57.00 | $10.47–$54.15 | 56% below | 25% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 EMPLOYEE HEPATITIS B | $42.75 | $57.00 | $10.47–$54.15 | 56% below | 25% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURFACE AB NVRH DH | $42.75 | $57.00 | $10.47–$54.15 | 56% below | 25% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 MAYO HEPATITIS B AB QT | $156.00 | $208.00 | $10.47–$197.60 | 62% above | 25% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 EMPLOYEE HEPATITIS B | $42.75 | $57.00 | $10.47–$54.15 | — | 25% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 UVM HEP B SURFACE ANTIBODY | $42.75 | $57.00 | $10.47–$54.15 | — | 25% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B SURFACE AB NVRH DH | $42.75 | $57.00 | $10.47–$54.15 | — | 25% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 MAYO HEPATITIS B AB QT | $156.00 | $208.00 | $10.47–$197.60 | — | 25% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 UVM HEP B SURFACE ANTIGEN | $34.50 | $46.00 | $10.07–$43.70 | 63% below | 25% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURFACE AG NVRH DH | $34.50 | $46.00 | $10.07–$43.70 | 63% below | 25% |
| Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS B SURFACE AG NVRH DH | $34.50 | $46.00 | $10.07–$43.70 | — | 25% |
| Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 UVM HEP B SURFACE ANTIGEN | $34.50 | $46.00 | $10.07–$43.70 | — | 25% |
| Hepatitis C antibody blood test (screening) CPT 86803 UVM HEPATITIS C Ab W/REFLEX | $124.50 | $166.00 | $13.91–$157.70 | 13% above | 25% |
| Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C AB/RLFX NVRH DHCC | $124.50 | $166.00 | $13.91–$157.70 | 13% above | 25% |
| Hepatitis C antibody blood test (screening) CPT 86803 MAYO HEP C AB | $124.50 | $166.00 | $13.91–$157.70 | 13% above | 25% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 UVM HEPATITIS C Ab W/REFLEX | $124.50 | $166.00 | $13.91–$157.70 | — | 25% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 MAYO HEP C AB | $124.50 | $166.00 | $13.91–$157.70 | — | 25% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C AB/RLFX NVRH DHCC | $124.50 | $166.00 | $13.91–$157.70 | — | 25% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 UVM HCV RNA DETECTION QUANTITA | $106.50 | $142.00 | $41.77–$134.90 | 77% below | 25% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 HEPC BRANCHED DNA | $972.75 | $1,297.00 | $41.77–$1,232.15 | 109% above | 25% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 HEP C (PCR) QUANT | $1,050.75 | $1,401.00 | $41.77–$1,330.95 | 125% above | 25% |
| Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 UVM HCV RNA DETECTION QUANTITA | $106.50 | $142.00 | $41.77–$134.90 | — | 25% |
| Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEPC BRANCHED DNA | $972.75 | $1,297.00 | $41.77–$1,232.15 | — | 25% |
| Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEP C (PCR) QUANT | $1,050.75 | $1,401.00 | $41.77–$1,330.95 | — | 25% |
| Herpes blood test, HSV-1 antibody CPT 86695 HERPES SIMPLEX,TYPE 1 | $160.50 | $214.00 | $12.86–$203.30 | 46% above | 25% |
| Herpes blood test, HSV-1 antibody CPT 86695 MAYO HSV 1&2 IgG,AB | $221.25 | $295.00 | $12.86–$280.25 | 101% above | 25% |
| Herpes blood test, HSV-1 antibody CPT 86695 HERPES I/IGM | $343.50 | $458.00 | $12.86–$435.10 | 212% above | 25% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 HERPES SIMPLEX,TYPE 1 | $160.50 | $214.00 | $12.86–$203.30 | — | 25% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 MAYO HSV 1&2 IgG,AB | $221.25 | $295.00 | $12.86–$280.25 | — | 25% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 HERPES I/IGM | $343.50 | $458.00 | $12.86–$435.10 | — | 25% |
| Herpes blood test, HSV-2 antibody CPT 86696 MAYO HSV 1&2 IgG,AB | $321.75 | $429.00 | $18.87–$407.55 | 169% above | 25% |
| Herpes blood test, HSV-2 antibody CPT 86696 HERPES II/IGM | $343.50 | $458.00 | $18.87–$435.10 | 187% above | 25% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 MAYO HSV 1&2 IgG,AB | $321.75 | $429.00 | $18.87–$407.55 | — | 25% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 HERPES II/IGM | $343.50 | $458.00 | $18.87–$435.10 | — | 25% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 UVM CRP HIGH SENSITIVITY | $28.50 | $38.00 | $12.63–$36.10 | 70% below | 25% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 CRP HIGH SENSITIVITY | $62.25 | $83.00 | $12.63–$78.85 | 35% below | 25% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROT HIGH SEN | $78.75 | $105.00 | $12.63–$99.75 | 18% below | 25% |
| High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 UVM CRP HIGH SENSITIVITY | $28.50 | $38.00 | $12.63–$36.10 | — | 25% |
| High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 CRP HIGH SENSITIVITY | $62.25 | $83.00 | $12.63–$78.85 | — | 25% |
| High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-REACTIVE PROT HIGH SEN | $78.75 | $105.00 | $12.63–$99.75 | — | 25% |
| Homocysteine blood test CPT 83090 MAYO CMMP | $203.25 | $271.00 | $17.47–$257.45 | at median | 25% |
| Homocysteine blood test CPT 83090 FAHC HOMOCYSTEINE | $300.75 | $401.00 | $17.47–$380.95 | 48% above | 25% |
| Homocysteine blood test inpatient CPT 83090 MAYO CMMP | $203.25 | $271.00 | $17.47–$257.45 | — | 25% |
| Homocysteine blood test inpatient CPT 83090 FAHC HOMOCYSTEINE | $300.75 | $401.00 | $17.47–$380.95 | — | 25% |
| Insulin blood test CPT 83525 MAYO INSULIN FREE & TOTAL | $32.25 | $43.00 | $11.14–$40.85 | 69% below | 25% |
| Insulin blood test CPT 83525 INSULIN | $126.00 | $168.00 | $11.14–$159.60 | 22% above | 25% |
| Insulin blood test inpatient CPT 83525 MAYO INSULIN FREE & TOTAL | $32.25 | $43.00 | $11.14–$40.85 | — | 25% |
| Insulin blood test inpatient CPT 83525 INSULIN | $126.00 | $168.00 | $11.14–$159.60 | — | 25% |
| Iron blood test (serum iron) CPT 83540 IRON SERUM | $82.50 | $110.00 | $6.31–$104.50 | 18% above | 25% |
| Iron blood test (serum iron) CPT 83540 IRON (NVRH DHCC) | $82.50 | $110.00 | $6.31–$104.50 | 18% above | 25% |
| Iron blood test (serum iron) inpatient CPT 83540 IRON SERUM | $82.50 | $110.00 | $6.31–$104.50 | — | 25% |
| Iron blood test (serum iron) inpatient CPT 83540 IRON (NVRH DHCC) | $82.50 | $110.00 | $6.31–$104.50 | — | 25% |
| Iron-binding capacity (TIBC) test CPT 83550 IRON BINDG CAP TOTAL | $129.75 | $173.00 | $8.52–$164.35 | 59% above | 25% |
| Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BINDG CAP TOTAL | $129.75 | $173.00 | $8.52–$164.35 | — | 25% |
| Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL | $116.25 | $155.00 | $8.46–$147.25 | 3% below | 25% |
| Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL | $116.25 | $155.00 | $8.46–$147.25 | — | 25% |
| LH (luteinizing hormone) test CPT 83002 MAYO LH, PEDIATRICS | $141.75 | $189.00 | $18.06–$179.55 | 12% below | 25% |
| LH (luteinizing hormone) test CPT 83002 LH | $367.50 | $490.00 | $18.06–$465.50 | 129% above | 25% |
| LH (luteinizing hormone) test inpatient CPT 83002 MAYO LH, PEDIATRICS | $141.75 | $189.00 | $18.06–$179.55 | — | 25% |
| LH (luteinizing hormone) test inpatient CPT 83002 LH | $367.50 | $490.00 | $18.06–$465.50 | — | 25% |
| Lactate (lactic acid) blood test CPT 83605 LACTATE | $180.00 | $240.00 | $11.28–$228.00 | 58% above | 25% |
| Lactate (lactic acid) blood test CPT 83605 LACTIC ACID | $180.00 | $240.00 | $11.28–$228.00 | 58% above | 25% |
| Lactate (lactic acid) blood test inpatient CPT 83605 LACTIC ACID | $180.00 | $240.00 | $11.28–$228.00 | — | 25% |
| Lactate (lactic acid) blood test inpatient CPT 83605 LACTATE | $180.00 | $240.00 | $11.28–$228.00 | — | 25% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 LDH | $88.50 | $118.00 | $5.89–$112.10 | 6% above | 25% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 LDH (NVRH DHCC) | $88.50 | $118.00 | $5.89–$112.10 | 6% above | 25% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 MAYO LD BODY FLUID | $93.75 | $125.00 | $5.89–$118.75 | 13% above | 25% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH (NVRH DHCC) | $88.50 | $118.00 | $5.89–$112.10 | — | 25% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH | $88.50 | $118.00 | $5.89–$112.10 | — | 25% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 MAYO LD BODY FLUID | $93.75 | $125.00 | $5.89–$118.75 | — | 25% |
| Lipase blood test (pancreas enzyme) CPT 83690 MAYO LIPASE BODY FLUID | $40.50 | $54.00 | $6.72–$51.30 | 17% below | 25% |
| Lipase blood test (pancreas enzyme) CPT 83690 LIPASE | $83.25 | $111.00 | $6.72–$105.45 | 70% above | 25% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 MAYO LIPASE BODY FLUID | $40.50 | $54.00 | $6.72–$51.30 | — | 25% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE | $83.25 | $111.00 | $6.72–$105.45 | — | 25% |
| Liver function blood test panel CPT 80076 LIVER PANEL | $110.25 | $147.00 | $7.97–$139.65 | at median | 25% |
| Liver function blood test panel inpatient CPT 80076 LIVER PANEL | $110.25 | $147.00 | $7.97–$139.65 | — | 25% |
| Lyme disease antibody test CPT 86618 MAYO LYME DISEASE SEROLOGY | $18.00 | $24.00 | $8.64–$22.80 | 82% below | 25% |
| Lyme disease antibody test CPT 86618 UVM LYME AB W/REFLEX LYME WB | $231.00 | $308.00 | $16.60–$292.60 | 132% above | 25% |
| Lyme disease antibody test CPT 86618 MAYO LYME DISEASE CSF | $237.75 | $317.00 | $16.60–$301.15 | 138% above | 25% |
| Lyme disease antibody test CPT 86618 MAYO TICK BORNE AB PANEL | $240.75 | $321.00 | $16.60–$304.95 | 141% above | 25% |
| Lyme disease antibody test inpatient CPT 86618 MAYO LYME DISEASE SEROLOGY | $18.00 | $24.00 | $8.64–$22.80 | — | 25% |
| Lyme disease antibody test inpatient CPT 86618 UVM LYME AB W/REFLEX LYME WB | $231.00 | $308.00 | $16.60–$292.60 | — | 25% |
| Lyme disease antibody test inpatient CPT 86618 MAYO LYME DISEASE CSF | $237.75 | $317.00 | $16.60–$301.15 | — | 25% |
| Lyme disease antibody test inpatient CPT 86618 MAYO TICK BORNE AB PANEL | $240.75 | $321.00 | $16.60–$304.95 | — | 25% |
| Magnesium blood test CPT 83735 MAYO SUPERSATURATION 24HR URIN | $13.50 | $18.00 | $6.48–$17.10 | 76% below | 25% |
| Magnesium blood test CPT 83735 MAYO MUMPS QB IGB&IGM SERUM | $54.00 | $72.00 | $6.53–$68.40 | 4% below | 25% |
| Magnesium blood test CPT 83735 MAGNESIUM 24HR URINE | $72.00 | $96.00 | $6.53–$91.20 | 28% above | 25% |
| Magnesium blood test CPT 83735 MAGNESIUM | $101.25 | $135.00 | $6.53–$128.25 | 80% above | 25% |
| Magnesium blood test CPT 83735 MAGNESIUM (NVRH DHCC) | $101.25 | $135.00 | $6.53–$128.25 | 80% above | 25% |
| Magnesium blood test CPT 83735 MAYO MAGNESIUM RBC'S | $116.25 | $155.00 | $6.53–$147.25 | 106% above | 25% |
| Magnesium blood test CPT 83735 MAYO ELECTROLYTES STOOL | $116.25 | $155.00 | $6.53–$147.25 | 106% above | 25% |
| Magnesium blood test CPT 83735 MAGNESIUM RBC&PLASMA | $183.00 | $244.00 | $6.53–$231.80 | 225% above | 25% |
| Magnesium blood test inpatient CPT 83735 MAYO SUPERSATURATION 24HR URIN | $13.50 | $18.00 | $6.48–$17.10 | — | 25% |
| Magnesium blood test inpatient CPT 83735 MAYO MUMPS QB IGB&IGM SERUM | $54.00 | $72.00 | $6.53–$68.40 | — | 25% |
| Magnesium blood test inpatient CPT 83735 MAGNESIUM 24HR URINE | $72.00 | $96.00 | $6.53–$91.20 | — | 25% |
| Magnesium blood test inpatient CPT 83735 MAGNESIUM | $101.25 | $135.00 | $6.53–$128.25 | — | 25% |
| Magnesium blood test inpatient CPT 83735 MAGNESIUM (NVRH DHCC) | $101.25 | $135.00 | $6.53–$128.25 | — | 25% |
| Magnesium blood test inpatient CPT 83735 MAYO ELECTROLYTES STOOL | $116.25 | $155.00 | $6.53–$147.25 | — | 25% |
| Magnesium blood test inpatient CPT 83735 MAYO MAGNESIUM RBC'S | $116.25 | $155.00 | $6.53–$147.25 | — | 25% |
| Magnesium blood test inpatient CPT 83735 MAGNESIUM RBC&PLASMA | $183.00 | $244.00 | $6.53–$231.80 | — | 25% |
| Measles (rubeola) antibody test CPT 86765 MAYO MEASLES (RUBEOLA), IGM | $32.25 | $43.00 | $12.56–$40.85 | 60% below | 25% |
| Measles (rubeola) antibody test CPT 86765 UVM MEASLES IgG Ab | $48.75 | $65.00 | $12.56–$61.75 | 39% below | 25% |
| Measles (rubeola) antibody test CPT 86765 RUBEOLA IGM ANTIBODY | $331.50 | $442.00 | $12.56–$419.90 | 314% above | 25% |
| Measles (rubeola) antibody test inpatient CPT 86765 MAYO MEASLES (RUBEOLA), IGM | $32.25 | $43.00 | $12.56–$40.85 | — | 25% |
| Measles (rubeola) antibody test inpatient CPT 86765 UVM MEASLES IgG Ab | $48.75 | $65.00 | $12.56–$61.75 | — | 25% |
| Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA IGM ANTIBODY | $331.50 | $442.00 | $12.56–$419.90 | — | 25% |
| Mono test (heterophile antibody, Monospot) CPT 86308 MONO TESTING | $36.75 | $49.00 | $5.05–$46.55 | 23% below | 25% |
| Mono test (heterophile antibody, Monospot) CPT 86308 INFO MONO SCREENING | $65.25 | $87.00 | $5.05–$82.65 | 37% above | 25% |
| Mono test (heterophile antibody, Monospot) CPT 86308 UVM MONOSPOT | $65.25 | $87.00 | $5.05–$82.65 | 37% above | 25% |
| Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONO TESTING | $36.75 | $49.00 | $5.05–$46.55 | — | 25% |
| Mono test (heterophile antibody, Monospot) inpatient CPT 86308 INFO MONO SCREENING | $65.25 | $87.00 | $5.05–$82.65 | — | 25% |
| Mono test (heterophile antibody, Monospot) inpatient CPT 86308 UVM MONOSPOT | $65.25 | $87.00 | $5.05–$82.65 | — | 25% |
| Mumps immunity blood test CPT 86735 MUMPS ANTIBODY | $48.75 | $65.00 | $12.72–$61.75 | 56% below | 25% |
| Mumps immunity blood test CPT 86735 MAYO MUMPS QB IGB&IGM SERUM | $54.00 | $72.00 | $12.72–$68.40 | 51% below | 25% |
| Mumps immunity blood test CPT 86735 MAYO MUMPS AB IGB&IGM CSF | $70.50 | $94.00 | $12.72–$89.30 | 36% below | 25% |
| Mumps immunity blood test CPT 86735 MAYO MUMPS QB IGB&IGM CSF | $72.00 | $96.00 | $12.72–$91.20 | 35% below | 25% |
| Mumps immunity blood test inpatient CPT 86735 MUMPS ANTIBODY | $48.75 | $65.00 | $12.72–$61.75 | — | 25% |
| Mumps immunity blood test inpatient CPT 86735 MAYO MUMPS QB IGB&IGM SERUM | $54.00 | $72.00 | $12.72–$68.40 | — | 25% |
| Mumps immunity blood test inpatient CPT 86735 MAYO MUMPS AB IGB&IGM CSF | $70.50 | $94.00 | $12.72–$89.30 | — | 25% |
| Mumps immunity blood test inpatient CPT 86735 MAYO MUMPS QB IGB&IGM CSF | $72.00 | $96.00 | $12.72–$91.20 | — | 25% |
| Obstetric blood test panel CPT 80055 PRENATAL PROFILE I | $528.00 | $704.00 | $46.61–$668.80 | 81% above | 25% |
| Obstetric blood test panel inpatient CPT 80055 PRENATAL PROFILE I | $528.00 | $704.00 | $46.61–$668.80 | — | 25% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 MAYO REFLEX PROSTATE FREE PSA | $29.25 | $39.00 | $14.04–$37.05 | 79% below | 25% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PSA TOTAL & FREE | $296.25 | $395.00 | $17.93–$375.25 | 108% above | 25% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 MAYO REFLEX PROSTATE FREE PSA | $29.25 | $39.00 | $14.04–$37.05 | — | 25% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA TOTAL & FREE | $296.25 | $395.00 | $17.93–$375.25 | — | 25% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 MAYO PROSTATE HEATH INDEX, REF | $29.25 | $39.00 | $14.04–$37.05 | 78% below | 25% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 MAYO PSA,ULTRASENSITIVE | $100.50 | $134.00 | $17.93–$127.30 | 25% below | 25% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA, SCREENING NVRH | $173.25 | $231.00 | $17.93–$219.45 | 29% above | 25% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 UVM PSA DIAGNOSTIC | $296.25 | $395.00 | $17.93–$375.25 | 120% above | 25% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA SCREENING NVRH DHCC | $319.50 | $426.00 | $17.93–$404.70 | 138% above | 25% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 UVM PSA SCREENING | $319.50 | $426.00 | $17.93–$404.70 | 138% above | 25% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 MAYO PROSTATE HEATH INDEX, REF | $29.25 | $39.00 | $14.04–$37.05 | — | 25% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 MAYO PSA,ULTRASENSITIVE | $100.50 | $134.00 | $17.93–$127.30 | — | 25% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA, SCREENING NVRH | $173.25 | $231.00 | $17.93–$219.45 | — | 25% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 UVM PSA DIAGNOSTIC | $296.25 | $395.00 | $17.93–$375.25 | — | 25% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 UVM PSA SCREENING | $319.50 | $426.00 | $17.93–$404.70 | — | 25% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA SCREENING NVRH DHCC | $319.50 | $426.00 | $17.93–$404.70 | — | 25% |
| Pap test (liquid-based, automated screening with review) CPT 88175 FAHC THIN PREP DIAGNOSTIC PAP | $282.75 | $377.00 | $25.94–$358.15 | 191% above | 25% |
| Pap test (liquid-based, automated screening with review) inpatient CPT 88175 FAHC THIN PREP DIAGNOSTIC PAP | $282.75 | $377.00 | $25.94–$358.15 | — | 25% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 LRH THIN PREP PAP SCREENING | $273.00 | $364.00 | $19.75–$345.80 | 104% above | 25% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 LRH THIN PREP PAP DIAGN | $273.00 | $364.00 | $19.75–$345.80 | 104% above | 25% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 FAHC THIN PREP PAP SCREENING | $273.00 | $364.00 | $19.75–$345.80 | 104% above | 25% |
| Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 LRH THIN PREP PAP DIAGN | $273.00 | $364.00 | $19.75–$345.80 | — | 25% |
| Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 LRH THIN PREP PAP SCREENING | $273.00 | $364.00 | $19.75–$345.80 | — | 25% |
| Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 FAHC THIN PREP PAP SCREENING | $273.00 | $364.00 | $19.75–$345.80 | — | 25% |
