Perry County Memorial Hospital
Perry County Memorial Hospital in Tell City, IN publishes cash prices for 352 common procedures listed here, from its own machine-readable price file updated Oct 13, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Indiana median for 227 of 352 procedures and below it for 123. By typical cash price it ranks #61 of 84 Indiana hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.
8885 ST ROAD 237,TELL CITY,IN,47586-2751 Collected Oct 15, 2026 Source price file Check a bill from this hospital (812) 547-7011
Critical access hospital (rural, 25 beds or fewer) Nonprofit hospital Emergency department CMS star rating 2 of 5 CCN 151322 · CMS hospital register NPI 1699779017
Financial assistance
Nonprofit hospital: it must offer free or discounted care to patients who qualify. How to apply
Perry County Memorial 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.
CMS price transparency record
The federal Centers for Medicare & Medicaid Services (CMS) enforces the rule that makes hospitals publish their prices. Its public enforcement list shows 4 actions for a hospital named Perry County Memorial Hospital in Tell City, IN:
- Sep 18, 2025 Warning notice
- Nov 10, 2025 Case closed
- May 27, 2026 Warning notice
- Jun 16, 2026 Case closed
Warning notice: CMS reviewed the hospital and told it that it had found possible violations of the price transparency rules. Case closed: CMS closed the case after the hospital addressed the problems.
A notice records a step in a CMS review; it is not a court finding. Source: CMS, Hospital Price Transparency Enforcement Activities and Outcomes, actions through Jul 31, 2026.
Scans and imaging
| Procedure | Cash price | List price | Insurers pay | vs Indiana | Off list |
|---|---|---|---|---|---|
| Abdominal CT scan without and with contrast CPT 74170 CT ABD WO CNTRST FLWD CNTRST | $2,074.10 | $2,963.00 | $562.93–$2,963.00 | 53% above | 30% |
| Abdominal CT scan without and with contrast CPT 74170 CT ABD WW CON | $2,074.10 | $2,963.00 | $562.93–$2,963.00 | 53% above | 30% |
| Abdominal CT scan without and with contrast inpatient CPT 74170 CT ABD WW CON | $2,074.10 | $2,963.00 | $562.93–$2,963.00 | — | 30% |
| Abdominal CT scan without and with contrast inpatient CPT 74170 CT ABD WO CNTRST FLWD CNTRST | $2,074.10 | $2,963.00 | $562.93–$2,963.00 | — | 30% |
| Ankle X-ray, complete, 3 or more views CPT 73610 X-RAY EXAM OF ANKLE | $257.60 | $368.00 | $68.29–$922.00 | 31% above | 30% |
| Ankle X-ray, complete, 3 or more views CPT 73610 ANKLE COMP MIN 3VWS | $257.60 | $368.00 | $68.29–$922.00 | 31% above | 30% |
| Ankle X-ray, complete, 3 or more views CPT 73610 ANKLE COMP MIN3V BIL | $387.80 | $554.00 | $68.29–$922.00 | 98% above | 30% |
| Ankle X-ray, complete, 3 or more views inpatient CPT 73610 ANKLE COMP MIN 3VWS | $257.60 | $368.00 | $68.29–$922.00 | — | 30% |
| Ankle X-ray, complete, 3 or more views inpatient CPT 73610 X-RAY EXAM OF ANKLE | $257.60 | $368.00 | $68.29–$922.00 | — | 30% |
| Ankle X-ray, complete, 3 or more views inpatient CPT 73610 ANKLE COMP MIN3V BIL | $387.80 | $554.00 | $68.29–$922.00 | — | 30% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 UPR/L XTREMITY ART 2 LEVELS | $165.90 | $237.00 | $131.27–$822.00 | 55% below | 30% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 BIL SINGLE LEVEL AB1 | $165.90 | $237.00 | $131.27–$822.00 | 55% below | 30% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 US ABI TBI | $170.10 | $243.00 | $131.27–$822.00 | 54% below | 30% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 PHYS SNGLE LEVEL | $239.40 | $342.00 | $131.27–$822.00 | 35% below | 30% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 BIL SINGLE LEVEL AB1 | $165.90 | $237.00 | $131.27–$822.00 | — | 30% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 UPR/L XTREMITY ART 2 LEVELS | $165.90 | $237.00 | $131.27–$822.00 | — | 30% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 US ABI TBI | $170.10 | $243.00 | $131.27–$822.00 | — | 30% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 PHYS SNGLE LEVEL | $239.40 | $342.00 | $131.27–$822.00 | — | 30% |
| Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 CT UP EXT W/O CON | $1,597.40 | $2,282.00 | $381.26–$2,282.00 | 99% above | 30% |
| Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 CT UPPER EXTREMITY W/O DYE | $1,597.40 | $2,282.00 | $381.26–$2,282.00 | 99% above | 30% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 CT UP EXT W/O CON | $1,597.40 | $2,282.00 | $381.26–$2,282.00 | — | 30% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 CT UPPER EXTREMITY W/O DYE | $1,597.40 | $2,282.00 | $381.26–$2,282.00 | — | 30% |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 X-RAY XM ESOPHAGUS 1CNTRST | $504.70 | $721.00 | $165.83–$721.00 | 8% above | 30% |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 ESOPHAGUS | $504.70 | $721.00 | $165.83–$721.00 | 8% above | 30% |
| Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 X-RAY XM ESOPHAGUS 1CNTRST | $504.70 | $721.00 | $165.83–$721.00 | — | 30% |
| Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 ESOPHAGUS | $504.70 | $721.00 | $165.83–$721.00 | — | 30% |
| Bone scan, whole body (nuclear medicine) CPT 78306 BONE SCAN WHOLEBODY | $1,582.00 | $2,260.00 | $519.80–$2,260.00 | at median | 30% |
| Bone scan, whole body (nuclear medicine) CPT 78306 BONE IMAGING WHOLE BODY | $1,582.00 | $2,260.00 | $519.80–$2,260.00 | at median | 30% |
| Bone scan, whole body (nuclear medicine) inpatient CPT 78306 BONE IMAGING WHOLE BODY | $1,582.00 | $2,260.00 | $519.80–$2,260.00 | — | 30% |
| Bone scan, whole body (nuclear medicine) inpatient CPT 78306 BONE SCAN WHOLEBODY | $1,582.00 | $2,260.00 | $519.80–$2,260.00 | — | 30% |
| Breast ultrasound, complete, one breast CPT 76641 US BREAST UNIL COMPLETE | $416.50 | $595.00 | $136.85–$595.00 | 4% below | 30% |
| Breast ultrasound, complete, one breast CPT 76641 ULTRASOUND BREAST COMPLETE | $416.50 | $595.00 | $136.85–$595.00 | 4% below | 30% |
| Breast ultrasound, complete, one breast inpatient CPT 76641 US BREAST UNIL COMPLETE | $416.50 | $595.00 | $136.85–$595.00 | — | 30% |
| Breast ultrasound, complete, one breast inpatient CPT 76641 ULTRASOUND BREAST COMPLETE | $416.50 | $595.00 | $136.85–$595.00 | — | 30% |
| Breast ultrasound, limited (one breast or one area) CPT 76642 US BREAST UNIL LIMITED | $363.30 | $519.00 | $119.37–$519.00 | 12% above | 30% |
| Breast ultrasound, limited (one breast or one area) CPT 76642 ULTRASOUND BREAST LIMITED | $363.30 | $519.00 | $119.37–$519.00 | 12% above | 30% |
| Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 ULTRASOUND BREAST LIMITED | $363.30 | $519.00 | $119.37–$519.00 | — | 30% |
| Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 US BREAST UNIL LIMITED | $363.30 | $519.00 | $119.37–$519.00 | — | 30% |
| CT angiography (CTA) of the abdomen and pelvis CPT 74174 CTA ABDOMEN/PELVIS | $1,555.40 | $2,222.00 | $511.06–$2,222.00 | 18% below | 30% |
| CT angiography (CTA) of the abdomen and pelvis CPT 74174 CTA ABD&PLVS W/CONTRAST | $1,555.40 | $2,222.00 | $511.06–$2,222.00 | 18% below | 30% |
| CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CTA ABD&PLVS W/CONTRAST | $1,555.40 | $2,222.00 | $511.06–$2,222.00 | — | 30% |
| CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CTA ABDOMEN/PELVIS | $1,555.40 | $2,222.00 | $511.06–$2,222.00 | — | 30% |
| CT angiography (CTA) of the head CPT 70496 CTA HEAD W/WO CONTRA | $1,506.40 | $2,152.00 | $494.96–$2,152.00 | 18% above | 30% |
| CT angiography (CTA) of the head CPT 70496 CT ANGIOGRAPHY HEAD | $1,506.40 | $2,152.00 | $494.96–$2,152.00 | 18% above | 30% |
| CT angiography (CTA) of the head inpatient CPT 70496 CT ANGIOGRAPHY HEAD | $1,506.40 | $2,152.00 | $494.96–$2,152.00 | — | 30% |
| CT angiography (CTA) of the head inpatient CPT 70496 CTA HEAD W/WO CONTRA | $1,506.40 | $2,152.00 | $494.96–$2,152.00 | — | 30% |
| CT angiography (CTA) of the neck CPT 70498 CT ANGIOGRAPHY NECK | $1,506.40 | $2,152.00 | $494.96–$2,152.00 | 24% above | 30% |
| CT angiography (CTA) of the neck CPT 70498 CTA NECK W/WO CONTRA | $1,506.40 | $2,152.00 | $494.96–$2,152.00 | 24% above | 30% |
| CT angiography (CTA) of the neck inpatient CPT 70498 CT ANGIOGRAPHY NECK | $1,506.40 | $2,152.00 | $494.96–$2,152.00 | — | 30% |
| CT angiography (CTA) of the neck inpatient CPT 70498 CTA NECK W/WO CONTRA | $1,506.40 | $2,152.00 | $494.96–$2,152.00 | — | 30% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT ANGIOGRAPHY CHEST | $1,555.40 | $2,222.00 | $511.06–$2,222.00 | 22% above | 30% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA CHEST W/WO CONTR | $1,555.40 | $2,222.00 | $511.06–$2,222.00 | 22% above | 30% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT ANGIOGRAPHY CHEST | $1,555.40 | $2,222.00 | $511.06–$2,222.00 | — | 30% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA CHEST W/WO CONTR | $1,555.40 | $2,222.00 | $511.06–$2,222.00 | — | 30% |
| CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT CALIUM SCORING | $34.30 | $49.00 | $11.27–$210.29 | 82% below | 30% |
| CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT HRT W/O DYE W/CA TEST | $34.30 | $49.00 | $11.27–$210.29 | 82% below | 30% |
| CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT HRT W/O DYE W/CA TEST | $34.30 | $49.00 | $11.27–$210.29 | — | 30% |
| CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT CALIUM SCORING | $34.30 | $49.00 | $11.27–$210.29 | — | 30% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD & PELVIS W/O CONTRAST | $1,356.60 | $1,938.00 | $350.38–$1,938.00 | 13% above | 30% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD/PELVIS WITHOUT CONTRAST | $1,356.60 | $1,938.00 | $350.38–$1,938.00 | 13% above | 30% |
| CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD & PELVIS W/O CONTRAST | $1,356.60 | $1,938.00 | $350.38–$1,938.00 | — | 30% |
| CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD/PELVIS WITHOUT CONTRAST | $1,356.60 | $1,938.00 | $350.38–$1,938.00 | — | 30% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD/PELVIS WITH CONTRAST | $2,155.30 | $3,079.00 | $632.46–$3,079.00 | 25% above | 30% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD & PELVIS W/CONTRAST | $2,155.30 | $3,079.00 | $632.46–$3,079.00 | 25% above | 30% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD & PELVIS W/CONTRAST | $2,155.30 | $3,079.00 | $632.46–$3,079.00 | — | 30% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD/PELVIS WITH CONTRAST | $2,155.30 | $3,079.00 | $632.46–$3,079.00 | — | 30% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT UROGRAM | $967.40 | $1,382.00 | $751.30–$4,734.00 | 44% below | 30% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD&PLV WO CNTR FLWD CNTR | $2,346.40 | $3,352.00 | $751.30–$4,734.00 | 37% above | 30% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD/PELVIS W/WO CONTRAST | $2,346.40 | $3,352.00 | $751.30–$4,734.00 | 37% above | 30% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT UROGRAM | $967.40 | $1,382.00 | $751.30–$4,734.00 | — | 30% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD&PLV WO CNTR FLWD CNTR | $2,346.40 | $3,352.00 | $751.30–$4,734.00 | — | 30% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD/PELVIS W/WO CONTRAST | $2,346.40 | $3,352.00 | $751.30–$4,734.00 | — | 30% |
| CT scan of the abdomen with contrast CPT 74160 CT ABD W CON | $1,783.60 | $2,548.00 | $478.84–$2,548.00 | 67% above | 30% |
| CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W/CONTRAST | $1,783.60 | $2,548.00 | $478.84–$2,548.00 | 67% above | 30% |
| CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN W/CONTRAST | $1,783.60 | $2,548.00 | $478.84–$2,548.00 | — | 30% |
| CT scan of the abdomen with contrast inpatient CPT 74160 CT ABD W CON | $1,783.60 | $2,548.00 | $478.84–$2,548.00 | — | 30% |
| CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/O CONTRAST | $1,530.90 | $2,187.00 | $256.66–$2,187.00 | 81% above | 30% |
| CT scan of the abdomen without contrast CPT 74150 CT ABD WO CON | $1,530.90 | $2,187.00 | $256.66–$2,187.00 | 81% above | 30% |
| CT scan of the abdomen without contrast inpatient CPT 74150 CT ABD WO CON | $1,530.90 | $2,187.00 | $256.66–$2,187.00 | — | 30% |
| CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN W/O CONTRAST | $1,530.90 | $2,187.00 | $256.66–$2,187.00 | — | 30% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIAL W/O DYE | $1,043.00 | $1,490.00 | $342.70–$1,490.00 | 25% above | 30% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAX/FAC WO | $1,043.00 | $1,490.00 | $342.70–$1,490.00 | 25% above | 30% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAX/FAC WO | $1,043.00 | $1,490.00 | $342.70–$1,490.00 | — | 30% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILLOFACIAL W/O DYE | $1,043.00 | $1,490.00 | $342.70–$1,490.00 | — | 30% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD/BRAIN W/O DYE | $1,043.00 | $1,490.00 | $220.90–$1,490.00 | 36% above | 30% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD WO CON | $1,043.00 | $1,490.00 | $220.90–$1,490.00 | 36% above | 30% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD/BRAIN W/O DYE | $1,043.00 | $1,490.00 | $220.90–$1,490.00 | — | 30% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD WO CON | $1,043.00 | $1,490.00 | $220.90–$1,490.00 | — | 30% |
| CT scan of the head with contrast CPT 70460 CT HEAD/BRAIN W/DYE | $1,525.30 | $2,179.00 | $305.92–$2,179.00 | 79% above | 30% |
| CT scan of the head with contrast CPT 70460 CT HEAD W CONT | $1,525.30 | $2,179.00 | $305.92–$2,179.00 | 79% above | 30% |
| CT scan of the head with contrast inpatient CPT 70460 CT HEAD/BRAIN W/DYE | $1,525.30 | $2,179.00 | $305.92–$2,179.00 | — | 30% |
| CT scan of the head with contrast inpatient CPT 70460 CT HEAD W CONT | $1,525.30 | $2,179.00 | $305.92–$2,179.00 | — | 30% |
| CT scan of the head without and with contrast CPT 70470 CT HEAD/BRAIN W/O & W/DYE | $1,718.50 | $2,455.00 | $378.38–$2,455.00 | 65% above | 30% |
| CT scan of the head without and with contrast CPT 70470 CT HEAD WW CON | $1,718.50 | $2,455.00 | $378.38–$2,455.00 | 65% above | 30% |
| CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD WW CON | $1,718.50 | $2,455.00 | $378.38–$2,455.00 | — | 30% |
| CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD/BRAIN W/O & W/DYE | $1,718.50 | $2,455.00 | $378.38–$2,455.00 | — | 30% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMBAR SPINE W/O DYE | $1,224.30 | $1,749.00 | $382.24–$1,749.00 | 38% above | 30% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT L-SP WO CON | $1,224.30 | $1,749.00 | $382.24–$1,749.00 | 38% above | 30% |
| CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT LUMBAR SPINE W/O DYE | $1,224.30 | $1,749.00 | $382.24–$1,749.00 | — | 30% |
| CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT L-SP WO CON | $1,224.30 | $1,749.00 | $382.24–$1,749.00 | — | 30% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT NECK SPINE W/O DYE | $1,143.80 | $1,634.00 | $375.82–$1,634.00 | 37% above | 30% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT C-SP WO CON | $1,143.80 | $1,634.00 | $375.82–$1,634.00 | 37% above | 30% |
| CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT C-SP WO CON | $1,143.80 | $1,634.00 | $375.82–$1,634.00 | — | 30% |
| CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT NECK SPINE W/O DYE | $1,143.80 | $1,634.00 | $375.82–$1,634.00 | — | 30% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W CO | $1,733.20 | $2,476.00 | $480.79–$2,476.00 | 88% above | 30% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/DYE | $1,733.20 | $2,476.00 | $480.79–$2,476.00 | 88% above | 30% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W CO | $1,733.20 | $2,476.00 | $480.79–$2,476.00 | — | 30% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/DYE | $1,733.20 | $2,476.00 | $480.79–$2,476.00 | — | 30% |
| Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 EXTRACRANIAL BILAT STUDY | $932.40 | $1,332.00 | $306.36–$1,332.00 | — | 30% |
| Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 CAROTID DOPPLER | $932.40 | $1,332.00 | $306.36–$1,332.00 | 3% below | 30% |
| Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 EXTRACRANIAL BILAT STUDY | $932.40 | $1,332.00 | $306.36–$1,332.00 | — | 30% |
| Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 CAROTID DOPPLER | $932.40 | $1,332.00 | $306.36–$1,332.00 | — | 30% |
| Chest CT scan without and with contrast CPT 71270 CT CHEST WW C | $2,021.60 | $2,888.00 | $597.68–$2,888.00 | 86% above | 30% |
| Chest CT scan without and with contrast CPT 71270 CT THORAX DX C-/C+ | $2,021.60 | $2,888.00 | $597.68–$2,888.00 | 86% above | 30% |
| Chest CT scan without and with contrast inpatient CPT 71270 CT THORAX DX C-/C+ | $2,021.60 | $2,888.00 | $597.68–$2,888.00 | — | 30% |
| Chest CT scan without and with contrast inpatient CPT 71270 CT CHEST WW C | $2,021.60 | $2,888.00 | $597.68–$2,888.00 | — | 30% |
| Chest X-ray, 2 views CPT 71046 X-RAY EXAM CHEST 2 VIEWS | $266.00 | $380.00 | $87.40–$380.00 | 29% above | 30% |
| Chest X-ray, 2 views CPT 71046 CHEST; 2 VIEWS | $266.00 | $380.00 | $87.40–$380.00 | 29% above | 30% |
| Chest X-ray, 2 views inpatient CPT 71046 CHEST; 2 VIEWS | $266.00 | $380.00 | $87.40–$380.00 | — | 30% |
| Chest X-ray, 2 views inpatient CPT 71046 X-RAY EXAM CHEST 2 VIEWS | $266.00 | $380.00 | $87.40–$380.00 | — | 30% |
| Chest X-ray, single view CPT 71045 X-RAY EXAM CHEST 1 VIEW | $234.50 | $335.00 | $77.05–$335.00 | 44% above | 30% |
| Chest X-ray, single view CPT 71045 CHEST; SINGLE VIEW | $234.50 | $335.00 | $77.05–$335.00 | 44% above | 30% |
| Chest X-ray, single view inpatient CPT 71045 CHEST; SINGLE VIEW | $234.50 | $335.00 | $77.05–$335.00 | — | 30% |
| Chest X-ray, single view inpatient CPT 71045 X-RAY EXAM CHEST 1 VIEW | $234.50 | $335.00 | $77.05–$335.00 | — | 30% |
| Collarbone (clavicle) X-ray, complete both sides CPT 73000 CLAVICLE COMP BILAT | $426.30 | $609.00 | $56.67–$1,014.00 | — | 30% |
| Collarbone (clavicle) X-ray, complete CPT 73000 X-RAY EXAM OF COLLAR BONE | $283.50 | $405.00 | $56.67–$1,014.00 | 48% above | 30% |
| Collarbone (clavicle) X-ray, complete CPT 73000 CLAVICLE COMPLETE | $283.50 | $405.00 | $56.67–$1,014.00 | 48% above | 30% |
| Collarbone (clavicle) X-ray, complete inpatient both sides CPT 73000 CLAVICLE COMP BILAT | $426.30 | $609.00 | $56.67–$1,014.00 | — | 30% |
| Collarbone (clavicle) X-ray, complete inpatient CPT 73000 X-RAY EXAM OF COLLAR BONE | $283.50 | $405.00 | $56.67–$1,014.00 | — | 30% |
| Collarbone (clavicle) X-ray, complete inpatient CPT 73000 CLAVICLE COMPLETE | $283.50 | $405.00 | $56.67–$1,014.00 | — | 30% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US EXAM ABDO BACK WALL COMP | $476.70 | $681.00 | $156.63–$681.00 | 5% below | 30% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US KIDNEY(S) | $476.70 | $681.00 | $156.63–$681.00 | 5% below | 30% |
| Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US KIDNEY(S) | $476.70 | $681.00 | $156.63–$681.00 | — | 30% |
| Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US EXAM ABDO BACK WALL COMP | $476.70 | $681.00 | $156.63–$681.00 | — | 30% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 DXA BONE DENSITY AXIAL | $388.50 | $555.00 | $104.99–$555.00 | 34% above | 30% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 DXA BONE DENSITY | $388.50 | $555.00 | $104.99–$555.00 | 34% above | 30% |
| DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DXA BONE DENSITY AXIAL | $388.50 | $555.00 | $104.99–$555.00 | — | 30% |
| DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DXA BONE DENSITY | $388.50 | $555.00 | $104.99–$555.00 | — | 30% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST HIGH RESOLUTION | $1,551.20 | $2,216.00 | $381.26–$4,432.00 | 86% above | 30% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST WO CO | $1,551.20 | $2,216.00 | $381.26–$4,432.00 | 86% above | 30% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT THORAX DX C- | $1,551.20 | $2,216.00 | $381.26–$4,432.00 | 86% above | 30% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT THORAX DX C- | $1,551.20 | $2,216.00 | $381.26–$4,432.00 | — | 30% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST WO CO | $1,551.20 | $2,216.00 | $381.26–$4,432.00 | — | 30% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST HIGH RESOLUTION | $1,551.20 | $2,216.00 | $381.26–$4,432.00 | — | 30% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST W CON | $1,675.10 | $2,393.00 | $480.79–$2,393.00 | 79% above | 30% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT THORAX DX C+ | $1,675.10 | $2,393.00 | $480.79–$2,393.00 | 79% above | 30% |
| Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT THORAX DX C+ | $1,675.10 | $2,393.00 | $480.79–$2,393.00 | — | 30% |
| Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT CHEST W CON | $1,675.10 | $2,393.00 | $480.79–$2,393.00 | — | 30% |
| Diagnostic mammogram, both breasts both sides CPT 77066 DX MAMMO INCL CAD BI | $467.60 | $668.00 | $146.74–$868.00 | — | 30% |
| Diagnostic mammogram, both breasts CPT 77066 MAMMOGRAM PCHD | $140.00 | $200.00 | $146.74–$868.00 | 68% below | 30% |
| Diagnostic mammogram, both breasts CPT 77066 MAMMO DIAG DIGIT BIL | $467.60 | $668.00 | $146.74–$868.00 | 7% above | 30% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 DX MAMMO INCL CAD BI | $467.60 | $668.00 | $146.74–$868.00 | — | 30% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 MAMMOGRAM PCHD | $140.00 | $200.00 | $146.74–$868.00 | — | 30% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 MAMMO DIAG DIGIT BIL | $467.60 | $668.00 | $146.74–$868.00 | — | 30% |
| Diagnostic mammogram, one breast CPT 77065 MAMMO ADD VW UNI 3D | $462.70 | $661.00 | $115.91–$1,983.00 | 108% above | 30% |
| Diagnostic mammogram, one breast CPT 77065 MAGSPOT 2D ONLY | $462.70 | $661.00 | $115.91–$1,983.00 | 108% above | 30% |
| Diagnostic mammogram, one breast CPT 77065 DX MAMMO INCL CAD UNI | $462.70 | $661.00 | $115.91–$1,983.00 | 108% above | 30% |
| Diagnostic mammogram, one breast one side CPT 77065 DX MAMMO INCL CAD;UNILATERAL | $462.70 | $661.00 | $115.91–$1,983.00 | 108% above | 30% |
| Diagnostic mammogram, one breast inpatient CPT 77065 MAMMO ADD VW UNI 3D | $462.70 | $661.00 | $115.91–$1,983.00 | — | 30% |
| Diagnostic mammogram, one breast inpatient CPT 77065 DX MAMMO INCL CAD UNI | $462.70 | $661.00 | $115.91–$1,983.00 | — | 30% |
| Diagnostic mammogram, one breast inpatient CPT 77065 MAGSPOT 2D ONLY | $462.70 | $661.00 | $115.91–$1,983.00 | — | 30% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 DX MAMMO INCL CAD;UNILATERAL | $462.70 | $661.00 | $115.91–$1,983.00 | — | 30% |
| Duplex ultrasound of the leg arteries, both legs CPT 93925 LOWER EXTREMITY STUDY | $1,025.50 | $1,465.00 | $336.95–$1,465.00 | 9% above | 30% |
| Duplex ultrasound of the leg arteries, both legs CPT 93925 LOW EXT ART BIL | $1,025.50 | $1,465.00 | $336.95–$1,465.00 | 9% above | 30% |
| Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 LOW EXT ART BIL | $1,025.50 | $1,465.00 | $336.95–$1,465.00 | — | 30% |
| Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 LOWER EXTREMITY STUDY | $1,025.50 | $1,465.00 | $336.95–$1,465.00 | — | 30% |
| Duplex ultrasound of the leg veins, both legs CPT 93970 EXTREMITY STUDY | $1,096.90 | $1,567.00 | $360.41–$1,567.00 | 16% below | 30% |
| Duplex ultrasound of the leg veins, both legs CPT 93970 UP/LOW EXTREM VEINS | $1,096.90 | $1,567.00 | $360.41–$1,567.00 | 16% below | 30% |
| Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 UP/LOW EXTREM VEINS | $1,096.90 | $1,567.00 | $360.41–$1,567.00 | — | 30% |
| Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 EXTREMITY STUDY | $1,096.90 | $1,567.00 | $360.41–$1,567.00 | — | 30% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 TTE W/DOPPLER COMPLETE | $1,502.90 | $2,147.00 | $1,234.41–$5,367.00 | 9% below | 30% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 COMPLETE ECHO W/STRAIN IMAGING | $2,254.00 | $3,220.00 | $1,234.41–$5,367.00 | 36% above | 30% |
| Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 TTE W/DOPPLER COMPLETE | $1,502.90 | $2,147.00 | $1,234.41–$5,367.00 | — | 30% |
| Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 COMPLETE ECHO W/STRAIN IMAGING | $2,254.00 | $3,220.00 | $1,234.41–$5,367.00 | — | 30% |
| Elbow X-ray, 2 views both sides CPT 73070 ELBOW 2VWS BILAT | $609.00 | $870.00 | $55.69–$1,187.00 | — | 30% |
| Elbow X-ray, 2 views CPT 73070 ELBOW <3 VWS | $221.90 | $317.00 | $55.69–$1,187.00 | 34% above | 30% |
| Elbow X-ray, 2 views CPT 73070 X-RAY EXAM OF ELBOW | $221.90 | $317.00 | $55.69–$1,187.00 | 34% above | 30% |
| Elbow X-ray, 2 views inpatient both sides CPT 73070 ELBOW 2VWS BILAT | $609.00 | $870.00 | $55.69–$1,187.00 | — | 30% |
| Elbow X-ray, 2 views inpatient CPT 73070 ELBOW <3 VWS | $221.90 | $317.00 | $55.69–$1,187.00 | — | 30% |
| Elbow X-ray, 2 views inpatient CPT 73070 X-RAY EXAM OF ELBOW | $221.90 | $317.00 | $55.69–$1,187.00 | — | 30% |
| Elbow X-ray, complete, 3 or more views CPT 73080 ELBOW COMP MIN 3VWS | $266.70 | $381.00 | $68.29–$953.00 | 4% above | 30% |
| Elbow X-ray, complete, 3 or more views CPT 73080 X-RAY EXAM OF ELBOW | $266.70 | $381.00 | $68.29–$953.00 | 4% above | 30% |
| Elbow X-ray, complete, 3 or more views CPT 73080 ELBOW COMP MIN3V BIL | $400.40 | $572.00 | $68.29–$953.00 | 57% above | 30% |
| Elbow X-ray, complete, 3 or more views inpatient CPT 73080 X-RAY EXAM OF ELBOW | $266.70 | $381.00 | $68.29–$953.00 | — | 30% |
| Elbow X-ray, complete, 3 or more views inpatient CPT 73080 ELBOW COMP MIN 3VWS | $266.70 | $381.00 | $68.29–$953.00 | — | 30% |
| Elbow X-ray, complete, 3 or more views inpatient CPT 73080 ELBOW COMP MIN3V BIL | $400.40 | $572.00 | $68.29–$953.00 | — | 30% |
| Eye socket (orbit) CT scan without contrast CPT 70480 CT IN EAR WO C | $1,043.00 | $1,490.00 | $342.70–$1,490.00 | 22% above | 30% |
| Eye socket (orbit) CT scan without contrast CPT 70480 CT ORBIT/EAR/FOSSA W/O DYE | $1,043.00 | $1,490.00 | $342.70–$1,490.00 | 22% above | 30% |
| Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT IN EAR WO C | $1,043.00 | $1,490.00 | $342.70–$1,490.00 | — | 30% |
| Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT ORBIT/EAR/FOSSA W/O DYE | $1,043.00 | $1,490.00 | $342.70–$1,490.00 | — | 30% |
| Facial bones X-ray, complete, 3 or more views CPT 70150 FACIAL BONES COMP MI | $410.20 | $586.00 | $81.78–$586.00 | 50% above | 30% |
| Facial bones X-ray, complete, 3 or more views CPT 70150 X-RAY EXAM OF FACIAL BONES | $410.20 | $586.00 | $81.78–$586.00 | 50% above | 30% |
| Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 FACIAL BONES COMP MI | $410.20 | $586.00 | $81.78–$586.00 | — | 30% |
| Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 X-RAY EXAM OF FACIAL BONES | $410.20 | $586.00 | $81.78–$586.00 | — | 30% |
| Forearm X-ray (radius and ulna), 2 views both sides CPT 73090 FOREARM 2VWS BILAT | $387.10 | $553.00 | $53.78–$920.00 | — | 30% |
| Forearm X-ray (radius and ulna), 2 views CPT 73090 X-RAY EXAM OF FOREARM | $256.90 | $367.00 | $53.78–$920.00 | 39% above | 30% |
| Forearm X-ray (radius and ulna), 2 views CPT 73090 FOREARM 2VWS | $256.90 | $367.00 | $53.78–$920.00 | 39% above | 30% |
| Forearm X-ray (radius and ulna), 2 views inpatient both sides CPT 73090 FOREARM 2VWS BILAT | $387.10 | $553.00 | $53.78–$920.00 | — | 30% |
| Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 FOREARM 2VWS | $256.90 | $367.00 | $53.78–$920.00 | — | 30% |
| Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 X-RAY EXAM OF FOREARM | $256.90 | $367.00 | $53.78–$920.00 | — | 30% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HEPATOBILIARY SYSTEM IMAGING | $1,171.10 | $1,673.00 | $384.79–$1,673.00 | 11% below | 30% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM HIDA WITHOUT EF | $1,171.10 | $1,673.00 | $384.79–$1,673.00 | 11% below | 30% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HEPATOBILIARY SYSTEM IMAGING | $1,171.10 | $1,673.00 | $384.79–$1,673.00 | — | 30% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM HIDA WITHOUT EF | $1,171.10 | $1,673.00 | $384.79–$1,673.00 | — | 30% |
| Hand X-ray, 2 views both sides CPT 73120 HAND 2VWS BILAT | $333.90 | $477.00 | $52.81–$794.00 | — | 30% |
| Hand X-ray, 2 views CPT 73120 X-RAY EXAM OF HAND | $221.90 | $317.00 | $52.81–$794.00 | 29% above | 30% |
| Hand X-ray, 2 views CPT 73120 HAND 2 VWS | $221.90 | $317.00 | $52.81–$794.00 | 29% above | 30% |
| Hand X-ray, 2 views inpatient both sides CPT 73120 HAND 2VWS BILAT | $333.90 | $477.00 | $52.81–$794.00 | — | 30% |
| Hand X-ray, 2 views inpatient CPT 73120 X-RAY EXAM OF HAND | $221.90 | $317.00 | $52.81–$794.00 | — | 30% |
| Hand X-ray, 2 views inpatient CPT 73120 HAND 2 VWS | $221.90 | $317.00 | $52.81–$794.00 | — | 30% |
| Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 CALCANEUS MIN 2 VW | $257.60 | $368.00 | $55.69–$922.00 | 21% above | 30% |
| Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 X-RAY EXAM OF HEEL | $257.60 | $368.00 | $55.69–$922.00 | 21% above | 30% |
| Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 CALCANEUS MIN2V BILA | $387.80 | $554.00 | $55.69–$922.00 | 82% above | 30% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 X-RAY EXAM OF HEEL | $257.60 | $368.00 | $55.69–$922.00 | — | 30% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 CALCANEUS MIN 2 VW | $257.60 | $368.00 | $55.69–$922.00 | — | 30% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 CALCANEUS MIN2V BILA | $387.80 | $554.00 | $55.69–$922.00 | — | 30% |
| Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 SLEEP STUDY UNATT&RESP EFFT | $540.40 | $772.00 | $177.56–$772.00 | 31% above | 30% |
| Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 HOME SLEEP STUDY | $540.40 | $772.00 | $177.56–$772.00 | 31% above | 30% |
| Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 HOME SLEEP STUDY | $540.40 | $772.00 | $177.56–$772.00 | — | 30% |
| Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 SLEEP STUDY UNATT&RESP EFFT | $540.40 | $772.00 | $177.56–$772.00 | — | 30% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 POLYS 6YRS+ 4/PARAM CPAP REDUCED | $2,102.10 | $3,003.00 | $1,857.71–$8,077.00 | 35% below | 30% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 POLYS 6YRS+4/>PARAM CPAP | $3,551.80 | $5,074.00 | $1,857.71–$8,077.00 | 9% above | 30% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 POLYSOM 6/>YRS CPAP 4/> PARM | $3,551.80 | $5,074.00 | $1,857.71–$8,077.00 | 9% above | 30% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 POLYS 6YRS+ 4/PARAM CPAP REDUCED | $2,102.10 | $3,003.00 | $1,857.71–$8,077.00 | — | 30% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 POLYS 6YRS+4/>PARAM CPAP | $3,551.80 | $5,074.00 | $1,857.71–$8,077.00 | — | 30% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 POLYSOM 6/>YRS CPAP 4/> PARM | $3,551.80 | $5,074.00 | $1,857.71–$8,077.00 | — | 30% |
| Knee X-ray, 3 views both sides CPT 73562 KNEE 3VWS BILAT | $433.30 | $619.00 | $75.04–$1,033.00 | — | 30% |
| Knee X-ray, 3 views CPT 73562 X-RAY EXAM OF KNEE 3 | $289.80 | $414.00 | $75.04–$1,033.00 | 26% above | 30% |
| Knee X-ray, 3 views CPT 73562 KNEE 3VWS | $289.80 | $414.00 | $75.04–$1,033.00 | 26% above | 30% |
| Knee X-ray, 3 views inpatient both sides CPT 73562 KNEE 3VWS BILAT | $433.30 | $619.00 | $75.04–$1,033.00 | — | 30% |
| Knee X-ray, 3 views inpatient CPT 73562 X-RAY EXAM OF KNEE 3 | $289.80 | $414.00 | $75.04–$1,033.00 | — | 30% |
| Knee X-ray, 3 views inpatient CPT 73562 KNEE 3VWS | $289.80 | $414.00 | $75.04–$1,033.00 | — | 30% |
| Knee X-ray, complete, 4 or more views CPT 73564 KNEE COMP MIN 4V | $360.50 | $515.00 | $86.62–$1,289.00 | 38% above | 30% |
| Knee X-ray, complete, 4 or more views CPT 73564 X-RAY EXAM KNEE 4 OR MORE | $360.50 | $515.00 | $86.62–$1,289.00 | 38% above | 30% |
| Knee X-ray, complete, 4 or more views CPT 73564 KNEE COMP MIN 4V BIL | $541.80 | $774.00 | $86.62–$1,289.00 | 107% above | 30% |
| Knee X-ray, complete, 4 or more views inpatient CPT 73564 X-RAY EXAM KNEE 4 OR MORE | $360.50 | $515.00 | $86.62–$1,289.00 | — | 30% |
| Knee X-ray, complete, 4 or more views inpatient CPT 73564 KNEE COMP MIN 4V | $360.50 | $515.00 | $86.62–$1,289.00 | — | 30% |
| Knee X-ray, complete, 4 or more views inpatient CPT 73564 KNEE COMP MIN 4V BIL | $541.80 | $774.00 | $86.62–$1,289.00 | — | 30% |
| Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT LOWER EXTREMITY W/O DYE | $1,551.20 | $2,216.00 | $381.26–$2,216.00 | 98% above | 30% |
| Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT LOW EXT WO CON | $1,551.20 | $2,216.00 | $381.26–$2,216.00 | 98% above | 30% |
| Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 CT LOW EXT WO CON | $1,551.20 | $2,216.00 | $381.26–$2,216.00 | — | 30% |
| Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 CT LOWER EXTREMITY W/O DYE | $1,551.20 | $2,216.00 | $381.26–$2,216.00 | — | 30% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US LIVER W/ELASTOGRAPHY | $244.30 | $349.00 | $216.10–$7,431.00 | 47% below | 30% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US LIVER DOPPLER | $702.80 | $1,004.00 | $216.10–$7,431.00 | 54% above | 30% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 UL SPLEEN ONLY | $709.10 | $1,013.00 | $216.10–$7,431.00 | 55% above | 30% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US PANCREAS | $709.10 | $1,013.00 | $216.10–$7,431.00 | 55% above | 30% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABD LTD | $709.10 | $1,013.00 | $216.10–$7,431.00 | 55% above | 30% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 UL LIVER ONLY | $709.10 | $1,013.00 | $216.10–$7,431.00 | 55% above | 30% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US RUQ | $709.10 | $1,013.00 | $216.10–$7,431.00 | 55% above | 30% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 UL GALLBLADDER | $709.10 | $1,013.00 | $216.10–$7,431.00 | 55% above | 30% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ECHO EXAM OF ABDOMEN | $709.10 | $1,013.00 | $216.10–$7,431.00 | 55% above | 30% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US LIVER W/ELASTOGRAPHY | $244.30 | $349.00 | $216.10–$7,431.00 | — | 30% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US LIVER DOPPLER | $702.80 | $1,004.00 | $216.10–$7,431.00 | — | 30% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 UL SPLEEN ONLY | $709.10 | $1,013.00 | $216.10–$7,431.00 | — | 30% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 ECHO EXAM OF ABDOMEN | $709.10 | $1,013.00 | $216.10–$7,431.00 | — | 30% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABD LTD | $709.10 | $1,013.00 | $216.10–$7,431.00 | — | 30% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US RUQ | $709.10 | $1,013.00 | $216.10–$7,431.00 | — | 30% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US PANCREAS | $709.10 | $1,013.00 | $216.10–$7,431.00 | — | 30% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 UL GALLBLADDER | $709.10 | $1,013.00 | $216.10–$7,431.00 | — | 30% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 UL LIVER ONLY | $709.10 | $1,013.00 | $216.10–$7,431.00 | — | 30% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US LMTD JT/FCL EVL NVASC XTR | $462.00 | $660.00 | $29.64–$660.00 | 53% above | 30% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US EXTREMIT NON-VAS | $462.00 | $660.00 | $29.64–$660.00 | 53% above | 30% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US LMTD JT/FCL EVL NVASC XTR | $462.00 | $660.00 | $29.64–$660.00 | — | 30% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US EXTREMIT NON-VAS | $462.00 | $660.00 | $29.64–$660.00 | — | 30% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT THORAX LUNG CANCER SCR C- | $570.50 | $815.00 | $187.45–$815.00 | 200% above | 30% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT LUNG SCREENING | $570.50 | $815.00 | $187.45–$815.00 | 200% above | 30% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT LUNG SCREENING | $570.50 | $815.00 | $187.45–$815.00 | — | 30% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT THORAX LUNG CANCER SCR C- | $570.50 | $815.00 | $187.45–$815.00 | — | 30% |
| Lower leg X-ray (tibia and fibula), 2 views CPT 73590 TIBIA/FIBULA 2VWS | $283.50 | $405.00 | $51.83–$1,014.00 | 43% above | 30% |
| Lower leg X-ray (tibia and fibula), 2 views CPT 73590 X-RAY EXAM OF LOWER LEG | $283.50 | $405.00 | $51.83–$1,014.00 | 43% above | 30% |
| Lower leg X-ray (tibia and fibula), 2 views CPT 73590 TIBIA/FIBULA 2V BILA | $426.30 | $609.00 | $51.83–$1,014.00 | 115% above | 30% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 TIBIA/FIBULA 2VWS | $283.50 | $405.00 | $51.83–$1,014.00 | — | 30% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 X-RAY EXAM OF LOWER LEG | $283.50 | $405.00 | $51.83–$1,014.00 | — | 30% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 TIBIA/FIBULA 2V BILA | $426.30 | $609.00 | $51.83–$1,014.00 | — | 30% |
| MR angiography (MRA) of the head without contrast CPT 70544 MRA HEAD W/O CON | $1,858.50 | $2,655.00 | $610.65–$2,655.00 | 66% above | 30% |
| MR angiography (MRA) of the head without contrast CPT 70544 MR ANGIOGRAPHY HEAD W/O DYE | $1,858.50 | $2,655.00 | $610.65–$2,655.00 | 66% above | 30% |
| MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRA HEAD W/O CON | $1,858.50 | $2,655.00 | $610.65–$2,655.00 | — | 30% |
| MR angiography (MRA) of the head without contrast inpatient CPT 70544 MR ANGIOGRAPHY HEAD W/O DYE | $1,858.50 | $2,655.00 | $610.65–$2,655.00 | — | 30% |
| MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 MRI LOW EXT JT BILAT | $3,630.20 | $5,186.00 | $504.93–$8,642.00 | — | 30% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI LOW EXT JT W/O C | $2,419.20 | $3,456.00 | $504.93–$8,642.00 | 135% above | 30% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI JNT OF LWR EXTRE W/O DYE | $2,419.20 | $3,456.00 | $504.93–$8,642.00 | 135% above | 30% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient both sides CPT 73721 MRI LOW EXT JT BILAT | $3,630.20 | $5,186.00 | $504.93–$8,642.00 | — | 30% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI JNT OF LWR EXTRE W/O DYE | $2,419.20 | $3,456.00 | $504.93–$8,642.00 | — | 30% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI LOW EXT JT W/O C | $2,419.20 | $3,456.00 | $504.93–$8,642.00 | — | 30% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI LOW EXT JT W/W/O | $2,808.40 | $4,012.00 | $922.76–$4,012.00 | 94% above | 30% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI JOINT LWR EXTR W/O&W/DYE | $2,808.40 | $4,012.00 | $922.76–$4,012.00 | 94% above | 30% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI LOW EXT JT W/W/O | $2,808.40 | $4,012.00 | $922.76–$4,012.00 | — | 30% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI JOINT LWR EXTR W/O&W/DYE | $2,808.40 | $4,012.00 | $922.76–$4,012.00 | — | 30% |
| MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN W/O CON | $2,419.20 | $3,456.00 | $717.48–$3,456.00 | 126% above | 30% |
| MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN W/O CONTRAST | $2,419.20 | $3,456.00 | $717.48–$3,456.00 | 126% above | 30% |
| MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN W/O CON | $2,419.20 | $3,456.00 | $717.48–$3,456.00 | — | 30% |
| MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN W/O CONTRAST | $2,419.20 | $3,456.00 | $717.48–$3,456.00 | — | 30% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABD W/O CNTR FLWD CNTR | $2,816.80 | $4,024.00 | $925.52–$4,024.00 | 78% above | 30% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN W/W/O CO | $2,816.80 | $4,024.00 | $925.52–$4,024.00 | 78% above | 30% |
| MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABD W/O CNTR FLWD CNTR | $2,816.80 | $4,024.00 | $925.52–$4,024.00 | — | 30% |
| MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABDOMEN W/W/O CO | $2,816.80 | $4,024.00 | $925.52–$4,024.00 | — | 30% |
| MRI of the brain, no contrast dye CPT 70551 MRI BRAIN/IAC NO CONT | $1,839.60 | $2,628.00 | $464.37–$2,628.00 | 81% above | 30% |
| MRI of the brain, no contrast dye CPT 70551 MRI BRAIN STEM W/O DYE | $1,839.60 | $2,628.00 | $464.37–$2,628.00 | 81% above | 30% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN/IAC NO CONT | $1,839.60 | $2,628.00 | $464.37–$2,628.00 | — | 30% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN STEM W/O DYE | $1,839.60 | $2,628.00 | $464.37–$2,628.00 | — | 30% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN/IAC W/WO | $2,998.10 | $4,283.00 | $756.13–$4,283.00 | 129% above | 30% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN STEM W/O & W/DYE | $2,998.10 | $4,283.00 | $756.13–$4,283.00 | 129% above | 30% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN STEM W/O & W/DYE | $2,998.10 | $4,283.00 | $756.13–$4,283.00 | — | 30% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN/IAC W/WO | $2,998.10 | $4,283.00 | $756.13–$4,283.00 | — | 30% |
| MRI of the lower back, no contrast dye CPT 72148 MR LUMBA-SP W/O CON | $1,839.60 | $2,628.00 | $457.59–$2,628.00 | 81% above | 30% |
| MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR SPINE W/O DYE | $1,839.60 | $2,628.00 | $457.59–$2,628.00 | 81% above | 30% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MRI LUMBAR SPINE W/O DYE | $1,839.60 | $2,628.00 | $457.59–$2,628.00 | — | 30% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MR LUMBA-SP W/O CON | $1,839.60 | $2,628.00 | $457.59–$2,628.00 | — | 30% |
| MRI of the lower back, without and then with contrast dye CPT 72158 MR LUM-SP W/W/O CON | $2,998.10 | $4,283.00 | $752.27–$4,283.00 | 105% above | 30% |
| MRI of the lower back, without and then with contrast dye CPT 72158 MRI LUMBAR SPINE W/O & W/DYE | $2,998.10 | $4,283.00 | $752.27–$4,283.00 | 105% above | 30% |
| MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MR LUM-SP W/W/O CON | $2,998.10 | $4,283.00 | $752.27–$4,283.00 | — | 30% |
| MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI LUMBAR SPINE W/O & W/DYE | $2,998.10 | $4,283.00 | $752.27–$4,283.00 | — | 30% |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI CHEST SPINE W/O DYE | $1,839.60 | $2,628.00 | $457.59–$2,628.00 | 83% above | 30% |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MR THORA-SP W/O CON | $1,839.60 | $2,628.00 | $457.59–$2,628.00 | 83% above | 30% |
| MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MR THORA-SP W/O CON | $1,839.60 | $2,628.00 | $457.59–$2,628.00 | — | 30% |
| MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI CHEST SPINE W/O DYE | $1,839.60 | $2,628.00 | $457.59–$2,628.00 | — | 30% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 MR CERV-SP W/W/O CON | $2,998.10 | $4,283.00 | $757.11–$4,283.00 | 105% above | 30% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI NECK SPINE W/O & W/DYE | $2,998.10 | $4,283.00 | $757.11–$4,283.00 | 105% above | 30% |
| MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MR CERV-SP W/W/O CON | $2,998.10 | $4,283.00 | $757.11–$4,283.00 | — | 30% |
| MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI NECK SPINE W/O & W/DYE | $2,998.10 | $4,283.00 | $757.11–$4,283.00 | — | 30% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI NECK SPINE W/O DYE | $1,839.60 | $2,628.00 | $457.59–$2,628.00 | 77% above | 30% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI CERV SPINE W/O C | $1,839.60 | $2,628.00 | $457.59–$2,628.00 | 77% above | 30% |
| MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI CERV SPINE W/O C | $1,839.60 | $2,628.00 | $457.59–$2,628.00 | — | 30% |
| MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI NECK SPINE W/O DYE | $1,839.60 | $2,628.00 | $457.59–$2,628.00 | — | 30% |
| MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS W/W/O CON | $2,198.70 | $3,141.00 | $722.43–$3,141.00 | 51% above | 30% |
| MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS W/O & W/DYE | $2,198.70 | $3,141.00 | $722.43–$3,141.00 | 51% above | 30% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS W/O & W/DYE | $2,198.70 | $3,141.00 | $722.43–$3,141.00 | — | 30% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS W/W/O CON | $2,198.70 | $3,141.00 | $722.43–$3,141.00 | — | 30% |
| MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS W/O CON | $1,684.20 | $2,406.00 | $553.38–$2,406.00 | 60% above | 30% |
| MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS W/O DYE | $1,684.20 | $2,406.00 | $553.38–$2,406.00 | 60% above | 30% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS W/O DYE | $1,684.20 | $2,406.00 | $553.38–$2,406.00 | — | 30% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS W/O CON | $1,684.20 | $2,406.00 | $553.38–$2,406.00 | — | 30% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI JOINT UPR EXTREM W/O DYE | $2,419.20 | $3,456.00 | $503.96–$3,456.00 | 127% above | 30% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI UP EXT JT W/O CO | $2,419.20 | $3,456.00 | $503.96–$3,456.00 | 127% above | 30% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MRI UP EXT JT W/O CO | $2,419.20 | $3,456.00 | $503.96–$3,456.00 | — | 30% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MRI JOINT UPR EXTREM W/O DYE | $2,419.20 | $3,456.00 | $503.96–$3,456.00 | — | 30% |
| Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 C-SPINE 4-5 VW | $413.00 | $590.00 | $89.51–$590.00 | 19% above | 30% |
| Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 X-RAY EXAM NECK SPINE 4/5VWS | $413.00 | $590.00 | $89.51–$590.00 | 19% above | 30% |
| Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 C-SPINE 4-5 VW | $413.00 | $590.00 | $89.51–$590.00 | — | 30% |
| Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 X-RAY EXAM NECK SPINE 4/5VWS | $413.00 | $590.00 | $89.51–$590.00 | — | 30% |
| Neck soft tissue CT scan with contrast CPT 70491 CT ST NECK W C | $1,677.90 | $2,397.00 | $478.84–$2,397.00 | 71% above | 30% |
| Neck soft tissue CT scan with contrast CPT 70491 CT SOFT TISSUE NECK W/DYE | $1,677.90 | $2,397.00 | $478.84–$2,397.00 | 71% above | 30% |
| Neck soft tissue CT scan with contrast inpatient CPT 70491 CT ST NECK W C | $1,677.90 | $2,397.00 | $478.84–$2,397.00 | — | 30% |
| Neck soft tissue CT scan with contrast inpatient CPT 70491 CT SOFT TISSUE NECK W/DYE | $1,677.90 | $2,397.00 | $478.84–$2,397.00 | — | 30% |
| Neck soft tissue CT scan without contrast CPT 70490 CT ST NECK WO | $1,381.10 | $1,973.00 | $381.26–$1,973.00 | 66% above | 30% |
| Neck soft tissue CT scan without contrast CPT 70490 CT SOFT TISSUE NECK W/O DYE | $1,381.10 | $1,973.00 | $381.26–$1,973.00 | 66% above | 30% |
| Neck soft tissue CT scan without contrast inpatient CPT 70490 CT SOFT TISSUE NECK W/O DYE | $1,381.10 | $1,973.00 | $381.26–$1,973.00 | — | 30% |
| Neck soft tissue CT scan without contrast inpatient CPT 70490 CT ST NECK WO | $1,381.10 | $1,973.00 | $381.26–$1,973.00 | — | 30% |
| Neck soft tissue X-ray CPT 70360 X-RAY EXAM OF NECK | $304.50 | $435.00 | $56.67–$435.00 | 76% above | 30% |
| Neck soft tissue X-ray CPT 70360 SOFTTISSUE NECK | $304.50 | $435.00 | $56.67–$435.00 | 76% above | 30% |
| Neck soft tissue X-ray inpatient CPT 70360 SOFTTISSUE NECK | $304.50 | $435.00 | $56.67–$435.00 | — | 30% |
| Neck soft tissue X-ray inpatient CPT 70360 X-RAY EXAM OF NECK | $304.50 | $435.00 | $56.67–$435.00 | — | 30% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HT MUSCLE IMAGE SPECT MULT | $3,989.30 | $5,699.00 | $1,095.24–$5,699.00 | 4% above | 30% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 MYOCARDIAL SPECT MUL | $3,989.30 | $5,699.00 | $1,095.24–$5,699.00 | 4% above | 30% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 MYOCARDIAL SPECT MUL | $3,989.30 | $5,699.00 | $1,095.24–$5,699.00 | — | 30% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HT MUSCLE IMAGE SPECT MULT | $3,989.30 | $5,699.00 | $1,095.24–$5,699.00 | — | 30% |
| PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET IMAGE W/CT SKULL-THIGH | $4,333.00 | $6,190.00 | $1,423.70–$6,190.00 | 7% above | 30% |
| PET/CT scan from the base of the skull to mid-thigh CPT 78815 MN PET IMG W/CT SKULL BS MID | $4,333.00 | $6,190.00 | $1,423.70–$6,190.00 | 7% above | 30% |
| PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 MN PET IMG W/CT SKULL BS MID | $4,333.00 | $6,190.00 | $1,423.70–$6,190.00 | — | 30% |
| PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET IMAGE W/CT SKULL-THIGH | $4,333.00 | $6,190.00 | $1,423.70–$6,190.00 | — | 30% |
| Pelvic CT scan without contrast CPT 72192 CT PELVIS W/O DYE | $1,124.90 | $1,607.00 | $262.47–$1,607.00 | 35% above | 30% |
| Pelvic CT scan without contrast CPT 72192 CT PELVIS WO CO | $1,124.90 | $1,607.00 | $262.47–$1,607.00 | 35% above | 30% |
| Pelvic CT scan without contrast inpatient CPT 72192 CT PELVIS WO CO | $1,124.90 | $1,607.00 | $262.47–$1,607.00 | — | 30% |
| Pelvic CT scan without contrast inpatient CPT 72192 CT PELVIS W/O DYE | $1,124.90 | $1,607.00 | $262.47–$1,607.00 | — | 30% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US EXAM PELVIC LIMITED | $476.70 | $681.00 | $94.34–$681.00 | 34% above | 30% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIS LMT OR FOL | $476.70 | $681.00 | $94.34–$681.00 | 34% above | 30% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIS LMT OR FOL | $476.70 | $681.00 | $94.34–$681.00 | — | 30% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US EXAM PELVIC LIMITED | $476.70 | $681.00 | $94.34–$681.00 | — | 30% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 UL PELVIC NONOB COMP | $676.20 | $966.00 | $222.18–$966.00 | 46% above | 30% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US EXAM PELVIC COMPLETE | $676.20 | $966.00 | $222.18–$966.00 | 46% above | 30% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US EXAM PELVIC COMPLETE | $676.20 | $966.00 | $222.18–$966.00 | — | 30% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 UL PELVIC NONOB COMP | $676.20 | $966.00 | $222.18–$966.00 | — | 30% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OB US >/= 14 WKS SNGL FETUS | $702.80 | $1,004.00 | $230.92–$1,004.00 | 27% above | 30% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US PREG UTERUS COMP | $702.80 | $1,004.00 | $230.92–$1,004.00 | 27% above | 30% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 OB US >/= 14 WKS SNGL FETUS | $702.80 | $1,004.00 | $230.92–$1,004.00 | — | 30% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US PREG UTERUS COMP | $702.80 | $1,004.00 | $230.92–$1,004.00 | — | 30% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB <14 WKS | $258.30 | $369.00 | $84.87–$369.00 | 50% below | 30% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 OB US < 14 WKS SINGLE FETUS | $258.30 | $369.00 | $84.87–$369.00 | 50% below | 30% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OB <14 WKS | $258.30 | $369.00 | $84.87–$369.00 | — | 30% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 OB US < 14 WKS SINGLE FETUS | $258.30 | $369.00 | $84.87–$369.00 | — | 30% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 OB US LIMITED FETUS(S) | $406.70 | $581.00 | $133.63–$581.00 | 7% above | 30% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB LIMITED | $406.70 | $581.00 | $133.63–$581.00 | 7% above | 30% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 OB US LIMITED FETUS(S) | $406.70 | $581.00 | $133.63–$581.00 | — | 30% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB LIMITED | $406.70 | $581.00 | $133.63–$581.00 | — | 30% |
| Rib X-ray, one side, 2 views CPT 71100 X-RAY EXAM RIBS UNI 2 VIEWS | $334.60 | $478.00 | $59.59–$478.00 | 64% above | 30% |
| Rib X-ray, one side, 2 views one side CPT 71100 RIBS UNILAT 2VIEWS | $334.60 | $478.00 | $59.59–$478.00 | 64% above | 30% |
| Rib X-ray, one side, 2 views inpatient CPT 71100 X-RAY EXAM RIBS UNI 2 VIEWS | $334.60 | $478.00 | $59.59–$478.00 | — | 30% |
| Rib X-ray, one side, 2 views inpatient one side CPT 71100 RIBS UNILAT 2VIEWS | $334.60 | $478.00 | $59.59–$478.00 | — | 30% |
| Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 RIBS UNI MIN3V W/PA | $360.50 | $515.00 | $73.09–$515.00 | 48% above | 30% |
| Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 X-RAY EXAM UNILAT RIBS/CHEST | $360.50 | $515.00 | $73.09–$515.00 | 48% above | 30% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient CPT 71101 RIBS UNI MIN3V W/PA | $360.50 | $515.00 | $73.09–$515.00 | — | 30% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 X-RAY EXAM UNILAT RIBS/CHEST | $360.50 | $515.00 | $73.09–$515.00 | — | 30% |