| Parathyroid hormone (PTH) blood test CPT 83970 FAHC PTH INTACT | $398.25 | $531.00 | $40.25–$504.45 | 59% above | 25% |
| Parathyroid hormone (PTH) blood test CPT 83970 PTH, INTACT NVRH DHCC | $398.25 | $531.00 | $40.25–$504.45 | 59% above | 25% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH, INTACT NVRH DHCC | $398.25 | $531.00 | $40.25–$504.45 | — | 25% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 FAHC PTH INTACT | $398.25 | $531.00 | $40.25–$504.45 | — | 25% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 MAYO APTT | $7.50 | $10.00 | $3.60–$9.50 | 86% below | 25% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 MAYO ACTIVATED PART THROMB TIM | $22.50 | $30.00 | $5.86–$28.50 | 59% below | 25% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 MAYO PROLONGED CLOT TIME PRO | $103.50 | $138.00 | $5.86–$131.10 | 89% above | 25% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PARTIAL THROMBO (PTT | $103.50 | $138.00 | $5.86–$131.10 | 89% above | 25% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PTT ACTIVATED NVRH DHCC | $103.50 | $138.00 | $5.86–$131.10 | 89% above | 25% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PTT | $204.00 | $272.00 | $5.86–$258.40 | 273% above | 25% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PROTEIN C | $244.50 | $326.00 | $5.86–$309.70 | 347% above | 25% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 FAHC PTT | $270.75 | $361.00 | $5.86–$342.95 | 395% above | 25% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 MAYO APTT | $7.50 | $10.00 | $3.60–$9.50 | — | 25% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 MAYO ACTIVATED PART THROMB TIM | $22.50 | $30.00 | $5.86–$28.50 | — | 25% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 MAYO PROLONGED CLOT TIME PRO | $103.50 | $138.00 | $5.86–$131.10 | — | 25% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PARTIAL THROMBO (PTT | $103.50 | $138.00 | $5.86–$131.10 | — | 25% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT ACTIVATED NVRH DHCC | $103.50 | $138.00 | $5.86–$131.10 | — | 25% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT | $204.00 | $272.00 | $5.86–$258.40 | — | 25% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PROTEIN C | $244.50 | $326.00 | $5.86–$309.70 | — | 25% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 FAHC PTT | $270.75 | $361.00 | $5.86–$342.95 | — | 25% |
| Phosphorus (phosphate) blood test CPT 84100 PHOSPHORUS NVRH DHCC | $60.00 | $80.00 | $4.62–$76.00 | 33% above | 25% |
| Phosphorus (phosphate) blood test CPT 84100 PHOSPHORUS | $60.00 | $80.00 | $4.62–$76.00 | 33% above | 25% |
| Phosphorus (phosphate) blood test CPT 84100 MAYO ELECTROLYTES STOOL | $65.25 | $87.00 | $4.62–$82.65 | 45% above | 25% |
| Phosphorus (phosphate) blood test inpatient CPT 84100 PHOSPHORUS NVRH DHCC | $60.00 | $80.00 | $4.62–$76.00 | — | 25% |
| Phosphorus (phosphate) blood test inpatient CPT 84100 PHOSPHORUS | $60.00 | $80.00 | $4.62–$76.00 | — | 25% |
| Phosphorus (phosphate) blood test inpatient CPT 84100 MAYO ELECTROLYTES STOOL | $65.25 | $87.00 | $4.62–$82.65 | — | 25% |
| Potassium blood test CPT 84132 POTASSIUM | $81.00 | $108.00 | $4.64–$102.60 | 95% above | 25% |
| Potassium blood test CPT 84132 MAYO POTASSIUM, RBC'S | $121.50 | $162.00 | $4.64–$153.90 | 192% above | 25% |
| Potassium blood test inpatient CPT 84132 POTASSIUM | $81.00 | $108.00 | $4.64–$102.60 | — | 25% |
| Potassium blood test inpatient CPT 84132 MAYO POTASSIUM, RBC'S | $121.50 | $162.00 | $4.64–$153.90 | — | 25% |
| Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 MAYO MATERNIT21 PLUS | $606.75 | $809.00 | $291.24–$768.55 | — | 25% |
| Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 MAYO MATERNIT21 PLUS | $606.75 | $809.00 | $291.24–$768.55 | — | 25% |
| Progesterone blood test CPT 84144 MAYO PROGESTERONE | $45.00 | $60.00 | $20.34–$57.00 | 74% below | 25% |
| Progesterone blood test CPT 84144 PROGESTERONE | $335.25 | $447.00 | $20.34–$424.65 | 90% above | 25% |
| Progesterone blood test inpatient CPT 84144 MAYO PROGESTERONE | $45.00 | $60.00 | $20.34–$57.00 | — | 25% |
| Progesterone blood test inpatient CPT 84144 PROGESTERONE | $335.25 | $447.00 | $20.34–$424.65 | — | 25% |
| Prolactin blood test CPT 84146 MAYO PROLACTIN, UNPRECIPITATED | $27.75 | $37.00 | $13.32–$35.15 | 81% below | 25% |
| Prolactin blood test CPT 84146 MAYO PROLACTIN, TOTAL | $27.75 | $37.00 | $13.32–$35.15 | 81% below | 25% |
| Prolactin blood test CPT 84146 PROLACTIN | $245.25 | $327.00 | $18.90–$310.65 | 70% above | 25% |
| Prolactin blood test inpatient CPT 84146 MAYO PROLACTIN, UNPRECIPITATED | $27.75 | $37.00 | $13.32–$35.15 | — | 25% |
| Prolactin blood test inpatient CPT 84146 MAYO PROLACTIN, TOTAL | $27.75 | $37.00 | $13.32–$35.15 | — | 25% |
| Prolactin blood test inpatient CPT 84146 PROLACTIN | $245.25 | $327.00 | $18.90–$310.65 | — | 25% |
| Prothrombin time (PT/INR) clotting test CPT 85610 MAYO PROTHROMBIN TIME | $6.00 | $8.00 | $2.88–$7.60 | 84% below | 25% |
| Prothrombin time (PT/INR) clotting test CPT 85610 MAYO PROLONGED CLOT TIME PRO | $72.75 | $97.00 | $4.18–$92.15 | 91% above | 25% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME NVRH DHCC | $72.75 | $97.00 | $4.18–$92.15 | 91% above | 25% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME | $72.75 | $97.00 | $4.18–$92.15 | 91% above | 25% |
| Prothrombin time (PT/INR) clotting test CPT 85610 FAHC PROTIME | $270.75 | $361.00 | $4.18–$342.95 | 612% above | 25% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 MAYO PROTHROMBIN TIME | $6.00 | $8.00 | $2.88–$7.60 | — | 25% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 MAYO PROLONGED CLOT TIME PRO | $72.75 | $97.00 | $4.18–$92.15 | — | 25% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME NVRH DHCC | $72.75 | $97.00 | $4.18–$92.15 | — | 25% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME | $72.75 | $97.00 | $4.18–$92.15 | — | 25% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 FAHC PROTIME | $270.75 | $361.00 | $4.18–$342.95 | — | 25% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 URINE DRUG SCREEN | $83.25 | $111.00 | $12.29–$105.45 | 116% above | 25% |
| Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 URINE DRUG SCREEN | $83.25 | $111.00 | $12.29–$105.45 | — | 25% |
| Rapid flu test (influenza antigen) CPT 87804 INFLUENZA A & B | $24.00 | $32.00 | $11.60–$30.40 | 48% below | 25% |
| Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA A & B | $24.00 | $32.00 | $11.60–$30.40 | — | 25% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREP GROUP A | $22.50 | $30.00 | $10.88–$28.50 | 66% below | 25% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 RAPID STREP TEST - ER | $87.75 | $117.00 | $16.12–$111.15 | 31% above | 25% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREP A ANTIGEN | $95.25 | $127.00 | $16.12–$120.65 | 42% above | 25% |
| Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 STREP GROUP A | $22.50 | $30.00 | $10.88–$28.50 | — | 25% |
| Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 RAPID STREP TEST - ER | $87.75 | $117.00 | $16.12–$111.15 | — | 25% |
| Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 STREP A ANTIGEN | $95.25 | $127.00 | $16.12–$120.65 | — | 25% |
| Renin blood test CPT 84244 RENIN | $365.25 | $487.00 | $21.44–$462.65 | 76% above | 25% |
| Renin blood test inpatient CPT 84244 RENIN | $365.25 | $487.00 | $21.44–$462.65 | — | 25% |
| Rh blood typing CPT 86901 ARC RH | $66.00 | $88.00 | $2.92–$83.60 | 36% above | 25% |
| Rh blood typing CPT 86901 UVM ISOHEMAGGLUTININS QT | $66.00 | $88.00 | $2.92–$83.60 | 36% above | 25% |
| Rh blood typing CPT 86901 RHD | $66.00 | $88.00 | $2.92–$83.60 | 36% above | 25% |
| Rh blood typing inpatient CPT 86901 UVM ISOHEMAGGLUTININS QT | $66.00 | $88.00 | $2.92–$83.60 | — | 25% |
| Rh blood typing inpatient CPT 86901 RHD | $66.00 | $88.00 | $2.92–$83.60 | — | 25% |
| Rh blood typing inpatient CPT 86901 ARC RH | $66.00 | $88.00 | $2.92–$83.60 | — | 25% |
| Rheumatoid factor (RF) test CPT 86431 UVM RHEUMATOID FACTOR | $100.50 | $134.00 | $5.53–$127.30 | 78% above | 25% |
| Rheumatoid factor (RF) test inpatient CPT 86431 UVM RHEUMATOID FACTOR | $100.50 | $134.00 | $5.53–$127.30 | — | 25% |
| Rubella antibody test (immunity check) CPT 86762 RUBELLA | $48.75 | $65.00 | $14.03–$61.75 | 50% below | 25% |
| Rubella antibody test (immunity check) CPT 86762 PRNTL PKG RUBELLA | $136.50 | $182.00 | $14.03–$172.90 | 39% above | 25% |
| Rubella antibody test (immunity check) CPT 86762 MAYO RUBELLA IGM | $378.00 | $504.00 | $14.03–$478.80 | 286% above | 25% |
| Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA | $48.75 | $65.00 | $14.03–$61.75 | — | 25% |
| Rubella antibody test (immunity check) inpatient CPT 86762 PRNTL PKG RUBELLA | $136.50 | $182.00 | $14.03–$172.90 | — | 25% |
| Rubella antibody test (immunity check) inpatient CPT 86762 MAYO RUBELLA IGM | $378.00 | $504.00 | $14.03–$478.80 | — | 25% |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 SEDRATE ESR | $51.75 | $69.00 | $2.63–$65.55 | 23% above | 25% |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 ESR NVRH DHCC | $51.75 | $69.00 | $2.63–$65.55 | 23% above | 25% |
| Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 SEDRATE ESR | $51.75 | $69.00 | $2.63–$65.55 | — | 25% |
| Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 ESR NVRH DHCC | $51.75 | $69.00 | $2.63–$65.55 | — | 25% |
| Sodium blood test CPT 84295 SODIUM | $49.50 | $66.00 | $4.69–$62.70 | 10% above | 25% |
| Sodium blood test inpatient CPT 84295 SODIUM | $49.50 | $66.00 | $4.69–$62.70 | — | 25% |
| Stool ova and parasites exam CPT 87177 MAYO PARASITIC EXAM (O&P) | $21.00 | $28.00 | $8.68–$26.60 | 79% below | 25% |
| Stool ova and parasites exam CPT 87177 UVM OVA & PARASITE EXAM | $24.75 | $33.00 | $8.68–$31.35 | 76% below | 25% |
| Stool ova and parasites exam CPT 87177 OVA PARASITES | $120.75 | $161.00 | $8.68–$152.95 | 19% above | 25% |
| Stool ova and parasites exam inpatient CPT 87177 MAYO PARASITIC EXAM (O&P) | $21.00 | $28.00 | $8.68–$26.60 | — | 25% |
| Stool ova and parasites exam inpatient CPT 87177 UVM OVA & PARASITE EXAM | $24.75 | $33.00 | $8.68–$31.35 | — | 25% |
| Stool ova and parasites exam inpatient CPT 87177 OVA PARASITES | $120.75 | $161.00 | $8.68–$152.95 | — | 25% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 GUAIAC CARD 3 | $15.00 | $20.00 | $4.27–$19.00 | 18% below | 25% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 STOOL OCCULT BLOOD X3 | $41.25 | $55.00 | $4.27–$52.25 | 126% above | 25% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 STOOL OCCULT BLOOD | $41.25 | $55.00 | $4.27–$52.25 | 126% above | 25% |
| Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 GUAIAC CARD 3 | $15.00 | $20.00 | $4.27–$19.00 | — | 25% |
| Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 STOOL OCCULT BLOOD X3 | $41.25 | $55.00 | $4.27–$52.25 | — | 25% |
| Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 STOOL OCCULT BLOOD | $41.25 | $55.00 | $4.27–$52.25 | — | 25% |
| Stool test for hidden blood by immunoassay (FIT) CPT 82274 MAYO OCCULT BLD QL | $124.50 | $166.00 | $15.52–$157.70 | 28% above | 25% |
| Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 MAYO OCCULT BLD QL | $124.50 | $166.00 | $15.52–$157.70 | — | 25% |
| Syphilis antibody test (Treponema pallidum) CPT 86780 MAYO SYPHILIS Ab BY TP-PA | $53.25 | $71.00 | $12.91–$67.45 | 8% below | 25% |
| Syphilis antibody test (Treponema pallidum) CPT 86780 MAYO SYPHILIS TOTAL Ab W/REFLE | $75.00 | $100.00 | $12.91–$95.00 | 29% above | 25% |
| Syphilis antibody test (Treponema pallidum) CPT 86780 FTA | $170.25 | $227.00 | $12.91–$215.65 | 194% above | 25% |
| Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 MAYO SYPHILIS Ab BY TP-PA | $53.25 | $71.00 | $12.91–$67.45 | — | 25% |
| Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 MAYO SYPHILIS TOTAL Ab W/REFLE | $75.00 | $100.00 | $12.91–$95.00 | — | 25% |
| Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 FTA | $170.25 | $227.00 | $12.91–$215.65 | — | 25% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 CSF VDRL | $72.00 | $96.00 | $4.16–$91.20 | at median | 25% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR | $72.00 | $96.00 | $4.16–$91.20 | at median | 25% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 MAYO SYPHILIS IgG & IgM | $76.50 | $102.00 | $4.16–$96.90 | 6% above | 25% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR | $72.00 | $96.00 | $4.16–$91.20 | — | 25% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 CSF VDRL | $72.00 | $96.00 | $4.16–$91.20 | — | 25% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 MAYO SYPHILIS IgG & IgM | $76.50 | $102.00 | $4.16–$96.90 | — | 25% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 UVM TB Quantiferon Gold plus | $189.75 | $253.00 | $60.43–$240.35 | 5% below | 25% |
| TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 UVM TB Quantiferon Gold plus | $189.75 | $253.00 | $60.43–$240.35 | — | 25% |
| Testosterone blood test, total (not free testosterone) CPT 84403 MAYO TOTAL TESTOSTERONE | $24.75 | $33.00 | $11.88–$31.35 | 88% below | 25% |
| Testosterone blood test, total (not free testosterone) CPT 84403 MAYO TESTOSTERONE T,BIO,FREE | $45.00 | $60.00 | $21.60–$57.00 | 78% below | 25% |
| Testosterone blood test, total (not free testosterone) CPT 84403 MAYO TESTOSTERONE TOT/BIO | $45.00 | $60.00 | $21.60–$57.00 | 78% below | 25% |
| Testosterone blood test, total (not free testosterone) CPT 84403 MAYO TESTOSTERONE T,BIO FREE | $46.50 | $62.00 | $22.32–$58.90 | 77% below | 25% |
| Testosterone blood test, total (not free testosterone) CPT 84403 MAYO TESTOSTERONE | $56.25 | $75.00 | $25.16–$71.25 | 72% below | 25% |
| Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE,TOTAL NVRH DHCC | $176.25 | $235.00 | $25.16–$223.25 | 12% below | 25% |
| Testosterone blood test, total (not free testosterone) CPT 84403 MAYO TESTOSTERONE,TOTAL | $439.50 | $586.00 | $25.16–$556.70 | 119% above | 25% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 MAYO TOTAL TESTOSTERONE | $24.75 | $33.00 | $11.88–$31.35 | — | 25% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 MAYO TESTOSTERONE TOT/BIO | $45.00 | $60.00 | $21.60–$57.00 | — | 25% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 MAYO TESTOSTERONE T,BIO,FREE | $45.00 | $60.00 | $21.60–$57.00 | — | 25% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 MAYO TESTOSTERONE T,BIO FREE | $46.50 | $62.00 | $22.32–$58.90 | — | 25% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 MAYO TESTOSTERONE | $56.25 | $75.00 | $25.16–$71.25 | — | 25% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE,TOTAL NVRH DHCC | $176.25 | $235.00 | $25.16–$223.25 | — | 25% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 MAYO TESTOSTERONE,TOTAL | $439.50 | $586.00 | $25.16–$556.70 | — | 25% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 MAYO THYROPEROXIDASE AB | $236.25 | $315.00 | $14.19–$299.25 | 96% above | 25% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 THYRD AB GROUP | $244.50 | $326.00 | $14.19–$309.70 | 103% above | 25% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 MAYO LIVER CYTOSOL (LC-1) AUTO | $351.00 | $468.00 | $14.19–$444.60 | 191% above | 25% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 MAYO THYROPEROXIDASE AB | $236.25 | $315.00 | $14.19–$299.25 | — | 25% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 THYRD AB GROUP | $244.50 | $326.00 | $14.19–$309.70 | — | 25% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 MAYO LIVER CYTOSOL (LC-1) AUTO | $351.00 | $468.00 | $14.19–$444.60 | — | 25% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH (NVRH DHCC) | $224.25 | $299.00 | $16.38–$284.05 | 18% above | 25% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH | $224.25 | $299.00 | $16.38–$284.05 | 18% above | 25% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 UVM THYROID CASCADE | $279.00 | $372.00 | $16.38–$353.40 | 47% above | 25% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 MAYO TSH SENSITIVE | $300.75 | $401.00 | $16.38–$380.95 | 58% above | 25% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH | $224.25 | $299.00 | $16.38–$284.05 | — | 25% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH (NVRH DHCC) | $224.25 | $299.00 | $16.38–$284.05 | — | 25% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 UVM THYROID CASCADE | $279.00 | $372.00 | $16.38–$353.40 | — | 25% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 MAYO TSH SENSITIVE | $300.75 | $401.00 | $16.38–$380.95 | — | 25% |
| Total IgE blood test CPT 82785 MAYO RESP PROFILE REG 2,MID-AT | $12.00 | $16.00 | $5.76–$16.00 | 86% below | 25% |
| Total IgE blood test CPT 82785 IGE | $123.75 | $165.00 | $16.05–$156.75 | 47% above | 25% |
| Total IgE blood test CPT 82785 MAYO RESP PROFILE REG 1N ATLAN | $191.25 | $255.00 | $16.05–$242.25 | 128% above | 25% |
| Total IgE blood test CPT 82785 IMGLOB E | $218.25 | $291.00 | $16.05–$276.45 | 160% above | 25% |
| Total IgE blood test inpatient CPT 82785 MAYO RESP PROFILE REG 2,MID-AT | $12.00 | $16.00 | $5.76–$16.00 | — | 25% |
| Total IgE blood test inpatient CPT 82785 IGE | $123.75 | $165.00 | $16.05–$156.75 | — | 25% |
| Total IgE blood test inpatient CPT 82785 MAYO RESP PROFILE REG 1N ATLAN | $191.25 | $255.00 | $16.05–$242.25 | — | 25% |
| Total IgE blood test inpatient CPT 82785 IMGLOB E | $218.25 | $291.00 | $16.05–$276.45 | — | 25% |
| Total cholesterol blood test CPT 82465 CHOLESTEROL TOTAL CDC S | $18.75 | $25.00 | $4.24–$23.75 | 54% below | 25% |
| Total cholesterol blood test CPT 82465 MAYO CHOLESTEROL | $33.00 | $44.00 | $4.24–$41.80 | 19% below | 25% |
| Total cholesterol blood test CPT 82465 CHOLESTEROL | $56.25 | $75.00 | $4.24–$71.25 | 38% above | 25% |
| Total cholesterol blood test CPT 82465 LIPID 2 CHOLESTEROL | $90.00 | $120.00 | $4.24–$114.00 | 120% above | 25% |
| Total cholesterol blood test inpatient CPT 82465 CHOLESTEROL TOTAL CDC S | $18.75 | $25.00 | $4.24–$23.75 | — | 25% |
| Total cholesterol blood test inpatient CPT 82465 MAYO CHOLESTEROL | $33.00 | $44.00 | $4.24–$41.80 | — | 25% |
| Total cholesterol blood test inpatient CPT 82465 CHOLESTEROL | $56.25 | $75.00 | $4.24–$71.25 | — | 25% |
| Total cholesterol blood test inpatient CPT 82465 LIPID 2 CHOLESTEROL | $90.00 | $120.00 | $4.24–$114.00 | — | 25% |
| Total thyroxine (T4) blood test CPT 84436 MAYO FREE THYROXINE INDEX | $41.25 | $55.00 | $6.70–$52.25 | 28% below | 25% |
| Total thyroxine (T4) blood test CPT 84436 T4 | $85.50 | $114.00 | $6.70–$108.30 | 50% above | 25% |
| Total thyroxine (T4) blood test inpatient CPT 84436 MAYO FREE THYROXINE INDEX | $41.25 | $55.00 | $6.70–$52.25 | — | 25% |
| Total thyroxine (T4) blood test inpatient CPT 84436 T4 | $85.50 | $114.00 | $6.70–$108.30 | — | 25% |
| Total triiodothyronine (T3) blood test CPT 84480 TOTAL T3 | $163.50 | $218.00 | $13.83–$207.10 | 32% above | 25% |
| Total triiodothyronine (T3) blood test inpatient CPT 84480 TOTAL T3 | $163.50 | $218.00 | $13.83–$207.10 | — | 25% |
| Transferrin blood test CPT 84466 TRANSFERRIN | $213.75 | $285.00 | $12.44–$270.75 | 116% above | 25% |
| Transferrin blood test inpatient CPT 84466 TRANSFERRIN | $213.75 | $285.00 | $12.44–$270.75 | — | 25% |
| Trichomonas test (NAAT) CPT 87661 UVM TRICHOMONAS VAGINALIS | $14.25 | $19.00 | $6.84–$19.00 | 76% below | 25% |
| Trichomonas test (NAAT) CPT 87661 MAYO TRICHOMONAS VAGINALIS | $25.50 | $34.00 | $12.24–$34.00 | 57% below | 25% |
| Trichomonas test (NAAT) CPT 87661 MAYO TRICH VAGINALIS RNA | $113.25 | $151.00 | $34.21–$143.45 | 93% above | 25% |
| Trichomonas test (NAAT) inpatient CPT 87661 UVM TRICHOMONAS VAGINALIS | $14.25 | $19.00 | $6.84–$19.00 | — | 25% |
| Trichomonas test (NAAT) inpatient CPT 87661 MAYO TRICHOMONAS VAGINALIS | $25.50 | $34.00 | $12.24–$34.00 | — | 25% |
| Trichomonas test (NAAT) inpatient CPT 87661 MAYO TRICH VAGINALIS RNA | $113.25 | $151.00 | $34.21–$143.45 | — | 25% |
| Triglycerides blood test CPT 84478 MAYO ASSAY OF TRIGLYCERIDES | $15.00 | $20.00 | $5.60–$19.00 | 63% below | 25% |
| Triglycerides blood test CPT 84478 TRIGLYCERIDES TOTAL CDC S | $18.75 | $25.00 | $5.60–$23.75 | 54% below | 25% |
| Triglycerides blood test CPT 84478 MAYO TRIGLYCERIDE | $69.00 | $92.00 | $5.60–$87.40 | 71% above | 25% |
| Triglycerides blood test CPT 84478 TRIGLYCERIDES | $72.00 | $96.00 | $5.60–$91.20 | 79% above | 25% |
| Triglycerides blood test CPT 84478 MAYO TRIGLYCERIDES,BF | $184.50 | $246.00 | $5.60–$233.70 | 357% above | 25% |
| Triglycerides blood test inpatient CPT 84478 MAYO ASSAY OF TRIGLYCERIDES | $15.00 | $20.00 | $5.60–$19.00 | — | 25% |
| Triglycerides blood test inpatient CPT 84478 TRIGLYCERIDES TOTAL CDC S | $18.75 | $25.00 | $5.60–$23.75 | — | 25% |
| Triglycerides blood test inpatient CPT 84478 MAYO TRIGLYCERIDE | $69.00 | $92.00 | $5.60–$87.40 | — | 25% |
| Triglycerides blood test inpatient CPT 84478 TRIGLYCERIDES | $72.00 | $96.00 | $5.60–$91.20 | — | 25% |
| Triglycerides blood test inpatient CPT 84478 MAYO TRIGLYCERIDES,BF | $184.50 | $246.00 | $5.60–$233.70 | — | 25% |
| Troponin test, quantitative CPT 84484 MAYO TROPONIN, 5TH GEN | $57.00 | $76.00 | $12.16–$72.20 | 65% below | 25% |
| Troponin test, quantitative CPT 84484 TROPONIN-I, QT | $167.25 | $223.00 | $12.16–$211.85 | 1% above | 25% |
| Troponin test, quantitative inpatient CPT 84484 MAYO TROPONIN, 5TH GEN | $57.00 | $76.00 | $12.16–$72.20 | — | 25% |
| Troponin test, quantitative inpatient CPT 84484 TROPONIN-I, QT | $167.25 | $223.00 | $12.16–$211.85 | — | 25% |
| Uric acid blood test CPT 84550 URIC ACID | $65.25 | $87.00 | $4.41–$82.65 | at median | 25% |
| Uric acid blood test CPT 84550 URIC ACID NVRH DHCC | $65.25 | $87.00 | $4.41–$82.65 | at median | 25% |
| Uric acid blood test inpatient CPT 84550 URIC ACID NVRH DHCC | $65.25 | $87.00 | $4.41–$82.65 | — | 25% |
| Uric acid blood test inpatient CPT 84550 URIC ACID | $65.25 | $87.00 | $4.41–$82.65 | — | 25% |
| Urinalysis with microscope exam, automated CPT 81001 URINALYSIS AUTOMATED,W/MICRO | $11.25 | $15.00 | $3.09–$14.25 | 76% below | 25% |
| Urinalysis with microscope exam, automated CPT 81001 URINALYSIS AUTOMATED, W/MICR | $11.25 | $15.00 | $3.09–$14.25 | 76% below | 25% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS AUTOMATED, W/MICR | $11.25 | $15.00 | $3.09–$14.25 | — | 25% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS AUTOMATED,W/MICRO | $11.25 | $15.00 | $3.09–$14.25 | — | 25% |
| Urinalysis with microscope exam, manual CPT 81000 URINE ANALIYSIS COMPLETE ~G | $16.50 | $22.00 | $3.92–$20.90 | 15% below | 25% |
| Urinalysis with microscope exam, manual CPT 81000 URINE ANALIYSIS COMPLETE | $16.50 | $22.00 | $3.92–$20.90 | 15% below | 25% |
| Urinalysis with microscope exam, manual CPT 81000 URINE ANALYSIS COMPLETE | $16.50 | $22.00 | $3.92–$20.90 | 15% below | 25% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 URINE ANALYSIS COMPLETE | $16.50 | $22.00 | $3.92–$20.90 | — | 25% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 URINE ANALIYSIS COMPLETE ~G | $16.50 | $22.00 | $3.92–$20.90 | — | 25% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 URINE ANALIYSIS COMPLETE | $16.50 | $22.00 | $3.92–$20.90 | — | 25% |
| Urinalysis without microscope exam, automated CPT 81003 URINALYSIS AUTOMATED,W/MICRO | $11.25 | $15.00 | $2.19–$14.25 | 70% below | 25% |
| Urinalysis without microscope exam, automated CPT 81003 URINALYSIS-AUTOMATED,W/O MIC | $11.25 | $15.00 | $2.19–$14.25 | 70% below | 25% |
| Urinalysis without microscope exam, automated CPT 81003 URINALYSIS DIP (NVRH DHCC) | $42.75 | $57.00 | $2.19–$54.15 | 12% above | 25% |
| Urinalysis without microscope exam, automated CPT 81003 URINALYSIS | $42.75 | $57.00 | $2.19–$54.15 | 12% above | 25% |
| Urinalysis without microscope exam, automated CPT 81003 URINE (DIP ONLY) | $42.75 | $57.00 | $2.19–$54.15 | 12% above | 25% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS AUTOMATED,W/MICRO | $11.25 | $15.00 | $2.19–$14.25 | — | 25% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS-AUTOMATED,W/O MIC | $11.25 | $15.00 | $2.19–$14.25 | — | 25% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINE (DIP ONLY) | $42.75 | $57.00 | $2.19–$54.15 | — | 25% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS | $42.75 | $57.00 | $2.19–$54.15 | — | 25% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS DIP (NVRH DHCC) | $42.75 | $57.00 | $2.19–$54.15 | — | 25% |
| Urinalysis without microscope exam, manual CPT 81002 URINE MICRAL | $12.00 | $16.00 | $3.39–$15.20 | 48% below | 25% |
| Urinalysis without microscope exam, manual CPT 81002 ICOTEST | $36.75 | $49.00 | $3.39–$46.55 | 60% above | 25% |
| Urinalysis without microscope exam, manual CPT 81002 MAYO HEMOGLOBIN URINE | $90.00 | $120.00 | $3.39–$114.00 | 291% above | 25% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 URINE MICRAL | $12.00 | $16.00 | $3.39–$15.20 | — | 25% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 ICOTEST | $36.75 | $49.00 | $3.39–$46.55 | — | 25% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 MAYO HEMOGLOBIN URINE | $90.00 | $120.00 | $3.39–$114.00 | — | 25% |
| Urine culture for bacteria, with colony count CPT 87086 URINE CULTURE | $78.00 | $104.00 | $7.87–$98.80 | 2% above | 25% |
| Urine culture for bacteria, with colony count inpatient CPT 87086 URINE CULTURE | $78.00 | $104.00 | $7.87–$98.80 | — | 25% |
| Urine microalbumin (albumin) test CPT 82043 MAYO ALBUMIN, RANDOM URINE | $12.75 | $17.00 | $5.64–$16.15 | 75% below | 25% |
| Urine microalbumin (albumin) test CPT 82043 MAYO MICROALBUMINURIA 24 HR UR | $24.75 | $33.00 | $5.64–$31.35 | 51% below | 25% |
| Urine microalbumin (albumin) test CPT 82043 MICRO ALBUMIN | $93.75 | $125.00 | $5.64–$118.75 | 86% above | 25% |
| Urine microalbumin (albumin) test CPT 82043 MICROALBUMIN | $93.75 | $125.00 | $5.64–$118.75 | 86% above | 25% |
| Urine microalbumin (albumin) test inpatient CPT 82043 MAYO ALBUMIN, RANDOM URINE | $12.75 | $17.00 | $5.64–$16.15 | — | 25% |
| Urine microalbumin (albumin) test inpatient CPT 82043 MAYO MICROALBUMINURIA 24 HR UR | $24.75 | $33.00 | $5.64–$31.35 | — | 25% |
| Urine microalbumin (albumin) test inpatient CPT 82043 MICROALBUMIN | $93.75 | $125.00 | $5.64–$118.75 | — | 25% |
| Urine microalbumin (albumin) test inpatient CPT 82043 MICRO ALBUMIN | $93.75 | $125.00 | $5.64–$118.75 | — | 25% |
| Urine pregnancy test, read by color change CPT 81025 URINE PREG TEST COLOR COMPAR | $20.25 | $27.00 | $8.39–$25.65 | 49% below | 25% |
| Urine pregnancy test, read by color change CPT 81025 URINE HCG | $57.00 | $76.00 | $8.39–$72.20 | 44% above | 25% |
| Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY TEST - ER | $57.00 | $76.00 | $8.39–$72.20 | 44% above | 25% |
| Urine pregnancy test, read by color change CPT 81025 HCG QUAL URINE NVRH DHCC | $111.00 | $148.00 | $8.39–$140.60 | 181% above | 25% |
| Urine pregnancy test, read by color change CPT 81025 HCG QUAL URINE | $111.00 | $148.00 | $8.39–$140.60 | 181% above | 25% |
| Urine pregnancy test, read by color change inpatient CPT 81025 URINE PREG TEST COLOR COMPAR | $20.25 | $27.00 | $8.39–$25.65 | — | 25% |
| Urine pregnancy test, read by color change inpatient CPT 81025 URINE HCG | $57.00 | $76.00 | $8.39–$72.20 | — | 25% |
| Urine pregnancy test, read by color change inpatient CPT 81025 URINE PREGNANCY TEST - ER | $57.00 | $76.00 | $8.39–$72.20 | — | 25% |
| Urine pregnancy test, read by color change inpatient CPT 81025 HCG QUAL URINE NVRH DHCC | $111.00 | $148.00 | $8.39–$140.60 | — | 25% |
| Urine pregnancy test, read by color change inpatient CPT 81025 HCG QUAL URINE | $111.00 | $148.00 | $8.39–$140.60 | — | 25% |
| Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B12 CCC | $144.75 | $193.00 | $14.70–$183.35 | 30% above | 25% |
| Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B12 NVRH DHCC | $163.50 | $218.00 | $14.70–$207.10 | 47% above | 25% |
| Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B12 | $163.50 | $218.00 | $14.70–$207.10 | 47% above | 25% |
| Vitamin B12 (cobalamin) blood test CPT 82607 B12 | $170.25 | $227.00 | $14.70–$215.65 | 53% above | 25% |
| Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Vitamin B12 CCC | $144.75 | $193.00 | $14.70–$183.35 | — | 25% |
| Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B12 | $163.50 | $218.00 | $14.70–$207.10 | — | 25% |
| Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B12 NVRH DHCC | $163.50 | $218.00 | $14.70–$207.10 | — | 25% |
| Vitamin B12 (cobalamin) blood test inpatient CPT 82607 B12 | $170.25 | $227.00 | $14.70–$215.65 | — | 25% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25 TOTAL | $253.50 | $338.00 | $28.86–$321.10 | 20% above | 25% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D(25-HYDROXY) | $253.50 | $338.00 | $28.86–$321.10 | 20% above | 25% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D25 TOTAL NVRH DHCC | $253.50 | $338.00 | $28.86–$321.10 | 20% above | 25% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D25 TOTAL NVRH DHCC | $253.50 | $338.00 | $28.86–$321.10 | — | 25% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D(25-HYDROXY) | $253.50 | $338.00 | $28.86–$321.10 | — | 25% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D 25 TOTAL | $253.50 | $338.00 | $28.86–$321.10 | — | 25% |
| Vitamin D, 1,25-dihydroxy blood test CPT 82652 VITAMIN D(1,25 DIHYDROXY) | $633.75 | $845.00 | $37.54–$802.75 | 82% above | 25% |
| Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 VITAMIN D(1,25 DIHYDROXY) | $633.75 | $845.00 | $37.54–$802.75 | — | 25% |
| Zinc blood test CPT 84630 MAYO ZINC, S | $27.75 | $37.00 | $11.11–$35.15 | 82% below | 25% |
| Zinc blood test CPT 84630 MAYO ZINC, PLASMA | $78.75 | $105.00 | $11.11–$99.75 | 49% below | 25% |
| Zinc blood test CPT 84630 MAYO ZINC RBC'S | $139.50 | $186.00 | $11.11–$176.70 | 9% below | 25% |
| Zinc blood test inpatient CPT 84630 MAYO ZINC, S | $27.75 | $37.00 | $11.11–$35.15 | — | 25% |
| Zinc blood test inpatient CPT 84630 MAYO ZINC, PLASMA | $78.75 | $105.00 | $11.11–$99.75 | — | 25% |
| Zinc blood test inpatient CPT 84630 MAYO ZINC RBC'S | $139.50 | $186.00 | $11.11–$176.70 | — | 25% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG QUANTAT SER | $204.00 | $272.00 | $14.67–$258.40 | 63% above | 25% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG TUMOR MARKER | $243.75 | $325.00 | $14.67–$308.75 | 95% above | 25% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG QUANT SERUM | $243.75 | $325.00 | $14.67–$308.75 | 95% above | 25% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCG QUANTAT SER | $204.00 | $272.00 | $14.67–$258.40 | — | 25% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCG TUMOR MARKER | $243.75 | $325.00 | $14.67–$308.75 | — | 25% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCG QUANT SERUM | $243.75 | $325.00 | $14.67–$308.75 | — | 25% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Vermont | Off list |
|---|---|---|---|---|---|
| Adenoid removal (adenoidectomy), child under 12 CPT 42830 REMOVAL OF ADENOIDS | $354.75 | $473.00 | $160.23–$449.35 | — | 25% |
| Adenoid removal (adenoidectomy), child under 12 inpatient CPT 42830 REMOVAL OF ADENOIDS | $354.75 | $473.00 | $160.23–$449.35 | — | 25% |
| Appendectomy for a ruptured appendix with abscess or peritonitis CPT 44960 APPENDECTOMY | $1,256.25 | $1,675.00 | $607.36–$1,591.25 | — | 25% |
| Appendectomy for a ruptured appendix with abscess or peritonitis inpatient CPT 44960 APPENDECTOMY | $1,256.25 | $1,675.00 | $607.36–$1,591.25 | — | 25% |
| Appendectomy, open surgery CPT 44950 APPENDECTOMY | $1,017.75 | $1,357.00 | $476.61–$1,289.15 | — | 25% |
| Appendectomy, open surgery inpatient CPT 44950 APPENDECTOMY | $1,017.75 | $1,357.00 | $476.61–$1,289.15 | — | 25% |
| Arthroscopic ACL reconstruction or repair of the knee CPT 29888 KNEE ARTHROSCOPY/SURGERY | $1,716.00 | $2,288.00 | $715.28–$2,173.60 | — | 25% |
| Arthroscopic ACL reconstruction or repair of the knee inpatient CPT 29888 KNEE ARTHROSCOPY/SURGERY | $1,716.00 | $2,288.00 | $715.28–$2,173.60 | — | 25% |
| Arthroscopic rotator cuff repair of the shoulder CPT 29827 ARTHROSCOP ROTATOR CUFF REPR | $1,913.25 | $2,551.00 | $784.53–$2,423.45 | — | 25% |
| Arthroscopic rotator cuff repair of the shoulder inpatient CPT 29827 ARTHROSCOP ROTATOR CUFF REPR | $1,913.25 | $2,551.00 | $784.53–$2,423.45 | — | 25% |
| Botox injections for chronic migraine CPT 64615 CHEMICAL DENERVATION PROC HE | $216.00 | $288.00 | $104.43–$273.60 | 47% below | 25% |
| Botox injections for chronic migraine inpatient CPT 64615 CHEMICAL DENERVATION PROC HE | $216.00 | $288.00 | $104.43–$273.60 | — | 25% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 BX BREAST 1ST LESION STRTC | $707.25 | $943.00 | $341.93–$895.85 | 76% below | 25% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 BX BREAST 1ST LESION STRTC | $707.25 | $943.00 | $341.93–$895.85 | — | 25% |
| Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 CLSD TX DISTAL FIBULA FX ~T | $620.25 | $827.00 | $259.31–$785.65 | 33% above | 25% |
| Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 CLSD TX DISTAL FIBULA FX ~T | $620.25 | $827.00 | $259.31–$785.65 | — | 25% |
| Broken foot (metatarsal) treatment without surgery or setting CPT 28470 TREAT METATARSAL FRACTURE | $324.75 | $433.00 | $157.01–$411.35 | 17% below | 25% |
| Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 TREAT METATARSAL FRACTURE | $324.75 | $433.00 | $157.01–$411.35 | — | 25% |
| Bunion correction with a bone cut near the head of the first metatarsal CPT 28296 CORRECTION OF BUNION | $1,031.25 | $1,375.00 | $498.58–$1,375.00 | — | 25% |
| Bunion correction with a bone cut near the head of the first metatarsal inpatient CPT 28296 CORRECTION OF BUNION | $1,031.25 | $1,375.00 | $498.58–$1,375.00 | — | 25% |
| Bunion correction with removal of part of the big toe joint CPT 28292 CORRECTION OF BUNION | $885.00 | $1,180.00 | $427.87–$1,180.00 | — | 25% |
| Bunion correction with removal of part of the big toe joint inpatient CPT 28292 CORRECTION OF BUNION | $885.00 | $1,180.00 | $427.87–$1,180.00 | — | 25% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ELECTRIC, EXT | $279.00 | $372.00 | $128.91–$353.40 | 82% below | 25% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION | $1,646.25 | $2,195.00 | $148.30–$2,085.25 | 8% above | 25% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION ELECTRIC, EXT | $279.00 | $372.00 | $128.91–$353.40 | — | 25% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION | $1,646.25 | $2,195.00 | $148.30–$2,085.25 | — | 25% |
| Carpal tunnel release, open surgery CPT 64721 CARPAL TUNNEL SURGERY | $894.75 | $1,193.00 | $395.16–$1,133.35 | 47% below | 25% |
| Carpal tunnel release, open surgery inpatient CPT 64721 CARPAL TUNNEL SURGERY | $894.75 | $1,193.00 | $395.16–$1,133.35 | — | 25% |