| Screening mammogram, both breasts both sides CPT 77067 SCR MAMMO BI INCL CAD | $568.40 | $812.00 | $83.48–$1,180.00 | — | 30% |
| Screening mammogram, both breasts both sides CPT 77067 SCR MAMMO INCL CAD;BILATERAL | $568.40 | $812.00 | $83.48–$1,180.00 | — | 30% |
| Screening mammogram, both breasts CPT 77067 MAMMO OCT SPECIAL DIGITAL | $257.60 | $368.00 | $83.48–$1,180.00 | 3% above | 30% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 SCR MAMMO BI INCL CAD | $568.40 | $812.00 | $83.48–$1,180.00 | — | 30% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 SCR MAMMO INCL CAD;BILATERAL | $568.40 | $812.00 | $83.48–$1,180.00 | — | 30% |
| Screening mammogram, both breasts inpatient CPT 77067 MAMMO OCT SPECIAL DIGITAL | $257.60 | $368.00 | $83.48–$1,180.00 | — | 30% |
| Shoulder X-ray, complete, 2 or more views both sides CPT 73030 SHOULDER COMP M2V BI | $426.30 | $609.00 | $57.64–$1,014.00 | — | 30% |
| Shoulder X-ray, complete, 2 or more views CPT 73030 X-RAY EXAM OF SHOULDER | $283.50 | $405.00 | $57.64–$1,014.00 | 36% above | 30% |
| Shoulder X-ray, complete, 2 or more views CPT 73030 SHOULDER 2-3VW | $283.50 | $405.00 | $57.64–$1,014.00 | 36% above | 30% |
| Shoulder X-ray, complete, 2 or more views inpatient both sides CPT 73030 SHOULDER COMP M2V BI | $426.30 | $609.00 | $57.64–$1,014.00 | — | 30% |
| Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 SHOULDER 2-3VW | $283.50 | $405.00 | $57.64–$1,014.00 | — | 30% |
| Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 X-RAY EXAM OF SHOULDER | $283.50 | $405.00 | $57.64–$1,014.00 | — | 30% |
| Sinus X-ray, complete, 3 or more views CPT 70220 SINUS PARANASAL MIN3 | $410.20 | $586.00 | $72.15–$586.00 | 45% above | 30% |
| Sinus X-ray, complete, 3 or more views CPT 70220 X-RAY EXAM OF SINUSES | $410.20 | $586.00 | $72.15–$586.00 | 45% above | 30% |
| Sinus X-ray, complete, 3 or more views inpatient CPT 70220 SINUS PARANASAL MIN3 | $410.20 | $586.00 | $72.15–$586.00 | — | 30% |
| Sinus X-ray, complete, 3 or more views inpatient CPT 70220 X-RAY EXAM OF SINUSES | $410.20 | $586.00 | $72.15–$586.00 | — | 30% |
| Skull X-ray, fewer than 4 views CPT 70250 SKULL <4V | $364.00 | $520.00 | $68.29–$520.00 | 56% above | 30% |
| Skull X-ray, fewer than 4 views CPT 70250 X-RAY EXAM OF SKULL | $364.00 | $520.00 | $68.29–$520.00 | 56% above | 30% |
| Skull X-ray, fewer than 4 views inpatient CPT 70250 SKULL <4V | $364.00 | $520.00 | $68.29–$520.00 | — | 30% |
| Skull X-ray, fewer than 4 views inpatient CPT 70250 X-RAY EXAM OF SKULL | $364.00 | $520.00 | $68.29–$520.00 | — | 30% |
| Sleep study in a lab (polysomnography) CPT 95810 POLYS 6 HRS+4> PARAM REDUCED | $2,102.10 | $3,003.00 | $1,857.71–$8,077.00 | 20% below | 30% |
| Sleep study in a lab (polysomnography) CPT 95810 POLSY 6YRS, 4 OR > PARAM | $3,551.80 | $5,074.00 | $1,857.71–$8,077.00 | 35% above | 30% |
| Sleep study in a lab (polysomnography) CPT 95810 POLYSOM 6/> YRS 4/> PARAM | $3,551.80 | $5,074.00 | $1,857.71–$8,077.00 | 35% above | 30% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 POLYS 6 HRS+4> PARAM REDUCED | $2,102.10 | $3,003.00 | $1,857.71–$8,077.00 | — | 30% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 POLSY 6YRS, 4 OR > PARAM | $3,551.80 | $5,074.00 | $1,857.71–$8,077.00 | — | 30% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 POLYSOM 6/> YRS 4/> PARAM | $3,551.80 | $5,074.00 | $1,857.71–$8,077.00 | — | 30% |
| Swallow study (modified barium swallow, video X-ray) CPT 74230 X-RAY XM SWLNG FUNCJ C+ | $221.20 | $316.00 | $72.68–$316.00 | 39% below | 30% |
| Swallow study (modified barium swallow, video X-ray) CPT 74230 MODIFIED BA SWALLOW | $221.20 | $316.00 | $72.68–$316.00 | 39% below | 30% |
| Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 X-RAY XM SWLNG FUNCJ C+ | $221.20 | $316.00 | $72.68–$316.00 | — | 30% |
| Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 MODIFIED BA SWALLOW | $221.20 | $316.00 | $72.68–$316.00 | — | 30% |
| Thigh bone (femur) X-ray, 2 or more views both sides CPT 73552 FEMUR 2VWS BILAT | $426.30 | $609.00 | $61.50–$1,014.00 | — | 30% |
| Thigh bone (femur) X-ray, 2 or more views CPT 73552 X-RAY EXAM OF FEMUR 2/> | $283.50 | $405.00 | $61.50–$1,014.00 | 41% above | 30% |
| Thigh bone (femur) X-ray, 2 or more views CPT 73552 FEMUR 2VWS | $283.50 | $405.00 | $61.50–$1,014.00 | 41% above | 30% |
| Thigh bone (femur) X-ray, 2 or more views inpatient both sides CPT 73552 FEMUR 2VWS BILAT | $426.30 | $609.00 | $61.50–$1,014.00 | — | 30% |
| Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 X-RAY EXAM OF FEMUR 2/> | $283.50 | $405.00 | $61.50–$1,014.00 | — | 30% |
| Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 FEMUR 2VWS | $283.50 | $405.00 | $61.50–$1,014.00 | — | 30% |
| Thoracic spine (mid back) CT scan without contrast CPT 72128 CT T-SP WO CONT | $1,426.60 | $2,038.00 | $384.19–$2,038.00 | 68% above | 30% |
| Thoracic spine (mid back) CT scan without contrast CPT 72128 CT CHEST SPINE W/O DYE | $1,426.60 | $2,038.00 | $384.19–$2,038.00 | 68% above | 30% |
| Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT CHEST SPINE W/O DYE | $1,426.60 | $2,038.00 | $384.19–$2,038.00 | — | 30% |
| Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT T-SP WO CONT | $1,426.60 | $2,038.00 | $384.19–$2,038.00 | — | 30% |
| Toe X-ray, 2 or more views CPT 73660 TOE(S) MIN 2V | $221.90 | $317.00 | $65.36–$317.00 | 45% above | 30% |
| Toe X-ray, 2 or more views CPT 73660 X-RAY EXAM OF TOE(S) | $221.90 | $317.00 | $65.36–$317.00 | 45% above | 30% |
| Toe X-ray, 2 or more views inpatient CPT 73660 TOE(S) MIN 2V | $221.90 | $317.00 | $65.36–$317.00 | — | 30% |
| Toe X-ray, 2 or more views inpatient CPT 73660 X-RAY EXAM OF TOE(S) | $221.90 | $317.00 | $65.36–$317.00 | — | 30% |
| Transvaginal pelvic ultrasound CPT 76830 UL TRANSVAG NON-OB | $421.40 | $602.00 | $138.46–$602.00 | 4% above | 30% |
| Transvaginal pelvic ultrasound CPT 76830 TRANSVAGINAL US NON-OB | $421.40 | $602.00 | $138.46–$602.00 | 4% above | 30% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 UL TRANSVAG NON-OB | $421.40 | $602.00 | $138.46–$602.00 | — | 30% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 TRANSVAGINAL US NON-OB | $421.40 | $602.00 | $138.46–$602.00 | — | 30% |
| Transvaginal ultrasound during pregnancy CPT 76817 TRANSVAGINAL US OBSTETRIC | $421.40 | $602.00 | $138.46–$602.00 | 14% above | 30% |
| Transvaginal ultrasound during pregnancy CPT 76817 US TRANSVAGINAL OB | $421.40 | $602.00 | $138.46–$602.00 | 14% above | 30% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 TRANSVAGINAL US OBSTETRIC | $421.40 | $602.00 | $138.46–$602.00 | — | 30% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 US TRANSVAGINAL OB | $421.40 | $602.00 | $138.46–$602.00 | — | 30% |
| Ultrasound of the abdomen, complete CPT 76700 US EXAM ABDOM COMPLETE | $788.90 | $1,127.00 | $259.21–$1,127.00 | 51% above | 30% |
| Ultrasound of the abdomen, complete CPT 76700 US ABD COMPLETE | $788.90 | $1,127.00 | $259.21–$1,127.00 | 51% above | 30% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US EXAM ABDOM COMPLETE | $788.90 | $1,127.00 | $259.21–$1,127.00 | — | 30% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US ABD COMPLETE | $788.90 | $1,127.00 | $259.21–$1,127.00 | — | 30% |
| Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM & CONTENT | $639.80 | $914.00 | $113.69–$914.00 | 51% above | 30% |
| Ultrasound of the scrotum and testicles CPT 76870 US EXAM SCROTUM | $639.80 | $914.00 | $113.69–$914.00 | 51% above | 30% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM & CONTENT | $639.80 | $914.00 | $113.69–$914.00 | — | 30% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 US EXAM SCROTUM | $639.80 | $914.00 | $113.69–$914.00 | — | 30% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US EXAM OF HEAD AND NECK | $639.80 | $914.00 | $210.22–$914.00 | 50% above | 30% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US SOFT TISS HD/NECK | $639.80 | $914.00 | $210.22–$914.00 | 50% above | 30% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US EXAM OF HEAD AND NECK | $639.80 | $914.00 | $210.22–$914.00 | — | 30% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US SOFT TISS HD/NECK | $639.80 | $914.00 | $210.22–$914.00 | — | 30% |
| Upper arm X-ray (humerus), 2 views both sides CPT 73060 HUMERUS MIN 2V BILAT | $387.10 | $553.00 | $55.69–$920.00 | — | 30% |
| Upper arm X-ray (humerus), 2 views CPT 73060 HUMERUS MIN2V | $256.90 | $367.00 | $55.69–$920.00 | 34% above | 30% |
| Upper arm X-ray (humerus), 2 views CPT 73060 X-RAY EXAM OF HUMERUS | $256.90 | $367.00 | $55.69–$920.00 | 34% above | 30% |
| Upper arm X-ray (humerus), 2 views inpatient both sides CPT 73060 HUMERUS MIN 2V BILAT | $387.10 | $553.00 | $55.69–$920.00 | — | 30% |
| Upper arm X-ray (humerus), 2 views inpatient CPT 73060 X-RAY EXAM OF HUMERUS | $256.90 | $367.00 | $55.69–$920.00 | — | 30% |
| Upper arm X-ray (humerus), 2 views inpatient CPT 73060 HUMERUS MIN2V | $256.90 | $367.00 | $55.69–$920.00 | — | 30% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 US EXTR VEINS UNIL/L | $654.50 | $935.00 | $440.68–$1,916.00 | 3% above | 30% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 LOW EXT UNI DVT93971 | $686.70 | $981.00 | $440.68–$1,916.00 | 8% above | 30% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 EXTREMITY STUDY | $686.70 | $981.00 | $440.68–$1,916.00 | 8% above | 30% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 US EXTR VEINS UNIL/L | $654.50 | $935.00 | $440.68–$1,916.00 | — | 30% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 EXTREMITY STUDY | $686.70 | $981.00 | $440.68–$1,916.00 | — | 30% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 LOW EXT UNI DVT93971 | $686.70 | $981.00 | $440.68–$1,916.00 | — | 30% |
| Wrist X-ray, 2 views both sides CPT 73100 WRIST 2VWS BILAT | $333.90 | $477.00 | $61.50–$794.00 | — | 30% |
| Wrist X-ray, 2 views CPT 73100 X-RAY EXAM OF WRIST | $221.90 | $317.00 | $61.50–$794.00 | 42% above | 30% |
| Wrist X-ray, 2 views CPT 73100 WRIST <3 VWS | $221.90 | $317.00 | $61.50–$794.00 | 42% above | 30% |
| Wrist X-ray, 2 views inpatient both sides CPT 73100 WRIST 2VWS BILAT | $333.90 | $477.00 | $61.50–$794.00 | — | 30% |
| Wrist X-ray, 2 views inpatient CPT 73100 WRIST <3 VWS | $221.90 | $317.00 | $61.50–$794.00 | — | 30% |
| Wrist X-ray, 2 views inpatient CPT 73100 X-RAY EXAM OF WRIST | $221.90 | $317.00 | $61.50–$794.00 | — | 30% |
| Wrist X-ray, complete, 3 or more views both sides CPT 73110 WRIST COMP MIN3VW BI | $619.50 | $885.00 | $79.87–$1,249.00 | — | 30% |
| Wrist X-ray, complete, 3 or more views CPT 73110 X-RAY EXAM OF WRIST | $254.80 | $364.00 | $79.87–$1,249.00 | at median | 30% |
| Wrist X-ray, complete, 3 or more views CPT 73110 WRIST COMP MIN 3VWS | $254.80 | $364.00 | $79.87–$1,249.00 | at median | 30% |
| Wrist X-ray, complete, 3 or more views inpatient both sides CPT 73110 WRIST COMP MIN3VW BI | $619.50 | $885.00 | $79.87–$1,249.00 | — | 30% |
| Wrist X-ray, complete, 3 or more views inpatient CPT 73110 X-RAY EXAM OF WRIST | $254.80 | $364.00 | $79.87–$1,249.00 | — | 30% |
| Wrist X-ray, complete, 3 or more views inpatient CPT 73110 WRIST COMP MIN 3VWS | $254.80 | $364.00 | $79.87–$1,249.00 | — | 30% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 HIP AP/LAT | $336.70 | $481.00 | $80.85–$1,201.00 | 27% above | 30% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 X-RAY EXAM HIP UNI 2-3 VIEWS | $336.70 | $481.00 | $80.85–$1,201.00 | 27% above | 30% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 PELVIS/HIPS INF/CHIL | $504.00 | $720.00 | $80.85–$1,201.00 | 90% above | 30% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 HIP AP/LAT | $336.70 | $481.00 | $80.85–$1,201.00 | — | 30% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 X-RAY EXAM HIP UNI 2-3 VIEWS | $336.70 | $481.00 | $80.85–$1,201.00 | — | 30% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 PELVIS/HIPS INF/CHIL | $504.00 | $720.00 | $80.85–$1,201.00 | — | 30% |
| X-ray of the abdomen, 1 view CPT 74018 ABD SINGLE AP VIEW | $238.00 | $340.00 | $78.20–$340.00 | 10% above | 30% |
| X-ray of the abdomen, 1 view CPT 74018 RADEX ABDOMEN 1 VIEW | $238.00 | $340.00 | $78.20–$340.00 | 10% above | 30% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 RADEX ABDOMEN 1 VIEW | $238.00 | $340.00 | $78.20–$340.00 | — | 30% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 ABD SINGLE AP VIEW | $238.00 | $340.00 | $78.20–$340.00 | — | 30% |
| X-ray of the ankle, 2 views both sides CPT 73600 ANKLE 2VWS BILAT | $333.90 | $477.00 | $55.69–$794.00 | — | 30% |
| X-ray of the ankle, 2 views CPT 73600 ANKLE AP/LAT | $221.90 | $317.00 | $55.69–$794.00 | 39% above | 30% |
| X-ray of the ankle, 2 views CPT 73600 X-RAY EXAM OF ANKLE | $221.90 | $317.00 | $55.69–$794.00 | 39% above | 30% |
| X-ray of the ankle, 2 views inpatient both sides CPT 73600 ANKLE 2VWS BILAT | $333.90 | $477.00 | $55.69–$794.00 | — | 30% |
| X-ray of the ankle, 2 views inpatient CPT 73600 X-RAY EXAM OF ANKLE | $221.90 | $317.00 | $55.69–$794.00 | — | 30% |
| X-ray of the ankle, 2 views inpatient CPT 73600 ANKLE AP/LAT | $221.90 | $317.00 | $55.69–$794.00 | — | 30% |
| X-ray of the finger(s), 2 or more views CPT 73140 X-RAY EXAM OF FINGER(S) | $237.30 | $339.00 | $72.15–$339.00 | 49% above | 30% |
| X-ray of the finger(s), 2 or more views CPT 73140 FINGER(S) MIN 2VWS | $237.30 | $339.00 | $72.15–$339.00 | 49% above | 30% |
| X-ray of the finger(s), 2 or more views inpatient CPT 73140 X-RAY EXAM OF FINGER(S) | $237.30 | $339.00 | $72.15–$339.00 | — | 30% |
| X-ray of the finger(s), 2 or more views inpatient CPT 73140 FINGER(S) MIN 2VWS | $237.30 | $339.00 | $72.15–$339.00 | — | 30% |
| X-ray of the foot, 2 views both sides CPT 73620 FOOT AP/LAT BILAT | $333.90 | $477.00 | $53.78–$794.00 | — | 30% |
| X-ray of the foot, 2 views CPT 73620 X-RAY EXAM OF FOOT | $221.90 | $317.00 | $53.78–$794.00 | 36% above | 30% |
| X-ray of the foot, 2 views CPT 73620 FOOT AP/LAT | $221.90 | $317.00 | $53.78–$794.00 | 36% above | 30% |
| X-ray of the foot, 2 views inpatient both sides CPT 73620 FOOT AP/LAT BILAT | $333.90 | $477.00 | $53.78–$794.00 | — | 30% |
| X-ray of the foot, 2 views inpatient CPT 73620 X-RAY EXAM OF FOOT | $221.90 | $317.00 | $53.78–$794.00 | — | 30% |
| X-ray of the foot, 2 views inpatient CPT 73620 FOOT AP/LAT | $221.90 | $317.00 | $53.78–$794.00 | — | 30% |
| X-ray of the foot, complete, 3 or more views both sides CPT 73630 FT COMP MIN 3V BILAT | $426.30 | $609.00 | $63.45–$1,014.00 | — | 30% |
| X-ray of the foot, complete, 3 or more views CPT 73630 X-RAY EXAM OF FOOT | $283.50 | $405.00 | $63.45–$1,014.00 | 41% above | 30% |
| X-ray of the foot, complete, 3 or more views CPT 73630 FOOT COMP MIN 3 VWS | $283.50 | $405.00 | $63.45–$1,014.00 | 41% above | 30% |
| X-ray of the foot, complete, 3 or more views inpatient both sides CPT 73630 FT COMP MIN 3V BILAT | $426.30 | $609.00 | $63.45–$1,014.00 | — | 30% |
| X-ray of the foot, complete, 3 or more views inpatient CPT 73630 FOOT COMP MIN 3 VWS | $283.50 | $405.00 | $63.45–$1,014.00 | — | 30% |
| X-ray of the foot, complete, 3 or more views inpatient CPT 73630 X-RAY EXAM OF FOOT | $283.50 | $405.00 | $63.45–$1,014.00 | — | 30% |
| X-ray of the hand, 3 or more views both sides CPT 73130 HAND MIN 3VWS BILAT | $373.10 | $533.00 | $66.34–$889.00 | — | 30% |
| X-ray of the hand, 3 or more views CPT 73130 X-RAY EXAM OF HAND | $249.20 | $356.00 | $66.34–$889.00 | 24% above | 30% |
| X-ray of the hand, 3 or more views CPT 73130 HAND MIN 3 VIEWS | $249.20 | $356.00 | $66.34–$889.00 | 24% above | 30% |
| X-ray of the hand, 3 or more views inpatient both sides CPT 73130 HAND MIN 3VWS BILAT | $373.10 | $533.00 | $66.34–$889.00 | — | 30% |
| X-ray of the hand, 3 or more views inpatient CPT 73130 X-RAY EXAM OF HAND | $249.20 | $356.00 | $66.34–$889.00 | — | 30% |
| X-ray of the hand, 3 or more views inpatient CPT 73130 HAND MIN 3 VIEWS | $249.20 | $356.00 | $66.34–$889.00 | — | 30% |
| X-ray of the knee, 1 or 2 views both sides CPT 73560 KNEE 1-2 VWS BILAT | $426.30 | $609.00 | $58.62–$1,014.00 | — | 30% |
| X-ray of the knee, 1 or 2 views CPT 73560 KNEE 1-2 VWS | $283.50 | $405.00 | $58.62–$1,014.00 | 36% above | 30% |
| X-ray of the knee, 1 or 2 views CPT 73560 X-RAY EXAM OF KNEE 1 OR 2 | $283.50 | $405.00 | $58.62–$1,014.00 | 36% above | 30% |
| X-ray of the knee, 1 or 2 views inpatient both sides CPT 73560 KNEE 1-2 VWS BILAT | $426.30 | $609.00 | $58.62–$1,014.00 | — | 30% |
| X-ray of the knee, 1 or 2 views inpatient CPT 73560 X-RAY EXAM OF KNEE 1 OR 2 | $283.50 | $405.00 | $58.62–$1,014.00 | — | 30% |
| X-ray of the knee, 1 or 2 views inpatient CPT 73560 KNEE 1-2 VWS | $283.50 | $405.00 | $58.62–$1,014.00 | — | 30% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 X-RAY EXAM L-S SPINE 2/3 VWS | $334.60 | $478.00 | $66.34–$478.00 | 33% above | 30% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 SPINE LUMBAR 2 OR 3 VIEWS | $334.60 | $478.00 | $66.34–$478.00 | 33% above | 30% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 X-RAY EXAM L-S SPINE 2/3 VWS | $334.60 | $478.00 | $66.34–$478.00 | — | 30% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 SPINE LUMBAR 2 OR 3 VIEWS | $334.60 | $478.00 | $66.34–$478.00 | — | 30% |
| X-ray of the lower back, 4 or more views CPT 72110 SPINE LUMBAR 4 VIEWS | $410.20 | $586.00 | $91.46–$586.00 | 18% above | 30% |
| X-ray of the lower back, 4 or more views CPT 72110 X-RAY EXAM L-2 SPINE 4/>VWS | $410.20 | $586.00 | $91.46–$586.00 | 18% above | 30% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 X-RAY EXAM L-2 SPINE 4/>VWS | $410.20 | $586.00 | $91.46–$586.00 | — | 30% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 SPINE LUMBAR 4 VIEWS | $410.20 | $586.00 | $91.46–$586.00 | — | 30% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 X-RAY EXAM THORAC SPINE 2VWS | $91.00 | $130.00 | $29.90–$130.00 | 61% below | 30% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 XR THORACIC SP 2 VWS | $91.00 | $130.00 | $29.90–$130.00 | 61% below | 30% |
| X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 XR THORACIC SP 2 VWS | $91.00 | $130.00 | $29.90–$130.00 | — | 30% |
| X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 X-RAY EXAM THORAC SPINE 2VWS | $91.00 | $130.00 | $29.90–$130.00 | — | 30% |
| X-ray of the nasal bones, 3 or more views CPT 70160 NASAL BONES COMP M3V | $334.60 | $478.00 | $69.23–$478.00 | 65% above | 30% |
| X-ray of the nasal bones, 3 or more views CPT 70160 X-RAY EXAM OF NASAL BONES | $334.60 | $478.00 | $69.23–$478.00 | 65% above | 30% |
| X-ray of the nasal bones, 3 or more views inpatient CPT 70160 X-RAY EXAM OF NASAL BONES | $334.60 | $478.00 | $69.23–$478.00 | — | 30% |
| X-ray of the nasal bones, 3 or more views inpatient CPT 70160 NASAL BONES COMP M3V | $334.60 | $478.00 | $69.23–$478.00 | — | 30% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 X-RAY EXAM NECK SPINE 2-3 VW | $319.20 | $456.00 | $66.34–$456.00 | 28% above | 30% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 C-SPINE 2-3 VW | $319.20 | $456.00 | $66.34–$456.00 | 28% above | 30% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 C-SPINE 2-3 VW | $319.20 | $456.00 | $66.34–$456.00 | — | 30% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 X-RAY EXAM NECK SPINE 2-3 VW | $319.20 | $456.00 | $66.34–$456.00 | — | 30% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 X-RAY EXAM OF PELVIS | $283.50 | $405.00 | $53.78–$405.00 | 44% above | 30% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS AP ONLY | $283.50 | $405.00 | $53.78–$405.00 | 44% above | 30% |
| X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 X-RAY EXAM OF PELVIS | $283.50 | $405.00 | $53.78–$405.00 | — | 30% |
| X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PELVIS AP ONLY | $283.50 | $405.00 | $53.78–$405.00 | — | 30% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 X-RAY EXAM SACRUM TAILBONE | $334.60 | $478.00 | $55.69–$478.00 | 53% above | 30% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 SACRUM-COCCYX | $334.60 | $478.00 | $55.69–$478.00 | 53% above | 30% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 SACRUM-COCCYX | $334.60 | $478.00 | $55.69–$478.00 | — | 30% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 X-RAY EXAM SACRUM TAILBONE | $334.60 | $478.00 | $55.69–$478.00 | — | 30% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Indiana | Off list |
|---|---|---|---|---|---|
| ACTH blood test CPT 82024 ASSAY OF ACTH | $208.60 | $298.00 | $18.27–$298.00 | 16% below | 30% |
| ACTH blood test CPT 82024 ACTH | $208.60 | $298.00 | $18.27–$298.00 | 16% below | 30% |
| ACTH blood test inpatient CPT 82024 ACTH | $208.60 | $298.00 | $18.27–$298.00 | — | 30% |
| ACTH blood test inpatient CPT 82024 ASSAY OF ACTH | $208.60 | $298.00 | $18.27–$298.00 | — | 30% |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALT/SGPT | $84.00 | $120.00 | $2.51–$120.00 | 205% above | 30% |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALANINE AMINO (ALT) (SGPT) | $84.00 | $120.00 | $2.51–$120.00 | 205% above | 30% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALT/SGPT | $84.00 | $120.00 | $2.51–$120.00 | — | 30% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALANINE AMINO (ALT) (SGPT) | $84.00 | $120.00 | $2.51–$120.00 | — | 30% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 TRANSFERASE (AST) (SGOT) | $84.00 | $120.00 | $2.44–$120.00 | 190% above | 30% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 AST/SGOT | $84.00 | $120.00 | $2.44–$120.00 | 190% above | 30% |
| AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 AST/SGOT | $84.00 | $120.00 | $2.44–$120.00 | — | 30% |
| AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 TRANSFERASE (AST) (SGOT) | $84.00 | $120.00 | $2.44–$120.00 | — | 30% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE HEPATITIS | $231.00 | $330.00 | $13.68–$330.00 | 27% below | 30% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE HEPATITIS PANEL | $231.00 | $330.00 | $13.68–$330.00 | 27% below | 30% |
| Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 ACUTE HEPATITIS PANEL | $231.00 | $330.00 | $13.68–$330.00 | — | 30% |
| Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 ACUTE HEPATITIS | $231.00 | $330.00 | $13.68–$330.00 | — | 30% |
| Albumin blood test CPT 82040 ASSAY OF SERUM ALBUMIN | $84.00 | $120.00 | $2.71–$120.00 | 268% above | 30% |
| Albumin blood test CPT 82040 ALBUMIN SERUM | $84.00 | $120.00 | $2.71–$120.00 | 268% above | 30% |
| Albumin blood test inpatient CPT 82040 ALBUMIN SERUM | $84.00 | $120.00 | $2.71–$120.00 | — | 30% |
| Albumin blood test inpatient CPT 82040 ASSAY OF SERUM ALBUMIN | $84.00 | $120.00 | $2.71–$120.00 | — | 30% |
| Aldosterone blood test CPT 82088 ASSAY OF ALDOSTERONE | $181.30 | $259.00 | $20.12–$259.00 | 12% below | 30% |
| Aldosterone blood test CPT 82088 ALDOSTERONE | $181.30 | $259.00 | $20.12–$259.00 | 12% below | 30% |
| Aldosterone blood test inpatient CPT 82088 ASSAY OF ALDOSTERONE | $181.30 | $259.00 | $20.12–$259.00 | — | 30% |
| Aldosterone blood test inpatient CPT 82088 ALDOSTERONE | $181.30 | $259.00 | $20.12–$259.00 | — | 30% |
| Alkaline phosphatase (ALP) blood test CPT 84075 ALKALINE PHOSPHATSE | $84.00 | $120.00 | $2.45–$120.00 | 162% above | 30% |
| Alkaline phosphatase (ALP) blood test CPT 84075 ASSAY ALKALINE PHOSPHATASE | $84.00 | $120.00 | $2.45–$120.00 | 162% above | 30% |
| Alkaline phosphatase (ALP) blood test inpatient CPT 84075 ALKALINE PHOSPHATSE | $84.00 | $120.00 | $2.45–$120.00 | — | 30% |