| Cervical biopsy CPT 57500 BIOPSY OF CERVIX | $165.00 | $220.00 | $79.77–$220.00 | 81% below | 25% |
| Cervical biopsy inpatient CPT 57500 BIOPSY OF CERVIX | $165.00 | $220.00 | $79.77–$220.00 | — | 25% |
| Cesarean delivery, including prenatal and postpartum care CPT 59510 CESAREAN DELIVERY | $3,306.00 | $4,408.00 | $1,598.34–$4,187.60 | — | 25% |
| Cesarean delivery, including prenatal and postpartum care inpatient CPT 59510 CESAREAN DELIVERY | $3,306.00 | $4,408.00 | $1,598.34–$4,187.60 | — | 25% |
| Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 CIRCUMCISION | $338.25 | $451.00 | $147.46–$428.45 | 47% below | 25% |
| Circumcision by surgical excision, older than 28 days (children and adults) inpatient CPT 54161 CIRCUMCISION | $338.25 | $451.00 | $147.46–$428.45 | — | 25% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION | $1,270.50 | $1,694.00 | $144.25–$1,694.00 | 55% below | 25% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 CIRCUMCISION | $1,270.50 | $1,694.00 | $144.25–$1,694.00 | — | 25% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 TREAT FRACTURE RADIUS/ULNA | $435.00 | $580.00 | $210.31–$580.00 | 19% below | 25% |
| Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 TREAT FRACTURE RADIUS/ULNA | $435.00 | $580.00 | $210.31–$580.00 | — | 25% |
| Colonoscopy with polyp removal CPT 45385 LESION REMOVAL COLONOSCOPY | $607.50 | $810.00 | $293.71–$769.50 | 84% below | 25% |
| Colonoscopy with polyp removal inpatient CPT 45385 LESION REMOVAL COLONOSCOPY | $607.50 | $810.00 | $293.71–$769.50 | — | 25% |
| Colonoscopy with tissue sample CPT 45380 COLONOSCOPY AND BIOPSY | $540.00 | $720.00 | $261.07–$684.00 | 86% below | 25% |
| Colonoscopy with tissue sample inpatient CPT 45380 COLONOSCOPY AND BIOPSY | $540.00 | $720.00 | $261.07–$684.00 | — | 25% |
| Colonoscopy, diagnostic CPT 45378 DIAGNOSTIC COLONOSCOPY | $450.00 | $600.00 | $217.56–$586.30 | 86% below | 25% |
| Colonoscopy, diagnostic inpatient CPT 45378 DIAGNOSTIC COLONOSCOPY | $450.00 | $600.00 | $217.56–$586.30 | — | 25% |
| Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 BX OF CERVIX W/SCOPE, LEEP | $405.00 | $540.00 | $195.80–$517.18 | at median | 25% |
| Colposcopy with LEEP (loop electrosurgical excision) inpatient CPT 57460 BX OF CERVIX W/SCOPE, LEEP | $405.00 | $540.00 | $195.80–$517.18 | — | 25% |
| Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 BX/CURETT OF CERVIX W/SCOPE | $248.25 | $331.00 | $120.02–$314.45 | 15% above | 25% |
| Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 BX/CURETT OF CERVIX W/SCOPE | $248.25 | $331.00 | $120.02–$314.45 | — | 25% |
| Cystoscopy with ureteral stent placement CPT 52332 CYSTOSCOPY AND TREATMENT | $780.00 | $1,040.00 | $310.84–$988.00 | at median | 25% |
| Cystoscopy with ureteral stent placement inpatient CPT 52332 CYSTOSCOPY AND TREATMENT | $780.00 | $1,040.00 | $310.84–$988.00 | — | 25% |
| Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOSCOPY | $247.50 | $330.00 | $119.66–$330.00 | 43% below | 25% |
| Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOURETHROSCOPY ~T | $1,428.75 | $1,905.00 | $206.66–$1,809.75 | 226% above | 25% |
| Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 CYSTOSCOPY | $247.50 | $330.00 | $119.66–$330.00 | — | 25% |
| Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 CYSTOURETHROSCOPY ~T | $1,428.75 | $1,905.00 | $206.66–$1,809.75 | — | 25% |
| D&C (dilation and curettage), not related to pregnancy CPT 58120 DILATION AND CURETTAGE | $364.50 | $486.00 | $176.22–$486.00 | 80% below | 25% |
| D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 DILATION AND CURETTAGE | $364.50 | $486.00 | $176.22–$486.00 | — | 25% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTROY BENIGN/PREMLG LESION | $81.00 | $108.00 | $39.16–$102.60 | 2% below | 25% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 DESTROY BENIGN/PREMLG LESION | $81.00 | $108.00 | $39.16–$102.60 | — | 25% |
| Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 CREATE EARDRUM OPENING | $294.75 | $393.00 | $118.61–$373.35 | 27% below | 25% |
| Ear tube placement (tympanostomy) under general anesthesia, one ear inpatient CPT 69436 CREATE EARDRUM OPENING | $294.75 | $393.00 | $118.61–$373.35 | — | 25% |
| Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 MYRINGOTOMY | $300.00 | $400.00 | $145.04–$380.00 | 15% below | 25% |
| Ear tube placement (tympanostomy) with local anesthesia, one ear inpatient CPT 69433 MYRINGOTOMY | $300.00 | $400.00 | $145.04–$380.00 | — | 25% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 CERUMEN REMOVAL IRRIGATION/L | $19.50 | $26.00 | $9.43–$24.70 | 80% below | 25% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVAL IMP CERUMEN FLUSHING~T | $148.50 | $198.00 | $16.37–$188.10 | 49% above | 25% |
| Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 CERUMEN REMOVAL IRRIGATION/L | $19.50 | $26.00 | $9.43–$24.70 | — | 25% |
| Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 REMOVAL IMP CERUMEN FLUSHING~T | $148.50 | $198.00 | $16.37–$188.10 | — | 25% |
| Earwax removal with instruments, one ear CPT 69210 REMOVAL IMPACTED CERUMEN | $54.00 | $72.00 | $26.11–$72.00 | 67% below | 25% |
| Earwax removal with instruments, one ear CPT 69210 REMOVE IMPACTED EAR WAX | $59.25 | $79.00 | $28.65–$75.05 | 64% below | 25% |
| Earwax removal with instruments, one ear inpatient CPT 69210 REMOVAL IMPACTED CERUMEN | $54.00 | $72.00 | $26.11–$72.00 | — | 25% |
| Earwax removal with instruments, one ear inpatient CPT 69210 REMOVE IMPACTED EAR WAX | $59.25 | $79.00 | $28.65–$75.05 | — | 25% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 BIOPSY OF UTERUS LINING | $161.25 | $215.00 | $77.96–$204.25 | 31% below | 25% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 BIOPSY OF UTERUS LINING | $161.25 | $215.00 | $77.96–$204.25 | — | 25% |
| Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue CPT 31267 ENDOSCOPY, MAXILLARY SINUS | $613.50 | $818.00 | $180.59–$777.10 | — | 25% |
| Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue inpatient CPT 31267 ENDOSCOPY, MAXILLARY SINUS | $613.50 | $818.00 | $180.59–$777.10 | — | 25% |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 INJ SPINE C/T W/ IMAGIN | $290.25 | $387.00 | $140.33–$385.56 | 85% below | 25% |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 CERVICAL/THORACIC WITH IMAGING | $1,626.75 | $2,169.00 | $266.09–$2,060.55 | 13% below | 25% |
| Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 INJ SPINE C/T W/ IMAGIN | $290.25 | $387.00 | $140.33–$385.56 | — | 25% |
| Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 CERVICAL/THORACIC WITH IMAGING | $1,626.75 | $2,169.00 | $266.09–$2,060.55 | — | 25% |
| Facet joint injection, lower back, one level, with imaging guidance CPT 64493 NJX DX/THER AGT PVRT FACET J | $247.50 | $330.00 | $119.66–$313.50 | 89% below | 25% |
| Facet joint injection, lower back, one level, with imaging guidance CPT 64493 INJ PARAVERT F JNT L/S 2 LEV | $450.00 | $600.00 | $182.98–$600.00 | 81% below | 25% |
| Facet joint injection, lower back, one level, with imaging guidance CPT 64493 LUMBAR/SACRAL SINGLE LVL | $1,460.25 | $1,947.00 | $182.98–$1,849.65 | 37% below | 25% |
| Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 NJX DX/THER AGT PVRT FACET J | $247.50 | $330.00 | $119.66–$313.50 | — | 25% |
| Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 INJ PARAVERT F JNT L/S 2 LEV | $450.00 | $600.00 | $182.98–$600.00 | — | 25% |
| Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 LUMBAR/SACRAL SINGLE LVL | $1,460.25 | $1,947.00 | $182.98–$1,849.65 | — | 25% |
| First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 HERNIA REPAIR 3CM TO 10CM REDU | $1,188.00 | $1,584.00 | $408.25–$1,504.80 | — | 25% |
| First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm inpatient CPT 49593 HERNIA REPAIR 3CM TO 10CM REDU | $1,188.00 | $1,584.00 | $408.25–$1,504.80 | — | 25% |
| First repair of a front abdominal hernia larger than 10 cm CPT 49595 REPAIR OF ABD HERNIA | $1,089.75 | $1,453.00 | $526.86–$1,380.35 | — | 25% |
| First repair of a front abdominal hernia larger than 10 cm inpatient CPT 49595 REPAIR OF ABD HERNIA | $1,089.75 | $1,453.00 | $526.86–$1,380.35 | — | 25% |
| First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 ABD HERNIA REPAIR <3CM | $1,010.25 | $1,347.00 | $246.61–$1,279.65 | — | 25% |
| First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm inpatient CPT 49591 ABD HERNIA REPAIR <3CM | $1,010.25 | $1,347.00 | $246.61–$1,279.65 | — | 25% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 DIAGNOSTIC SIGMOIDOSCOPY | $165.00 | $220.00 | $79.77–$220.00 | 87% below | 25% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 DIAGNOSTIC SIGMOIDOSCOPY | $165.00 | $220.00 | $79.77–$220.00 | — | 25% |
| Gallbladder removal, laparoscopic CPT 47562 LAPAROSCOPIC CHOLECYSTECTOMY | $1,141.50 | $1,522.00 | $498.01–$1,445.90 | 84% below | 25% |
| Gallbladder removal, laparoscopic inpatient CPT 47562 LAPAROSCOPIC CHOLECYSTECTOMY | $1,141.50 | $1,522.00 | $498.01–$1,445.90 | — | 25% |
| Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 LAPARO CHOLECYSTECTOMY/GRAPH | $1,224.75 | $1,633.00 | $538.82–$1,551.35 | — | 25% |
| Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery inpatient CPT 47563 LAPARO CHOLECYSTECTOMY/GRAPH | $1,224.75 | $1,633.00 | $538.82–$1,551.35 | — | 25% |
| Gallbladder removal, open surgery through a larger incision CPT 47600 REMOVAL OF GALLBLADDER | $1,530.75 | $2,041.00 | $740.07–$1,938.95 | — | 25% |
| Gallbladder removal, open surgery through a larger incision inpatient CPT 47600 REMOVAL OF GALLBLADDER | $1,530.75 | $2,041.00 | $740.07–$1,938.95 | — | 25% |
| Hammertoe correction surgery CPT 28285 CORRECTION HAMMER TOE | $545.25 | $727.00 | $263.61–$727.00 | 37% below | 25% |
| Hammertoe correction surgery inpatient CPT 28285 CORRECTION HAMMER TOE | $545.25 | $727.00 | $263.61–$727.00 | — | 25% |
| Hemorrhoid banding (rubber band ligation) CPT 46221 LIGATION OF HEMORRHOID(S) | $276.75 | $369.00 | $133.80–$369.00 | 79% below | 25% |
| Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 LIGATION OF HEMORRHOID(S) | $276.75 | $369.00 | $133.80–$369.00 | — | 25% |
| Hemorrhoidectomy (internal and external), one area CPT 46255 HEMORRHOIDECTOMY | $523.50 | $698.00 | $253.09–$698.00 | 86% below | 25% |
| Hemorrhoidectomy (internal and external), one area inpatient CPT 46255 HEMORRHOIDECTOMY | $523.50 | $698.00 | $253.09–$698.00 | — | 25% |
| Hip replacement after an earlier hip surgery (conversion to total hip) CPT 27132 TOTAL HIP ARTHROPLASTY | $2,776.50 | $3,702.00 | $1,199.90–$3,516.90 | — | 25% |
| Hip replacement after an earlier hip surgery (conversion to total hip) inpatient CPT 27132 TOTAL HIP ARTHROPLASTY | $2,776.50 | $3,702.00 | $1,199.90–$3,516.90 | — | 25% |
| Hysterectomy through an abdominal incision (total) CPT 58150 TOTAL HYSTERECTOMY | $1,605.75 | $2,141.00 | $742.93–$2,033.95 | — | 25% |
| Hysterectomy through an abdominal incision (total) inpatient CPT 58150 TOTAL HYSTERECTOMY | $1,605.75 | $2,141.00 | $742.93–$2,033.95 | — | 25% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 CATHETER FOR HYSTEROGRAPHY | $277.50 | $370.00 | $134.16–$370.00 | 26% below | 25% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 CATHETER FOR HYSTEROGRAPHY | $277.50 | $370.00 | $134.16–$370.00 | — | 25% |
| Hysteroscopy with endometrial ablation CPT 58563 HYSTEROSCOPY, ABLATION | $2,880.00 | $3,840.00 | $1,392.38–$3,648.00 | — | 25% |
| Hysteroscopy with endometrial ablation inpatient CPT 58563 HYSTEROSCOPY, ABLATION | $2,880.00 | $3,840.00 | $1,392.38–$3,648.00 | — | 25% |
| Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 HYSTEROSCOPY, BIOPSY | $1,252.50 | $1,670.00 | $605.54–$1,670.00 | 53% below | 25% |
| Hysteroscopy with uterine lining sampling and/or polyp removal inpatient CPT 58558 HYSTEROSCOPY, BIOPSY | $1,252.50 | $1,670.00 | $605.54–$1,670.00 | — | 25% |
| IUD insertion (the device itself billed separately) CPT 58300 INSERT IUD | $132.00 | $176.00 | $63.82–$176.00 | 75% below | 25% |
| IUD insertion (the device itself billed separately) inpatient CPT 58300 INSERT IUD | $132.00 | $176.00 | $63.82–$176.00 | — | 25% |
| Incision and drainage of a simple or single skin abscess CPT 10060 I&D, ABSCESS; SIMPLE 10060~P | $75.00 | $100.00 | $36.26–$100.00 | 84% below | 25% |
| Incision and drainage of a simple or single skin abscess CPT 10060 DRAINAGE OF SKIN ABSCESS | $147.75 | $197.00 | $71.43–$197.00 | 68% below | 25% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D, ABSCESS; SIMPLE 10060~P | $75.00 | $100.00 | $36.26–$100.00 | — | 25% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 DRAINAGE OF SKIN ABSCESS | $147.75 | $197.00 | $71.43–$197.00 | — | 25% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 PRP I/HERN INIT REDUC >5 YR | $805.50 | $1,074.00 | $389.43–$1,020.30 | 84% below | 25% |
| Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 PRP I/HERN INIT REDUC >5 YR | $805.50 | $1,074.00 | $389.43–$1,020.30 | — | 25% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ TENDON SHEATH/LIGAMENT | $75.75 | $101.00 | $36.62–$101.00 | 73% below | 25% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ TENDON SHEATH OR LIGAMENT | $518.25 | $691.00 | $57.47–$656.45 | 81% above | 25% |
| Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJ TENDON SHEATH/LIGAMENT | $75.75 | $101.00 | $36.62–$101.00 | — | 25% |
| Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJ TENDON SHEATH OR LIGAMENT | $518.25 | $691.00 | $57.47–$656.45 | — | 25% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DI INJECTION PROC MAJOR JOINT | $77.25 | $103.00 | $37.08–$103.00 | 89% below | 25% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJECT JNT W/OUS ~20610 | $85.50 | $114.00 | $41.34–$114.00 | 87% below | 25% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJECT, JOINT W/O US | $93.75 | $125.00 | $45.32–$118.75 | 86% below | 25% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 INJ BURSA/TENDON MAJOR W/O US | $518.25 | $691.00 | $64.94–$656.45 | 24% below | 25% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DI INJECTION PROC MAJOR JOINT | $77.25 | $103.00 | $37.08–$103.00 | — | 25% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRAIN/INJECT JNT W/OUS ~20610 | $85.50 | $114.00 | $41.34–$114.00 | — | 25% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRAIN/INJECT, JOINT W/O US | $93.75 | $125.00 | $45.32–$118.75 | — | 25% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 INJ BURSA/TENDON MAJOR W/O US | $518.25 | $691.00 | $64.94–$656.45 | — | 25% |
| Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 INSERT DRUG IMPLANT DEVICE | $151.50 | $202.00 | $73.25–$191.90 | 19% below | 25% |
| Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 INSERT DRUG IMPLANT DEVICE | $151.50 | $202.00 | $73.25–$191.90 | — | 25% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/INJECT, JOINT W/O US | $74.25 | $99.00 | $35.90–$98.60 | 73% below | 25% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 INJ BURSA/TENDON INTERMED | $518.25 | $691.00 | $54.36–$656.45 | 86% above | 25% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ASP/INJ,INTERMED JOINT -TC | $574.50 | $766.00 | $54.36–$727.70 | 106% above | 25% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 DRAIN/INJECT, JOINT W/O US | $74.25 | $99.00 | $35.90–$98.60 | — | 25% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 INJ BURSA/TENDON INTERMED | $518.25 | $691.00 | $54.36–$656.45 | — | 25% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ASP/INJ,INTERMED JOINT -TC | $574.50 | $766.00 | $54.36–$727.70 | — | 25% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAIN/INJECT, JOINT/BURSA | $72.00 | $96.00 | $34.81–$96.00 | 80% below | 25% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 INJ BURSA/TENDON SMALL W/O US | $478.50 | $638.00 | $53.38–$606.10 | 33% above | 25% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 DRAIN/INJECT, JOINT/BURSA | $72.00 | $96.00 | $34.81–$96.00 | — | 25% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 INJ BURSA/TENDON SMALL W/O US | $478.50 | $638.00 | $53.38–$606.10 | — | 25% |
| Knee arthroscopy with meniscus repair (one side of the knee) CPT 29882 KNEE ARTHROSCOPY/SURGERY | $1,128.00 | $1,504.00 | $517.91–$1,428.80 | — | 25% |
| Knee arthroscopy with meniscus repair (one side of the knee) inpatient CPT 29882 KNEE ARTHROSCOPY/SURGERY | $1,128.00 | $1,504.00 | $517.91–$1,428.80 | — | 25% |
| Knee arthroscopy with meniscus trim CPT 29881 KNEE ARTHROSCOPY/SURGERY | $1,042.50 | $1,390.00 | $417.68–$1,320.50 | — | 25% |
| Knee arthroscopy with meniscus trim inpatient CPT 29881 KNEE ARTHROSCOPY/SURGERY | $1,042.50 | $1,390.00 | $417.68–$1,320.50 | — | 25% |
| Knee arthroscopy with removal of both torn meniscus parts CPT 29880 KNEE ARTHROSCOPY/SURGERY | $1,125.00 | $1,500.00 | $431.13–$1,425.00 | — | 25% |
| Knee arthroscopy with removal of both torn meniscus parts inpatient CPT 29880 KNEE ARTHROSCOPY/SURGERY | $1,125.00 | $1,500.00 | $431.13–$1,425.00 | — | 25% |
| Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 KNEE ARTHROSCOPY/SURGERY | $998.25 | $1,331.00 | $474.04–$1,264.45 | — | 25% |
| Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) inpatient CPT 29877 KNEE ARTHROSCOPY/SURGERY | $998.25 | $1,331.00 | $474.04–$1,264.45 | — | 25% |
| Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 LAPAROSCOPY, APPENDECTOMY | $908.25 | $1,211.00 | $439.11–$1,150.45 | — | 25% |
| Laparoscopic appendectomy (appendix removal through small cuts) inpatient CPT 44970 LAPAROSCOPY, APPENDECTOMY | $908.25 | $1,211.00 | $439.11–$1,150.45 | — | 25% |
| Laparoscopic fundoplication (anti-reflux surgery) CPT 43280 LAPAROSCOPY, FUNDOPLASTY | $1,743.75 | $2,325.00 | $792.94–$2,208.75 | — | 25% |
| Laparoscopic fundoplication (anti-reflux surgery) inpatient CPT 43280 LAPAROSCOPY, FUNDOPLASTY | $1,743.75 | $2,325.00 | $792.94–$2,208.75 | — | 25% |
| Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries CPT 58571 TLH W/T/O 250 G OR LESS | $1,506.75 | $2,009.00 | $660.52–$1,908.55 | — | 25% |
| Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries inpatient CPT 58571 TLH W/T/O 250 G OR LESS | $1,506.75 | $2,009.00 | $660.52–$1,908.55 | — | 25% |
| Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 LAPARO HERNIA REPAIR INITIAL | $675.00 | $900.00 | $326.34–$855.00 | — | 25% |
| Laparoscopic inguinal (groin) hernia repair, first repair on that side inpatient CPT 49650 LAPARO HERNIA REPAIR INITIAL | $675.00 | $900.00 | $326.34–$855.00 | — | 25% |
| Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 LAPARO HERNIA REPAIR RECUR | $873.75 | $1,165.00 | $422.43–$1,106.75 | — | 25% |
| Laparoscopic inguinal (groin) hernia repair, recurrent hernia inpatient CPT 49651 LAPARO HERNIA REPAIR RECUR | $873.75 | $1,165.00 | $422.43–$1,106.75 | — | 25% |
| Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 LAPAROSCOPY, REMOVE ADNEXA | $1,144.50 | $1,526.00 | $466.79–$1,449.70 | — | 25% |
| Laparoscopic removal of fallopian tubes and/or ovaries inpatient CPT 58661 LAPAROSCOPY, REMOVE ADNEXA | $1,144.50 | $1,526.00 | $466.79–$1,449.70 | — | 25% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 LAYER CLOSURE OF WOUND(S) | $219.00 | $292.00 | $105.88–$292.00 | 52% below | 25% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 LAYER CLOSURE OF WOUND(S) | $219.00 | $292.00 | $105.88–$292.00 | — | 25% |
| Lower-back epidural injection, with imaging guidance CPT 62323 INJ SPINE L/S W/IMAGING | $259.50 | $346.00 | $125.46–$346.00 | 88% below | 25% |
| Lower-back epidural injection, with imaging guidance CPT 62323 INTRATHECAL BLOCK WITH US | $1,626.75 | $2,169.00 | $262.96–$2,060.55 | 22% below | 25% |
| Lower-back epidural injection, with imaging guidance CPT 62323 LUMBAR/SACRAL WITH IMAGING | $1,626.75 | $2,169.00 | $262.96–$2,060.55 | 22% below | 25% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 INJ SPINE L/S W/IMAGING | $259.50 | $346.00 | $125.46–$346.00 | — | 25% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 INTRATHECAL BLOCK WITH US | $1,626.75 | $2,169.00 | $262.96–$2,060.55 | — | 25% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 LUMBAR/SACRAL WITH IMAGING | $1,626.75 | $2,169.00 | $262.96–$2,060.55 | — | 25% |
| Lower-back epidural injection, without imaging guidance CPT 62322 INJ SPINE L/S W/O IMAGING | $149.25 | $199.00 | $72.16–$199.00 | 91% below | 25% |
| Lower-back epidural injection, without imaging guidance CPT 62322 LUMBAR/SACRAL W/O IMAGING | $1,460.25 | $1,947.00 | $139.40–$1,849.65 | 16% below | 25% |
| Lower-back epidural injection, without imaging guidance CPT 62322 INTRATHECAL BLOCK | $1,460.25 | $1,947.00 | $139.40–$1,849.65 | 16% below | 25% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 INJ SPINE L/S W/O IMAGING | $149.25 | $199.00 | $72.16–$199.00 | — | 25% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 INTRATHECAL BLOCK | $1,460.25 | $1,947.00 | $139.40–$1,849.65 | — | 25% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 LUMBAR/SACRAL W/O IMAGING | $1,460.25 | $1,947.00 | $139.40–$1,849.65 | — | 25% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJ FORAMEN EPIDURAL L/S | $337.50 | $450.00 | $163.17–$427.50 | 86% below | 25% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 TRANSFORAMINAL LUMBAR/SACRAL | $1,460.25 | $1,947.00 | $254.89–$1,849.65 | 40% below | 25% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 INJ FORAMEN EPIDURAL L/S | $337.50 | $450.00 | $163.17–$427.50 | — | 25% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 TRANSFORAMINAL LUMBAR/SACRAL | $1,460.25 | $1,947.00 | $254.89–$1,849.65 | — | 25% |
| Lumpectomy (partial mastectomy) CPT 19301 MAST PRTL | $914.25 | $1,219.00 | $442.01–$1,158.05 | 75% below | 25% |
| Lumpectomy (partial mastectomy) inpatient CPT 19301 MAST PRTL | $914.25 | $1,219.00 | $442.01–$1,158.05 | — | 25% |
| Mastectomy (total removal of the breast) CPT 19303 MAST SMPL COMPL | $1,415.25 | $1,887.00 | $684.23–$1,792.65 | — | 25% |
| Mastectomy (total removal of the breast) inpatient CPT 19303 MAST SMPL COMPL | $1,415.25 | $1,887.00 | $684.23–$1,792.65 | — | 25% |
| Miscarriage treatment with D&C, first trimester CPT 59820 CARE OF MISCARRIAGE | $546.00 | $728.00 | $263.97–$691.60 | 88% below | 25% |
| Miscarriage treatment with D&C, first trimester inpatient CPT 59820 CARE OF MISCARRIAGE | $546.00 | $728.00 | $263.97–$691.60 | — | 25% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC TR-EXT B9+MARG 0.5 < CM | $120.75 | $161.00 | $58.38–$161.00 | 44% below | 25% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXC TR-EXT B9+MARG 0.5 < CM | $120.75 | $161.00 | $58.38–$161.00 | — | 25% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXC FACE-MM B9+MARG 0.5 < CM | $125.25 | $167.00 | $60.55–$167.00 | 66% below | 25% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 EXC FACE-MM B9+MARG 0.5 < CM | $125.25 | $167.00 | $60.55–$167.00 | — | 25% |
| Nail removal (partial or complete), one nail CPT 11730 REMOVAL OF NAIL PLATE | $112.50 | $150.00 | $54.39–$150.00 | 72% below | 25% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 REMOVAL OF NAIL PLATE | $112.50 | $150.00 | $54.39–$150.00 | — | 25% |
| Occipital nerve block (injection for headaches) CPT 64405 N BLOCK INJ, OCCIPITAL | $125.25 | $167.00 | $60.55–$158.65 | 76% below | 25% |
| Occipital nerve block (injection for headaches) CPT 64405 GREATER OCCIPITAL NERVE | $749.25 | $999.00 | $73.45–$949.05 | 46% above | 25% |
| Occipital nerve block (injection for headaches) inpatient CPT 64405 N BLOCK INJ, OCCIPITAL | $125.25 | $167.00 | $60.55–$158.65 | — | 25% |
| Occipital nerve block (injection for headaches) inpatient CPT 64405 GREATER OCCIPITAL NERVE | $749.25 | $999.00 | $73.45–$949.05 | — | 25% |
| Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS W/IMAGING ~T | $180.75 | $241.00 | $86.76–$241.00 | 74% below | 25% |
| Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS W/IMAGING | $315.00 | $420.00 | $152.29–$420.00 | 55% below | 25% |
| Paracentesis with imaging guidance inpatient CPT 49083 ABD PARACENTESIS W/IMAGING ~T | $180.75 | $241.00 | $86.76–$241.00 | — | 25% |
| Paracentesis with imaging guidance inpatient CPT 49083 ABD PARACENTESIS W/IMAGING | $315.00 | $420.00 | $152.29–$420.00 | — | 25% |
| Partial knee replacement (one compartment) CPT 27446 REVISION OF KNEE JOINT | $1,932.75 | $2,577.00 | $837.96–$2,448.15 | — | 25% |
| Partial knee replacement (one compartment) inpatient CPT 27446 REVISION OF KNEE JOINT | $1,932.75 | $2,577.00 | $837.96–$2,448.15 | — | 25% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 REMOVE PORTION OF TOENAIL | $168.00 | $224.00 | $81.22–$224.00 | 82% below | 25% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 REMOVAL OF NAIL BED | $252.75 | $337.00 | $122.20–$320.15 | 72% below | 25% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 REMOVE PORTION OF TOENAIL | $168.00 | $224.00 | $81.22–$224.00 | — | 25% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 REMOVAL OF NAIL BED | $252.75 | $337.00 | $122.20–$320.15 | — | 25% |
| Prostate biopsy CPT 55700 BIOPSY OF PROSTATE | $270.00 | $360.00 | $130.54–$360.00 | 51% below | 25% |
| Prostate biopsy inpatient CPT 55700 BIOPSY OF PROSTATE | $270.00 | $360.00 | $130.54–$360.00 | — | 25% |
| Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 DESTROY LUMB/SAC FACET JNT | $457.50 | $610.00 | $221.19–$610.00 | 88% below | 25% |
| Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 SINGLE FACET JOINT, LUMBAR/SAC | $1,869.00 | $2,492.00 | $447.56–$2,367.40 | 51% below | 25% |
| Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 SINGLE FACET JOINT L/S COOL | $3,644.25 | $4,859.00 | $447.56–$4,616.05 | 5% below | 25% |
| Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 DESTROY LUMB/SAC FACET JNT | $457.50 | $610.00 | $221.19–$610.00 | — | 25% |
| Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 SINGLE FACET JOINT, LUMBAR/SAC | $1,869.00 | $2,492.00 | $447.56–$2,367.40 | — | 25% |
| Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 SINGLE FACET JOINT L/S COOL | $3,644.25 | $4,859.00 | $447.56–$4,616.05 | — | 25% |
| Removal of a breast lump, open surgery CPT 19120 REMOVAL OF BREAST LESION | $612.75 | $817.00 | $296.24–$817.00 | 78% below | 25% |
| Removal of a breast lump, open surgery inpatient CPT 19120 REMOVAL OF BREAST LESION | $612.75 | $817.00 | $296.24–$817.00 | — | 25% |
| Removal of a foreign object under the skin, simple CPT 10120 REMOVAL FB-SIMPLE -10120 | $135.00 | $180.00 | $65.27–$180.00 | 73% below | 25% |
| Removal of a foreign object under the skin, simple CPT 10120 REMOVE FOREIGN BODY | $153.75 | $205.00 | $74.33–$205.00 | 69% below | 25% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 REMOVAL FB-SIMPLE -10120 | $135.00 | $180.00 | $65.27–$180.00 | — | 25% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 REMOVE FOREIGN BODY | $153.75 | $205.00 | $74.33–$205.00 | — | 25% |
| Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 COLORECTAL CA SCREENING COLO | $368.25 | $491.00 | $178.04–$491.00 | — | 25% |
| Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 COLORECTAL CA SCREENING COLO | $368.25 | $491.00 | $178.04–$491.00 | — | 25% |
| Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 COLORECTAL CA SCREENING COLO | $368.25 | $491.00 | $178.04–$491.00 | — | 25% |
| Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 COLORECTAL CA SCREENING COLO | $368.25 | $491.00 | $178.04–$491.00 | — | 25% |
| Septoplasty to straighten the nasal septum CPT 30520 REPAIR OF NASAL SEPTUM | $931.50 | $1,242.00 | $450.35–$1,179.90 | — | 25% |
| Septoplasty to straighten the nasal septum inpatient CPT 30520 REPAIR OF NASAL SEPTUM | $931.50 | $1,242.00 | $450.35–$1,179.90 | — | 25% |
| Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 FRAGMENTING OF KIDNEY STONE | $964.50 | $1,286.00 | $466.30–$1,231.95 | 94% below | 25% |
| Shock-wave lithotripsy to break up kidney stones (from outside the body) inpatient CPT 50590 FRAGMENTING OF KIDNEY STONE | $964.50 | $1,286.00 | $466.30–$1,231.95 | — | 25% |
| Short arm cast (elbow to hand) CPT 29075 APPLICATION OF FOREARM CAST | $103.50 | $138.00 | $50.04–$138.00 | 74% below | 25% |
| Short arm cast (elbow to hand) CPT 29075 SHORT ARM CAST APPLICATION ~T | $409.50 | $546.00 | $92.65–$518.70 | 1% above | 25% |
| Short arm cast (elbow to hand) inpatient CPT 29075 APPLICATION OF FOREARM CAST | $103.50 | $138.00 | $50.04–$138.00 | — | 25% |
| Short arm cast (elbow to hand) inpatient CPT 29075 SHORT ARM CAST APPLICATION ~T | $409.50 | $546.00 | $92.65–$518.70 | — | 25% |
| Short arm splint (forearm and hand) CPT 29125 APPLY FOREARM SPLINT | $69.75 | $93.00 | $33.72–$93.00 | 69% below | 25% |
| Short arm splint (forearm and hand) inpatient CPT 29125 APPLY FOREARM SPLINT | $69.75 | $93.00 | $33.72–$93.00 | — | 25% |
| Short leg cast (below the knee) CPT 29405 APPLY SHORT LEG CAST | $112.50 | $150.00 | $54.39–$149.04 | 69% below | 25% |
| Short leg cast (below the knee) CPT 29405 SHORT LEG CAST APPLICATION ~T | $409.50 | $546.00 | $83.42–$518.70 | 13% above | 25% |
| Short leg cast (below the knee) inpatient CPT 29405 APPLY SHORT LEG CAST | $112.50 | $150.00 | $54.39–$149.04 | — | 25% |
| Short leg cast (below the knee) inpatient CPT 29405 SHORT LEG CAST APPLICATION ~T | $409.50 | $546.00 | $83.42–$518.70 | — | 25% |
| Short leg splint (calf to foot) CPT 29515 APPLICATION LOWER LEG SPLINT | $85.50 | $114.00 | $41.34–$114.00 | 75% below | 25% |
| Short leg splint (calf to foot) inpatient CPT 29515 APPLICATION LOWER LEG SPLINT | $85.50 | $114.00 | $41.34–$114.00 | — | 25% |
| Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 SHOULDER ARTHROSCOPY/SURGERY | $1,116.75 | $1,489.00 | $516.78–$1,414.55 | — | 25% |
| Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) inpatient CPT 29824 SHOULDER ARTHROSCOPY/SURGERY | $1,116.75 | $1,489.00 | $516.78–$1,414.55 | — | 25% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 SHOULDER ARTHROSCOPY/SURGERY | $1,172.25 | $1,563.00 | $116.95–$1,484.85 | — | 25% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 SHOULDER ARTHROSCOPY/SURGERY | $1,172.25 | $1,563.00 | $116.95–$1,484.85 | — | 25% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 REPAIR SUPERFICIAL WOUND(S) | $174.75 | $233.00 | $84.49–$221.35 | 56% below | 25% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 REPAIR SUPERFICIAL WOUND(S) | $174.75 | $233.00 | $84.49–$221.35 | — | 25% |
| Skin biopsy, punch, one lesion CPT 11104 PUNCH BIOPSY ~T | $39.75 | $53.00 | $19.08–$53.00 | 83% below | 25% |
| Skin biopsy, punch, one lesion CPT 11104 PUNCH BIOPSY | $189.75 | $253.00 | $91.74–$240.35 | 17% below | 25% |
| Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BIOPSY ~T | $39.75 | $53.00 | $19.08–$53.00 | — | 25% |
| Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BIOPSY | $189.75 | $253.00 | $91.74–$240.35 | — | 25% |
| Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 EXC TR-EXT MLG+MARG 0.5 < CM | $180.75 | $241.00 | $87.39–$241.00 | 32% below | 25% |
| Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 EXC TR-EXT MLG+MARG 0.5 < CM | $180.75 | $241.00 | $87.39–$241.00 | — | 25% |
| Skin tag removal, up to 15 tags CPT 11200 REMOVAL OF SKIN TAGS | $107.25 | $143.00 | $51.85–$135.85 | 46% below | 25% |
| Skin tag removal, up to 15 tags inpatient CPT 11200 REMOVAL OF SKIN TAGS | $107.25 | $143.00 | $51.85–$135.85 | — | 25% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL FLUID TAP, DIAGNOSTIC | $172.50 | $230.00 | $83.40–$225.87 | 80% below | 25% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL PUNCTURE, LUMBAR -62270 | $172.50 | $230.00 | $83.40–$225.87 | 80% below | 25% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL PUNCTURE LMB 62270~T | $573.00 | $764.00 | $155.88–$742.06 | 32% below | 25% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL PUNCTURE LUMBAR | $714.75 | $953.00 | $155.88–$905.35 | 15% below | 25% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 LUMBAR PUNCTURE DIAGNOSTIC | $749.25 | $999.00 | $155.88–$949.05 | 11% below | 25% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL PUNCTURE, LUMBAR -62270 | $172.50 | $230.00 | $83.40–$225.87 | — | 25% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL FLUID TAP, DIAGNOSTIC | $172.50 | $230.00 | $83.40–$225.87 | — | 25% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL PUNCTURE LMB 62270~T | $573.00 | $764.00 | $155.88–$742.06 | — | 25% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL PUNCTURE LUMBAR | $714.75 | $953.00 | $155.88–$905.35 | — | 25% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 LUMBAR PUNCTURE DIAGNOSTIC | $749.25 | $999.00 | $155.88–$949.05 | — | 25% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 REPAIR SUPERFICIAL WOUND (S)~T | $32.25 | $43.00 | $15.48–$43.00 | 94% below | 25% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 REPAIR SUPERFICIAL WOUND(S) | $195.75 | $261.00 | $94.64–$247.95 | 63% below | 25% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 REPAIR SUPERFICIAL WOUND (S)~T | $32.25 | $43.00 | $15.48–$43.00 | — | 25% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 REPAIR SUPERFICIAL WOUND(S) | $195.75 | $261.00 | $94.64–$247.95 | — | 25% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 REPAIR SUPERFICIAL WOUND(S) | $180.00 | $240.00 | $87.02–$228.00 | 61% below | 25% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 REPAIR SUPERFICIAL WOUND(S) | $180.00 | $240.00 | $87.02–$228.00 | — | 25% |
| TURP (transurethral resection of the prostate) CPT 52601 PROSTATECTOMY (TURP) | $1,240.50 | $1,654.00 | $427.95–$1,571.30 | — | 25% |
| TURP (transurethral resection of the prostate) inpatient CPT 52601 PROSTATECTOMY (TURP) | $1,240.50 | $1,654.00 | $427.95–$1,571.30 | — | 25% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 SKIN BIOPSY ~T | $30.00 | $40.00 | $14.40–$40.00 | 79% below | 25% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 SKIN BIOPSY | $150.75 | $201.00 | $72.88–$190.95 | 6% above | 25% |
| Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 SKIN BIOPSY ~T | $30.00 | $40.00 | $14.40–$40.00 | — | 25% |
| Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 SKIN BIOPSY | $150.75 | $201.00 | $72.88–$190.95 | — | 25% |
| Thoracentesis with imaging guidance CPT 32555 THORACENTESIS W/IMAGIN GUID | $763.50 | $1,018.00 | $260.43–$967.10 | 39% below | 25% |
| Thoracentesis with imaging guidance CPT 32555 THORACENTESIS W/IMAG GUIDAN~T | $1,428.75 | $1,905.00 | $298.93–$1,809.75 | 14% above | 25% |
| Thoracentesis with imaging guidance inpatient CPT 32555 THORACENTESIS W/IMAGIN GUID | $763.50 | $1,018.00 | $260.43–$967.10 | — | 25% |
| Thoracentesis with imaging guidance inpatient CPT 32555 THORACENTESIS W/IMAG GUIDAN~T | $1,428.75 | $1,905.00 | $298.93–$1,809.75 | — | 25% |
| Tonsil and adenoid removal, age 12 or older CPT 42821 REMOVE TONSILS AND ADENOIDS | $540.00 | $720.00 | $222.07–$684.00 | — | 25% |