| Alkaline phosphatase (ALP) blood test inpatient CPT 84075 ASSAY ALKALINE PHOSPHATASE | $84.00 | $120.00 | $2.45–$120.00 | — | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 EGG YOLK | $11.20 | $16.00 | $2.96–$2,603.00 | 42% below | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 CORN | $11.20 | $16.00 | $2.96–$2,603.00 | 42% below | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 PINE NUT | $11.20 | $16.00 | $2.96–$2,603.00 | 42% below | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 BEEF | $11.20 | $16.00 | $2.96–$2,603.00 | 42% below | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 SESAME SEED | $11.20 | $16.00 | $2.96–$2,603.00 | 42% below | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALMOND | $11.20 | $16.00 | $2.96–$2,603.00 | 42% below | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 WHEAT | $11.20 | $16.00 | $2.96–$2,603.00 | 42% below | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 RYE | $11.20 | $16.00 | $2.96–$2,603.00 | 42% below | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 EGG, WHOLE | $11.20 | $16.00 | $2.96–$2,603.00 | 42% below | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 PLANTAIN, ENGLISH | $11.20 | $16.00 | $2.96–$2,603.00 | 42% below | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 BARLEY | $11.20 | $16.00 | $2.96–$2,603.00 | 42% below | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 SWEET CHESTNUT | $11.20 | $16.00 | $2.96–$2,603.00 | 42% below | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 GLUTEN | $11.20 | $16.00 | $2.96–$2,603.00 | 42% below | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 EGG WHITE | $11.20 | $16.00 | $2.96–$2,603.00 | 42% below | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 BLUEGRASS KY | $11.20 | $16.00 | $2.96–$2,603.00 | 42% below | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 COCONUT | $11.20 | $16.00 | $2.96–$2,603.00 | 42% below | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 SHRIMP | $11.20 | $16.00 | $2.96–$2,603.00 | 42% below | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 PECAN NUT | $11.20 | $16.00 | $2.96–$2,603.00 | 42% below | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 GELATIN | $11.20 | $16.00 | $2.96–$2,603.00 | 42% below | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 IGE - LATEX | $19.60 | $28.00 | $2.96–$2,603.00 | 2% above | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALPHA GAL | $38.50 | $55.00 | $2.96–$2,603.00 | 101% above | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MINI RAST UNITS X10 | $142.10 | $203.00 | $2.96–$2,603.00 | 640% above | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLG SPEC IGE CRUDE XTRC EA | $200.20 | $286.00 | $2.96–$2,603.00 | 943% above | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 RAST FOOD | $200.20 | $286.00 | $2.96–$2,603.00 | 943% above | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALPHA GAL PANEL | $258.30 | $369.00 | $2.96–$2,603.00 | 1245% above | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ZONE 5 | $333.20 | $476.00 | $2.96–$2,603.00 | 1635% above | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGENS BONE 8 | $617.40 | $882.00 | $2.96–$2,603.00 | 3116% above | 30% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 PECAN NUT | $11.20 | $16.00 | $2.96–$2,603.00 | — | 30% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 SHRIMP | $11.20 | $16.00 | $2.96–$2,603.00 | — | 30% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALMOND | $11.20 | $16.00 | $2.96–$2,603.00 | — | 30% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 SESAME SEED | $11.20 | $16.00 | $2.96–$2,603.00 | — | 30% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 WHEAT | $11.20 | $16.00 | $2.96–$2,603.00 | — | 30% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 EGG YOLK | $11.20 | $16.00 | $2.96–$2,603.00 | — | 30% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 EGG WHITE | $11.20 | $16.00 | $2.96–$2,603.00 | — | 30% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CORN | $11.20 | $16.00 | $2.96–$2,603.00 | — | 30% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 GLUTEN | $11.20 | $16.00 | $2.96–$2,603.00 | — | 30% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RYE | $11.20 | $16.00 | $2.96–$2,603.00 | — | 30% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 COCONUT | $11.20 | $16.00 | $2.96–$2,603.00 | — | 30% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 BARLEY | $11.20 | $16.00 | $2.96–$2,603.00 | — | 30% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 GELATIN | $11.20 | $16.00 | $2.96–$2,603.00 | — | 30% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 BEEF | $11.20 | $16.00 | $2.96–$2,603.00 | — | 30% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 BLUEGRASS KY | $11.20 | $16.00 | $2.96–$2,603.00 | — | 30% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 PINE NUT | $11.20 | $16.00 | $2.96–$2,603.00 | — | 30% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 SWEET CHESTNUT | $11.20 | $16.00 | $2.96–$2,603.00 | — | 30% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 PLANTAIN, ENGLISH | $11.20 | $16.00 | $2.96–$2,603.00 | — | 30% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 EGG, WHOLE | $11.20 | $16.00 | $2.96–$2,603.00 | — | 30% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 IGE - LATEX | $19.60 | $28.00 | $2.96–$2,603.00 | — | 30% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALPHA GAL | $38.50 | $55.00 | $2.96–$2,603.00 | — | 30% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MINI RAST UNITS X10 | $142.10 | $203.00 | $2.96–$2,603.00 | — | 30% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RAST FOOD | $200.20 | $286.00 | $2.96–$2,603.00 | — | 30% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLG SPEC IGE CRUDE XTRC EA | $200.20 | $286.00 | $2.96–$2,603.00 | — | 30% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALPHA GAL PANEL | $258.30 | $369.00 | $2.96–$2,603.00 | — | 30% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ZONE 5 | $333.20 | $476.00 | $2.96–$2,603.00 | — | 30% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGENS BONE 8 | $617.40 | $882.00 | $2.96–$2,603.00 | — | 30% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 AFP TETRA | $45.50 | $65.00 | $7.94–$283.00 | 55% below | 30% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 AFT X-TRA | $56.00 | $80.00 | $7.94–$283.00 | 45% below | 30% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 ALPHA FETOPROTE SERU | $96.60 | $138.00 | $7.94–$283.00 | 5% below | 30% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 ALPHA-FETOPROTEIN SERUM | $96.60 | $138.00 | $7.94–$283.00 | 5% below | 30% |
| Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 AFP TETRA | $45.50 | $65.00 | $7.94–$283.00 | — | 30% |
| Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 AFT X-TRA | $56.00 | $80.00 | $7.94–$283.00 | — | 30% |
| Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 ALPHA FETOPROTE SERU | $96.60 | $138.00 | $7.94–$283.00 | — | 30% |
| Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 ALPHA-FETOPROTEIN SERUM | $96.60 | $138.00 | $7.94–$283.00 | — | 30% |
| Ammonia blood test CPT 82140 AMMONIA | $245.70 | $351.00 | $7.20–$351.00 | 104% above | 30% |
| Ammonia blood test CPT 82140 ASSAY OF AMMONIA | $245.70 | $351.00 | $7.20–$351.00 | 104% above | 30% |
| Ammonia blood test inpatient CPT 82140 ASSAY OF AMMONIA | $245.70 | $351.00 | $7.20–$351.00 | — | 30% |
| Ammonia blood test inpatient CPT 82140 AMMONIA | $245.70 | $351.00 | $7.20–$351.00 | — | 30% |
| Amylase blood test CPT 82150 AMYLASE BF | $56.00 | $80.00 | $3.07–$200.00 | 8% above | 30% |
| Amylase blood test CPT 82150 AMYLASE | $84.00 | $120.00 | $3.07–$200.00 | 62% above | 30% |
| Amylase blood test CPT 82150 ASSAY OF AMYLASE | $84.00 | $120.00 | $3.07–$200.00 | 62% above | 30% |
| Amylase blood test inpatient CPT 82150 AMYLASE BF | $56.00 | $80.00 | $3.07–$200.00 | — | 30% |
| Amylase blood test inpatient CPT 82150 AMYLASE | $84.00 | $120.00 | $3.07–$200.00 | — | 30% |
| Amylase blood test inpatient CPT 82150 ASSAY OF AMYLASE | $84.00 | $120.00 | $3.07–$200.00 | — | 30% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP ABS | $93.10 | $133.00 | $6.39–$133.00 | 77% above | 30% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP ANTIBODY | $93.10 | $133.00 | $6.39–$133.00 | 77% above | 30% |
| Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CCP ABS | $93.10 | $133.00 | $6.39–$133.00 | — | 30% |
| Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CCP ANTIBODY | $93.10 | $133.00 | $6.39–$133.00 | — | 30% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODIES | $129.50 | $185.00 | $5.72–$461.00 | 116% above | 30% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA | $129.50 | $185.00 | $5.72–$461.00 | 116% above | 30% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA FEFLEX | $193.20 | $276.00 | $5.72–$461.00 | 222% above | 30% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA | $129.50 | $185.00 | $5.72–$461.00 | — | 30% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR ANTIBODIES | $129.50 | $185.00 | $5.72–$461.00 | — | 30% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA FEFLEX | $193.20 | $276.00 | $5.72–$461.00 | — | 30% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 ASSAY OF NATRIURETIC PEPTIDE | $243.60 | $348.00 | $16.06–$696.00 | 43% above | 30% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 BNP | $243.60 | $348.00 | $16.06–$696.00 | 43% above | 30% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NT-PRO BNP | $243.60 | $348.00 | $16.06–$696.00 | 43% above | 30% |
| BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NT-PRO BNP | $243.60 | $348.00 | $16.06–$696.00 | — | 30% |
| BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 ASSAY OF NATRIURETIC PEPTIDE | $243.60 | $348.00 | $16.06–$696.00 | — | 30% |
| BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 BNP | $243.60 | $348.00 | $16.06–$696.00 | — | 30% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE EAR | $72.80 | $104.00 | $4.26–$449.00 | 22% below | 30% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE SPUTUM | $119.00 | $170.00 | $4.26–$449.00 | 27% above | 30% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE OTHR SPECIMN AEROBIC | $122.50 | $175.00 | $4.26–$449.00 | 31% above | 30% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE AEROBIC OTHER | $122.50 | $175.00 | $4.26–$449.00 | 31% above | 30% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE EAR | $72.80 | $104.00 | $4.26–$449.00 | — | 30% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE SPUTUM | $119.00 | $170.00 | $4.26–$449.00 | — | 30% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE OTHR SPECIMN AEROBIC | $122.50 | $175.00 | $4.26–$449.00 | — | 30% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE AEROBIC OTHER | $122.50 | $175.00 | $4.26–$449.00 | — | 30% |
| Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PNL TOTAL CA | $134.40 | $192.00 | $3.47–$192.00 | 72% above | 30% |
| Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANE | $134.40 | $192.00 | $3.47–$192.00 | 72% above | 30% |
| Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANE | $134.40 | $192.00 | $3.47–$192.00 | — | 30% |
| Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PNL TOTAL CA | $134.40 | $192.00 | $3.47–$192.00 | — | 30% |
| Bilirubin blood test, total CPT 82247 BILIRUBIN TOT&DIR | $93.80 | $134.00 | $1.91–$292.00 | 171% above | 30% |
| Bilirubin blood test, total CPT 82247 BILIRUBIN TOTAL | $110.60 | $158.00 | $1.91–$292.00 | 219% above | 30% |
| Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN TOT&DIR | $93.80 | $134.00 | $1.91–$292.00 | — | 30% |
| Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN TOTAL | $110.60 | $158.00 | $1.91–$292.00 | — | 30% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 LVL IV SUR GRS MICRO | $98.00 | $140.00 | $71.12–$318.00 | 62% below | 30% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 TISSUE EXAM BY PATHOLOGIST | $98.00 | $140.00 | $71.12–$318.00 | 62% below | 30% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 SURG PAT G/M LEVEL 4 | $124.60 | $178.00 | $71.12–$318.00 | 52% below | 30% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 LVL IV SUR GRS MICRO | $98.00 | $140.00 | $71.12–$318.00 | — | 30% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 TISSUE EXAM BY PATHOLOGIST | $98.00 | $140.00 | $71.12–$318.00 | — | 30% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 SURG PAT G/M LEVEL 4 | $124.60 | $178.00 | $71.12–$318.00 | — | 30% |
| Blood culture for bacteria CPT 87040 BLOOD CULTURE FOR BACTERIA | $149.10 | $213.00 | $4.88–$213.00 | 14% above | 30% |
| Blood culture for bacteria CPT 87040 BLOOD CULTURE | $149.10 | $213.00 | $4.88–$213.00 | 14% above | 30% |
| Blood culture for bacteria inpatient CPT 87040 BLOOD CULTURE FOR BACTERIA | $149.10 | $213.00 | $4.88–$213.00 | — | 30% |
| Blood culture for bacteria inpatient CPT 87040 BLOOD CULTURE | $149.10 | $213.00 | $4.88–$213.00 | — | 30% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENI-PUNC COLL FEE EMERGENCY ROOM | $14.00 | $20.00 | $3.00–$87.00 | 16% below | 30% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENI PUNCTURE | $14.70 | $21.00 | $3.00–$87.00 | 11% below | 30% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLL VENOUS BLD VENIPUNCTURE | $14.70 | $21.00 | $3.00–$87.00 | 11% below | 30% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENI-PUNC COLL FEE | $14.70 | $21.00 | $3.00–$87.00 | 11% below | 30% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 UMBILICAL CORD VENOUS BLOOD GAS | $17.50 | $25.00 | $3.00–$87.00 | 5% above | 30% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENI-PUNC COLL FEE EMERGENCY ROOM | $14.00 | $20.00 | $3.00–$87.00 | — | 30% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENI PUNCTURE | $14.70 | $21.00 | $3.00–$87.00 | — | 30% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENI-PUNC COLL FEE | $14.70 | $21.00 | $3.00–$87.00 | — | 30% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 COLL VENOUS BLD VENIPUNCTURE | $14.70 | $21.00 | $3.00–$87.00 | — | 30% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 UMBILICAL CORD VENOUS BLOOD GAS | $17.50 | $25.00 | $3.00–$87.00 | — | 30% |
| Blood glucose (sugar) test CPT 82947 ASSAY GLUCOSE BLOOD QUANT | $69.30 | $99.00 | $1.94–$198.00 | 160% above | 30% |
| Blood glucose (sugar) test CPT 82947 2 HR POST PRANDIAL | $69.30 | $99.00 | $1.94–$198.00 | 160% above | 30% |
| Blood glucose (sugar) test CPT 82947 GLUCOSE BLOOD | $69.30 | $99.00 | $1.94–$198.00 | 160% above | 30% |
| Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE BLOOD | $69.30 | $99.00 | $1.94–$198.00 | — | 30% |
| Blood glucose (sugar) test inpatient CPT 82947 ASSAY GLUCOSE BLOOD QUANT | $69.30 | $99.00 | $1.94–$198.00 | — | 30% |
| Blood glucose (sugar) test inpatient CPT 82947 2 HR POST PRANDIAL | $69.30 | $99.00 | $1.94–$198.00 | — | 30% |
| Blood lead test CPT 83655 ASSAY OF LEAD | $139.30 | $199.00 | $7.00–$199.00 | 95% above | 30% |
| Blood lead test CPT 83655 LEAD, QUAN | $139.30 | $199.00 | $7.00–$199.00 | 95% above | 30% |
| Blood lead test inpatient CPT 83655 LEAD, QUAN | $139.30 | $199.00 | $7.00–$199.00 | — | 30% |
| Blood lead test inpatient CPT 83655 ASSAY OF LEAD | $139.30 | $199.00 | $7.00–$199.00 | — | 30% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 CHORIONIC GONADOTROPIN ASSAY | $96.60 | $138.00 | $3.55–$138.00 | 33% above | 30% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HCG Q | $96.60 | $138.00 | $3.55–$138.00 | 33% above | 30% |
| Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 CHORIONIC GONADOTROPIN ASSAY | $96.60 | $138.00 | $3.55–$138.00 | — | 30% |
| Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HCG Q | $96.60 | $138.00 | $3.55–$138.00 | — | 30% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPING ABO | $22.40 | $32.00 | $1.41–$99.00 | 54% below | 30% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPING SEROLOGIC ABO | $22.40 | $32.00 | $1.41–$99.00 | 54% below | 30% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ARC ABO | $46.90 | $67.00 | $1.41–$99.00 | 4% below | 30% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BLOOD TYPING ABO | $22.40 | $32.00 | $1.41–$99.00 | — | 30% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BLOOD TYPING SEROLOGIC ABO | $22.40 | $32.00 | $1.41–$99.00 | — | 30% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ARC ABO | $46.90 | $67.00 | $1.41–$99.00 | — | 30% |
| Blood urea nitrogen (BUN) test CPT 84520 BUN | $51.80 | $74.00 | $1.87–$74.00 | 119% above | 30% |
| Blood urea nitrogen (BUN) test CPT 84520 ASSAY OF UREA NITROGEN | $51.80 | $74.00 | $1.87–$74.00 | 119% above | 30% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 BUN | $51.80 | $74.00 | $1.87–$74.00 | — | 30% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 ASSAY OF UREA NITROGEN | $51.80 | $74.00 | $1.87–$74.00 | — | 30% |
| C-peptide blood test CPT 84681 C-PEPTIDE | $156.10 | $223.00 | $9.84–$223.00 | 14% above | 30% |
| C-peptide blood test CPT 84681 ASSAY OF C-PEPTIDE | $156.10 | $223.00 | $9.84–$223.00 | 14% above | 30% |
| C-peptide blood test inpatient CPT 84681 ASSAY OF C-PEPTIDE | $156.10 | $223.00 | $9.84–$223.00 | — | 30% |
| C-peptide blood test inpatient CPT 84681 C-PEPTIDE | $156.10 | $223.00 | $9.84–$223.00 | — | 30% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C REACTIVE PROTEIN | $69.30 | $99.00 | $2.45–$99.00 | 1% above | 30% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN | $69.30 | $99.00 | $2.45–$99.00 | 1% above | 30% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN | $69.30 | $99.00 | $2.45–$99.00 | — | 30% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C REACTIVE PROTEIN | $69.30 | $99.00 | $2.45–$99.00 | — | 30% |
| CA 19-9 blood test (tumor marker) CPT 86301 IMMUNOASSAY TUMOR CA 19-9 | $137.90 | $197.00 | $10.26–$197.00 | 5% below | 30% |
| CA 19-9 blood test (tumor marker) CPT 86301 CA19-9 | $137.90 | $197.00 | $10.26–$197.00 | 5% below | 30% |
| CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA19-9 | $137.90 | $197.00 | $10.26–$197.00 | — | 30% |
| CA 19-9 blood test (tumor marker) inpatient CPT 86301 IMMUNOASSAY TUMOR CA 19-9 | $137.90 | $197.00 | $10.26–$197.00 | — | 30% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 IMMUNOASSAY TUMOR CA 125 | $153.30 | $219.00 | $10.26–$219.00 | 6% below | 30% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 CA 125 | $153.30 | $219.00 | $10.26–$219.00 | 6% below | 30% |
| CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 IMMUNOASSAY TUMOR CA 125 | $153.30 | $219.00 | $10.26–$219.00 | — | 30% |
| CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA 125 | $153.30 | $219.00 | $10.26–$219.00 | — | 30% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID NOW | $129.50 | $185.00 | $20.52–$414.00 | 22% above | 30% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-COV-2 COVID-19 AMP PRB | $160.30 | $229.00 | $20.52–$414.00 | 52% above | 30% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID 19 | $160.30 | $229.00 | $20.52–$414.00 | 52% above | 30% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COVID NOW | $129.50 | $185.00 | $20.52–$414.00 | — | 30% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COVID 19 | $160.30 | $229.00 | $20.52–$414.00 | — | 30% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-COV-2 COVID-19 AMP PRB | $160.30 | $229.00 | $20.52–$414.00 | — | 30% |
| Calcium blood test, total CPT 82310 CALCIUM TOTAL | $69.30 | $99.00 | $2.44–$99.00 | 162% above | 30% |
| Calcium blood test, total CPT 82310 ASSAY OF CALCIUM | $69.30 | $99.00 | $2.44–$99.00 | 162% above | 30% |
| Calcium blood test, total inpatient CPT 82310 ASSAY OF CALCIUM | $69.30 | $99.00 | $2.44–$99.00 | — | 30% |
| Calcium blood test, total inpatient CPT 82310 CALCIUM TOTAL | $69.30 | $99.00 | $2.44–$99.00 | — | 30% |
| Carcinoembryonic antigen (CEA) test CPT 82378 CARCINOEMBRYONIC ANTIGEN | $254.80 | $364.00 | $8.98–$364.00 | 111% above | 30% |
| Carcinoembryonic antigen (CEA) test CPT 82378 CEA | $254.80 | $364.00 | $8.98–$364.00 | 111% above | 30% |
| Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CEA | $254.80 | $364.00 | $8.98–$364.00 | — | 30% |
| Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CARCINOEMBRYONIC ANTIGEN | $254.80 | $364.00 | $8.98–$364.00 | — | 30% |
| Chickenpox (varicella) immunity blood test CPT 86787 VARCELLA ZOSTER ANTI | $208.60 | $298.00 | $6.09–$298.00 | 114% above | 30% |
| Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA-ZOSTER ANTIBODY | $208.60 | $298.00 | $6.09–$298.00 | 114% above | 30% |
| Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA-ZOSTER ANTIBODY | $208.60 | $298.00 | $6.09–$298.00 | — | 30% |
| Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARCELLA ZOSTER ANTI | $208.60 | $298.00 | $6.09–$298.00 | — | 30% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLMYD TRACH DNA AMP PROBE | $92.40 | $132.00 | $16.60–$271.00 | 5% below | 30% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA APTIMA | $92.40 | $132.00 | $16.60–$271.00 | 5% below | 30% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 VAGINITIS PLUS | $97.30 | $139.00 | $16.60–$271.00 | at median | 30% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLMYD TRACH DNA AMP PROBE | $92.40 | $132.00 | $16.60–$271.00 | — | 30% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA APTIMA | $92.40 | $132.00 | $16.60–$271.00 | — | 30% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 VAGINITIS PLUS | $97.30 | $139.00 | $16.60–$271.00 | — | 30% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PROFILE | $105.00 | $150.00 | $6.02–$150.00 | at median | 30% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL | $105.00 | $150.00 | $6.02–$150.00 | at median | 30% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL | $105.00 | $150.00 | $6.02–$150.00 | — | 30% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PROFILE | $105.00 | $150.00 | $6.02–$150.00 | — | 30% |
| Complete blood count (CBC) with differential CPT 85025 CBC COMPLETE BLD CT | $75.60 | $108.00 | $4.23–$108.00 | 83% above | 30% |
| Complete blood count (CBC) with differential CPT 85025 COMPLETE CBC W/AUTO DIFF WBC | $75.60 | $108.00 | $4.23–$108.00 | 83% above | 30% |
| Complete blood count (CBC) with differential inpatient CPT 85025 CBC COMPLETE BLD CT | $75.60 | $108.00 | $4.23–$108.00 | — | 30% |
| Complete blood count (CBC) with differential inpatient CPT 85025 COMPLETE CBC W/AUTO DIFF WBC | $75.60 | $108.00 | $4.23–$108.00 | — | 30% |
| Complete blood count (CBC), no differential CPT 85027 CBC WITHOUT DIFFERENTIAL | $54.60 | $78.00 | $3.06–$78.00 | 85% above | 30% |
| Complete blood count (CBC), no differential CPT 85027 COMPLETE CBC AUTOMATED | $54.60 | $78.00 | $3.06–$78.00 | 85% above | 30% |
| Complete blood count (CBC), no differential inpatient CPT 85027 COMPLETE CBC AUTOMATED | $54.60 | $78.00 | $3.06–$78.00 | — | 30% |
| Complete blood count (CBC), no differential inpatient CPT 85027 CBC WITHOUT DIFFERENTIAL | $54.60 | $78.00 | $3.06–$78.00 | — | 30% |
| Comprehensive metabolic panel (blood test) CPT 80053 COMPREHEN METABOLIC PANEL | $146.30 | $209.00 | $5.75–$209.00 | 65% above | 30% |
| Comprehensive metabolic panel (blood test) CPT 80053 COMPRE METABOLIC PAN | $146.30 | $209.00 | $5.75–$209.00 | 65% above | 30% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPRE METABOLIC PAN | $146.30 | $209.00 | $5.75–$209.00 | — | 30% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHEN METABOLIC PANEL | $146.30 | $209.00 | $5.75–$209.00 | — | 30% |
| Cortisol blood test, total CPT 82533 TOTAL CORTISOL | $237.30 | $339.00 | $7.71–$339.00 | 151% above | 30% |
| Cortisol blood test, total CPT 82533 CORTISOL | $237.30 | $339.00 | $7.71–$339.00 | 151% above | 30% |
| Cortisol blood test, total inpatient CPT 82533 CORTISOL | $237.30 | $339.00 | $7.71–$339.00 | — | 30% |
| Cortisol blood test, total inpatient CPT 82533 TOTAL CORTISOL | $237.30 | $339.00 | $7.71–$339.00 | — | 30% |
| Creatine kinase (CK) blood test, total CPT 82550 ASSAY OF CK (CPK) | $84.00 | $120.00 | $3.08–$120.00 | 116% above | 30% |
| Creatine kinase (CK) blood test, total CPT 82550 CK TOTAL | $84.00 | $120.00 | $3.08–$120.00 | 116% above | 30% |
| Creatine kinase (CK) blood test, total inpatient CPT 82550 CK TOTAL | $84.00 | $120.00 | $3.08–$120.00 | — | 30% |
| Creatine kinase (CK) blood test, total inpatient CPT 82550 ASSAY OF CK (CPK) | $84.00 | $120.00 | $3.08–$120.00 | — | 30% |
| Creatinine blood test CPT 82565 CREATININE SERUM WS | $51.80 | $74.00 | $2.42–$148.00 | 80% above | 30% |
| Creatinine blood test CPT 82565 POCT | $51.80 | $74.00 | $2.42–$148.00 | 80% above | 30% |
| Creatinine blood test CPT 82565 ASSAY OF CREATININE | $51.80 | $74.00 | $2.42–$148.00 | 80% above | 30% |
| Creatinine blood test inpatient CPT 82565 POCT | $51.80 | $74.00 | $2.42–$148.00 | — | 30% |
| Creatinine blood test inpatient CPT 82565 ASSAY OF CREATININE | $51.80 | $74.00 | $2.42–$148.00 | — | 30% |
| Creatinine blood test inpatient CPT 82565 CREATININE SERUM WS | $51.80 | $74.00 | $2.42–$148.00 | — | 30% |
| Cytomegalovirus (CMV) antibody test CPT 86644 TORCH IGG AND IGM | $81.20 | $116.00 | $6.81–$336.00 | 2% above | 30% |
| Cytomegalovirus (CMV) antibody test CPT 86644 CMV ANTIBODY | $154.00 | $220.00 | $6.81–$336.00 | 93% above | 30% |
| Cytomegalovirus (CMV) antibody test CPT 86644 CMV IGG | $154.00 | $220.00 | $6.81–$336.00 | 93% above | 30% |
| Cytomegalovirus (CMV) antibody test inpatient CPT 86644 TORCH IGG AND IGM | $81.20 | $116.00 | $6.81–$336.00 | — | 30% |
| Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CMV IGG | $154.00 | $220.00 | $6.81–$336.00 | — | 30% |
| Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CMV ANTIBODY | $154.00 | $220.00 | $6.81–$336.00 | — | 30% |
| D-dimer blood test (blood clot marker) CPT 85379 FIBRIN DEGRADATION QUANT | $168.70 | $241.00 | $5.02–$241.00 | 38% above | 30% |
| D-dimer blood test (blood clot marker) CPT 85379 DDIMER | $168.70 | $241.00 | $5.02–$241.00 | 38% above | 30% |
| D-dimer blood test (blood clot marker) inpatient CPT 85379 FIBRIN DEGRADATION QUANT | $168.70 | $241.00 | $5.02–$241.00 | — | 30% |
| D-dimer blood test (blood clot marker) inpatient CPT 85379 DDIMER | $168.70 | $241.00 | $5.02–$241.00 | — | 30% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 DEHYDROEPIANDROSTERONE | $213.50 | $305.00 | $10.52–$305.00 | 46% above | 30% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 DHEAS | $213.50 | $305.00 | $10.52–$305.00 | 46% above | 30% |
| DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEAS | $213.50 | $305.00 | $10.52–$305.00 | — | 30% |
| DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DEHYDROEPIANDROSTERONE | $213.50 | $305.00 | $10.52–$305.00 | — | 30% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 ACETOMINOPHEN | $18.90 | $27.00 | $31.70–$474.00 | 83% below | 30% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZR | $18.90 | $27.00 | $31.70–$474.00 | 83% below | 30% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 APETAMINE/METHAPHME PANEL | $18.90 | $27.00 | $31.70–$474.00 | 83% below | 30% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 APHETAMINE/METHAPHME | $135.10 | $193.00 | $31.70–$474.00 | 18% above | 30% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 NICOTINE SCREEN | $158.90 | $227.00 | $31.70–$474.00 | 39% above | 30% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 APETAMINE/METHAPHME PANEL | $18.90 | $27.00 | $31.70–$474.00 | — | 30% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 ACETOMINOPHEN | $18.90 | $27.00 | $31.70–$474.00 | — | 30% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZR | $18.90 | $27.00 | $31.70–$474.00 | — | 30% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 APHETAMINE/METHAPHME | $135.10 | $193.00 | $31.70–$474.00 | — | 30% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 NICOTINE SCREEN | $158.90 | $227.00 | $31.70–$474.00 | — | 30% |
| Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 ELECTROLYTE PANEL | $28.00 | $40.00 | $2.14–$40.00 | 56% below | 30% |
| Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 ELECTROLYTE PANEL | $28.00 | $40.00 | $2.14–$40.00 | — | 30% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 EPSTEIN-BARR CAPSID VCA | $189.70 | $271.00 | $6.50–$271.00 | 133% above | 30% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 EPSTEIN BARR VIRAL C | $189.70 | $271.00 | $6.50–$271.00 | 133% above | 30% |
| Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EPSTEIN-BARR CAPSID VCA | $189.70 | $271.00 | $6.50–$271.00 | — | 30% |
| Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EPSTEIN BARR VIRAL C | $189.70 | $271.00 | $6.50–$271.00 | — | 30% |
| Estradiol blood test CPT 82670 ASSAY OF TOTAL ESTRADIOL | $57.40 | $82.00 | $13.22–$82.00 | 55% below | 30% |
| Estradiol blood test CPT 82670 ESTRADIOL | $57.40 | $82.00 | $13.22–$82.00 | 55% below | 30% |
| Estradiol blood test inpatient CPT 82670 ESTRADIOL | $57.40 | $82.00 | $13.22–$82.00 | — | 30% |
| Estradiol blood test inpatient CPT 82670 ASSAY OF TOTAL ESTRADIOL | $57.40 | $82.00 | $13.22–$82.00 | — | 30% |
| FSH (follicle-stimulating hormone) test CPT 83001 FSH | $117.60 | $168.00 | $8.79–$168.00 | 8% below | 30% |
| FSH (follicle-stimulating hormone) test CPT 83001 ASSAY OF GONADOTROPIN (FSH) | $117.60 | $168.00 | $8.79–$168.00 | 8% below | 30% |
| FSH (follicle-stimulating hormone) test inpatient CPT 83001 ASSAY OF GONADOTROPIN (FSH) | $117.60 | $168.00 | $8.79–$168.00 | — | 30% |
| FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH | $117.60 | $168.00 | $8.79–$168.00 | — | 30% |
| Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN, FECAL | $179.20 | $256.00 | $9.60–$256.00 | 1% below | 30% |
| Fecal calprotectin (stool inflammation test) CPT 83993 ASSAY FOR CALPROTECTIN FECAL | $179.20 | $256.00 | $9.60–$256.00 | 1% below | 30% |
| Fecal calprotectin (stool inflammation test) inpatient CPT 83993 ASSAY FOR CALPROTECTIN FECAL | $179.20 | $256.00 | $9.60–$256.00 | — | 30% |
| Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CALPROTECTIN, FECAL | $179.20 | $256.00 | $9.60–$256.00 | — | 30% |
| Ferritin blood test (iron stores) CPT 82728 FERRITIN | $95.90 | $137.00 | $6.44–$137.00 | 20% above | 30% |
| Ferritin blood test (iron stores) CPT 82728 ASSAY OF FERRITIN | $95.90 | $137.00 | $6.44–$137.00 | 20% above | 30% |
| Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN | $95.90 | $137.00 | $6.44–$137.00 | — | 30% |
| Ferritin blood test (iron stores) inpatient CPT 82728 ASSAY OF FERRITIN | $95.90 | $137.00 | $6.44–$137.00 | — | 30% |
| Fibrinogen blood test CPT 85384 FIBRINOGEN SEM QUANT | $125.30 | $179.00 | $4.20–$179.00 | 110% above | 30% |
| Fibrinogen blood test CPT 85384 FIBRINOGEN ACTIVITY | $125.30 | $179.00 | $4.20–$179.00 | 110% above | 30% |
| Fibrinogen blood test inpatient CPT 85384 FIBRINOGEN ACTIVITY | $125.30 | $179.00 | $4.20–$179.00 | — | 30% |
| Fibrinogen blood test inpatient CPT 85384 FIBRINOGEN SEM QUANT | $125.30 | $179.00 | $4.20–$179.00 | — | 30% |
| Folate (folic acid) blood test CPT 82746 FOLIC ACID SERUM | $173.60 | $248.00 | $6.95–$248.00 | 126% above | 30% |
| Folate (folic acid) blood test CPT 82746 ASSAY OF FOLIC ACID SERUM | $173.60 | $248.00 | $6.95–$248.00 | 126% above | 30% |
| Folate (folic acid) blood test inpatient CPT 82746 FOLIC ACID SERUM | $173.60 | $248.00 | $6.95–$248.00 | — | 30% |
| Folate (folic acid) blood test inpatient CPT 82746 ASSAY OF FOLIC ACID SERUM | $173.60 | $248.00 | $6.95–$248.00 | — | 30% |
| Free T3 thyroid hormone test CPT 84481 FREE T3 | $72.10 | $103.00 | $8.01–$501.00 | 46% below | 30% |
| Free T3 thyroid hormone test CPT 84481 FREE ASSAY (FT-3) | $278.60 | $398.00 | $8.01–$501.00 | 111% above | 30% |
| Free T3 thyroid hormone test CPT 84481 T3 RIA | $278.60 | $398.00 | $8.01–$501.00 | 111% above | 30% |
| Free T3 thyroid hormone test inpatient CPT 84481 FREE T3 | $72.10 | $103.00 | $8.01–$501.00 | — | 30% |
| Free T3 thyroid hormone test inpatient CPT 84481 FREE ASSAY (FT-3) | $278.60 | $398.00 | $8.01–$501.00 | — | 30% |
| Free T3 thyroid hormone test inpatient CPT 84481 T3 RIA | $278.60 | $398.00 | $8.01–$501.00 | — | 30% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 FREE T4 | $66.50 | $95.00 | $4.27–$95.00 | 18% below | 30% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 ASSAY OF FREE THYROXINE | $66.50 | $95.00 | $4.27–$95.00 | 18% below | 30% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 ASSAY OF FREE THYROXINE | $66.50 | $95.00 | $4.27–$95.00 | — | 30% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 FREE T4 | $66.50 | $95.00 | $4.27–$95.00 | — | 30% |
| Free testosterone test CPT 84402 TESTOSTERONE, FREE | $129.50 | $185.00 | $12.04–$185.00 | 55% above | 30% |
| Free testosterone test CPT 84402 ASSAY OF FREE TESTOSTERONE | $129.50 | $185.00 | $12.04–$185.00 | 55% above | 30% |
| Free testosterone test inpatient CPT 84402 ASSAY OF FREE TESTOSTERONE | $129.50 | $185.00 | $12.04–$185.00 | — | 30% |
| Free testosterone test inpatient CPT 84402 TESTOSTERONE, FREE | $129.50 | $185.00 | $12.04–$185.00 | — | 30% |
| Gamma-glutamyl transferase (GGT) blood test CPT 82977 GGT | $81.90 | $117.00 | $3.41–$117.00 | 152% above | 30% |
| Gamma-glutamyl transferase (GGT) blood test CPT 82977 ASSAY OF GGT | $81.90 | $117.00 | $3.41–$117.00 | 152% above | 30% |
| Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 ASSAY OF GGT | $81.90 | $117.00 | $3.41–$117.00 | — | 30% |
| Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 GGT | $81.90 | $117.00 | $3.41–$117.00 | — | 30% |
| General health panel: metabolic panel, blood count and TSH in one order CPT 80050 GENERAL HEALTH PANEL | $366.80 | $524.00 | $17.10–$524.00 | 20% above | 30% |
| General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 GENERAL HEALTH PANEL | $366.80 | $524.00 | $17.10–$524.00 | — | 30% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE POST DOSE | $69.30 | $99.00 | $2.25–$99.00 | 69% above | 30% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE TEST | $69.30 | $99.00 | $2.25–$99.00 | 69% above | 30% |
| Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE TEST | $69.30 | $99.00 | $2.25–$99.00 | — | 30% |
| Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE POST DOSE | $69.30 | $99.00 | $2.25–$99.00 | — | 30% |
| Glucose tolerance test, 3 samples CPT 82951 GLUCOSE 3HR/GESTATIONAL DIAB DIAG 100G | $274.40 | $392.00 | $4.63–$392.00 | 271% above | 30% |
| Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE TEST (GTT) | $274.40 | $392.00 | $4.63–$392.00 | 271% above | 30% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOLERANCE TEST (GTT) | $274.40 | $392.00 | $4.63–$392.00 | — | 30% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE 3HR/GESTATIONAL DIAB DIAG 100G | $274.40 | $392.00 | $4.63–$392.00 | — | 30% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 N.GONORRHOEAE DNA AMP PROB | $92.40 | $132.00 | $16.60–$271.00 | 5% below | 30% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GC APTIMA | $92.40 | $132.00 | $16.60–$271.00 | 5% below | 30% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 VAGINITIS | $97.30 | $139.00 | $16.60–$271.00 | at median | 30% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 GC APTIMA | $92.40 | $132.00 | $16.60–$271.00 | — | 30% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 N.GONORRHOEAE DNA AMP PROB | $92.40 | $132.00 | $16.60–$271.00 | — | 30% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 VAGINITIS | $97.30 | $139.00 | $16.60–$271.00 | — | 30% |
| H. pylori antibody blood test CPT 86677 CLO TEST | $21.00 | $30.00 | $6.87–$300.00 | 78% below | 30% |
| H. pylori antibody blood test CPT 86677 HELICOBACTER PYLORI ANTIBODY | $21.00 | $30.00 | $6.87–$300.00 | 78% below | 30% |
| H. pylori antibody blood test CPT 86677 HELICOBACTERPYLORI | $189.00 | $270.00 | $6.87–$300.00 | 96% above | 30% |
| H. pylori antibody blood test inpatient CPT 86677 CLO TEST | $21.00 | $30.00 | $6.87–$300.00 | — | 30% |
| H. pylori antibody blood test inpatient CPT 86677 HELICOBACTER PYLORI ANTIBODY | $21.00 | $30.00 | $6.87–$300.00 | — | 30% |
| H. pylori antibody blood test inpatient CPT 86677 HELICOBACTERPYLORI | $189.00 | $270.00 | $6.87–$300.00 | — | 30% |
| H. pylori stool antigen test CPT 87338 HPYLORI STOOL AG IA | $134.40 | $192.00 | $6.49–$192.00 | 3% above | 30% |
| H. pylori stool antigen test CPT 87338 HPYLORI AG,EIA,STOOL | $134.40 | $192.00 | $6.49–$192.00 | 3% above | 30% |
| H. pylori stool antigen test inpatient CPT 87338 HPYLORI AG,EIA,STOOL | $134.40 | $192.00 | $6.49–$192.00 | — | 30% |
| H. pylori stool antigen test inpatient CPT 87338 HPYLORI STOOL AG IA | $134.40 | $192.00 | $6.49–$192.00 | — | 30% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 QUANT&REVRSE TRNSCRPJ | $180.60 | $258.00 | $40.25–$258.00 | 49% below | 30% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV 1 QUANT, REAL TIME PCR | $180.60 | $258.00 | $40.25–$258.00 | 49% below | 30% |
| HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV 1 QUANT, REAL TIME PCR | $180.60 | $258.00 | $40.25–$258.00 | — | 30% |
| HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV-1 QUANT&REVRSE TRNSCRPJ | $180.60 | $258.00 | $40.25–$258.00 | — | 30% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV-1 AG W/HIV-1&-2 AB AG IA | $116.90 | $167.00 | $8.62–$167.00 | 96% above | 30% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV ANITGEN/ANTIBODY COMBO | $116.90 | $167.00 | $8.62–$167.00 | 96% above | 30% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV ANITGEN/ANTIBODY COMBO | $116.90 | $167.00 | $8.62–$167.00 | — | 30% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV-1 AG W/HIV-1&-2 AB AG IA | $116.90 | $167.00 | $8.62–$167.00 | — | 30% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN GLYCOSYLATED A1C | $92.40 | $132.00 | $7.19–$132.00 | 41% above | 30% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 A1C | $92.40 | $132.00 | $7.19–$132.00 | 41% above | 30% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 A1C | $92.40 | $132.00 | $7.19–$132.00 | — | 30% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HEMOGLOBIN GLYCOSYLATED A1C | $92.40 | $132.00 | $7.19–$132.00 | — | 30% |
| Hemoglobin blood test CPT 85018 HEMOGLOBIN | $57.40 | $82.00 | $1.76–$82.00 | 212% above | 30% |
| Hemoglobin blood test inpatient CPT 85018 HEMOGLOBIN | $57.40 | $82.00 | $1.76–$82.00 | — | 30% |
| Hepatitis B core antibody test (total) CPT 86704 HEP B CORE ANTIBODY TOTAL | $154.00 | $220.00 | $5.70–$220.00 | 130% above | 30% |
| Hepatitis B core antibody test (total) CPT 86704 HEPAT B CORE ANTI | $154.00 | $220.00 | $5.70–$220.00 | 130% above | 30% |
| Hepatitis B core antibody test (total) inpatient CPT 86704 HEP B CORE ANTIBODY TOTAL | $154.00 | $220.00 | $5.70–$220.00 | — | 30% |
| Hepatitis B core antibody test (total) inpatient CPT 86704 HEPAT B CORE ANTI | $154.00 | $220.00 | $5.70–$220.00 | — | 30% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEP B SURFACE ANTIBODY | $100.80 | $144.00 | $5.08–$144.00 | 54% above | 30% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEP B SURFACE AB | $100.80 | $144.00 | $5.08–$144.00 | 54% above | 30% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEP B SURFACE AB | $100.80 | $144.00 | $5.08–$144.00 | — | 30% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEP B SURFACE ANTIBODY | $100.80 | $144.00 | $5.08–$144.00 | — | 30% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B ANTIGEN | $101.50 | $145.00 | $4.40–$145.00 | 66% above | 30% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURFACE AG IA | $101.50 | $145.00 | $4.40–$145.00 | 66% above | 30% |
| Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS B ANTIGEN | $101.50 | $145.00 | $4.40–$145.00 | — | 30% |
| Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS B SURFACE AG IA | $101.50 | $145.00 | $4.40–$145.00 | — | 30% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 HEPATITIS C | $90.30 | $129.00 | $20.26–$129.00 | 60% below | 30% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 HEPATITIS C REVRS TRNSCRPJ | $90.30 | $129.00 | $20.26–$129.00 | 60% below | 30% |
| Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEPATITIS C REVRS TRNSCRPJ | $90.30 | $129.00 | $20.26–$129.00 | — | 30% |
| Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEPATITIS C | $90.30 | $129.00 | $20.26–$129.00 | — | 30% |
| Herpes blood test, HSV-1 antibody CPT 86695 HERPES SIMPLEX TYPE 1 TEST | $69.30 | $99.00 | $6.23–$198.00 | 37% above | 30% |
| Herpes blood test, HSV-1 antibody CPT 86695 HERPES 1 | $69.30 | $99.00 | $6.23–$198.00 | 37% above | 30% |
| Herpes blood test, HSV-1 antibody CPT 86695 HERPES IGM TYPE 1 | $69.30 | $99.00 | $6.23–$198.00 | 37% above | 30% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 HERPES IGM TYPE 1 | $69.30 | $99.00 | $6.23–$198.00 | — | 30% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 HERPES 1 | $69.30 | $99.00 | $6.23–$198.00 | — | 30% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 HERPES SIMPLEX TYPE 1 TEST | $69.30 | $99.00 | $6.23–$198.00 | — | 30% |
| Herpes blood test, HSV-2 antibody CPT 86696 HERPES SIMPLEX TYPE 2 TEST | $53.90 | $77.00 | $9.16–$77.00 | 26% below | 30% |
| Herpes blood test, HSV-2 antibody CPT 86696 HERPES IGM TYPE 2 | $53.90 | $77.00 | $9.16–$77.00 | 26% below | 30% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 HERPES IGM TYPE 2 | $53.90 | $77.00 | $9.16–$77.00 | — | 30% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 HERPES SIMPLEX TYPE 2 TEST | $53.90 | $77.00 | $9.16–$77.00 | — | 30% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 CRP - CARDIAC RISK | $81.20 | $116.00 | $6.12–$116.00 | 10% above | 30% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROTEIN HS | $81.20 | $116.00 | $6.12–$116.00 | 10% above | 30% |
| High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-REACTIVE PROTEIN HS | $81.20 | $116.00 | $6.12–$116.00 | — | 30% |
| High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 CRP - CARDIAC RISK | $81.20 | $116.00 | $6.12–$116.00 | — | 30% |
| Homocysteine blood test CPT 83090 HOMOCYSTEINE | $374.50 | $535.00 | $8.33–$535.00 | 188% above | 30% |
| Homocysteine blood test CPT 83090 ASSAY OF HOMOCYSTEINE | $374.50 | $535.00 | $8.33–$535.00 | 188% above | 30% |
| Homocysteine blood test inpatient CPT 83090 ASSAY OF HOMOCYSTEINE | $374.50 | $535.00 | $8.33–$535.00 | — | 30% |
| Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINE | $374.50 | $535.00 | $8.33–$535.00 | — | 30% |
| Insulin blood test CPT 83525 INSULIN SERUM | $110.60 | $158.00 | $5.41–$343.00 | 55% above | 30% |
| Insulin blood test CPT 83525 ASSAY OF INSULIN | $110.60 | $158.00 | $5.41–$343.00 | 55% above | 30% |
| Insulin blood test CPT 83525 C-PEP INSULIN | $129.50 | $185.00 | $5.41–$343.00 | 81% above | 30% |
| Insulin blood test inpatient CPT 83525 INSULIN SERUM | $110.60 | $158.00 | $5.41–$343.00 | — | 30% |
| Insulin blood test inpatient CPT 83525 ASSAY OF INSULIN | $110.60 | $158.00 | $5.41–$343.00 | — | 30% |
| Insulin blood test inpatient CPT 83525 C-PEP INSULIN | $129.50 | $185.00 | $5.41–$343.00 | — | 30% |
| Iron blood test (serum iron) CPT 83540 ASSAY OF IRON | $84.00 | $120.00 | $3.06–$120.00 | 75% above | 30% |
| Iron blood test (serum iron) CPT 83540 IRON, SERUM | $84.00 | $120.00 | $3.06–$120.00 | 75% above | 30% |
| Iron blood test (serum iron) inpatient CPT 83540 ASSAY OF IRON | $84.00 | $120.00 | $3.06–$120.00 | — | 30% |
| Iron blood test (serum iron) inpatient CPT 83540 IRON, SERUM | $84.00 | $120.00 | $3.06–$120.00 | — | 30% |
| Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING TEST | $176.40 | $252.00 | $4.13–$252.00 | 299% above | 30% |
| Iron-binding capacity (TIBC) test CPT 83550 IRON BIND CAP TIBC | $176.40 | $252.00 | $4.13–$252.00 | 299% above | 30% |
| Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BIND CAP TIBC | $176.40 | $252.00 | $4.13–$252.00 | — | 30% |
| Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BINDING TEST | $176.40 | $252.00 | $4.13–$252.00 | — | 30% |
| Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL | $266.00 | $380.00 | $4.11–$380.00 | 163% above | 30% |
| Kidney function blood test panel CPT 80069 RENAL FUNCTION | $266.00 | $380.00 | $4.11–$380.00 | 163% above | 30% |
| Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL | $266.00 | $380.00 | $4.11–$380.00 | — | 30% |
| Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION | $266.00 | $380.00 | $4.11–$380.00 | — | 30% |
| LH (luteinizing hormone) test CPT 83002 ASSAY OF GONADOTROPIN (LH) | $235.20 | $336.00 | $8.76–$336.00 | 66% above | 30% |
| LH (luteinizing hormone) test CPT 83002 LH | $235.20 | $336.00 | $8.76–$336.00 | 66% above | 30% |
| LH (luteinizing hormone) test inpatient CPT 83002 LH | $235.20 | $336.00 | $8.76–$336.00 | — | 30% |
| LH (luteinizing hormone) test inpatient CPT 83002 ASSAY OF GONADOTROPIN (LH) | $235.20 | $336.00 | $8.76–$336.00 | — | 30% |
| Lactate (lactic acid) blood test CPT 83605 LACTATE | $179.20 | $256.00 | $5.05–$256.00 | 99% above | 30% |
| Lactate (lactic acid) blood test CPT 83605 ASSAY OF LACTIC ACID | $179.20 | $256.00 | $5.05–$256.00 | 99% above | 30% |
| Lactate (lactic acid) blood test inpatient CPT 83605 ASSAY OF LACTIC ACID | $179.20 | $256.00 | $5.05–$256.00 | — | 30% |
| Lactate (lactic acid) blood test inpatient CPT 83605 LACTATE | $179.20 | $256.00 | $5.05–$256.00 | — | 30% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 LD BF | $75.60 | $108.00 | $2.86–$228.00 | 77% above | 30% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 LACTATE (LD) (LDH) ENZYME | $84.00 | $120.00 | $2.86–$228.00 | 96% above | 30% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 LDH WS | $84.00 | $120.00 | $2.86–$228.00 | 96% above | 30% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LD BF | $75.60 | $108.00 | $2.86–$228.00 | — | 30% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH WS | $84.00 | $120.00 | $2.86–$228.00 | — | 30% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LACTATE (LD) (LDH) ENZYME | $84.00 | $120.00 | $2.86–$228.00 | — | 30% |
| Lipase blood test (pancreas enzyme) CPT 83690 LIPASE | $100.80 | $144.00 | $3.26–$144.00 | 14% above | 30% |
| Lipase blood test (pancreas enzyme) CPT 83690 ASSAY OF LIPASE | $100.80 | $144.00 | $3.26–$144.00 | 14% above | 30% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 ASSAY OF LIPASE | $100.80 | $144.00 | $3.26–$144.00 | — | 30% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE | $100.80 | $144.00 | $3.26–$144.00 | — | 30% |
| Liver function blood test panel CPT 80076 HEPATIC FUNCT PROF | $288.40 | $412.00 | $2.99–$412.00 | 205% above | 30% |
| Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL | $288.40 | $412.00 | $2.99–$412.00 | 205% above | 30% |
| Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCT PROF | $288.40 | $412.00 | $2.99–$412.00 | — | 30% |
| Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL | $288.40 | $412.00 | $2.99–$412.00 | — | 30% |
| Lyme disease antibody test CPT 86618 LYME | $200.20 | $286.00 | $8.06–$286.00 | 63% above | 30% |
| Lyme disease antibody test CPT 86618 LYME DISEASE ANTIBODY | $200.20 | $286.00 | $8.06–$286.00 | 63% above | 30% |
| Lyme disease antibody test inpatient CPT 86618 LYME DISEASE ANTIBODY | $200.20 | $286.00 | $8.06–$286.00 | — | 30% |
| Lyme disease antibody test inpatient CPT 86618 LYME | $200.20 | $286.00 | $8.06–$286.00 | — | 30% |
| Magnesium blood test CPT 83735 MAGNESIUM,RBC | $9.10 | $13.00 | $2.73–$226.00 | 81% below | 30% |
| Magnesium blood test CPT 83735 MAGNESIUM | $149.10 | $213.00 | $2.73–$226.00 | 213% above | 30% |
| Magnesium blood test CPT 83735 ASSAY OF MAGNESIUM | $149.10 | $213.00 | $2.73–$226.00 | 213% above | 30% |
| Magnesium blood test inpatient CPT 83735 MAGNESIUM,RBC | $9.10 | $13.00 | $2.73–$226.00 | — | 30% |
| Magnesium blood test inpatient CPT 83735 ASSAY OF MAGNESIUM | $149.10 | $213.00 | $2.73–$226.00 | — | 30% |
| Magnesium blood test inpatient CPT 83735 MAGNESIUM | $149.10 | $213.00 | $2.73–$226.00 | — | 30% |
| Measles (rubeola) antibody test CPT 86765 RUBEOLA ANTIBODY | $179.20 | $256.00 | $6.09–$256.00 | 128% above | 30% |
| Measles (rubeola) antibody test CPT 86765 RUBEOLA | $179.20 | $256.00 | $6.09–$256.00 | 128% above | 30% |
| Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA | $179.20 | $256.00 | $6.09–$256.00 | — | 30% |
| Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA ANTIBODY | $179.20 | $256.00 | $6.09–$256.00 | — | 30% |
| Mono test (heterophile antibody, Monospot) CPT 86308 MONOTEST | $66.50 | $95.00 | $2.45–$95.00 | 15% below | 30% |
| Mono test (heterophile antibody, Monospot) CPT 86308 HETEROPHILE ANTIBODY SCREEN | $66.50 | $95.00 | $2.45–$95.00 | 15% below | 30% |
| Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HETEROPHILE ANTIBODY SCREEN | $66.50 | $95.00 | $2.45–$95.00 | — | 30% |
| Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONOTEST | $66.50 | $95.00 | $2.45–$95.00 | — | 30% |
| Mumps immunity blood test CPT 86735 MUMPS IGM | $200.90 | $287.00 | $6.17–$657.00 | 163% above | 30% |
| Mumps immunity blood test CPT 86735 MUMPS ANTIBODIES IGG | $259.00 | $370.00 | $6.17–$657.00 | 240% above | 30% |
| Mumps immunity blood test CPT 86735 MUMPS ANTIBODY | $259.00 | $370.00 | $6.17–$657.00 | 240% above | 30% |
| Mumps immunity blood test inpatient CPT 86735 MUMPS IGM | $200.90 | $287.00 | $6.17–$657.00 | — | 30% |
| Mumps immunity blood test inpatient CPT 86735 MUMPS ANTIBODY | $259.00 | $370.00 | $6.17–$657.00 | — | 30% |
| Mumps immunity blood test inpatient CPT 86735 MUMPS ANTIBODIES IGG | $259.00 | $370.00 | $6.17–$657.00 | — | 30% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 ASSAY OF PSA TOTAL | $137.90 | $197.00 | $10.42–$507.00 | 73% above | 30% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA | $137.90 | $197.00 | $10.42–$507.00 | 73% above | 30% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA REFLEX | $217.00 | $310.00 | $10.42–$507.00 | 172% above | 30% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA | $137.90 | $197.00 | $10.42–$507.00 | — | 30% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 ASSAY OF PSA TOTAL | $137.90 | $197.00 | $10.42–$507.00 | — | 30% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA REFLEX | $217.00 | $310.00 | $10.42–$507.00 | — | 30% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 CYTO GYN THIN PREP DX | $161.00 | $230.00 | $20.26–$230.00 | 131% above | 30% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 CYTOPATH C/V THIN LAYER | $161.00 | $230.00 | $20.26–$230.00 | 131% above | 30% |
| Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 CYTO GYN THIN PREP DX | $161.00 | $230.00 | $20.26–$230.00 | — | 30% |
| Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 CYTOPATH C/V THIN LAYER | $161.00 | $230.00 | $20.26–$230.00 | — | 30% |
| Parathyroid hormone (PTH) blood test CPT 83970 ASSAY OF PARATHORMONE | $198.80 | $284.00 | $19.53–$284.00 | 3% above | 30% |
| Parathyroid hormone (PTH) blood test CPT 83970 PARATHYROID HORMONE | $198.80 | $284.00 | $19.53–$284.00 | 3% above | 30% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 PARATHYROID HORMONE | $198.80 | $284.00 | $19.53–$284.00 | — | 30% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 ASSAY OF PARATHORMONE | $198.80 | $284.00 | $19.53–$284.00 | — | 30% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PARTIAL | $75.60 | $108.00 | $2.97–$108.00 | 51% above | 30% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PTT | $75.60 | $108.00 | $2.97–$108.00 | 51% above | 30% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT | $75.60 | $108.00 | $2.97–$108.00 | — | 30% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME PARTIAL | $75.60 | $108.00 | $2.97–$108.00 | — | 30% |
| Phosphorus (phosphate) blood test CPT 84100 ASSAY OF PHOSPHORUS | $75.60 | $108.00 | $2.24–$108.00 | 164% above | 30% |
| Phosphorus (phosphate) blood test CPT 84100 PHOSPHORUS WS | $75.60 | $108.00 | $2.24–$108.00 | 164% above | 30% |
| Phosphorus (phosphate) blood test inpatient CPT 84100 ASSAY OF PHOSPHORUS | $75.60 | $108.00 | $2.24–$108.00 | — | 30% |
| Phosphorus (phosphate) blood test inpatient CPT 84100 PHOSPHORUS WS | $75.60 | $108.00 | $2.24–$108.00 | — | 30% |
| Potassium blood test CPT 84132 ASSAY OF SERUM POTASSIUM | $69.30 | $99.00 | $2.17–$99.00 | 143% above | 30% |
| Potassium blood test CPT 84132 POTASSIUM WS | $69.30 | $99.00 | $2.17–$99.00 | 143% above | 30% |
| Potassium blood test inpatient CPT 84132 ASSAY OF SERUM POTASSIUM | $69.30 | $99.00 | $2.17–$99.00 | — | 30% |
| Potassium blood test inpatient CPT 84132 POTASSIUM WS | $69.30 | $99.00 | $2.17–$99.00 | — | 30% |
| Progesterone blood test CPT 84144 ASSAY OF PROGESTERONE | $75.60 | $108.00 | $9.06–$108.00 | 45% below | 30% |
| Progesterone blood test CPT 84144 PROGESTERONE | $75.60 | $108.00 | $9.06–$108.00 | 45% below | 30% |
| Progesterone blood test inpatient CPT 84144 PROGESTERONE | $75.60 | $108.00 | $9.06–$108.00 | — | 30% |
| Progesterone blood test inpatient CPT 84144 ASSAY OF PROGESTERONE | $75.60 | $108.00 | $9.06–$108.00 | — | 30% |
| Prolactin blood test CPT 84146 PROLACTIN | $312.90 | $447.00 | $9.17–$447.00 | 211% above | 30% |
| Prolactin blood test CPT 84146 ASSAY OF PROLACTIN | $312.90 | $447.00 | $9.17–$447.00 | 211% above | 30% |
| Prolactin blood test inpatient CPT 84146 ASSAY OF PROLACTIN | $312.90 | $447.00 | $9.17–$447.00 | — | 30% |
| Prolactin blood test inpatient CPT 84146 PROLACTIN | $312.90 | $447.00 | $9.17–$447.00 | — | 30% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME | $57.40 | $82.00 | $2.91–$82.00 | 117% above | 30% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME | $57.40 | $82.00 | $2.91–$82.00 | — | 30% |
| Renin blood test CPT 84244 ASSAY OF RENIN | $222.60 | $318.00 | $8.21–$318.00 | 101% above | 30% |
| Renin blood test CPT 84244 RENIN | $222.60 | $318.00 | $8.21–$318.00 | 101% above | 30% |
| Renin blood test inpatient CPT 84244 ASSAY OF RENIN | $222.60 | $318.00 | $8.21–$318.00 | — | 30% |
| Renin blood test inpatient CPT 84244 RENIN | $222.60 | $318.00 | $8.21–$318.00 | — | 30% |
| Rh blood typing CPT 86901 BLOOD TYPING SEROLOGIC RH(D) | $22.40 | $32.00 | $1.48–$99.00 | 42% below | 30% |
| Rh blood typing CPT 86901 RH FACTOR | $22.40 | $32.00 | $1.48–$99.00 | 42% below | 30% |
| Rh blood typing CPT 86901 ARC RH FACTOR | $46.90 | $67.00 | $1.48–$99.00 | 21% above | 30% |
| Rh blood typing inpatient CPT 86901 RH FACTOR | $22.40 | $32.00 | $1.48–$99.00 | — | 30% |
| Rh blood typing inpatient CPT 86901 BLOOD TYPING SEROLOGIC RH(D) | $22.40 | $32.00 | $1.48–$99.00 | — | 30% |