| Tonsil and adenoid removal, age 12 or older inpatient CPT 42821 REMOVE TONSILS AND ADENOIDS | $540.00 | $720.00 | $222.07–$684.00 | — | 25% |
| Tonsil and adenoid removal, child under 12 CPT 42820 REMOVE TONSILS AND ADENOIDS | $498.75 | $665.00 | $212.73–$631.75 | — | 25% |
| Tonsil and adenoid removal, child under 12 inpatient CPT 42820 REMOVE TONSILS AND ADENOIDS | $498.75 | $665.00 | $212.73–$631.75 | — | 25% |
| Tonsil removal (tonsillectomy) only, age 12 or older CPT 42826 REMOVAL OF TONSILS | $444.00 | $592.00 | $189.38–$562.40 | — | 25% |
| Tonsil removal (tonsillectomy) only, age 12 or older inpatient CPT 42826 REMOVAL OF TONSILS | $444.00 | $592.00 | $189.38–$562.40 | — | 25% |
| Tonsil removal (tonsillectomy) only, child under 12 CPT 42825 REMOVAL OF TONSILS | $456.00 | $608.00 | $199.57–$577.60 | — | 25% |
| Tonsil removal (tonsillectomy) only, child under 12 inpatient CPT 42825 REMOVAL OF TONSILS | $456.00 | $608.00 | $199.57–$577.60 | — | 25% |
| Total hip replacement CPT 27130 TOTAL HIP ARTHROPLASTY | $2,383.50 | $3,178.00 | $927.74–$3,019.10 | — | 25% |
| Total hip replacement inpatient CPT 27130 TOTAL HIP ARTHROPLASTY | $2,383.50 | $3,178.00 | $927.74–$3,019.10 | — | 25% |
| Total knee replacement CPT 27447 TOTAL KNEE ARTHROPLASTY | $2,574.00 | $3,432.00 | $926.32–$3,260.40 | — | 25% |
| Total knee replacement inpatient CPT 27447 TOTAL KNEE ARTHROPLASTY | $2,574.00 | $3,432.00 | $926.32–$3,260.40 | — | 25% |
| Total shoulder replacement CPT 23472 RECONSTRUCT SHOULDER JOINT | $2,531.25 | $3,375.00 | $1,040.68–$3,206.25 | — | 25% |
| Total shoulder replacement inpatient CPT 23472 RECONSTRUCT SHOULDER JOINT | $2,531.25 | $3,375.00 | $1,040.68–$3,206.25 | — | 25% |
| Trigger finger release surgery CPT 26055 INCISE FINGER TENDON SHEATH ~T | $339.75 | $453.00 | $163.08–$453.00 | 63% below | 25% |
| Trigger finger release surgery CPT 26055 INCISE FINGER TENDON SHEATH | $750.00 | $1,000.00 | $362.60–$1,000.00 | 19% below | 25% |
| Trigger finger release surgery inpatient CPT 26055 INCISE FINGER TENDON SHEATH ~T | $339.75 | $453.00 | $163.08–$453.00 | — | 25% |
| Trigger finger release surgery inpatient CPT 26055 INCISE FINGER TENDON SHEATH | $750.00 | $1,000.00 | $362.60–$1,000.00 | — | 25% |
| Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINT, 1/2 MUSCL | $62.25 | $83.00 | $30.10–$83.00 | 89% below | 25% |
| Trigger point injections, 1 or 2 muscles CPT 20552 TPI SINGLE/ MULIT 1 OR 2 MUSCL | $518.25 | $691.00 | $49.33–$656.45 | 10% below | 25% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ TRIGGER POINT, 1/2 MUSCL | $62.25 | $83.00 | $30.10–$83.00 | — | 25% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 TPI SINGLE/ MULIT 1 OR 2 MUSCL | $518.25 | $691.00 | $49.33–$656.45 | — | 25% |
| Tubal ligation, laparoscopic (tubes sealed by cautery) CPT 58670 LAPAROSCOPY, TUBAL CAUTERY | $625.50 | $834.00 | $267.84–$792.30 | — | 25% |
| Tubal ligation, laparoscopic (tubes sealed by cautery) inpatient CPT 58670 LAPAROSCOPY, TUBAL CAUTERY | $625.50 | $834.00 | $267.84–$792.30 | — | 25% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 BIOPSY BREAST 1ST LESION,INC | $807.00 | $1,076.00 | $390.16–$1,022.20 | 69% below | 25% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 BIOPSY BREAST 1ST LESION,INC | $807.00 | $1,076.00 | $390.16–$1,022.20 | — | 25% |
| Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 ESOPH ENDOSCOPY, DILATION | $1,282.50 | $1,710.00 | $620.05–$1,710.00 | 59% below | 25% |
| Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 ESOPH ENDOSCOPY, DILATION | $1,282.50 | $1,710.00 | $620.05–$1,710.00 | — | 25% |
| Upper endoscopy (EGD) with biopsy CPT 43239 UPPER GI ENDOSCOPY, BIOPSY | $472.50 | $630.00 | $228.44–$630.00 | 85% below | 25% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 UPPER GI ENDOSCOPY, BIOPSY | $472.50 | $630.00 | $228.44–$630.00 | — | 25% |
| Upper endoscopy (EGD) with injection into the lining CPT 43236 UPPR GI SCOPE W/SUBMUC INJ | $442.50 | $590.00 | $213.93–$590.00 | 72% below | 25% |
| Upper endoscopy (EGD) with injection into the lining inpatient CPT 43236 UPPR GI SCOPE W/SUBMUC INJ | $442.50 | $590.00 | $213.93–$590.00 | — | 25% |
| Upper endoscopy (EGD) with polyp removal by snare CPT 43251 OPERATIVE UPPER GI ENDOSCOPY | $592.50 | $790.00 | $286.45–$790.00 | 80% below | 25% |
| Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 OPERATIVE UPPER GI ENDOSCOPY | $592.50 | $790.00 | $286.45–$790.00 | — | 25% |
| Upper endoscopy (EGD), diagnostic CPT 43235 UPPR GI ENDOSCOPY, DIAGNOSIS | $367.50 | $490.00 | $177.67–$490.00 | 87% below | 25% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 UPPR GI ENDOSCOPY, DIAGNOSIS | $367.50 | $490.00 | $177.67–$490.00 | — | 25% |
| Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 CYSTOURETERO W/LITHOTRIPSY | $756.00 | $1,008.00 | $278.20–$957.60 | — | 25% |
| Ureteroscopy with laser stone breaking (lithotripsy) inpatient CPT 52353 CYSTOURETERO W/LITHOTRIPSY | $756.00 | $1,008.00 | $278.20–$957.60 | — | 25% |
| Ureteroscopy with laser stone breaking and stent placement CPT 52356 URETHEROSCOPY W/LITHO & INDW | $621.75 | $829.00 | $294.91–$787.55 | — | 25% |
| Ureteroscopy with laser stone breaking and stent placement inpatient CPT 52356 URETHEROSCOPY W/LITHO & INDW | $621.75 | $829.00 | $294.91–$787.55 | — | 25% |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care CPT 59610 VBAC DELIVERY | $3,129.75 | $4,173.00 | $1,513.13–$3,964.35 | — | 25% |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care inpatient CPT 59610 VBAC DELIVERY | $3,129.75 | $4,173.00 | $1,513.13–$3,964.35 | — | 25% |
| Vaginal delivery, including prenatal and postpartum care CPT 59400 OBSTETRICAL CARE | $2,985.75 | $3,981.00 | $1,443.51–$3,781.95 | — | 25% |
| Vaginal delivery, including prenatal and postpartum care inpatient CPT 59400 OBSTETRICAL CARE | $2,985.75 | $3,981.00 | $1,443.51–$3,781.95 | — | 25% |
| Vasectomy, one or both sides, including follow-up semen testing CPT 55250 REMOVAL OF SPERM DUCT(S) | $690.00 | $920.00 | $288.18–$874.00 | 3% below | 25% |
| Vasectomy, one or both sides, including follow-up semen testing inpatient CPT 55250 REMOVAL OF SPERM DUCT(S) | $690.00 | $920.00 | $288.18–$874.00 | — | 25% |
| Vein ablation, radiofrequency, first vein CPT 36475 ENDOVENOUS RF, 1ST VEIN | $2,507.25 | $3,343.00 | $879.64–$3,175.85 | — | 25% |
| Vein ablation, radiofrequency, first vein inpatient CPT 36475 ENDOVENOUS RF, 1ST VEIN | $2,507.25 | $3,343.00 | $879.64–$3,175.85 | — | 25% |
| Wart removal, up to 14 warts CPT 17110 DESTRUCT LESION, 1-14 ~T | $26.25 | $35.00 | $12.60–$35.00 | 84% below | 25% |
| Wart removal, up to 14 warts CPT 17110 DESTRUCT LESION, 1-14 | $120.00 | $160.00 | $58.02–$155.08 | 25% below | 25% |
| Wart removal, up to 14 warts inpatient CPT 17110 DESTRUCT LESION, 1-14 ~T | $26.25 | $35.00 | $12.60–$35.00 | — | 25% |
| Wart removal, up to 14 warts inpatient CPT 17110 DESTRUCT LESION, 1-14 | $120.00 | $160.00 | $58.02–$155.08 | — | 25% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDE SKIN/TISSUE | $112.50 | $150.00 | $54.39–$150.00 | 70% below | 25% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDE SKIN/TISSUE | $112.50 | $150.00 | $54.39–$150.00 | — | 25% |
| Wrist fracture surgery (plate and screws), distal radius CPT 25607 OPTX DSTL RADL EX ARTIC FX | $1,058.25 | $1,411.00 | $511.63–$1,343.94 | — | 25% |
| Wrist fracture surgery (plate and screws), distal radius inpatient CPT 25607 OPTX DSTL RADL EX ARTIC FX | $1,058.25 | $1,411.00 | $511.63–$1,343.94 | — | 25% |
Doctor visits and therapy
| Procedure | Cash price | List price | Insurers pay | vs Vermont | Off list |
|---|---|---|---|---|---|
| Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION, BLOOD COMPONENTS | $2,850.00 | $3,800.00 | $45.54–$3,610.00 | 325% above | 25% |
| Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION,BLOOD COMPONENTS | $2,968.50 | $3,958.00 | $45.54–$3,760.10 | 343% above | 25% |
| Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSFUSION | $3,151.50 | $4,202.00 | $45.54–$3,991.90 | 370% above | 25% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSION, BLOOD COMPONENTS | $2,850.00 | $3,800.00 | $45.54–$3,610.00 | — | 25% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSION,BLOOD COMPONENTS | $2,968.50 | $3,958.00 | $45.54–$3,760.10 | — | 25% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD TRANSFUSION | $3,151.50 | $4,202.00 | $45.54–$3,991.90 | — | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AIRWAY INHALATION TREATMENT ~T | $27.00 | $36.00 | $8.27–$36.00 | 86% below | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AIRWAY INHALATION TREATMENT | $36.75 | $49.00 | $8.27–$49.00 | 81% below | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AEROSOL INHALATION | $159.75 | $213.00 | $8.27–$213.00 | 18% below | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 MDI SUB | $167.25 | $223.00 | $8.27–$223.00 | 14% below | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 MDI | $167.25 | $223.00 | $8.27–$223.00 | 14% below | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 UPDRAFT | $181.50 | $242.00 | $8.27–$230.20 | 7% below | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT AEROSAL THERAPY | $322.50 | $430.00 | $8.27–$408.50 | 66% above | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AIRWAY INHALATION TREATMENT ~T | $27.00 | $36.00 | $8.27–$36.00 | — | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AIRWAY INHALATION TREATMENT | $36.75 | $49.00 | $8.27–$49.00 | — | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AEROSOL INHALATION | $159.75 | $213.00 | $8.27–$213.00 | — | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 MDI | $167.25 | $223.00 | $8.27–$223.00 | — | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 MDI SUB | $167.25 | $223.00 | $8.27–$223.00 | — | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 UPDRAFT | $181.50 | $242.00 | $8.27–$230.20 | — | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RT AEROSAL THERAPY | $322.50 | $430.00 | $8.27–$408.50 | — | 25% |
| Chemotherapy IV infusion, first hour CPT 96413 CHEMO INF UP TO ONE HOUR - IT | $1,608.75 | $2,145.00 | $128.28–$2,037.75 | 129% above | 25% |
| Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO INF UP TO ONE HOUR - IT | $1,608.75 | $2,145.00 | $128.28–$2,037.75 | — | 25% |
| Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 COMPREHENSIVE HEARING TEST | $140.25 | $187.00 | $30.12–$177.65 | 30% above | 25% |
| Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 COMPREHENSIVE HEARING TEST | $140.25 | $187.00 | $30.12–$177.65 | — | 25% |
| Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE, FIRST HOUR | $366.75 | $489.00 | $177.31–$464.55 | 79% below | 25% |
| Critical care, first 30 to 74 minutes CPT 99291 CRTCAL CARE- 1ST 30-74 - 99291 | $366.75 | $489.00 | $177.31–$464.55 | 79% below | 25% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 CRITICAL CARE, FIRST HOUR | $366.75 | $489.00 | $177.31–$464.55 | — | 25% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 CRTCAL CARE- 1ST 30-74 - 99291 | $366.75 | $489.00 | $177.31–$464.55 | — | 25% |
| EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG, AWAKE AND DROWSY | $322.50 | $430.00 | $155.92–$430.00 | 41% below | 25% |
| EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG AWAKE AND DROWSY | $1,026.75 | $1,369.00 | $226.99–$1,300.55 | 89% above | 25% |
| EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 EEG, AWAKE AND DROWSY | $322.50 | $430.00 | $155.92–$430.00 | — | 25% |
| EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 EEG AWAKE AND DROWSY | $1,026.75 | $1,369.00 | $226.99–$1,300.55 | — | 25% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 9300536A | $32.25 | $43.00 | $6.64–$43.00 | 80% below | 25% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG | $32.25 | $43.00 | $5.81–$40.85 | 80% below | 25% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ELECTROCARDIOGRAM, TRACING | $32.25 | $43.00 | $5.81–$40.85 | 80% below | 25% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG 93005~T | $303.75 | $405.00 | $6.64–$384.75 | 84% above | 25% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG (RT) | $303.75 | $405.00 | $6.64–$384.75 | 84% above | 25% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG ICU | $322.50 | $430.00 | $6.64–$408.50 | 96% above | 25% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ELECTROCARDIOGRAM, TRACING | $32.25 | $43.00 | $5.81–$40.85 | — | 25% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG | $32.25 | $43.00 | $5.81–$40.85 | — | 25% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 9300536A | $32.25 | $43.00 | $6.64–$43.00 | — | 25% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG 93005~T | $303.75 | $405.00 | $6.64–$384.75 | — | 25% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG (RT) | $303.75 | $405.00 | $6.64–$384.75 | — | 25% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG ICU | $322.50 | $430.00 | $6.64–$408.50 | — | 25% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 LEVEL I 99281~TC,Technical Component | $284.25 | $379.00 | $10.30–$360.05 | 6% above | 25% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 LEVEL I 99281~TC,Technical Component | $284.25 | $379.00 | $10.30–$360.05 | — | 25% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 LEVEL II 99282~TC,Technical Component | $419.25 | $559.00 | $37.77–$531.05 | at median | 25% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 LEVEL II 9928225 99282~25,Technical Component | $419.25 | $559.00 | $37.77–$531.05 | at median | 25% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 LEVEL II 99282~TC,Technical Component | $419.25 | $559.00 | $37.77–$531.05 | — | 25% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 LEVEL II 9928225 99282~25,Technical Component | $419.25 | $559.00 | $37.77–$531.05 | — | 25% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 EMERGENCY DEPARTMENT E&M | $339.75 | $453.00 | $56.03–$430.35 | 54% below | 25% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 EMERGENCY DEPARTMENT E&M | $339.75 | $453.00 | $56.03–$430.35 | — | 25% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 LEVEL IV 99284~TC,Technical Component | $944.25 | $1,259.00 | $110.06–$1,196.05 | 2% below | 25% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 LEVEL IV 99284~TC,Technical Component | $944.25 | $1,259.00 | $110.06–$1,196.05 | — | 25% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 EMERGENCY DEPT VISIT | $515.25 | $687.00 | $138.38–$652.65 | 62% below | 25% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 EMERGENCY DEPT VISIT | $515.25 | $687.00 | $138.38–$652.65 | — | 25% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 CARDIOVASCULAR STRESS TEST | $1,139.25 | $1,519.00 | $37.59–$1,443.05 | 37% above | 25% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 C LAB STRESS TESTING | $1,522.50 | $2,030.00 | $37.59–$1,928.50 | 84% above | 25% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CARDIOVASCULAR STRESS TEST | $1,139.25 | $1,519.00 | $37.59–$1,443.05 | — | 25% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 C LAB STRESS TESTING | $1,522.50 | $2,030.00 | $37.59–$1,928.50 | — | 25% |
| Family therapy with the patient, 50 minutes CPT 90847 FAMILY PSYTX W/PATIENT | $204.75 | $273.00 | $62.00–$259.35 | at median | 25% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 FAMILY PSYTX W/PATIENT | $204.75 | $273.00 | $62.00–$259.35 | — | 25% |
| Family therapy without the patient, 50 minutes CPT 90846 FAMILY PSYTX W/O PATIENT | $172.50 | $230.00 | $62.00–$218.50 | 3% below | 25% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 FAMILY PSYTX W/O PATIENT | $172.50 | $230.00 | $62.00–$218.50 | — | 25% |
| Group psychotherapy session CPT 90853 GROUP PSYCHOTHERAPY | $61.50 | $82.00 | $25.59–$77.90 | 10% below | 25% |
| Group psychotherapy session inpatient CPT 90853 GROUP PSYCHOTHERAPY | $61.50 | $82.00 | $25.59–$77.90 | — | 25% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRATION IV INFUSION INIT | $86.25 | $115.00 | $28.17–$109.25 | 62% below | 25% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRATION IV UP TO ONE HOUR | $293.25 | $391.00 | $32.30–$371.45 | 29% above | 25% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HYDRATION IV INFUSION INIT | $86.25 | $115.00 | $28.17–$109.25 | — | 25% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HYDRATION IV UP TO ONE HOUR | $293.25 | $391.00 | $32.30–$371.45 | — | 25% |
| IV infusion of a medicine, first hour CPT 96365 THER/PROPH/DIAG IV INF INIT | $109.50 | $146.00 | $52.94–$138.70 | 65% below | 25% |
| IV infusion of a medicine, first hour CPT 96365 INFUSION THERAPY UP TO ONE HR | $1,083.00 | $1,444.00 | $64.57–$1,371.80 | 246% above | 25% |
| IV infusion of a medicine, first hour inpatient CPT 96365 THER/PROPH/DIAG IV INF INIT | $109.50 | $146.00 | $52.94–$138.70 | — | 25% |
| IV infusion of a medicine, first hour inpatient CPT 96365 INFUSION THERAPY UP TO ONE HR | $1,083.00 | $1,444.00 | $64.57–$1,371.80 | — | 25% |
| IV push of a medicine, first drug CPT 96374 THERAPEUTIC INJECTION,IV PUSH | $258.00 | $344.00 | $36.36–$326.80 | 8% above | 25% |
| IV push of a medicine, first drug CPT 96374 THERAEUPTIC INJECTION,IV PUSH | $262.50 | $350.00 | $36.36–$332.50 | 10% above | 25% |
| IV push of a medicine, first drug CPT 96374 THERAPEUTIC INJECTION, IV PUSH | $273.00 | $364.00 | $36.36–$345.80 | 15% above | 25% |
| IV push of a medicine, first drug inpatient CPT 96374 THERAPEUTIC INJECTION,IV PUSH | $258.00 | $344.00 | $36.36–$326.80 | — | 25% |
| IV push of a medicine, first drug inpatient CPT 96374 THERAEUPTIC INJECTION,IV PUSH | $262.50 | $350.00 | $36.36–$332.50 | — | 25% |
| IV push of a medicine, first drug inpatient CPT 96374 THERAPEUTIC INJECTION, IV PUSH | $273.00 | $364.00 | $36.36–$345.80 | — | 25% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION-MEDICATION | $31.50 | $42.00 | $14.81–$42.00 | 45% below | 25% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DIAG INJ SC/IM | $31.50 | $42.00 | $12.88–$39.90 | 45% below | 25% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DIAG INJ SC/IM ~T | $31.50 | $42.00 | $14.81–$42.00 | 45% below | 25% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 IM ADMIN OF DRUG | $148.50 | $198.00 | $12.88–$188.10 | 161% above | 25% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 THERAPEUTIC INJECTION SC/IM | $162.75 | $217.00 | $14.81–$206.15 | 186% above | 25% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 THERAPEUTIC INJECTION SC/IM-TC | $606.75 | $809.00 | $14.81–$768.55 | 967% above | 25% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJECTION-MEDICATION | $31.50 | $42.00 | $14.81–$42.00 | — | 25% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THER/PROPH/DIAG INJ SC/IM | $31.50 | $42.00 | $12.88–$39.90 | — | 25% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THER/PROPH/DIAG INJ SC/IM ~T | $31.50 | $42.00 | $14.81–$42.00 | — | 25% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 IM ADMIN OF DRUG | $148.50 | $198.00 | $12.88–$188.10 | — | 25% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THERAPEUTIC INJECTION SC/IM | $162.75 | $217.00 | $14.81–$206.15 | — | 25% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THERAPEUTIC INJECTION SC/IM-TC | $606.75 | $809.00 | $14.81–$768.55 | — | 25% |
| Mental health diagnostic evaluation (intake), without medical services CPT 90791 PSYC EVAL | $150.00 | $200.00 | $62.00–$193.96 | 25% below | 25% |
| Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 PSYC EVAL | $150.00 | $200.00 | $62.00–$193.96 | — | 25% |
| Nerve conduction study, 7 or 8 nerve studies CPT 95910 NERVE CONDUCTION STUDY 7-8 ~T | $88.50 | $118.00 | $42.48–$118.00 | 73% below | 25% |
| Nerve conduction study, 7 or 8 nerve studies CPT 95910 NERVE CONDUCTION STUDIES 7-8 | $343.50 | $458.00 | $155.36–$435.10 | 3% above | 25% |
| Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 NERVE CONDUCTION STUDY 7-8 ~T | $88.50 | $118.00 | $42.48–$118.00 | — | 25% |
| Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 NERVE CONDUCTION STUDIES 7-8 | $343.50 | $458.00 | $155.36–$435.10 | — | 25% |
| New patient office visit, about 30 minutes CPT 99203 OFFICE/OUTPATIENT VISIT NEW ~T | $52.50 | $70.00 | $25.20–$70.00 | 73% below | 25% |
| New patient office visit, about 30 minutes CPT 99203 OFFICE/OUTPATIENT VISIT, NEW~T | $52.50 | $70.00 | $25.20–$70.00 | 73% below | 25% |
| New patient office visit, about 30 minutes CPT 99203 OFFICE/OUTPATIENT VISIT,NEW ~T | $52.50 | $70.00 | $25.20–$70.00 | 73% below | 25% |
| New patient office visit, about 30 minutes CPT 99203 OFFICE/OUTPATIENT VISIT, NEW | $127.50 | $170.00 | $61.64–$162.36 | 35% below | 25% |
| New patient office visit, about 30 minutes CPT 99203 NEW PT LEVEL 3 CCC | $145.50 | $194.00 | $70.34–$184.30 | 26% below | 25% |
| New patient office visit, about 30 minutes CPT 99203 NEW PATIENT | $198.00 | $264.00 | $95.73–$250.80 | 1% above | 25% |
| New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE/OUTPATIENT VISIT, NEW~T | $52.50 | $70.00 | $25.20–$70.00 | — | 25% |
| New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE/OUTPATIENT VISIT NEW ~T | $52.50 | $70.00 | $25.20–$70.00 | — | 25% |
| New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE/OUTPATIENT VISIT,NEW ~T | $52.50 | $70.00 | $25.20–$70.00 | — | 25% |
| New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE/OUTPATIENT VISIT, NEW | $127.50 | $170.00 | $61.64–$162.36 | — | 25% |
| New patient office visit, about 30 minutes inpatient CPT 99203 NEW PT LEVEL 3 CCC | $145.50 | $194.00 | $70.34–$184.30 | — | 25% |
| New patient office visit, about 30 minutes inpatient CPT 99203 NEW PATIENT | $198.00 | $264.00 | $95.73–$250.80 | — | 25% |
| New patient office visit, about 45 minutes CPT 99204 OFFICE/OUTPATIENT VISIT,NEW ~T | $52.50 | $70.00 | $25.20–$70.00 | 79% below | 25% |
| New patient office visit, about 45 minutes CPT 99204 OFFICE/OUTPATIENT VISIT NEW ~T | $52.50 | $70.00 | $25.20–$70.00 | 79% below | 25% |
| New patient office visit, about 45 minutes CPT 99204 OFFICE/OUTPATIENT VISIT, NEW~T | $52.50 | $70.00 | $25.20–$70.00 | 79% below | 25% |
| New patient office visit, about 45 minutes CPT 99204 OFFICE/OUTPATIENT VISIT, NEW | $180.00 | $240.00 | $87.02–$240.00 | 28% below | 25% |
| New patient office visit, about 45 minutes CPT 99204 NEW PT LEVEL 4 CCC | $207.00 | $276.00 | $100.08–$262.20 | 18% below | 25% |
| New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE/OUTPATIENT VISIT NEW ~T | $52.50 | $70.00 | $25.20–$70.00 | — | 25% |
| New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE/OUTPATIENT VISIT,NEW ~T | $52.50 | $70.00 | $25.20–$70.00 | — | 25% |
| New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE/OUTPATIENT VISIT, NEW~T | $52.50 | $70.00 | $25.20–$70.00 | — | 25% |
| New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE/OUTPATIENT VISIT, NEW | $180.00 | $240.00 | $87.02–$240.00 | — | 25% |
| New patient office visit, about 45 minutes inpatient CPT 99204 NEW PT LEVEL 4 CCC | $207.00 | $276.00 | $100.08–$262.20 | — | 25% |
| New patient office visit, about 60 minutes CPT 99205 OFFICE/OUTPATIENT VISIT,NEW ~T | $90.00 | $120.00 | $43.20–$120.00 | 71% below | 25% |
| New patient office visit, about 60 minutes CPT 99205 OFFICE/OUTPATIENT VISIT NEW ~T | $90.00 | $120.00 | $43.20–$120.00 | 71% below | 25% |
| New patient office visit, about 60 minutes CPT 99205 OFFICE/OUTPATIENT VISIT, NEW~T | $90.00 | $120.00 | $43.20–$120.00 | 71% below | 25% |
| New patient office visit, about 60 minutes CPT 99205 OFFICE/OUTPATIENT VISIT NEW~T | $90.00 | $120.00 | $43.20–$120.00 | 71% below | 25% |
| New patient office visit, about 60 minutes CPT 99205 OFFICE/OUTPATIENT VISIT, NEW | $232.50 | $310.00 | $112.41–$310.00 | 25% below | 25% |
| New patient office visit, about 60 minutes inpatient CPT 99205 OFFICE/OUTPATIENT VISIT, NEW~T | $90.00 | $120.00 | $43.20–$120.00 | — | 25% |
| New patient office visit, about 60 minutes inpatient CPT 99205 OFFICE/OUTPATIENT VISIT NEW~T | $90.00 | $120.00 | $43.20–$120.00 | — | 25% |
| New patient office visit, about 60 minutes inpatient CPT 99205 OFFICE/OUTPATIENT VISIT NEW ~T | $90.00 | $120.00 | $43.20–$120.00 | — | 25% |
| New patient office visit, about 60 minutes inpatient CPT 99205 OFFICE/OUTPATIENT VISIT,NEW ~T | $90.00 | $120.00 | $43.20–$120.00 | — | 25% |
| New patient office visit, about 60 minutes inpatient CPT 99205 OFFICE/OUTPATIENT VISIT, NEW | $232.50 | $310.00 | $112.41–$310.00 | — | 25% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 OFFICE/OUTPATIENT VISIT,NEW ~T | $14.25 | $19.00 | $6.84–$19.00 | 91% below | 25% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 OFFICE/OUTPATIENT VISIT, NEW | $84.75 | $113.00 | $40.97–$107.35 | 44% below | 25% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW PT LEVEL 2 CCC | $99.75 | $133.00 | $48.23–$126.35 | 34% below | 25% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW PATIENT | $132.75 | $177.00 | $62.68–$168.15 | 12% below | 25% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 OFFICE/OUTPATIENT VISIT,NEW ~T | $14.25 | $19.00 | $6.84–$19.00 | — | 25% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 OFFICE/OUTPATIENT VISIT, NEW | $84.75 | $113.00 | $40.97–$107.35 | — | 25% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 NEW PT LEVEL 2 CCC | $99.75 | $133.00 | $48.23–$126.35 | — | 25% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 NEW PATIENT | $132.75 | $177.00 | $62.68–$168.15 | — | 25% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 NUTRN ASSMT-INITIAL EA-15 MIN | $75.00 | $100.00 | $30.98–$95.00 | 34% above | 25% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 NUTRN ASSMT-INITIAL EA-15 MIN | $75.00 | $100.00 | $30.98–$95.00 | — | 25% |
| Preventive checkup, new patient aged 18–39 CPT 99385 PREVENTIVE VIST NEW AGE 18-39 | $142.50 | $190.00 | $68.89–$180.50 | 13% below | 25% |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 PREVENTIVE VIST NEW AGE 18-39 | $142.50 | $190.00 | $68.89–$180.50 | — | 25% |
| Preventive checkup, new patient aged 40–64 CPT 99386 PREVENTIVE VISIT NEW AGE 40-64 | $172.50 | $230.00 | $83.40–$218.50 | 15% below | 25% |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 PREVENTIVE VISIT NEW AGE 40-64 | $172.50 | $230.00 | $83.40–$218.50 | — | 25% |
| Preventive checkup, new patient aged 65 or older CPT 99387 PREVENTATIVE NEW PT AGE 65+ | $187.50 | $250.00 | $90.65–$237.50 | 13% above | 25% |
| Preventive checkup, new patient aged 65 or older inpatient CPT 99387 PREVENTATIVE NEW PT AGE 65+ | $187.50 | $250.00 | $90.65–$237.50 | — | 25% |
| Preventive checkup, returning patient aged 18–39 CPT 99395 PREVENTATIVE EST AGE 18-39 | $120.00 | $160.00 | $58.02–$152.00 | 6% above | 25% |
| Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 PREVENTATIVE EST AGE 18-39 | $120.00 | $160.00 | $58.02–$152.00 | — | 25% |
| Preventive checkup, returning patient aged 40–64 CPT 99396 PREVENTATIVE EST AGE 40-64 | $127.50 | $170.00 | $61.64–$161.50 | 2% below | 25% |
| Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 PREVENTATIVE EST AGE 40-64 | $127.50 | $170.00 | $61.64–$161.50 | — | 25% |
| Preventive checkup, returning patient aged 65 or older CPT 99397 PREVENTATIVE EST AGE 65+ | $142.50 | $190.00 | $68.89–$180.50 | 4% above | 25% |
| Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 PREVENTATIVE EST AGE 65+ | $142.50 | $190.00 | $68.89–$180.50 | — | 25% |
| Psychiatric evaluation with medical services CPT 90792 PSYC EVAL W MEDICAL SERVICE | $165.00 | $220.00 | $62.00–$217.49 | 31% below | 25% |
| Psychiatric evaluation with medical services inpatient CPT 90792 PSYC EVAL W MEDICAL SERVICE | $165.00 | $220.00 | $62.00–$217.49 | — | 25% |
| Psychotherapy for crisis, first 60 minutes CPT 90839 CRISIS PSYCHOTHERAPY 60 MIN | $206.25 | $275.00 | $62.00–$261.25 | — | 25% |
| Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 CRISIS PSYCHOTHERAPY 60 MIN | $206.25 | $275.00 | $62.00–$261.25 | — | 25% |
| Psychotherapy session, 30 minutes CPT 90832 PSYC 30 MIN WITH PATIENT | $60.00 | $80.00 | $28.50–$80.00 | 47% below | 25% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 PSYC 30 MIN WITH PATIENT | $60.00 | $80.00 | $28.50–$80.00 | — | 25% |
| Psychotherapy session, 45 minutes CPT 90834 PSYC 45 MIN WITH PATIENT | $82.50 | $110.00 | $39.89–$110.00 | 41% below | 25% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 PSYC 45 MIN WITH PATIENT | $82.50 | $110.00 | $39.89–$110.00 | — | 25% |
| Psychotherapy session, 60 minutes CPT 90837 PSYC 60 MIN WITH PATIENT | $117.75 | $157.00 | $56.93–$157.00 | 48% below | 25% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 PSYC 60 MIN WITH PATIENT | $117.75 | $157.00 | $56.93–$157.00 | — | 25% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 BEHAV CHNG SMOKING 3-10 MIN~T | $3.75 | $5.00 | $1.80–$5.00 | 87% below | 25% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 BEHAV CHNG SMOKING 3-10 MIN | $17.25 | $23.00 | $8.34–$21.85 | 39% below | 25% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 SMOKING CESSATION COUN 3-10MIN | $24.00 | $32.00 | $11.60–$30.40 | 16% below | 25% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 SMOKING CESSATION 3-10 MINUTES | $36.00 | $48.00 | $14.67–$45.60 | 26% above | 25% |
| Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 BEHAV CHNG SMOKING 3-10 MIN~T | $3.75 | $5.00 | $1.80–$5.00 | — | 25% |
| Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 BEHAV CHNG SMOKING 3-10 MIN | $17.25 | $23.00 | $8.34–$21.85 | — | 25% |
| Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 SMOKING CESSATION COUN 3-10MIN | $24.00 | $32.00 | $11.60–$30.40 | — | 25% |
| Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 SMOKING CESSATION 3-10 MINUTES | $36.00 | $48.00 | $14.67–$45.60 | — | 25% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE/OUTPATIENT VISIT EST ~T | $52.50 | $70.00 | $25.20–$70.00 | 82% below | 25% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE/OUTPT VISIT, EST ~T | $52.50 | $70.00 | $25.20–$70.00 | 82% below | 25% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE/OUTPATIENT VISIT, EST~T | $52.50 | $70.00 | $25.20–$70.00 | 82% below | 25% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE/OUTPATIENT VISIT, EST | $172.50 | $230.00 | $83.40–$230.00 | 40% below | 25% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 ESTABLISHED PATIENT | $228.00 | $304.00 | $110.23–$288.80 | 20% below | 25% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 EST PT LEVEL 5 CCC | $228.00 | $304.00 | $110.23–$288.80 | 20% below | 25% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OFFICE/OUTPATIENT VISIT, EST~T | $52.50 | $70.00 | $25.20–$70.00 | — | 25% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OFFICE/OUTPT VISIT, EST ~T | $52.50 | $70.00 | $25.20–$70.00 | — | 25% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OFFICE/OUTPATIENT VISIT EST ~T | $52.50 | $70.00 | $25.20–$70.00 | — | 25% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OFFICE/OUTPATIENT VISIT, EST | $172.50 | $230.00 | $83.40–$230.00 | — | 25% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 ESTABLISHED PATIENT | $228.00 | $304.00 | $110.23–$288.80 | — | 25% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 EST PT LEVEL 5 CCC | $228.00 | $304.00 | $110.23–$288.80 | — | 25% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE/OUTPATIENT VISIT EST ~T | $27.75 | $37.00 | $13.32–$37.00 | 83% below | 25% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE/OUTPATIENT VISIT,EST ~T | $27.75 | $37.00 | $13.32–$37.00 | 83% below | 25% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE/OUTPATIENT VISIT, EST~T | $27.75 | $37.00 | $13.32–$37.00 | 83% below | 25% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE/OUTPATIENT VISIT, EST | $82.50 | $110.00 | $39.89–$110.00 | 49% below | 25% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 EST PT LEVEL 3 CCC | $93.75 | $125.00 | $45.32–$125.00 | 42% below | 25% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 ESTABLISHED PATIENT | $114.75 | $153.00 | $55.48–$145.35 | 29% below | 25% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OFFICE/OUTPATIENT VISIT, EST~T | $27.75 | $37.00 | $13.32–$37.00 | — | 25% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OFFICE/OUTPATIENT VISIT EST ~T | $27.75 | $37.00 | $13.32–$37.00 | — | 25% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OFFICE/OUTPATIENT VISIT,EST ~T | $27.75 | $37.00 | $13.32–$37.00 | — | 25% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OFFICE/OUTPATIENT VISIT, EST | $82.50 | $110.00 | $39.89–$110.00 | — | 25% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 EST PT LEVEL 3 CCC | $93.75 | $125.00 | $45.32–$125.00 | — | 25% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 ESTABLISHED PATIENT | $114.75 | $153.00 | $55.48–$145.35 | — | 25% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE/OUTPATIENT VISIT EST ~T | $45.00 | $60.00 | $21.60–$60.00 | 79% below | 25% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE/OUTPATIENT VISIT, EST~T | $45.00 | $60.00 | $21.60–$60.00 | 79% below | 25% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE/OUTPATIENT VISIT, EST | $127.50 | $170.00 | $61.64–$170.00 | 40% below | 25% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OFFICE/OUTPATIENT VISIT EST ~T | $45.00 | $60.00 | $21.60–$60.00 | — | 25% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OFFICE/OUTPATIENT VISIT, EST~T | $45.00 | $60.00 | $21.60–$60.00 | — | 25% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OFFICE/OUTPATIENT VISIT, EST | $127.50 | $170.00 | $61.64–$170.00 | — | 25% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE/OUTPATIENT VISIT, EST | $45.00 | $60.00 | $21.76–$60.00 | 59% below | 25% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 ESTABLISHED PATIENT | $72.00 | $96.00 | $34.81–$91.20 | 35% below | 25% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 EST PT LEVEL 2 CCC | $93.75 | $125.00 | $45.32–$118.75 | 15% below | 25% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OFFICE/OUTPATIENT VISIT, EST | $45.00 | $60.00 | $21.76–$60.00 | — | 25% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 ESTABLISHED PATIENT | $72.00 | $96.00 | $34.81–$91.20 | — | 25% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 EST PT LEVEL 2 CCC | $93.75 | $125.00 | $45.32–$118.75 | — | 25% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 OFFICE CONSULTATION | $142.50 | $190.00 | $68.89–$180.50 | at median | 25% |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 OFFICE CONSULTATION | $142.50 | $190.00 | $68.89–$180.50 | — | 25% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 OFFICE CONSULTATION | $202.50 | $270.00 | $97.90–$270.00 | 5% below | 25% |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 OFFICE CONSULTATION | $202.50 | $270.00 | $97.90–$270.00 | — | 25% |