| Rh blood typing inpatient CPT 86901 ARC RH FACTOR | $46.90 | $67.00 | $1.48–$99.00 | — | 30% |
| Rheumatoid factor (RF) test CPT 86431 RHEUMOTOID ARTH QUAN | $13.30 | $19.00 | $2.68–$19.00 | 73% below | 30% |
| Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANT | $13.30 | $19.00 | $2.68–$19.00 | 73% below | 30% |
| Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR QUANT | $13.30 | $19.00 | $2.68–$19.00 | — | 30% |
| Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMOTOID ARTH QUAN | $13.30 | $19.00 | $2.68–$19.00 | — | 30% |
| Rubella antibody test (immunity check) CPT 86762 TORCH IGG AND IGM | $81.20 | $116.00 | $6.81–$664.00 | 22% above | 30% |
| Rubella antibody test (immunity check) CPT 86762 RUBELLA ANTIBODY | $302.40 | $432.00 | $6.81–$664.00 | 354% above | 30% |
| Rubella antibody test (immunity check) CPT 86762 RUBELLA TITRE | $302.40 | $432.00 | $6.81–$664.00 | 354% above | 30% |
| Rubella antibody test (immunity check) inpatient CPT 86762 TORCH IGG AND IGM | $81.20 | $116.00 | $6.81–$664.00 | — | 30% |
| Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA ANTIBODY | $302.40 | $432.00 | $6.81–$664.00 | — | 30% |
| Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA TITRE | $302.40 | $432.00 | $6.81–$664.00 | — | 30% |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 RBC SED RATE AUTOMATED | $66.50 | $95.00 | $2.00–$95.00 | 71% above | 30% |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 SED RATE, AUTO | $66.50 | $95.00 | $2.00–$95.00 | 71% above | 30% |
| Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 SED RATE, AUTO | $66.50 | $95.00 | $2.00–$95.00 | — | 30% |
| Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 RBC SED RATE AUTOMATED | $66.50 | $95.00 | $2.00–$95.00 | — | 30% |
| Sodium blood test CPT 84295 SODIUM SERUM | $66.50 | $95.00 | $2.28–$95.00 | 82% above | 30% |
| Sodium blood test CPT 84295 ASSAY OF SERUM SODIUM | $66.50 | $95.00 | $2.28–$95.00 | 82% above | 30% |
| Sodium blood test inpatient CPT 84295 SODIUM SERUM | $66.50 | $95.00 | $2.28–$95.00 | — | 30% |
| Sodium blood test inpatient CPT 84295 ASSAY OF SERUM SODIUM | $66.50 | $95.00 | $2.28–$95.00 | — | 30% |
| Stool ova and parasites exam CPT 87177 OVA AND PARASITES SMEARS | $100.80 | $144.00 | $4.21–$144.00 | 108% above | 30% |
| Stool ova and parasites exam CPT 87177 O&P DIRECT CONC&ID | $100.80 | $144.00 | $4.21–$144.00 | 108% above | 30% |
| Stool ova and parasites exam inpatient CPT 87177 O&P DIRECT CONC&ID | $100.80 | $144.00 | $4.21–$144.00 | — | 30% |
| Stool ova and parasites exam inpatient CPT 87177 OVA AND PARASITES SMEARS | $100.80 | $144.00 | $4.21–$144.00 | — | 30% |
| Syphilis antibody test (Treponema pallidum) CPT 86780 TREPONEMA PALLIDUM | $11.20 | $16.00 | $2.49–$174.00 | 83% below | 30% |
| Syphilis antibody test (Treponema pallidum) CPT 86780 FTA ABS | $110.60 | $158.00 | $2.49–$174.00 | 64% above | 30% |
| Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 TREPONEMA PALLIDUM | $11.20 | $16.00 | $2.49–$174.00 | — | 30% |
| Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 FTA ABS | $110.60 | $158.00 | $2.49–$174.00 | — | 30% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 CSF RPR | $46.20 | $66.00 | $2.02–$148.00 | 13% above | 30% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 SYPHILIS TEST NON-TREP QUAL | $46.20 | $66.00 | $2.02–$148.00 | 13% above | 30% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR SCREENING | $57.40 | $82.00 | $2.02–$148.00 | 41% above | 30% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 CSF RPR | $46.20 | $66.00 | $2.02–$148.00 | — | 30% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 SYPHILIS TEST NON-TREP QUAL | $46.20 | $66.00 | $2.02–$148.00 | — | 30% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR SCREENING | $57.40 | $82.00 | $2.02–$148.00 | — | 30% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB TEST CELL IMMUN MEASURE | $217.00 | $310.00 | $30.61–$310.00 | 47% above | 30% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QUANTIFERON GOLD | $217.00 | $310.00 | $30.61–$310.00 | 47% above | 30% |
| TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 TB TEST CELL IMMUN MEASURE | $217.00 | $310.00 | $30.61–$310.00 | — | 30% |
| TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 QUANTIFERON GOLD | $217.00 | $310.00 | $30.61–$310.00 | — | 30% |
| Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE | $129.50 | $185.00 | $9.64–$185.00 | 9% above | 30% |
| Testosterone blood test, total (not free testosterone) CPT 84403 ASSAY OF TOTAL TESTOSTERONE | $129.50 | $185.00 | $9.64–$185.00 | 9% above | 30% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 ASSAY OF TOTAL TESTOSTERONE | $129.50 | $185.00 | $9.64–$185.00 | — | 30% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE | $129.50 | $185.00 | $9.64–$185.00 | — | 30% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 THY PEROXIDASE AB | $57.40 | $82.00 | $6.88–$82.00 | 38% below | 30% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 MICROSOMAL ANTIBODY EACH | $57.40 | $82.00 | $6.88–$82.00 | 38% below | 30% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 THY PEROXIDASE AB | $57.40 | $82.00 | $6.88–$82.00 | — | 30% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 MICROSOMAL ANTIBODY EACH | $57.40 | $82.00 | $6.88–$82.00 | — | 30% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH | $110.60 | $158.00 | $7.95–$158.00 | 36% above | 30% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 ASSAY THYROID STIM HORMONE | $110.60 | $158.00 | $7.95–$158.00 | 36% above | 30% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH | $110.60 | $158.00 | $7.95–$158.00 | — | 30% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 ASSAY THYROID STIM HORMONE | $110.60 | $158.00 | $7.95–$158.00 | — | 30% |
| Total IgE blood test CPT 82785 ALPHA GAL 2 | $38.50 | $55.00 | $7.79–$275.00 | 49% below | 30% |
| Total IgE blood test CPT 82785 ASSAY OF IGE | $154.00 | $220.00 | $7.79–$275.00 | 105% above | 30% |
| Total IgE blood test CPT 82785 IGE | $154.00 | $220.00 | $7.79–$275.00 | 105% above | 30% |
| Total IgE blood test inpatient CPT 82785 ALPHA GAL 2 | $38.50 | $55.00 | $7.79–$275.00 | — | 30% |
| Total IgE blood test inpatient CPT 82785 IGE | $154.00 | $220.00 | $7.79–$275.00 | — | 30% |
| Total IgE blood test inpatient CPT 82785 ASSAY OF IGE | $154.00 | $220.00 | $7.79–$275.00 | — | 30% |
| Total cholesterol blood test CPT 82465 ASSAY BLD/SERUM CHOLESTEROL | $75.60 | $108.00 | $2.06–$108.00 | 147% above | 30% |
| Total cholesterol blood test CPT 82465 CHOLESTEROL WS | $75.60 | $108.00 | $2.06–$108.00 | 147% above | 30% |
| Total cholesterol blood test inpatient CPT 82465 CHOLESTEROL WS | $75.60 | $108.00 | $2.06–$108.00 | — | 30% |
| Total cholesterol blood test inpatient CPT 82465 ASSAY BLD/SERUM CHOLESTEROL | $75.60 | $108.00 | $2.06–$108.00 | — | 30% |
| Total thyroxine (T4) blood test CPT 84436 T4 | $201.60 | $288.00 | $3.25–$586.00 | 325% above | 30% |
| Total thyroxine (T4) blood test CPT 84436 ASSAY OF TOTAL THYROXINE | $201.60 | $288.00 | $3.25–$586.00 | 325% above | 30% |
| Total thyroxine (T4) blood test CPT 84436 T4 RIA | $208.60 | $298.00 | $3.25–$586.00 | 340% above | 30% |
| Total thyroxine (T4) blood test inpatient CPT 84436 ASSAY OF TOTAL THYROXINE | $201.60 | $288.00 | $3.25–$586.00 | — | 30% |
| Total thyroxine (T4) blood test inpatient CPT 84436 T4 | $201.60 | $288.00 | $3.25–$586.00 | — | 30% |
| Total thyroxine (T4) blood test inpatient CPT 84436 T4 RIA | $208.60 | $298.00 | $3.25–$586.00 | — | 30% |
| Transferrin blood test CPT 84466 TRANFERRIN | $144.20 | $206.00 | $5.74–$206.00 | 70% above | 30% |
| Transferrin blood test CPT 84466 ASSAY OF TRANSFERRIN | $144.20 | $206.00 | $5.74–$206.00 | 70% above | 30% |
| Transferrin blood test inpatient CPT 84466 TRANFERRIN | $144.20 | $206.00 | $5.74–$206.00 | — | 30% |
| Transferrin blood test inpatient CPT 84466 ASSAY OF TRANSFERRIN | $144.20 | $206.00 | $5.74–$206.00 | — | 30% |
| Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS | $92.40 | $132.00 | $19.15–$271.00 | 3% below | 30% |
| Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS AMPLIF | $92.40 | $132.00 | $19.15–$271.00 | 3% below | 30% |
| Trichomonas test (NAAT) CPT 87661 VAGINITIS PLUS, NU SWAB | $97.30 | $139.00 | $19.15–$271.00 | 3% above | 30% |
| Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS VAGINALIS | $92.40 | $132.00 | $19.15–$271.00 | — | 30% |
| Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS VAGINALIS AMPLIF | $92.40 | $132.00 | $19.15–$271.00 | — | 30% |
| Trichomonas test (NAAT) inpatient CPT 87661 VAGINITIS PLUS, NU SWAB | $97.30 | $139.00 | $19.15–$271.00 | — | 30% |
| Triglycerides blood test CPT 84478 ASSAY OF TRIGLYCERIDES | $100.80 | $144.00 | $2.72–$144.00 | 182% above | 30% |
| Triglycerides blood test CPT 84478 TRIGLYCERIDES WS | $100.80 | $144.00 | $2.72–$144.00 | 182% above | 30% |
| Triglycerides blood test inpatient CPT 84478 TRIGLYCERIDES WS | $100.80 | $144.00 | $2.72–$144.00 | — | 30% |
| Triglycerides blood test inpatient CPT 84478 ASSAY OF TRIGLYCERIDES | $100.80 | $144.00 | $2.72–$144.00 | — | 30% |
| Troponin test, quantitative CPT 84484 TROPONIN I, QUANT | $213.50 | $305.00 | $4.66–$305.00 | 76% above | 30% |
| Troponin test, quantitative CPT 84484 ASSAY OF TROPONIN QUANT | $213.50 | $305.00 | $4.66–$305.00 | 76% above | 30% |
| Troponin test, quantitative inpatient CPT 84484 ASSAY OF TROPONIN QUANT | $213.50 | $305.00 | $4.66–$305.00 | — | 30% |
| Troponin test, quantitative inpatient CPT 84484 TROPONIN I, QUANT | $213.50 | $305.00 | $4.66–$305.00 | — | 30% |
| Uric acid blood test CPT 84550 ASSAY OF BLOOD/URIC ACID | $75.60 | $108.00 | $2.14–$108.00 | 58% above | 30% |
| Uric acid blood test CPT 84550 URIC ACID WS | $75.60 | $108.00 | $2.14–$108.00 | 58% above | 30% |
| Uric acid blood test inpatient CPT 84550 ASSAY OF BLOOD/URIC ACID | $75.60 | $108.00 | $2.14–$108.00 | — | 30% |
| Uric acid blood test inpatient CPT 84550 URIC ACID WS | $75.60 | $108.00 | $2.14–$108.00 | — | 30% |
| Urinalysis without microscope exam, automated CPT 81003 URINALYSIS AUTO W/O SCOPE | $66.50 | $95.00 | $1.66–$95.00 | 171% above | 30% |
| Urinalysis without microscope exam, automated CPT 81003 URINALYSIS | $66.50 | $95.00 | $1.66–$95.00 | 171% above | 30% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS AUTO W/O SCOPE | $66.50 | $95.00 | $1.66–$95.00 | — | 30% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS | $66.50 | $95.00 | $1.66–$95.00 | — | 30% |
| Urine culture for bacteria, with colony count CPT 87086 ANAEROBE DEFN ID EA | $23.80 | $34.00 | $3.98–$120.00 | 46% below | 30% |
| Urine culture for bacteria, with colony count CPT 87086 URINE CULTURE/COLONY COUNT | $60.20 | $86.00 | $3.98–$120.00 | 38% above | 30% |
| Urine culture for bacteria, with colony count CPT 87086 CULTURE URINE QUANT | $60.20 | $86.00 | $3.98–$120.00 | 38% above | 30% |
| Urine culture for bacteria, with colony count inpatient CPT 87086 ANAEROBE DEFN ID EA | $23.80 | $34.00 | $3.98–$120.00 | — | 30% |
| Urine culture for bacteria, with colony count inpatient CPT 87086 URINE CULTURE/COLONY COUNT | $60.20 | $86.00 | $3.98–$120.00 | — | 30% |
| Urine culture for bacteria, with colony count inpatient CPT 87086 CULTURE URINE QUANT | $60.20 | $86.00 | $3.98–$120.00 | — | 30% |
| Urine microalbumin (albumin) test CPT 82043 MICROALBUMIN/CREAT RATIO | $20.30 | $29.00 | $2.86–$278.00 | 41% below | 30% |
| Urine microalbumin (albumin) test CPT 82043 UR ALBUMIN QUANTITATIVE | $174.30 | $249.00 | $2.86–$278.00 | 403% above | 30% |
| Urine microalbumin (albumin) test CPT 82043 MICRO ALUBMIN URINE | $174.30 | $249.00 | $2.86–$278.00 | 403% above | 30% |
| Urine microalbumin (albumin) test inpatient CPT 82043 MICROALBUMIN/CREAT RATIO | $20.30 | $29.00 | $2.86–$278.00 | — | 30% |
| Urine microalbumin (albumin) test inpatient CPT 82043 MICRO ALUBMIN URINE | $174.30 | $249.00 | $2.86–$278.00 | — | 30% |
| Urine microalbumin (albumin) test inpatient CPT 82043 UR ALBUMIN QUANTITATIVE | $174.30 | $249.00 | $2.86–$278.00 | — | 30% |
| Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY TEST | $102.90 | $147.00 | $5.17–$147.00 | 91% above | 30% |
| Urine pregnancy test, read by color change CPT 81025 PREGNANCY TEST,URINE | $102.90 | $147.00 | $5.17–$147.00 | 91% above | 30% |
| Urine pregnancy test, read by color change inpatient CPT 81025 URINE PREGNANCY TEST | $102.90 | $147.00 | $5.17–$147.00 | — | 30% |
| Urine pregnancy test, read by color change inpatient CPT 81025 PREGNANCY TEST,URINE | $102.90 | $147.00 | $5.17–$147.00 | — | 30% |
| Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B12 | $150.50 | $215.00 | $7.13–$215.00 | 104% above | 30% |
| Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B-12 | $150.50 | $215.00 | $7.13–$215.00 | 104% above | 30% |
| Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B-12 | $150.50 | $215.00 | $7.13–$215.00 | — | 30% |
| Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B12 | $150.50 | $215.00 | $7.13–$215.00 | — | 30% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D OH | $144.90 | $207.00 | $14.00–$207.00 | 8% above | 30% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25 HYDROXY | $144.90 | $207.00 | $14.00–$207.00 | 8% above | 30% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D 25 HYDROXY | $144.90 | $207.00 | $14.00–$207.00 | — | 30% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D OH | $144.90 | $207.00 | $14.00–$207.00 | — | 30% |
| Vitamin D, 1,25-dihydroxy blood test CPT 82652 VITD 1,25 DIHY | $250.60 | $358.00 | $19.01–$358.00 | 41% above | 30% |
| Vitamin D, 1,25-dihydroxy blood test CPT 82652 VIT D 1 25-DIHYDROXY | $250.60 | $358.00 | $19.01–$358.00 | 41% above | 30% |
| Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 VIT D 1 25-DIHYDROXY | $250.60 | $358.00 | $19.01–$358.00 | — | 30% |
| Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 VITD 1,25 DIHY | $250.60 | $358.00 | $19.01–$358.00 | — | 30% |
| Zinc blood test CPT 84630 ZINC, SERUM OR PLASMA | $67.90 | $97.00 | $5.39–$287.00 | 18% below | 30% |
| Zinc blood test CPT 84630 ASSAY OF ZINC | $133.00 | $190.00 | $5.39–$287.00 | 61% above | 30% |
| Zinc blood test CPT 84630 URINE ZINC | $133.00 | $190.00 | $5.39–$287.00 | 61% above | 30% |
| Zinc blood test inpatient CPT 84630 ZINC, SERUM OR PLASMA | $67.90 | $97.00 | $5.39–$287.00 | — | 30% |
| Zinc blood test inpatient CPT 84630 URINE ZINC | $133.00 | $190.00 | $5.39–$287.00 | — | 30% |
| Zinc blood test inpatient CPT 84630 ASSAY OF ZINC | $133.00 | $190.00 | $5.39–$287.00 | — | 30% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 CHORIONIC GONADO | $42.00 | $60.00 | $7.01–$207.00 | 47% below | 30% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 BHCG QUANTITATIVE | $102.90 | $147.00 | $7.01–$207.00 | 29% above | 30% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 CHORIONIC GONADOTROPIN TEST | $102.90 | $147.00 | $7.01–$207.00 | 29% above | 30% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 CHORIONIC GONADO | $42.00 | $60.00 | $7.01–$207.00 | — | 30% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 CHORIONIC GONADOTROPIN TEST | $102.90 | $147.00 | $7.01–$207.00 | — | 30% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 BHCG QUANTITATIVE | $102.90 | $147.00 | $7.01–$207.00 | — | 30% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Indiana | Off list |
|---|---|---|---|---|---|
| Botox injections for chronic migraine CPT 64615 CHEMO MUSC MIGRAINE | $296.10 | $423.00 | $620.31–$2,697.00 | 54% below | 30% |
| Botox injections for chronic migraine CPT 64615 CHEMODENERV MUSC MIGRAINE | $296.10 | $423.00 | $620.31–$2,697.00 | 54% below | 30% |
| Botox injections for chronic migraine CPT 64615 CHEMO DENERVATION MUSCLE | $1,591.80 | $2,274.00 | $620.31–$2,697.00 | 147% above | 30% |
| Botox injections for chronic migraine inpatient CPT 64615 CHEMODENERV MUSC MIGRAINE | $296.10 | $423.00 | $620.31–$2,697.00 | — | 30% |
| Botox injections for chronic migraine inpatient CPT 64615 CHEMO MUSC MIGRAINE | $296.10 | $423.00 | $620.31–$2,697.00 | — | 30% |
| Botox injections for chronic migraine inpatient CPT 64615 CHEMO DENERVATION MUSCLE | $1,591.80 | $2,274.00 | $620.31–$2,697.00 | — | 30% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ELECTRIC EXT | $228.90 | $327.00 | $322.23–$1,728.79 | 84% below | 30% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION PROCEDURE | $751.80 | $1,074.00 | $322.23–$1,728.79 | 46% below | 30% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION ELECTRIC EXT | $228.90 | $327.00 | $322.23–$1,728.79 | — | 30% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION PROCEDURE | $751.80 | $1,074.00 | $322.23–$1,728.79 | — | 30% |
| Circumcision, surgical, older than a newborn CPT 54160 CIRCUMCISION SURGERY | $305.20 | $436.00 | $100.28–$1,728.79 | 23% below | 30% |
| Circumcision, surgical, older than a newborn CPT 54160 CIRCUMCISION NEONATE | $305.20 | $436.00 | $100.28–$1,728.79 | 23% below | 30% |
| Circumcision, surgical, older than a newborn inpatient CPT 54160 CIRCUMCISION SURGERY | $305.20 | $436.00 | $100.28–$1,728.79 | — | 30% |
| Circumcision, surgical, older than a newborn inpatient CPT 54160 CIRCUMCISION NEONATE | $305.20 | $436.00 | $100.28–$1,728.79 | — | 30% |
| Complex cataract surgery with lens implant CPT 66982 CATARACT SURGERY COMPLEX | $1,742.30 | $2,489.00 | $572.47–$4,315.74 | 71% below | 30% |
| Complex cataract surgery with lens implant CPT 66982 XCAPSL CTRC RMVL CPLX WO ECP | $1,742.30 | $2,489.00 | $572.47–$4,315.74 | 71% below | 30% |
| Complex cataract surgery with lens implant inpatient CPT 66982 CATARACT SURGERY COMPLEX | $1,742.30 | $2,489.00 | $572.47–$4,315.74 | — | 30% |
| Complex cataract surgery with lens implant inpatient CPT 66982 XCAPSL CTRC RMVL CPLX WO ECP | $1,742.30 | $2,489.00 | $572.47–$4,315.74 | — | 30% |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 CERIVCAL/THORACIC | $543.90 | $777.00 | $357.42–$1,554.00 | 49% below | 30% |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 CERVICAL/THORACIC | $543.90 | $777.00 | $357.42–$1,554.00 | 49% below | 30% |
| Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 CERIVCAL/THORACIC | $543.90 | $777.00 | $357.42–$1,554.00 | — | 30% |
| Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 CERVICAL/THORACIC | $543.90 | $777.00 | $357.42–$1,554.00 | — | 30% |
| Facet joint injection, lower back, one level, with imaging guidance CPT 64493 INJ PARAVERT F JNT L/S 1 LEV | $375.90 | $537.00 | $247.02–$1,242.31 | 67% below | 30% |
| Facet joint injection, lower back, one level, with imaging guidance CPT 64493 LUMBAR/SACRAL | $375.90 | $537.00 | $247.02–$1,242.31 | 67% below | 30% |
| Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 LUMBAR/SACRAL | $375.90 | $537.00 | $247.02–$1,242.31 | — | 30% |
| Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 INJ PARAVERT F JNT L/S 1 LEV | $375.90 | $537.00 | $247.02–$1,242.31 | — | 30% |
| Incision and drainage of a simple or single skin abscess CPT 10060 PHYS INCISION DRN | $305.90 | $437.00 | $100.51–$437.00 | 34% below | 30% |
| Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS SIMPLE/SINGLE | $305.90 | $437.00 | $100.51–$437.00 | 34% below | 30% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D ABSCESS SIMPLE/SINGLE | $305.90 | $437.00 | $100.51–$437.00 | — | 30% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 PHYS INCISION DRN | $305.90 | $437.00 | $100.51–$437.00 | — | 30% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJECT TENDON | $119.70 | $171.00 | $285.87–$2,487.00 | 78% below | 30% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 NJX 1 TENDON SHEATH/LIGAMENT | $537.60 | $768.00 | $285.87–$2,487.00 | 1% above | 30% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ TENDON SHEATH/LIGAMENT | $537.60 | $768.00 | $285.87–$2,487.00 | 1% above | 30% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ SG TENDON SHTH OR LIGAMENT | $541.80 | $774.00 | $285.87–$2,487.00 | 1% above | 30% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 CARPAL TUNNEL INJECTION | $541.80 | $774.00 | $285.87–$2,487.00 | 1% above | 30% |
| Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJECT TENDON | $119.70 | $171.00 | $285.87–$2,487.00 | — | 30% |
| Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJ TENDON SHEATH/LIGAMENT | $537.60 | $768.00 | $285.87–$2,487.00 | — | 30% |
| Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 NJX 1 TENDON SHEATH/LIGAMENT | $537.60 | $768.00 | $285.87–$2,487.00 | — | 30% |
| Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJ SG TENDON SHTH OR LIGAMENT | $541.80 | $774.00 | $285.87–$2,487.00 | — | 30% |
| Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 CARPAL TUNNEL INJECTION | $541.80 | $774.00 | $285.87–$2,487.00 | — | 30% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJ JOINT/BURSA W/O US | $134.40 | $192.00 | $285.87–$1,782.00 | 67% below | 30% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJECT JOINT | $134.40 | $192.00 | $285.87–$1,782.00 | 67% below | 30% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJECT JOINT/BURSA LG | $550.20 | $786.00 | $285.87–$1,782.00 | 33% above | 30% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ASP/INJECT LARGE JOINT | $562.80 | $804.00 | $285.87–$1,782.00 | 36% above | 30% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRAIN/INJ JOINT/BURSA W/O US | $134.40 | $192.00 | $285.87–$1,782.00 | — | 30% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRAIN/INJECT JOINT | $134.40 | $192.00 | $285.87–$1,782.00 | — | 30% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRAIN/INJECT JOINT/BURSA LG | $550.20 | $786.00 | $285.87–$1,782.00 | — | 30% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ASP/INJECT LARGE JOINT | $562.80 | $804.00 | $285.87–$1,782.00 | — | 30% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/INJECT JOINT | $113.40 | $162.00 | $285.87–$1,740.00 | 73% below | 30% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/INJECT JOINT/BURSA MED | $541.80 | $774.00 | $285.87–$1,740.00 | 27% above | 30% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/INJ JOINT/BURSA W/O US | $541.80 | $774.00 | $285.87–$1,740.00 | 27% above | 30% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ASP/INJECT MEDIUM JOINT | $562.80 | $804.00 | $285.87–$1,740.00 | 32% above | 30% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 DRAIN/INJECT JOINT | $113.40 | $162.00 | $285.87–$1,740.00 | — | 30% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 DRAIN/INJECT JOINT/BURSA MED | $541.80 | $774.00 | $285.87–$1,740.00 | — | 30% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 DRAIN/INJ JOINT/BURSA W/O US | $541.80 | $774.00 | $285.87–$1,740.00 | — | 30% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ASP/INJECT MEDIUM JOINT | $562.80 | $804.00 | $285.87–$1,740.00 | — | 30% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAIN/INJECT JOINT | $111.30 | $159.00 | $285.87–$1,737.00 | 62% below | 30% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAIN/INJ JOINT/BURSA W/O US | $541.80 | $774.00 | $285.87–$1,737.00 | 84% above | 30% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAIN/INJECT SM/BURSA | $541.80 | $774.00 | $285.87–$1,737.00 | 84% above | 30% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 ASP/INJECT SMALL JOINT | $562.80 | $804.00 | $285.87–$1,737.00 | 92% above | 30% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 DRAIN/INJECT JOINT | $111.30 | $159.00 | $285.87–$1,737.00 | — | 30% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 DRAIN/INJECT SM/BURSA | $541.80 | $774.00 | $285.87–$1,737.00 | — | 30% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 DRAIN/INJ JOINT/BURSA W/O US | $541.80 | $774.00 | $285.87–$1,737.00 | — | 30% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ASP/INJECT SMALL JOINT | $562.80 | $804.00 | $285.87–$1,737.00 | — | 30% |
| Laser treatment of clouding after cataract surgery (YAG) CPT 66821 YAG CAPSULOTOMY | $1,033.90 | $1,477.00 | $339.71–$1,728.79 | 50% below | 30% |
| Laser treatment of clouding after cataract surgery (YAG) CPT 66821 AFTER CATARACT LASER SURGERY | $1,033.90 | $1,477.00 | $339.71–$1,728.79 | 50% below | 30% |
| Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 YAG CAPSULOTOMY | $1,033.90 | $1,477.00 | $339.71–$1,728.79 | — | 30% |
| Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 AFTER CATARACT LASER SURGERY | $1,033.90 | $1,477.00 | $339.71–$1,728.79 | — | 30% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 INTMD RPR S/A/T/EXT 2.5 CM/< | $694.40 | $992.00 | $228.16–$992.00 | 3% below | 30% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 PHY REPAIR WOUND 2.5 | $694.40 | $992.00 | $228.16–$992.00 | 3% below | 30% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 INTMD RPR S/A/T/EXT 2.5 CM/< | $694.40 | $992.00 | $228.16–$992.00 | — | 30% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 PHY REPAIR WOUND 2.5 | $694.40 | $992.00 | $228.16–$992.00 | — | 30% |
| Lower-back epidural injection, with imaging guidance CPT 62323 LUMBER/SACRAL EPI | $537.60 | $768.00 | $353.28–$1,536.00 | 58% below | 30% |
| Lower-back epidural injection, with imaging guidance CPT 62323 LUMBAR/EPIDURAL | $537.60 | $768.00 | $353.28–$1,536.00 | 58% below | 30% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 LUMBER/SACRAL EPI | $537.60 | $768.00 | $353.28–$1,536.00 | — | 30% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 LUMBAR/EPIDURAL | $537.60 | $768.00 | $353.28–$1,536.00 | — | 30% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 NJX AA&/STRD TFRM EPI L/S 1 | $520.80 | $744.00 | $171.12–$1,242.31 | 68% below | 30% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 FORAMEN EPIDURAL | $520.80 | $744.00 | $171.12–$1,242.31 | 68% below | 30% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 NJX AA&/STRD TFRM EPI L/S 1 | $520.80 | $744.00 | $171.12–$1,242.31 | — | 30% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 FORAMEN EPIDURAL | $520.80 | $744.00 | $171.12–$1,242.31 | — | 30% |
| Nail removal (partial or complete), one nail CPT 11730 AVULSION OF TOENAIL | $105.00 | $150.00 | $159.62–$694.00 | 73% below | 30% |
| Nail removal (partial or complete), one nail CPT 11730 AVULSION NAIL PLATE SIMPLE 1 | $105.00 | $150.00 | $159.62–$694.00 | 73% below | 30% |
| Nail removal (partial or complete), one nail CPT 11730 PHYS AVULSION NAIL | $162.40 | $232.00 | $159.62–$694.00 | 59% below | 30% |
| Nail removal (partial or complete), one nail CPT 11730 ALUSION OF TOENAIL PHYSICIAN | $218.40 | $312.00 | $159.62–$694.00 | 45% below | 30% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSION OF TOENAIL | $105.00 | $150.00 | $159.62–$694.00 | — | 30% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSION NAIL PLATE SIMPLE 1 | $105.00 | $150.00 | $159.62–$694.00 | — | 30% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 PHYS AVULSION NAIL | $162.40 | $232.00 | $159.62–$694.00 | — | 30% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 ALUSION OF TOENAIL PHYSICIAN | $218.40 | $312.00 | $159.62–$694.00 | — | 30% |
| Occipital nerve block (injection for headaches) CPT 64405 NERVE BLOCK INJ | $153.30 | $219.00 | $403.65–$1,755.00 | 75% below | 30% |
| Occipital nerve block (injection for headaches) CPT 64405 NERVE BLOCK | $537.60 | $768.00 | $403.65–$1,755.00 | 11% below | 30% |
| Occipital nerve block (injection for headaches) CPT 64405 INJ ANESTH GREATER OCCIPITAL | $537.60 | $768.00 | $403.65–$1,755.00 | 11% below | 30% |
| Occipital nerve block (injection for headaches) CPT 64405 NJX AA&/STRD GR OCPL NRV | $537.60 | $768.00 | $403.65–$1,755.00 | 11% below | 30% |
| Occipital nerve block (injection for headaches) inpatient CPT 64405 NERVE BLOCK INJ | $153.30 | $219.00 | $403.65–$1,755.00 | — | 30% |
| Occipital nerve block (injection for headaches) inpatient CPT 64405 INJ ANESTH GREATER OCCIPITAL | $537.60 | $768.00 | $403.65–$1,755.00 | — | 30% |
| Occipital nerve block (injection for headaches) inpatient CPT 64405 NJX AA&/STRD GR OCPL NRV | $537.60 | $768.00 | $403.65–$1,755.00 | — | 30% |
| Occipital nerve block (injection for headaches) inpatient CPT 64405 NERVE BLOCK | $537.60 | $768.00 | $403.65–$1,755.00 | — | 30% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 PHYS EXCISION NAIL | $443.80 | $634.00 | $145.82–$648.18 | 36% below | 30% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION NAIL&NAIL MATRIX | $443.80 | $634.00 | $145.82–$648.18 | 36% below | 30% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXCISION NAIL&NAIL MATRIX | $443.80 | $634.00 | $145.82–$648.18 | — | 30% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 PHYS EXCISION NAIL | $443.80 | $634.00 | $145.82–$648.18 | — | 30% |
| Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 RFA LUMBAR/SACRAL | $913.50 | $1,305.00 | $300.15–$3,121.64 | 72% below | 30% |
| Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 DESTROY LUMB/SAC FACET JNT | $913.50 | $1,305.00 | $300.15–$3,121.64 | 72% below | 30% |
| Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 DESTROY LUMB/SAC FACET JNT | $913.50 | $1,305.00 | $300.15–$3,121.64 | — | 30% |
| Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 RFA LUMBAR/SACRAL | $913.50 | $1,305.00 | $300.15–$3,121.64 | — | 30% |
| Removal of a foreign object under the skin, simple CPT 10120 UNDER INCISION/DRAINAGE PRO SKIN | $240.10 | $343.00 | $78.89–$381.15 | 61% below | 30% |
| Removal of a foreign object under the skin, simple CPT 10120 INC&RMVL FB SUBQ TISS SMPL | $240.10 | $343.00 | $78.89–$381.15 | 61% below | 30% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 INC&RMVL FB SUBQ TISS SMPL | $240.10 | $343.00 | $78.89–$381.15 | — | 30% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 UNDER INCISION/DRAINAGE PRO SKIN | $240.10 | $343.00 | $78.89–$381.15 | — | 30% |
| Short arm splint (forearm and hand) CPT 29125 APPL SHORT ARM SPLINT STATIC | $147.70 | $211.00 | $48.53–$381.15 | 19% below | 30% |
| Short arm splint (forearm and hand) CPT 29125 OT APPLY FOREARM SPLINT STATIC | $147.70 | $211.00 | $48.53–$381.15 | 19% below | 30% |
| Short arm splint (forearm and hand) inpatient CPT 29125 APPL SHORT ARM SPLINT STATIC | $147.70 | $211.00 | $48.53–$381.15 | — | 30% |
| Short arm splint (forearm and hand) inpatient CPT 29125 OT APPLY FOREARM SPLINT STATIC | $147.70 | $211.00 | $48.53–$381.15 | — | 30% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 RPR S/N/AX/GEN/TRNK 2.5CM/< | $177.80 | $254.00 | $58.42–$381.15 | 59% below | 30% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 SIMPLE REPAIR PHYSICIAN SUPERFACIAL | $177.80 | $254.00 | $58.42–$381.15 | 59% below | 30% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 SIMPLE REPAIR PHYSICIAN SUPERFACIAL | $177.80 | $254.00 | $58.42–$381.15 | — | 30% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 RPR S/N/AX/GEN/TRNK 2.5CM/< | $177.80 | $254.00 | $58.42–$381.15 | — | 30% |
| Skin biopsy, punch, one lesion CPT 11104 PUNCH BX SKIN SINGLE LESION | $88.90 | $127.00 | $29.21–$648.18 | 80% below | 30% |
| Skin biopsy, punch, one lesion CPT 11104 PUNCH BIOPSY OF SKIN PHYS SIMPLE CLOSURE | $88.90 | $127.00 | $29.21–$648.18 | 80% below | 30% |
| Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BX SKIN SINGLE LESION | $88.90 | $127.00 | $29.21–$648.18 | — | 30% |
| Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BIOPSY OF SKIN PHYS SIMPLE CLOSURE | $88.90 | $127.00 | $29.21–$648.18 | — | 30% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL FLUID TAP DIAGNOSTIC | $756.00 | $1,080.00 | $248.40–$1,242.31 | 26% below | 30% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 DX LMBR SPI PNXR | $756.00 | $1,080.00 | $248.40–$1,242.31 | 26% below | 30% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 DX LMBR SPI PNXR | $756.00 | $1,080.00 | $248.40–$1,242.31 | — | 30% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL FLUID TAP DIAGNOSTIC | $756.00 | $1,080.00 | $248.40–$1,242.31 | — | 30% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 SIMPLE REPAIR PHYS 2.6 CM TO 7.5 CM | $177.80 | $254.00 | $58.42–$648.18 | 55% below | 30% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 RPR S/N/AX/GEN/TRNK2.6-7.5CM | $177.80 | $254.00 | $58.42–$648.18 | 55% below | 30% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 RPR S/N/AX/GEN/TRNK2.6-7.5CM | $177.80 | $254.00 | $58.42–$648.18 | — | 30% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 SIMPLE REPAIR PHYS 2.6 CM TO 7.5 CM | $177.80 | $254.00 | $58.42–$648.18 | — | 30% |
| Trigger point injections, 1 or 2 muscles CPT 20552 NJX 1/MLT TRIGGER POINT 1/2 | $81.20 | $116.00 | $285.87–$1,853.00 | 86% below | 30% |
| Trigger point injections, 1 or 2 muscles CPT 20552 INJECTION, SINGLE/MULTIPLE TRIGGER POINT | $81.20 | $116.00 | $285.87–$1,853.00 | 86% below | 30% |
| Trigger point injections, 1 or 2 muscles CPT 20552 INJECT TRIGGER 1-2 | $102.90 | $147.00 | $285.87–$1,853.00 | 82% below | 30% |
| Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINT 1/2 MUSCLE | $550.20 | $786.00 | $285.87–$1,853.00 | 3% below | 30% |
| Trigger point injections, 1 or 2 muscles CPT 20552 INJECTION MULTIPLE TRIGGER POINT SINGLE | $562.80 | $804.00 | $285.87–$1,853.00 | 1% below | 30% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 NJX 1/MLT TRIGGER POINT 1/2 | $81.20 | $116.00 | $285.87–$1,853.00 | — | 30% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJECTION, SINGLE/MULTIPLE TRIGGER POINT | $81.20 | $116.00 | $285.87–$1,853.00 | — | 30% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJECT TRIGGER 1-2 | $102.90 | $147.00 | $285.87–$1,853.00 | — | 30% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ TRIGGER POINT 1/2 MUSCLE | $550.20 | $786.00 | $285.87–$1,853.00 | — | 30% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJECTION MULTIPLE TRIGGER POINT SINGLE | $562.80 | $804.00 | $285.87–$1,853.00 | — | 30% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 BX BREAST 1ST LESION US IMAG | $274.40 | $392.00 | $90.16–$702.08 | 88% below | 30% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 BIOPSY BREAST PRECUT W/IMAGE | $274.40 | $392.00 | $90.16–$702.08 | 88% below | 30% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 BX BREAST 1ST LESION US IMAG | $274.40 | $392.00 | $90.16–$702.08 | — | 30% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 BIOPSY BREAST PRECUT W/IMAGE | $274.40 | $392.00 | $90.16–$702.08 | — | 30% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 PHYS DEBRIDMENT | $195.30 | $279.00 | $64.17–$1,728.79 | 75% below | 30% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DBRDMT SUBQ TIS 1ST 20SQCM/< | $195.30 | $279.00 | $64.17–$1,728.79 | 75% below | 30% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 PHYS DEBRIDMENT | $195.30 | $279.00 | $64.17–$1,728.79 | — | 30% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DBRDMT SUBQ TIS 1ST 20SQCM/< | $195.30 | $279.00 | $64.17–$1,728.79 | — | 30% |
Doctor visits and therapy
| Procedure | Cash price | List price | Insurers pay | vs Indiana | Off list |
|---|---|---|---|---|---|
| Blood transfusion (giving blood or blood components) CPT 36430 BLOOD PROC/ISS/ADM | $280.00 | $400.00 | $4,433.48–$19,276.00 | 69% below | 30% |
| Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSF COMPON | $522.90 | $747.00 | $4,433.48–$19,276.00 | 42% below | 30% |
| Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSFUSION COMPONET | $587.30 | $839.00 | $4,433.48–$19,276.00 | 35% below | 30% |
| Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSF LEV II | $936.60 | $1,338.00 | $4,433.48–$19,276.00 | 4% above | 30% |
| Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSFUSION LEVEL II | $1,050.70 | $1,501.00 | $4,433.48–$19,276.00 | 17% above | 30% |
| Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSF LEV III | $1,346.10 | $1,923.00 | $4,433.48–$19,276.00 | 50% above | 30% |
| Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSFUSION LEVEL III | $1,438.50 | $2,055.00 | $4,433.48–$19,276.00 | 60% above | 30% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD PROC/ISS/ADM | $280.00 | $400.00 | $4,433.48–$19,276.00 | — | 30% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD TRANSF COMPON | $522.90 | $747.00 | $4,433.48–$19,276.00 | — | 30% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD TRANSFUSION COMPONET | $587.30 | $839.00 | $4,433.48–$19,276.00 | — | 30% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD TRANSF LEV II | $936.60 | $1,338.00 | $4,433.48–$19,276.00 | — | 30% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD TRANSFUSION LEVEL II | $1,050.70 | $1,501.00 | $4,433.48–$19,276.00 | — | 30% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD TRANSF LEV III | $1,346.10 | $1,923.00 | $4,433.48–$19,276.00 | — | 30% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD TRANSFUSION LEVEL III | $1,438.50 | $2,055.00 | $4,433.48–$19,276.00 | — | 30% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 MINI NEB INITIAL | $394.10 | $563.00 | $129.49–$563.00 | 249% above | 30% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 MINI NEB INITIAL | $394.10 | $563.00 | $129.49–$563.00 | — | 30% |
| Chemotherapy IV infusion, first hour CPT 96413 CHEMO IV INFUSION 1 HR | $597.80 | $854.00 | $196.42–$854.00 | 12% below | 30% |
| Chemotherapy IV infusion, first hour CPT 96413 CHEMIV INFU INI UP1H | $597.80 | $854.00 | $196.42–$854.00 | 12% below | 30% |
| Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO IV INFUSION 1 HR | $597.80 | $854.00 | $196.42–$854.00 | — | 30% |
| Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMIV INFU INI UP1H | $597.80 | $854.00 | $196.42–$854.00 | — | 30% |
| Critical care, first 30 to 74 minutes CPT 99291 PHY CRIT CARE 30-74M | $1,252.30 | $1,789.00 | $1,331.01–$5,787.00 | 41% below | 30% |
| Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE LEVLV1 | $1,399.30 | $1,999.00 | $1,331.01–$5,787.00 | 34% below | 30% |
| Critical care, first 30 to 74 minutes CPT 99291 CRIT CARE ANC LEV V1 | $1,399.30 | $1,999.00 | $1,331.01–$5,787.00 | 34% below | 30% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 PHY CRIT CARE 30-74M | $1,252.30 | $1,789.00 | $1,331.01–$5,787.00 | — | 30% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 CRIT CARE ANC LEV V1 | $1,399.30 | $1,999.00 | $1,331.01–$5,787.00 | — | 30% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 CRITICAL CARE LEVLV1 | $1,399.30 | $1,999.00 | $1,331.01–$5,787.00 | — | 30% |
| EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG/AWAKE/DROWSY | $620.20 | $886.00 | $203.78–$886.00 | 9% below | 30% |
| EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 EEG/AWAKE/DROWSY | $620.20 | $886.00 | $203.78–$886.00 | — | 30% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG 12 LEAD TRACING | $214.90 | $307.00 | $70.61–$307.00 | 6% above | 30% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG 12 LEAD TRACING | $214.90 | $307.00 | $70.61–$307.00 | — | 30% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER PHYS FEE BRIEF | $130.90 | $187.00 | $235.75–$1,025.00 | 40% below | 30% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER PHYS FEE EVALUATI | $144.20 | $206.00 | $235.75–$1,025.00 | 34% below | 30% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER RM BRIEF ANC | $221.20 | $316.00 | $235.75–$1,025.00 | 2% above | 30% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 EMERG RM BRIEF | $221.20 | $316.00 | $235.75–$1,025.00 | 2% above | 30% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ER PHYS FEE BRIEF | $130.90 | $187.00 | $235.75–$1,025.00 | — | 30% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ER PHYS FEE EVALUATI | $144.20 | $206.00 | $235.75–$1,025.00 | — | 30% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ER RM BRIEF ANC | $221.20 | $316.00 | $235.75–$1,025.00 | — | 30% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 EMERG RM BRIEF | $221.20 | $316.00 | $235.75–$1,025.00 | — | 30% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 PHY CRIT CARE OV 2HR | $1,663.90 | $2,377.00 | $948.75–$4,125.00 | 297% above | 30% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 PHY CRIT CARE OV 2HR | $1,663.90 | $2,377.00 | $948.75–$4,125.00 | — | 30% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ER PHY FEE INTERMEDI | $406.70 | $581.00 | $749.80–$3,260.00 | 48% below | 30% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 EMERG RM INTERMEDIAT | $828.80 | $1,184.00 | $749.80–$3,260.00 | 7% above | 30% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ER RM INTER ANC | $828.80 | $1,184.00 | $749.80–$3,260.00 | 7% above | 30% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ER PHY FEE INTERMEDI | $406.70 | $581.00 | $749.80–$3,260.00 | — | 30% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ER RM INTER ANC | $828.80 | $1,184.00 | $749.80–$3,260.00 | — | 30% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 EMERG RM INTERMEDIAT | $828.80 | $1,184.00 | $749.80–$3,260.00 | — | 30% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ER PHY FEE EXTENDED | $681.80 | $974.00 | $1,078.24–$4,688.00 | 42% below | 30% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 EMERG RM EXTENDED | $1,299.90 | $1,857.00 | $1,078.24–$4,688.00 | 10% above | 30% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ER RM EXTENDED ANC | $1,299.90 | $1,857.00 | $1,078.24–$4,688.00 | 10% above | 30% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ER PHY FEE EXTENDED | $681.80 | $974.00 | $1,078.24–$4,688.00 | — | 30% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 EMERG RM EXTENDED | $1,299.90 | $1,857.00 | $1,078.24–$4,688.00 | — | 30% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ER RM EXTENDED ANC | $1,299.90 | $1,857.00 | $1,078.24–$4,688.00 | — | 30% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ER PHYS FEE SEVERE | $955.50 | $1,365.00 | $1,504.43–$6,541.00 | 45% below | 30% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ER SEVER ANC | $1,811.60 | $2,588.00 | $1,504.43–$6,541.00 | 4% above | 30% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ER SEVERE | $1,811.60 | $2,588.00 | $1,504.43–$6,541.00 | 4% above | 30% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ER PHYS FEE SEVERE | $955.50 | $1,365.00 | $1,504.43–$6,541.00 | — | 30% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ER SEVER ANC | $1,811.60 | $2,588.00 | $1,504.43–$6,541.00 | — | 30% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ER SEVERE | $1,811.60 | $2,588.00 | $1,504.43–$6,541.00 | — | 30% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 CARDIO STRESS TEST TRACING ONLY | $847.00 | $1,210.00 | $278.30–$1,210.00 | 11% above | 30% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CARDIO STRESS TEST TRACING ONLY | $847.00 | $1,210.00 | $278.30–$1,210.00 | — | 30% |
| Family therapy with the patient, 50 minutes CPT 90847 FAMILY THERAPY W/PT 1 HOUR | $217.70 | $311.00 | $71.53–$311.00 | 15% above | 30% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 FAMILY THERAPY W/PT 1 HOUR | $217.70 | $311.00 | $71.53–$311.00 | — | 30% |
| Family therapy without the patient, 50 minutes CPT 90846 FAMILY THERAPY W/O PT 1 HOUR | $207.20 | $296.00 | $68.08–$296.00 | 1% above | 30% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 FAMILY THERAPY W/O PT 1 HOUR | $207.20 | $296.00 | $68.08–$296.00 | — | 30% |
| Group psychotherapy session CPT 90853 GROUP THERAPY 1 HOUR | $174.30 | $249.00 | $57.27–$249.00 | 14% below | 30% |
| Group psychotherapy session inpatient CPT 90853 GROUP THERAPY 1 HOUR | $174.30 | $249.00 | $57.27–$249.00 | — | 30% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRA INT UP 1HR | $240.10 | $343.00 | $327.06–$1,422.00 | 35% below | 30% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRATION INITAL UP TO 1 HOUR | $275.10 | $393.00 | $327.06–$1,422.00 | 25% below | 30% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV HYDRA INT UP 1HR | $240.10 | $343.00 | $327.06–$1,422.00 | — | 30% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV HYDRATION INITAL UP TO 1 HOUR | $275.10 | $393.00 | $327.06–$1,422.00 | — | 30% |
| IV infusion of a medicine, first hour CPT 96365 IV INF DRUG UP 1HR | $413.70 | $591.00 | $699.43–$3,041.00 | 2% above | 30% |
| IV infusion of a medicine, first hour CPT 96365 IV INFUSION DRUG UP TO 1HOUR | $473.90 | $677.00 | $699.43–$3,041.00 | 17% above | 30% |
| IV infusion of a medicine, first hour inpatient CPT 96365 IV INF DRUG UP 1HR | $413.70 | $591.00 | $699.43–$3,041.00 | — | 30% |
| IV infusion of a medicine, first hour inpatient CPT 96365 IV INFUSION DRUG UP TO 1HOUR | $473.90 | $677.00 | $699.43–$3,041.00 | — | 30% |
| IV push of a medicine, first drug CPT 96374 IV PUSH INITAL | $227.50 | $325.00 | $458.62–$1,994.00 | 7% above | 30% |
| IV push of a medicine, first drug CPT 96374 IV PUSH INIT | $227.50 | $325.00 | $458.62–$1,994.00 | 7% above | 30% |
| IV push of a medicine, first drug CPT 96374 IV PUSH, INITIAL | $258.30 | $369.00 | $458.62–$1,994.00 | 22% above | 30% |
| IV push of a medicine, first drug inpatient CPT 96374 IV PUSH INIT | $227.50 | $325.00 | $458.62–$1,994.00 | — | 30% |
| IV push of a medicine, first drug inpatient CPT 96374 IV PUSH INITAL | $227.50 | $325.00 | $458.62–$1,994.00 | — | 30% |
| IV push of a medicine, first drug inpatient CPT 96374 IV PUSH, INITIAL | $258.30 | $369.00 | $458.62–$1,994.00 | — | 30% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 IM/SQ INJ NON CHE | $77.00 | $110.00 | $222.87–$969.00 | 27% below | 30% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 THERP INJ SUBQ OR IM | $77.00 | $110.00 | $222.87–$969.00 | 27% below | 30% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/DIAG INJ | $126.70 | $181.00 | $222.87–$969.00 | 20% above | 30% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 IM/SQ INJ NON CHE | $77.00 | $110.00 | $222.87–$969.00 | — | 30% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THERP INJ SUBQ OR IM | $77.00 | $110.00 | $222.87–$969.00 | — | 30% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THER/DIAG INJ | $126.70 | $181.00 | $222.87–$969.00 | — | 30% |
| Mental health diagnostic evaluation (intake), without medical services CPT 90791 NO MED SERVICE | $315.70 | $451.00 | $392.61–$1,707.00 | 26% above | 30% |
| Mental health diagnostic evaluation (intake), without medical services CPT 90791 EVALUATION/ASSESSMENT | $315.70 | $451.00 | $392.61–$1,707.00 | 26% above | 30% |
| Mental health diagnostic evaluation (intake), without medical services CPT 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION | $563.50 | $805.00 | $392.61–$1,707.00 | 125% above | 30% |
| Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 NO MED SERVICE | $315.70 | $451.00 | $392.61–$1,707.00 | — | 30% |
| Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 EVALUATION/ASSESSMENT | $315.70 | $451.00 | $392.61–$1,707.00 | — | 30% |
| Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION | $563.50 | $805.00 | $392.61–$1,707.00 | — | 30% |
| Neuromuscular re-education, 15 minutes CPT 97112 OT NEURO RE-ED EA 15 | $102.20 | $146.00 | $359.95–$1,565.00 | 35% above | 30% |
| Neuromuscular re-education, 15 minutes CPT 97112 PT NEURORE-ED EA 15M | $124.60 | $178.00 | $359.95–$1,565.00 | 64% above | 30% |
| Neuromuscular re-education, 15 minutes CPT 97112 PT NEURO RE-ED 30 M | $142.10 | $203.00 | $359.95–$1,565.00 | 88% above | 30% |
| Neuromuscular re-education, 15 minutes CPT 97112 OT NEURO RE-ED EACH 30 MINUTES | $205.10 | $293.00 | $359.95–$1,565.00 | 171% above | 30% |
| Neuromuscular re-education, 15 minutes CPT 97112 PT NEURO RE-ED 45 MIN PTA | $213.50 | $305.00 | $359.95–$1,565.00 | 182% above | 30% |
| Neuromuscular re-education, 15 minutes CPT 97112 OT NEURO RE-ED EACH 45 MINUTES | $308.00 | $440.00 | $359.95–$1,565.00 | 306% above | 30% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 OT NEURO RE-ED EA 15 | $102.20 | $146.00 | $359.95–$1,565.00 | — | 30% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 PT NEURORE-ED EA 15M | $124.60 | $178.00 | $359.95–$1,565.00 | — | 30% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 PT NEURO RE-ED 30 M | $142.10 | $203.00 | $359.95–$1,565.00 | — | 30% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 OT NEURO RE-ED EACH 30 MINUTES | $205.10 | $293.00 | $359.95–$1,565.00 | — | 30% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 PT NEURO RE-ED 45 MIN PTA | $213.50 | $305.00 | $359.95–$1,565.00 | — | 30% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 OT NEURO RE-ED EACH 45 MINUTES | $308.00 | $440.00 | $359.95–$1,565.00 | — | 30% |
| New patient office visit, about 30 minutes CPT 99203 NEW PROVIDER, VISIT INTERMEDIATE | $233.10 | $333.00 | $155.48–$676.00 | 41% above | 30% |
| New patient office visit, about 30 minutes CPT 99203 PHYS NEW INTERMEDIAT | $240.10 | $343.00 | $155.48–$676.00 | 45% above | 30% |
| New patient office visit, about 30 minutes inpatient CPT 99203 NEW PROVIDER, VISIT INTERMEDIATE | $233.10 | $333.00 | $155.48–$676.00 | — | 30% |
| New patient office visit, about 30 minutes inpatient CPT 99203 PHYS NEW INTERMEDIAT | $240.10 | $343.00 | $155.48–$676.00 | — | 30% |
| New patient office visit, about 45 minutes CPT 99204 NEW PROVIDER VISIT EXTENDED | $352.80 | $504.00 | $249.09–$1,083.00 | 87% above | 30% |
| New patient office visit, about 45 minutes CPT 99204 PHYS NEW EXTENDED | $405.30 | $579.00 | $249.09–$1,083.00 | 114% above | 30% |
| New patient office visit, about 45 minutes inpatient CPT 99204 NEW PROVIDER VISIT EXTENDED | $352.80 | $504.00 | $249.09–$1,083.00 | — | 30% |
| New patient office visit, about 45 minutes inpatient CPT 99204 PHYS NEW EXTENDED | $405.30 | $579.00 | $249.09–$1,083.00 | — | 30% |
| New patient office visit, about 60 minutes CPT 99205 NEW PROVIDER VISIT COMPLEX | $468.30 | $669.00 | $326.83–$1,421.00 | 85% above | 30% |
| New patient office visit, about 60 minutes CPT 99205 PHYS NEW COMPLEX | $526.40 | $752.00 | $326.83–$1,421.00 | 107% above | 30% |
| New patient office visit, about 60 minutes inpatient CPT 99205 NEW PROVIDER VISIT COMPLEX | $468.30 | $669.00 | $326.83–$1,421.00 | — | 30% |
| New patient office visit, about 60 minutes inpatient CPT 99205 PHYS NEW COMPLEX | $526.40 | $752.00 | $326.83–$1,421.00 | — | 30% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW PHYS VISIT, LIMITED | $149.10 | $213.00 | $171.12–$744.00 | 6% above | 30% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 PHYS NEW LIMITED | $156.10 | $223.00 | $171.12–$744.00 | 11% above | 30% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 OP TREAT ROOM NEW | $215.60 | $308.00 | $171.12–$744.00 | 53% above | 30% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 NEW PHYS VISIT, LIMITED | $149.10 | $213.00 | $171.12–$744.00 | — | 30% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 PHYS NEW LIMITED | $156.10 | $223.00 | $171.12–$744.00 | — | 30% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 OP TREAT ROOM NEW | $215.60 | $308.00 | $171.12–$744.00 | — | 30% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 EDUCATION SERVICE 1HOUR | $56.00 | $80.00 | $283.36–$1,232.00 | 64% above | 30% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MED NUT INITIAL 15 MINUTES | $69.30 | $99.00 | $283.36–$1,232.00 | 103% above | 30% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MED NUTRI THER 45MIN | $85.40 | $122.00 | $283.36–$1,232.00 | 150% above | 30% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MED NUTRI THER 30MIN | $108.50 | $155.00 | $283.36–$1,232.00 | 217% above | 30% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MED NUTRI THER 15MIN | $109.90 | $157.00 | $283.36–$1,232.00 | 221% above | 30% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MED NUTRI THER 60MIN | $115.50 | $165.00 | $283.36–$1,232.00 | 238% above | 30% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MED NUTRI THER 75MIN | $144.20 | $206.00 | $283.36–$1,232.00 | 322% above | 30% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MED NUTRI THER 90MIN | $173.60 | $248.00 | $283.36–$1,232.00 | 408% above | 30% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 EDUCATION SERVICE 1HOUR | $56.00 | $80.00 | $283.36–$1,232.00 | — | 30% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MED NUT INITIAL 15 MINUTES | $69.30 | $99.00 | $283.36–$1,232.00 | — | 30% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MED NUTRI THER 45MIN | $85.40 | $122.00 | $283.36–$1,232.00 | — | 30% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MED NUTRI THER 30MIN | $108.50 | $155.00 | $283.36–$1,232.00 | — | 30% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MED NUTRI THER 15MIN | $109.90 | $157.00 | $283.36–$1,232.00 | — | 30% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MED NUTRI THER 60MIN | $115.50 | $165.00 | $283.36–$1,232.00 | — | 30% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MED NUTRI THER 75MIN | $144.20 | $206.00 | $283.36–$1,232.00 | — | 30% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MED NUTRI THER 90MIN | $173.60 | $248.00 | $283.36–$1,232.00 | — | 30% |