| Spirometry (breathing test) CPT 94010 PFT | $142.50 | $190.00 | $28.58–$190.00 | 54% below | 25% |
| Spirometry (breathing test) CPT 94010 SPIROMETRY | $330.75 | $441.00 | $28.58–$418.95 | 6% above | 25% |
| Spirometry (breathing test) inpatient CPT 94010 PFT | $142.50 | $190.00 | $28.58–$190.00 | — | 25% |
| Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY | $330.75 | $441.00 | $28.58–$418.95 | — | 25% |
| Spirometry before and after a bronchodilator CPT 94060 PEAK EXPIRATORY FLOW RATE -TC | $531.00 | $708.00 | $41.88–$672.60 | 19% below | 25% |
| Spirometry before and after a bronchodilator CPT 94060 SPIROMETRY W/BD | $636.75 | $849.00 | $41.88–$806.55 | 3% below | 25% |
| Spirometry before and after a bronchodilator CPT 94060 BRONCHODILATION RESPONSIVENESS | $636.75 | $849.00 | $41.88–$806.55 | 3% below | 25% |
| Spirometry before and after a bronchodilator inpatient CPT 94060 PEAK EXPIRATORY FLOW RATE -TC | $531.00 | $708.00 | $41.88–$672.60 | — | 25% |
| Spirometry before and after a bronchodilator inpatient CPT 94060 SPIROMETRY W/BD | $636.75 | $849.00 | $41.88–$806.55 | — | 25% |
| Spirometry before and after a bronchodilator inpatient CPT 94060 BRONCHODILATION RESPONSIVENESS | $636.75 | $849.00 | $41.88–$806.55 | — | 25% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY | $140.25 | $187.00 | $67.81–$177.65 | 37% below | 25% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY,THERAPEUTIC | $168.75 | $225.00 | $81.00–$213.75 | 24% below | 25% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY,THERAPEUTIC 99915 | $272.25 | $363.00 | $94.48–$344.85 | 23% above | 25% |
| Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY | $140.25 | $187.00 | $67.81–$177.65 | — | 25% |
| Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY,THERAPEUTIC | $168.75 | $225.00 | $81.00–$213.75 | — | 25% |
| Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY,THERAPEUTIC 99915 | $272.25 | $363.00 | $94.48–$344.85 | — | 25% |
| Treadmill or drug stress test with ECG, supervision and report CPT 93015 EXERCISE STRESS TEST | $144.00 | $192.00 | $61.70–$182.40 | — | 25% |
| Treadmill or drug stress test with ECG, supervision and report inpatient CPT 93015 EXERCISE STRESS TEST | $144.00 | $192.00 | $61.70–$182.40 | — | 25% |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs Vermont | Off list |
|---|---|---|---|---|---|
| Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 FLU VACCINE 0.5ML | $53.25 | $71.00 | $25.74–$71.00 | 56% below | 25% |
| Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 FLU VACC TS 2025-26 .5ML>65 | $75.00 | $100.00 | $36.00–$96.20 | 38% below | 25% |
| Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 FLU VACCINE 0.5ML | $53.25 | $71.00 | $25.74–$71.00 | — | 25% |
| Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 FLU VACC TS 2025-26 .5ML>65 | $75.00 | $100.00 | $36.00–$96.20 | — | 25% |
| COVID-19 vaccine (Moderna), age 12 and older CPT 91322 MODERNA 50MCG/0.25ML | $120.00 | $160.00 | $58.02–$160.00 | 46% below | 25% |
| COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 MODERNA 50MCG/0.25ML | $120.00 | $160.00 | $58.02–$160.00 | — | 25% |
| COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 PFIZER VACCINE 30MCG/0.3ML | $105.00 | $140.00 | $50.76–$140.00 | 8% below | 25% |
| COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 PFIZER VACCINE 30MCG/0.3ML | $105.00 | $140.00 | $50.76–$140.00 | — | 25% |
| Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VACCINE, VARIVAX | $101.25 | $135.00 | $48.95–$135.00 | 67% below | 25% |
| Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 Varicella Vaccine- Chicken Pox | $495.75 | $661.00 | $237.96–$627.95 | 63% above | 25% |
| Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA VACCINE, VARIVAX | $101.25 | $135.00 | $48.95–$135.00 | — | 25% |
| Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 Varicella Vaccine- Chicken Pox | $495.75 | $661.00 | $237.96–$627.95 | — | 25% |
| DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 Pediarix | $75.00 | $100.00 | $36.26–$100.00 | at median | 25% |
| DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 Pediarix | $75.00 | $100.00 | $36.26–$100.00 | — | 25% |
| Flu shot, recombinant, egg-free (Flublok) CPT 90673 FLU VACCINE | $53.25 | $71.00 | $25.74–$71.00 | — | 25% |
| Flu shot, recombinant, egg-free (Flublok) inpatient CPT 90673 FLU VACCINE | $53.25 | $71.00 | $25.74–$71.00 | — | 25% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLU VACC 6MOS UP, FLUARIX | $15.00 | $20.00 | $7.25–$20.00 | 59% below | 25% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLU VACC TS 2025-26 .5ML SYR | $30.00 | $40.00 | $14.40–$38.00 | 19% below | 25% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLU VACC 6MOS UP, FLUARIX | $15.00 | $20.00 | $7.25–$20.00 | — | 25% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLU VACC TS 2025-26 .5ML SYR | $30.00 | $40.00 | $14.40–$38.00 | — | 25% |
| HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HPV9 | $296.25 | $395.00 | $143.23–$375.25 | 52% below | 25% |
| HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HPV9 | $296.25 | $395.00 | $143.23–$375.25 | — | 25% |
| Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 HEP A&B TWINRIX | $117.00 | $156.00 | $56.57–$148.20 | 35% below | 25% |
| Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 Hepatitis B/Hepatitis A Vaccin | $334.14 | $445.52 | $160.39–$423.24 | 85% above | 25% |
| Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 HEP A&B TWINRIX | $117.00 | $156.00 | $56.57–$148.20 | — | 25% |
| Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 Hepatitis B/Hepatitis A Vaccin | $334.14 | $445.52 | $160.39–$423.24 | — | 25% |
| Hepatitis A vaccine, adult dose CPT 90632 HEPATIS A INJ ADULT DOSAGE | $60.00 | $80.00 | $29.01–$76.00 | 28% below | 25% |
| Hepatitis A vaccine, adult dose CPT 90632 HEP A | $120.00 | $160.00 | $58.02–$152.00 | 44% above | 25% |
| Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATIS A INJ ADULT DOSAGE | $60.00 | $80.00 | $29.01–$76.00 | — | 25% |
| Hepatitis A vaccine, adult dose inpatient CPT 90632 HEP A | $120.00 | $160.00 | $58.02–$152.00 | — | 25% |
| Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 Hep-A | $30.00 | $40.00 | $14.50–$40.00 | 19% below | 25% |
| Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 Hep-A | $30.00 | $40.00 | $14.50–$40.00 | — | 25% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEP B VACCINE AGE>20 | $67.50 | $90.00 | $32.63–$85.50 | 29% below | 25% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEP B VAC CCC | $69.75 | $93.00 | $33.72–$88.35 | 27% below | 25% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 IMMUN HEP B ABOVE 19YRS | $130.50 | $174.00 | $62.64–$165.30 | 37% above | 25% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 ENERGIX-B 20 MCG/ML SYRINGE | $355.29 | $473.72 | $66.86–$450.03 | 274% above | 25% |
| Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEP B VACCINE AGE>20 | $67.50 | $90.00 | $32.63–$85.50 | — | 25% |
| Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEP B VAC CCC | $69.75 | $93.00 | $33.72–$88.35 | — | 25% |
| Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 IMMUN HEP B ABOVE 19YRS | $130.50 | $174.00 | $62.64–$165.30 | — | 25% |
| Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 ENERGIX-B 20 MCG/ML SYRINGE | $355.29 | $473.72 | $66.86–$450.03 | — | 25% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEP B VACCINE AGE<11 | $60.00 | $80.00 | $29.01–$76.00 | 11% above | 25% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 Hepatitis B Virus Vaccine 10 M | $218.32 | $291.09 | $30.09–$285.27 | 302% above | 25% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEP B VACCINE AGE<11 | $60.00 | $80.00 | $29.01–$76.00 | — | 25% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 Hepatitis B Virus Vaccine 10 M | $218.32 | $291.09 | $30.09–$285.27 | — | 25% |
| MMR vaccine (measles, mumps and rubella), live CPT 90707 Measles, Mumps, & Rubella Vacc | $458.82 | $611.76 | $220.23–$581.17 | 196% above | 25% |
| MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 Measles, Mumps, & Rubella Vacc | $458.82 | $611.76 | $220.23–$581.17 | — | 25% |
| Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENACTRA | $189.75 | $253.00 | $91.74–$240.35 | at median | 25% |
| Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENACTRA VACCINE | $279.75 | $373.00 | $135.25–$354.35 | 47% above | 25% |
| Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENACTRA | $189.75 | $253.00 | $91.74–$240.35 | — | 25% |
| Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENACTRA VACCINE | $279.75 | $373.00 | $135.25–$354.35 | — | 25% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENINGOCOCCAL VACCINE | $54.75 | $73.00 | $26.47–$73.00 | 87% below | 25% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 MENINGOCOCCAL VACCINE | $54.75 | $73.00 | $26.47–$73.00 | — | 25% |
| Nasal spray flu vaccine, live (FluMist) CPT 90660 FLU VACCINE 2-49yo,FLUMIST INT | $22.50 | $30.00 | $10.88–$29.71 | — | 25% |
| Nasal spray flu vaccine, live (FluMist) inpatient CPT 90660 FLU VACCINE 2-49yo,FLUMIST INT | $22.50 | $30.00 | $10.88–$29.71 | — | 25% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PREVNAR 13 PNEUMOCOCCAL VACC | $195.00 | $260.00 | $94.28–$260.00 | 22% below | 25% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PREVNAR 13 | $201.75 | $269.00 | $97.54–$269.00 | 19% below | 25% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 PREVNAR 13 PNEUMOCOCCAL VACC | $195.00 | $260.00 | $94.28–$260.00 | — | 25% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 PREVNAR 13 | $201.75 | $269.00 | $97.54–$269.00 | — | 25% |
| Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) CPT 90671 PNEUMOCOCCAL VACCINES PCV 15 | $202.50 | $270.00 | $97.90–$269.31 | — | 25% |
| Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) inpatient CPT 90671 PNEUMOCOCCAL VACCINES PCV 15 | $202.50 | $270.00 | $97.90–$269.31 | — | 25% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCOCCAL VACCINES PCV 20 | $217.50 | $290.00 | $105.15–$290.00 | 55% below | 25% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOCOCCAL VACCINES PCV 20 | $217.50 | $290.00 | $105.15–$290.00 | — | 25% |
| Pneumonia vaccine, 21-valent conjugate (Capvaxive) CPT 90684 PNEUMO 21-VAL SYRINGE | $333.75 | $445.00 | $161.36–$422.75 | 40% below | 25% |
| Pneumonia vaccine, 21-valent conjugate (Capvaxive) inpatient CPT 90684 PNEUMO 21-VAL SYRINGE | $333.75 | $445.00 | $161.36–$422.75 | — | 25% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL VACCINE | $105.00 | $140.00 | $50.76–$133.47 | 12% below | 25% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCCAL CCC | $108.75 | $145.00 | $52.58–$137.75 | 9% below | 25% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL VACCINE | $105.00 | $140.00 | $50.76–$133.47 | — | 25% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCCAL CCC | $108.75 | $145.00 | $52.58–$137.75 | — | 25% |
| RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 RSV VACCINE, ABRYSVO | $405.00 | $540.00 | $195.80–$513.00 | 19% below | 25% |
| RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 RSV VACCINE, ABRYSVO | $405.00 | $540.00 | $195.80–$513.00 | — | 25% |
| RSV vaccine with adjuvant (Arexvy), one dose for older adults CPT 90679 RSV VACCINE, AREXVY | $277.50 | $370.00 | $134.16–$351.50 | 32% below | 25% |
| RSV vaccine with adjuvant (Arexvy), one dose for older adults inpatient CPT 90679 RSV VACCINE, AREXVY | $277.50 | $370.00 | $134.16–$351.50 | — | 25% |
| Rabies vaccine, one dose CPT 90675 RABIES VACCINE, IM | $132.75 | $177.00 | $63.72–$177.00 | 68% below | 25% |
| Rabies vaccine, one dose CPT 90675 Rabies Vaccine 2.5 UNITS VIAL | $765.17 | $1,020.22 | $238.40–$969.21 | 82% above | 25% |
| Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE, IM | $132.75 | $177.00 | $63.72–$177.00 | — | 25% |
| Rabies vaccine, one dose inpatient CPT 90675 Rabies Vaccine 2.5 UNITS VIAL | $765.17 | $1,020.22 | $238.40–$969.21 | — | 25% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 D T VACCINE IMMUNIZATION | $33.00 | $44.00 | $15.95–$41.80 | 23% below | 25% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 Tetanus & Diphtheria Tox,ADULT | $315.34 | $420.45 | $35.50–$399.43 | 632% above | 25% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 D T VACCINE IMMUNIZATION | $33.00 | $44.00 | $15.95–$41.80 | — | 25% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 Tetanus & Diphtheria Tox,ADULT | $315.34 | $420.45 | $35.50–$399.43 | — | 25% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Tdap | $38.25 | $51.00 | $18.49–$48.45 | 32% below | 25% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TETANUS/DIPTH CCC | $48.00 | $64.00 | $23.21–$60.80 | 14% below | 25% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Diph,Pertuss(Acell),Tet Vac/Pf | $293.11 | $390.81 | $37.82–$371.27 | 423% above | 25% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Tdap | $38.25 | $51.00 | $18.49–$48.45 | — | 25% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TETANUS/DIPTH CCC | $48.00 | $64.00 | $23.21–$60.80 | — | 25% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Diph,Pertuss(Acell),Tet Vac/Pf | $293.11 | $390.81 | $37.82–$371.27 | — | 25% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADM MULTI CCC | $6.75 | $9.00 | $3.26–$9.00 | 86% below | 25% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN | $15.92 | $21.22 | $7.69–$21.22 | 67% below | 25% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMINISTRATION | $22.50 | $30.00 | $10.80–$30.00 | 53% below | 25% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMINISTRATION-PC | $36.75 | $49.00 | $17.64–$49.00 | 23% below | 25% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZAITON ADMIN | $44.25 | $59.00 | $18.54–$56.05 | 8% below | 25% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMINISTRATION~P | $53.25 | $71.00 | $21.29–$71.00 | 11% above | 25% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMINISTRATION ~T | $159.75 | $213.00 | $21.29–$202.35 | 233% above | 25% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMINISTRATION ~G | $159.75 | $213.00 | $21.29–$202.35 | 233% above | 25% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADM MULTI CCC | $6.75 | $9.00 | $3.26–$9.00 | — | 25% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMIN | $15.92 | $21.22 | $7.69–$21.22 | — | 25% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMINISTRATION | $22.50 | $30.00 | $10.80–$30.00 | — | 25% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMINISTRATION-PC | $36.75 | $49.00 | $17.64–$49.00 | — | 25% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZAITON ADMIN | $44.25 | $59.00 | $18.54–$56.05 | — | 25% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMINISTRATION~P | $53.25 | $71.00 | $21.29–$71.00 | — | 25% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMINISTRATION ~G | $159.75 | $213.00 | $21.29–$202.35 | — | 25% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMINISTRATION ~T | $159.75 | $213.00 | $21.29–$202.35 | — | 25% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMIN, EACH ADD | $15.92 | $21.22 | $7.69–$21.22 | 47% below | 25% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 EACH ADDITIONAL IMMUN ADMIN | $48.75 | $65.00 | $13.44–$61.75 | 61% above | 25% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUNIZATION ADMIN, EACH ADD | $15.92 | $21.22 | $7.69–$21.22 | — | 25% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 EACH ADDITIONAL IMMUN ADMIN | $48.75 | $65.00 | $13.44–$61.75 | — | 25% |
Procedure The service, with its billing code (CPT or HCPCS) and, in small type, the line exactly as the hospital wrote it in its price file. More
Cash price The hospital's own price for a patient paying without insurance (“discounted cash” in its price file). Hospitals must publish it under federal law, 45 CFR 180.50. Call to confirm it before booking. More
List price The hospital's full chargemaster price (“gross charge”) before any discount. Almost nobody pays it; the gap to the cash price shows what the self-pay discount is worth. More
Insurers pay The lowest and highest rates this hospital has agreed with insurance plans for the same item, from its price file. If the cash price is below what your plan pays and you have not met your deductible, paying cash can cost you less. More
Against the state median This hospital's cash price compared with the median cash price of hospitals in the state for the same code. Shown when at least three hospitals in the state price it.
Off list How much lower the cash price is than the list price.
No cash discount This line's cash price equals the hospital's full list price. Many hospitals still reduce bills for uninsured patients: ask the billing office for its self-pay discount in writing. More
At or below Medicare This cash price is at or below what Medicare pays a hospital for the same service, which is unusually low. It is what the hospital's file says; confirm it and what it includes before booking. More
Check the item The description in the hospital file looks like a supply or device (a catheter, a brace, an implant), not this procedure. The hospital may have filed it under the wrong code: ask before relying on this price.
Source file: https://nvrh.org/wp-content/uploads/2026/08/036013761_NORTHEASTERN-VERMONT-Regional-Hospital_standardcharges-2.csv