| Occupational therapy evaluation, low complexity CPT 97165 OT EVAL LOW COMPLEXITY | $234.50 | $335.00 | $77.05–$335.00 | 47% above | 30% |
| Occupational therapy evaluation, low complexity inpatient CPT 97165 OT EVAL LOW COMPLEXITY | $234.50 | $335.00 | $77.05–$335.00 | — | 30% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT EVALU HIGH COMPEXITY | $238.00 | $340.00 | $78.20–$340.00 | 2% above | 30% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT EVALU HIGH COMPEXITY | $238.00 | $340.00 | $78.20–$340.00 | — | 30% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT EVAL LOW COMPLEXITY | $238.00 | $340.00 | $78.20–$340.00 | 66% above | 30% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT EVAL LOW COMPLEXITY | $238.00 | $340.00 | $78.20–$340.00 | — | 30% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT EVAL MODERATE COMPLEXITY | $238.00 | $340.00 | $78.20–$340.00 | 27% above | 30% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT EVAL MODERATE COMPLEXITY | $238.00 | $340.00 | $78.20–$340.00 | — | 30% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 OT MANUAL THERAPY | $113.40 | $162.00 | $423.20–$1,840.00 | 32% above | 30% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MAN THER TEC EA 15MN | $121.10 | $173.00 | $423.20–$1,840.00 | 41% above | 30% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PT MAN THER TEC 30MN | $198.80 | $284.00 | $423.20–$1,840.00 | 132% above | 30% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 OT MANUAL THERAPY 30 MINUTES | $222.60 | $318.00 | $423.20–$1,840.00 | 160% above | 30% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PT MAN THER TEC 45 | $297.50 | $425.00 | $423.20–$1,840.00 | 247% above | 30% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 OT MANUAL THERAPY 45 MINUTES | $334.60 | $478.00 | $423.20–$1,840.00 | 291% above | 30% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 OT MANUAL THERAPY | $113.40 | $162.00 | $423.20–$1,840.00 | — | 30% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MAN THER TEC EA 15MN | $121.10 | $173.00 | $423.20–$1,840.00 | — | 30% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 PT MAN THER TEC 30MN | $198.80 | $284.00 | $423.20–$1,840.00 | — | 30% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 OT MANUAL THERAPY 30 MINUTES | $222.60 | $318.00 | $423.20–$1,840.00 | — | 30% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 PT MAN THER TEC 45 | $297.50 | $425.00 | $423.20–$1,840.00 | — | 30% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 OT MANUAL THERAPY 45 MINUTES | $334.60 | $478.00 | $423.20–$1,840.00 | — | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 BETTER BREATHERS<6 VISITS PER MONTH | $21.00 | $30.00 | $480.47–$2,089.00 | 72% below | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 BETTER BREATHERS >7 VISITS PER MONTH | $28.00 | $40.00 | $480.47–$2,089.00 | 63% below | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT THERA PROC EA 15M | $114.10 | $163.00 | $480.47–$2,089.00 | 51% above | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT THERAEX EA 15 MIN | $121.80 | $174.00 | $480.47–$2,089.00 | 61% above | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT THERA PROC EA 30 MINUTES | $224.70 | $321.00 | $480.47–$2,089.00 | 197% above | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT THERAEX 30 MIN | $244.30 | $349.00 | $480.47–$2,089.00 | 223% above | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT THERA PROC EA 45 MINUTES | $338.10 | $483.00 | $480.47–$2,089.00 | 347% above | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT THERAPY EXERCISE 45 | $368.20 | $526.00 | $480.47–$2,089.00 | 387% above | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 BETTER BREATHERS<6 VISITS PER MONTH | $21.00 | $30.00 | $480.47–$2,089.00 | — | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 BETTER BREATHERS >7 VISITS PER MONTH | $28.00 | $40.00 | $480.47–$2,089.00 | — | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT THERA PROC EA 15M | $114.10 | $163.00 | $480.47–$2,089.00 | — | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT THERAEX EA 15 MIN | $121.80 | $174.00 | $480.47–$2,089.00 | — | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT THERA PROC EA 30 MINUTES | $224.70 | $321.00 | $480.47–$2,089.00 | — | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT THERAEX 30 MIN | $244.30 | $349.00 | $480.47–$2,089.00 | — | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT THERA PROC EA 45 MINUTES | $338.10 | $483.00 | $480.47–$2,089.00 | — | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT THERAPY EXERCISE 45 | $368.20 | $526.00 | $480.47–$2,089.00 | — | 30% |
| Psychiatric evaluation with medical services CPT 90792 INDIV PSYCH EVAL WITH MEDICAL | $133.70 | $191.00 | $458.85–$1,995.00 | 32% below | 30% |
| Psychiatric evaluation with medical services CPT 90792 W/MED SERVICE | $357.00 | $510.00 | $458.85–$1,995.00 | 81% above | 30% |
| Psychiatric evaluation with medical services CPT 90792 PSY DIAGNOSTIC EVALUATION WITH MEDICAL | $905.80 | $1,294.00 | $458.85–$1,995.00 | 360% above | 30% |
| Psychiatric evaluation with medical services inpatient CPT 90792 INDIV PSYCH EVAL WITH MEDICAL | $133.70 | $191.00 | $458.85–$1,995.00 | — | 30% |
| Psychiatric evaluation with medical services inpatient CPT 90792 W/MED SERVICE | $357.00 | $510.00 | $458.85–$1,995.00 | — | 30% |
| Psychiatric evaluation with medical services inpatient CPT 90792 PSY DIAGNOSTIC EVALUATION WITH MEDICAL | $905.80 | $1,294.00 | $458.85–$1,995.00 | — | 30% |
| Psychotherapy session, 30 minutes CPT 90832 INDIVIDUAL THERAPY 16-27 MINUTES | $145.60 | $208.00 | $47.84–$208.00 | 48% above | 30% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 INDIVIDUAL THERAPY 16-27 MINUTES | $145.60 | $208.00 | $47.84–$208.00 | — | 30% |
| Psychotherapy session, 45 minutes CPT 90834 INDIVIDUAL THERAPY 38-52 | $193.20 | $276.00 | $63.48–$276.00 | 37% above | 30% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 INDIVIDUAL THERAPY 38-52 | $193.20 | $276.00 | $63.48–$276.00 | — | 30% |
| Psychotherapy session, 60 minutes CPT 90837 INDIVIDUAL THERAPY 53+ MINS | $282.80 | $404.00 | $92.92–$404.00 | 33% above | 30% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 INDIVIDUAL THERAPY 53+ MINS | $282.80 | $404.00 | $92.92–$404.00 | — | 30% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 BEHAV CHRGE SMOKING 3-10 MINS | $51.10 | $73.00 | $16.79–$73.00 | 70% above | 30% |
| Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 BEHAV CHRGE SMOKING 3-10 MINS | $51.10 | $73.00 | $16.79–$73.00 | — | 30% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 PHYS EST COMPLEX | $345.10 | $493.00 | $365.93–$1,591.00 | 129% above | 30% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 EST VISIT COMPLEX | $384.30 | $549.00 | $365.93–$1,591.00 | 155% above | 30% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 EST PROVIDER COMPLEX | $384.30 | $549.00 | $365.93–$1,591.00 | 155% above | 30% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 PHYS EST COMPLEX | $345.10 | $493.00 | $365.93–$1,591.00 | — | 30% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 EST VISIT COMPLEX | $384.30 | $549.00 | $365.93–$1,591.00 | — | 30% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 EST PROVIDER COMPLEX | $384.30 | $549.00 | $365.93–$1,591.00 | — | 30% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 PHYS EST INTERMEDIAT | $158.20 | $226.00 | $177.56–$772.00 | 80% above | 30% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 EST PROVIDER VISIT INTERMEDIATE | $191.10 | $273.00 | $177.56–$772.00 | 117% above | 30% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 EST VISIT INTERMEDIATE | $191.10 | $273.00 | $177.56–$772.00 | 117% above | 30% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 PHYS EST INTERMEDIAT | $158.20 | $226.00 | $177.56–$772.00 | — | 30% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 EST VISIT INTERMEDIATE | $191.10 | $273.00 | $177.56–$772.00 | — | 30% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 EST PROVIDER VISIT INTERMEDIATE | $191.10 | $273.00 | $177.56–$772.00 | — | 30% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 PHYS EST EXTENDED | $245.70 | $351.00 | $258.75–$1,125.00 | 121% above | 30% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 EST VISIT-EXTENDED | $270.90 | $387.00 | $258.75–$1,125.00 | 144% above | 30% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 EST PROVIDER VISIT | $270.90 | $387.00 | $258.75–$1,125.00 | 144% above | 30% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 PHYS EST EXTENDED | $245.70 | $351.00 | $258.75–$1,125.00 | — | 30% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 EST PROVIDER VISIT | $270.90 | $387.00 | $258.75–$1,125.00 | — | 30% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 EST VISIT-EXTENDED | $270.90 | $387.00 | $258.75–$1,125.00 | — | 30% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OP CLINIC EST | $53.90 | $77.00 | $148.12–$644.00 | 5% above | 30% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 PHYS EST LIMITED | $80.50 | $115.00 | $148.12–$644.00 | 56% above | 30% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OP VST ESTB PT | $81.20 | $116.00 | $148.12–$644.00 | 57% above | 30% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 EST VISIT LIMITED | $117.60 | $168.00 | $148.12–$644.00 | 128% above | 30% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 EST PROVIDER LIMITED | $117.60 | $168.00 | $148.12–$644.00 | 128% above | 30% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OP CLINIC EST | $53.90 | $77.00 | $148.12–$644.00 | — | 30% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 PHYS EST LIMITED | $80.50 | $115.00 | $148.12–$644.00 | — | 30% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OP VST ESTB PT | $81.20 | $116.00 | $148.12–$644.00 | — | 30% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 EST PROVIDER LIMITED | $117.60 | $168.00 | $148.12–$644.00 | — | 30% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 EST VISIT LIMITED | $117.60 | $168.00 | $148.12–$644.00 | — | 30% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 PHYS CONSULT INTER | $298.20 | $426.00 | $529.23–$2,301.00 | 36% above | 30% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 PRQ CARD REVASC CHRONIC 1 VSL | $1,312.50 | $1,875.00 | $529.23–$2,301.00 | 499% above | 30% |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 PHYS CONSULT INTER | $298.20 | $426.00 | $529.23–$2,301.00 | — | 30% |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 PRQ CARD REVASC CHRONIC 1 VSL | $1,312.50 | $1,875.00 | $529.23–$2,301.00 | — | 30% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 PHYS CONSULT EXTEND | $479.50 | $685.00 | $157.55–$685.00 | 98% above | 30% |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 PHYS CONSULT EXTEND | $479.50 | $685.00 | $157.55–$685.00 | — | 30% |
| Speech and language evaluation CPT 92523 EVALUATION OF LANGUAGE COMP & EXPRESS | $321.30 | $459.00 | $105.57–$459.00 | 57% above | 30% |
| Speech and language evaluation inpatient CPT 92523 EVALUATION OF LANGUAGE COMP & EXPRESS | $321.30 | $459.00 | $105.57–$459.00 | — | 30% |
| Speech therapy session, individual CPT 92507 SPEECH/LANG THER | $271.60 | $388.00 | $89.24–$388.00 | 87% above | 30% |
| Speech therapy session, individual inpatient CPT 92507 SPEECH/LANG THER | $271.60 | $388.00 | $89.24–$388.00 | — | 30% |
| Spirometry (breathing test) CPT 94010 SPIROMETRY-BASIC | $263.90 | $377.00 | $86.71–$377.00 | 8% above | 30% |
| Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY-BASIC | $263.90 | $377.00 | $86.71–$377.00 | — | 30% |
| Spirometry before and after a bronchodilator CPT 94060 SPIROMETRY-PRE/POST | $392.70 | $561.00 | $129.03–$561.00 | 28% below | 30% |
| Spirometry before and after a bronchodilator inpatient CPT 94060 SPIROMETRY-PRE/POST | $392.70 | $561.00 | $129.03–$561.00 | — | 30% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 PT THER ACT EA 15 MN | $108.50 | $155.00 | $434.47–$1,889.00 | 44% above | 30% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 OT THERA ACT EA 15MN | $113.40 | $162.00 | $434.47–$1,889.00 | 50% above | 30% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 PT THER ACTIVITY MIN | $217.00 | $310.00 | $434.47–$1,889.00 | 187% above | 30% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 OT THERAPY ACT EA 30 MINUTES | $222.60 | $318.00 | $434.47–$1,889.00 | 194% above | 30% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 PT THERAPY ACTIVITY 45 MINUTES | $326.20 | $466.00 | $434.47–$1,889.00 | 331% above | 30% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 OT THERAPY ACT EACH 45 MINUTES | $334.60 | $478.00 | $434.47–$1,889.00 | 343% above | 30% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 PT THER ACT EA 15 MN | $108.50 | $155.00 | $434.47–$1,889.00 | — | 30% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 OT THERA ACT EA 15MN | $113.40 | $162.00 | $434.47–$1,889.00 | — | 30% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 PT THER ACTIVITY MIN | $217.00 | $310.00 | $434.47–$1,889.00 | — | 30% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 OT THERAPY ACT EA 30 MINUTES | $222.60 | $318.00 | $434.47–$1,889.00 | — | 30% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 PT THERAPY ACTIVITY 45 MINUTES | $326.20 | $466.00 | $434.47–$1,889.00 | — | 30% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 OT THERAPY ACT EACH 45 MINUTES | $334.60 | $478.00 | $434.47–$1,889.00 | — | 30% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY | $149.10 | $213.00 | $48.99–$409.66 | 29% below | 30% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY, THERAPEU | $149.10 | $213.00 | $48.99–$409.66 | 29% below | 30% |
| Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY | $149.10 | $213.00 | $48.99–$409.66 | — | 30% |
| Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY, THERAPEU | $149.10 | $213.00 | $48.99–$409.66 | — | 30% |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs Indiana | Off list |
|---|---|---|---|---|---|
| Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARIVAX D | $130.90 | $187.00 | $43.01–$710.78 | 68% below | 30% |
| Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VAR VACCINE LIVE SUBQ | $130.90 | $187.00 | $43.01–$710.78 | 68% below | 30% |
| Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARIVAX D | $130.90 | $187.00 | $43.01–$710.78 | — | 30% |
| Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VAR VACCINE LIVE SUBQ | $130.90 | $187.00 | $43.01–$710.78 | — | 30% |
| DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 KINRIX | $92.40 | $132.00 | $30.36–$132.00 | 37% below | 30% |
| DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 KINRIX | $92.40 | $132.00 | $30.36–$132.00 | — | 30% |
| DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 INFANRIX | $42.70 | $61.00 | $14.03–$61.00 | 48% below | 30% |
| DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 INFANRIX | $42.70 | $61.00 | $14.03–$61.00 | — | 30% |
| DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 DTAP-HEP B-IPV VACCINE IM | $120.40 | $172.00 | $39.56–$385.83 | 37% below | 30% |
| DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 PEDIARIX | $120.40 | $172.00 | $39.56–$385.83 | 37% below | 30% |
| DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 DTAP-HEP B-IPV VACCINE IM | $120.40 | $172.00 | $39.56–$385.83 | — | 30% |
| DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 PEDIARIX | $120.40 | $172.00 | $39.56–$385.83 | — | 30% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 IIV3 VACC NO PRSV 0.5 ML IM | $52.50 | $75.00 | $17.25–$75.00 | 35% above | 30% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLULAVAL 0.5 ML | $52.50 | $75.00 | $17.25–$75.00 | 35% above | 30% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLULAVAL 0.5 ML | $52.50 | $75.00 | $17.25–$75.00 | — | 30% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 IIV3 VACC NO PRSV 0.5 ML IM | $52.50 | $75.00 | $17.25–$75.00 | — | 30% |
| HPV vaccine, 9-valent (Gardasil 9) CPT 90651 9VHPV VACCINE 2/3 DOSE IM | $235.90 | $337.00 | $77.51–$1,174.37 | 63% below | 30% |
| HPV vaccine, 9-valent (Gardasil 9) CPT 90651 GARDASIL 9 VACCINE | $235.90 | $337.00 | $77.51–$1,174.37 | 63% below | 30% |
| HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 GARDASIL 9 VACCINE | $235.90 | $337.00 | $77.51–$1,174.37 | — | 30% |
| HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 9VHPV VACCINE 2/3 DOSE IM | $235.90 | $337.00 | $77.51–$1,174.37 | — | 30% |
| Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 HEP A/HEP B ADULT | $150.50 | $215.00 | $49.45–$510.63 | 37% below | 30% |
| Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 HEP A/HEP B VACC ADULT IM | $150.50 | $215.00 | $49.45–$510.63 | 37% below | 30% |
| Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 HEP A/HEP B ADULT | $150.50 | $215.00 | $49.45–$510.63 | — | 30% |
| Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 HEP A/HEP B VACC ADULT IM | $150.50 | $215.00 | $49.45–$510.63 | — | 30% |
| Hepatitis A vaccine, adult dose CPT 90632 HAVRIX 1440U ADULT | $95.90 | $137.00 | $31.51–$137.00 | 44% below | 30% |
| Hepatitis A vaccine, adult dose inpatient CPT 90632 HAVRIX 1440U ADULT | $95.90 | $137.00 | $31.51–$137.00 | — | 30% |
| Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HAVRIX 720U PED | $50.40 | $72.00 | $16.56–$72.00 | 41% below | 30% |
| Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 HAVRIX 720U PED | $50.40 | $72.00 | $16.56–$72.00 | — | 30% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 ENGERIX B SD VIAL 20MCG | $84.00 | $120.00 | $27.60–$120.00 | 52% below | 30% |
| Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 ENGERIX B SD VIAL 20MCG | $84.00 | $120.00 | $27.60–$120.00 | — | 30% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 ENGERIX B 10MCG PED | $37.80 | $54.00 | $12.42–$54.00 | 48% below | 30% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 ENGERIX B 10MCG PED | $37.80 | $54.00 | $12.42–$54.00 | — | 30% |
| Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 PEDVAXHIB | $50.40 | $72.00 | $16.56–$72.00 | 23% below | 30% |
| Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) inpatient CPT 90647 PEDVAXHIB | $50.40 | $72.00 | $16.56–$72.00 | — | 30% |
| MMR vaccine (measles, mumps and rubella), live CPT 90707 MMR II INJECT | $84.00 | $120.00 | $27.60–$120.00 | 67% below | 30% |
| MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MMR II INJECT | $84.00 | $120.00 | $27.60–$120.00 | — | 30% |
| MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 MMRV VACCINE SC | $191.10 | $273.00 | $62.79–$1,093.99 | 55% below | 30% |
| MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 PROQUAD DS | $191.10 | $273.00 | $62.79–$1,093.99 | 55% below | 30% |
| MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 PROQUAD DS | $191.10 | $273.00 | $62.79–$1,093.99 | — | 30% |
| MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 MMRV VACCINE SC | $191.10 | $273.00 | $62.79–$1,093.99 | — | 30% |
| Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENACTRA | $162.40 | $232.00 | $53.36–$399.75 | 54% below | 30% |
| Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENACWYD/MENACWYCRM VACC IM | $162.40 | $232.00 | $53.36–$399.75 | 54% below | 30% |
| Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENACWYD/MENACWYCRM VACC IM | $162.40 | $232.00 | $53.36–$399.75 | — | 30% |
| Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENACTRA | $162.40 | $232.00 | $53.36–$399.75 | — | 30% |
| Meningococcal ACWY vaccine (MenQuadfi) CPT 90619 MENACWY-TT VACCINE IM | $214.20 | $306.00 | $70.38–$680.71 | 32% below | 30% |
| Meningococcal ACWY vaccine (MenQuadfi) CPT 90619 MENQUADFI | $214.20 | $306.00 | $70.38–$680.71 | 32% below | 30% |
| Meningococcal ACWY vaccine (MenQuadfi) inpatient CPT 90619 MENQUADFI | $214.20 | $306.00 | $70.38–$680.71 | — | 30% |
| Meningococcal ACWY vaccine (MenQuadfi) inpatient CPT 90619 MENACWY-TT VACCINE IM | $214.20 | $306.00 | $70.38–$680.71 | — | 30% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENB-4C VACCINE IM | $331.80 | $474.00 | $109.02–$913.19 | 14% below | 30% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 BEXSERO 0.5 ML PFS | $331.80 | $474.00 | $109.02–$913.19 | 14% below | 30% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 MENB-4C VACCINE IM | $331.80 | $474.00 | $109.02–$913.19 | — | 30% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 BEXSERO 0.5 ML PFS | $331.80 | $474.00 | $109.02–$913.19 | — | 30% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PCV13 VACCINE IM | $196.70 | $281.00 | $64.63–$924.18 | 58% below | 30% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PREVNAR 13 DS | $196.70 | $281.00 | $64.63–$924.18 | 58% below | 30% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 PREVNAR 13 DS | $196.70 | $281.00 | $64.63–$924.18 | — | 30% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 PCV13 VACCINE IM | $196.70 | $281.00 | $64.63–$924.18 | — | 30% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PCV20 VACCINE IM | $354.90 | $507.00 | $116.61–$1,068.02 | 43% below | 30% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PREVNAR 20 | $354.90 | $507.00 | $116.61–$1,068.02 | 43% below | 30% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PREVNAR 20 | $354.90 | $507.00 | $116.61–$1,068.02 | — | 30% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PCV20 VACCINE IM | $354.90 | $507.00 | $116.61–$1,068.02 | — | 30% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOVAX 23 | $105.70 | $151.00 | $34.73–$479.47 | 50% below | 30% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PPSV23 VACC 2 YRS+ SUBQ/IM | $105.70 | $151.00 | $34.73–$479.47 | 50% below | 30% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PPSV23 VACC 2 YRS+ SUBQ/IM | $105.70 | $151.00 | $34.73–$479.47 | — | 30% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOVAX 23 | $105.70 | $151.00 | $34.73–$479.47 | — | 30% |
| Polio vaccine, inactivated (IPV) CPT 90713 IPOL VACCINE 0.5 ML | $85.40 | $122.00 | $28.06–$122.00 | 31% below | 30% |
| Polio vaccine, inactivated (IPV) inpatient CPT 90713 IPOL VACCINE 0.5 ML | $85.40 | $122.00 | $28.06–$122.00 | — | 30% |
| Rabies vaccine, one dose CPT 90675 RABIES VACCINE IM | $1,225.00 | $1,750.00 | $402.50–$1,750.00 | 53% above | 30% |
| Rabies vaccine, one dose CPT 90675 RABAVERT VACCINE | $1,225.00 | $1,750.00 | $402.50–$1,750.00 | 53% above | 30% |
| Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE IM | $1,225.00 | $1,750.00 | $402.50–$1,750.00 | — | 30% |
| Rabies vaccine, one dose inpatient CPT 90675 RABAVERT VACCINE | $1,225.00 | $1,750.00 | $402.50–$1,750.00 | — | 30% |
| Rotavirus vaccine, oral, 2-dose schedule (Rotarix) CPT 90681 ROTAVIRUS VACCINE, LIVE, ORAL | $178.50 | $255.00 | $58.65–$255.00 | 6% above | 30% |
| Rotavirus vaccine, oral, 2-dose schedule (Rotarix) inpatient CPT 90681 ROTAVIRUS VACCINE, LIVE, ORAL | $178.50 | $255.00 | $58.65–$255.00 | — | 30% |
| Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 ROTATEQ SUSP | $115.50 | $165.00 | $37.95–$389.88 | 40% below | 30% |
| Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 RV5 VACC 3 DOSE LIVE ORAL | $115.50 | $165.00 | $37.95–$389.88 | 40% below | 30% |
| Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 RV5 VACC 3 DOSE LIVE ORAL | $115.50 | $165.00 | $37.95–$389.88 | — | 30% |
| Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 ROTATEQ SUSP | $115.50 | $165.00 | $37.95–$389.88 | — | 30% |
| Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 ZOSTER VACCINE RECOMBINANT, ADJUVANTED | $184.80 | $264.00 | $60.72–$810.38 | 53% below | 30% |
| Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 HZV VACC RECOMBINANT IM | $184.80 | $264.00 | $60.72–$810.38 | 53% below | 30% |
| Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 ZOSTER VACCINE RECOMBINANT, ADJUVANTED | $184.80 | $264.00 | $60.72–$810.38 | — | 30% |
| Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 HZV VACC RECOMBINANT IM | $184.80 | $264.00 | $60.72–$810.38 | — | 30% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS/DIPTHERIA VA | $64.40 | $92.00 | $21.16–$92.00 | 44% below | 30% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS/DIPTHERIA VA | $64.40 | $92.00 | $21.16–$92.00 | — | 30% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 BOOSTRIX 0.5ML SDV | $86.80 | $124.00 | $28.52–$124.00 | 29% below | 30% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 BOOSTRIX 0.5ML SDV | $86.80 | $124.00 | $28.52–$124.00 | — | 30% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZ ADMIN 1 VACC | $14.00 | $20.00 | $9.43–$41.00 | 77% below | 30% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADM IMMUN INIT | $14.70 | $21.00 | $9.43–$41.00 | 76% below | 30% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZ ADMIN 1 VACC | $14.00 | $20.00 | $9.43–$41.00 | — | 30% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADM IMMUN INIT | $14.70 | $21.00 | $9.43–$41.00 | — | 30% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 ADM IMMUN ADD'L | $14.70 | $21.00 | $9.89–$43.00 | 63% below | 30% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUN ADM EA ADD VAC | $15.40 | $22.00 | $9.89–$43.00 | 61% below | 30% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 ADM IMMUN ADD'L | $14.70 | $21.00 | $9.89–$43.00 | — | 30% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUN ADM EA ADD VAC | $15.40 | $22.00 | $9.89–$43.00 | — | 30% |
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.