Hospital

Ferrell Hospital Community Foundation

Ferrell Hospital Community Foundation in Eldorado, IL publishes cash prices for 363 common procedures listed here, from its own machine-readable price file updated Sep 22, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Illinois median for 281 of 356 procedures and above it for 71. By typical cash price it ranks #16 of 90 Illinois hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

1201 Pine St, Eldorado, IL 62930 Collected Sep 27, 2026 Source price file (618) 273-3361

Critical access hospital (rural, 25 beds or fewer) Emergency department CMS star rating 1 of 5 CCN 141324 · CMS hospital register

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Illinois	Off list
Ankle X-ray, complete, 3 or more views CPT 73610 HC XR ANKLE COMPLETE 3+ VIEWS	$213.75	$285.00	$128.25–$256.50	35% below	25%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 HC XR ANKLE COMPLETE 3+ VIEWS	$213.75	$285.00	$228.00–$256.50	—	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 HC CARD DOPPLER ARTERIAL EXTREMITY LIMITED BILAT	$721.50	$962.00	$432.90–$865.80	—	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 HC DOPPLER ARTERIAL EXTREMITY LIMITED BILAT	$729.75	$973.00	$437.85–$875.70	—	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient both sides CPT 93922 HC CARD DOPPLER ARTERIAL EXTREMITY LIMITED BILAT	$721.50	$962.00	$769.60–$865.80	—	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient both sides CPT 93922 HC DOPPLER ARTERIAL EXTREMITY LIMITED BILAT	$729.75	$973.00	$778.40–$875.70	—	25%
Barium swallow (esophagus X-ray with contrast) CPT 74220 HC XR EXAM ESOPHAGUS 1CNTRST	$354.75	$473.00	$212.85–$425.70	34% below	25%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 HC XR EXAM ESOPHAGUS 1CNTRST	$354.75	$473.00	$378.40–$425.70	—	25%
Bone scan, whole body (nuclear medicine) CPT 78306 HC NM BONE WHOLE BODY	$1,234.50	$1,646.00	$740.70–$1,481.40	20% below	25%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 HC NM BONE WHOLE BODY	$1,234.50	$1,646.00	$1,316.80–$1,481.40	—	25%
Breast ultrasound, complete, one breast both sides CPT 76641 HC US BREAST COMPLETE BILATERAL	$460.50	$614.00	$276.30–$552.60	—	25%
Breast ultrasound, complete, one breast one side CPT 76641 HC US BREAST COMPLETE UNILATERAL	$390.00	$520.00	$234.00–$468.00	11% below	25%
Breast ultrasound, complete, one breast inpatient both sides CPT 76641 HC US BREAST COMPLETE BILATERAL	$460.50	$614.00	$491.20–$552.60	—	25%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 HC US BREAST COMPLETE UNILATERAL	$390.00	$520.00	$416.00–$468.00	—	25%
Breast ultrasound, limited (one breast or one area) both sides CPT 76642 HC US BREAST LIMITED BILATERAL	$420.00	$560.00	$252.00–$504.00	—	25%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 HC US BREAST LIMITED UNILATERAL	$390.00	$520.00	$234.00–$468.00	5% above	25%
Breast ultrasound, limited (one breast or one area) inpatient both sides CPT 76642 HC US BREAST LIMITED BILATERAL	$420.00	$560.00	$448.00–$504.00	—	25%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 HC US BREAST LIMITED UNILATERAL	$390.00	$520.00	$416.00–$468.00	—	25%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HC CTA CHEST (NONCORONARY) W AND/OR W/O CONTRAST	$2,639.25	$3,519.00	$1,583.55–$3,167.10	14% above	25%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 HC CTA CHEST (NONCORONARY) W AND/OR W/O CONTRAST	$2,639.25	$3,519.00	$2,815.20–$3,167.10	—	25%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 HC CT ABDOMEN & PELVIS W/O CONTRAST	$3,030.75	$4,041.00	$1,818.45–$3,636.90	at median	25%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 HC CT ABDOMEN & PELVIS W/O CONTRAST	$3,030.75	$4,041.00	$3,232.80–$3,636.90	—	25%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT ABDOMEN AND PELVIS WITH CONTRAST	$3,188.25	$4,251.00	$1,912.95–$3,825.90	7% below	25%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT ABDOMEN AND PELVIS WITH CONTRAST	$3,188.25	$4,251.00	$3,400.80–$3,825.90	—	25%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC CT ABDOMEN & PELVIS W&W/O CONTRAST 1+ REGIONS	$3,908.25	$5,211.00	$2,344.95–$4,689.90	10% below	25%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 HC CT ABDOMEN & PELVIS W&W/O CONTRAST 1+ REGIONS	$3,908.25	$5,211.00	$4,168.80–$4,689.90	—	25%
CT scan of the abdomen with contrast CPT 74160 HC CT ABDOMEN W/CONTRAST	$1,704.75	$2,273.00	$1,022.85–$2,045.70	14% below	25%
CT scan of the abdomen with contrast inpatient CPT 74160 HC CT ABDOMEN W/CONTRAST	$1,704.75	$2,273.00	$1,818.40–$2,045.70	—	25%
CT scan of the abdomen without contrast CPT 74150 HC CT ABDOMEN W/O CONTRAST	$1,561.50	$2,082.00	$936.90–$1,873.80	4% below	25%
CT scan of the abdomen without contrast inpatient CPT 74150 HC CT ABDOMEN W/O CONTRAST	$1,561.50	$2,082.00	$1,665.60–$1,873.80	—	25%
CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT MAXILLOFACIAL W/O CONTRAST	$1,491.00	$1,988.00	$894.60–$1,789.20	4% above	25%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 HC CT MAXILLOFACIAL W/O CONTRAST	$1,491.00	$1,988.00	$1,590.40–$1,789.20	—	25%
CT scan of the head or brain, no contrast dye CPT 70450 HC CT HEAD/BRAIN W/O CONTRAST	$1,633.50	$2,178.00	$980.10–$1,960.20	4% above	25%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT HEAD/BRAIN W/O CONTRAST	$1,633.50	$2,178.00	$1,742.40–$1,960.20	—	25%
CT scan of the head with contrast CPT 70460 HC CT HEAD/BRAIN W/CONTRAST	$1,527.00	$2,036.00	$916.20–$1,832.40	5% below	25%
CT scan of the head with contrast inpatient CPT 70460 HC CT HEAD/BRAIN W/CONTRAST	$1,527.00	$2,036.00	$1,628.80–$1,832.40	—	25%
CT scan of the head without and with contrast CPT 70470 HC CT HEAD/BRAIN W&W/O CONTRAST	$2,022.75	$2,697.00	$1,213.65–$2,427.30	6% below	25%
CT scan of the head without and with contrast inpatient CPT 70470 HC CT HEAD/BRAIN W&W/O CONTRAST	$2,022.75	$2,697.00	$2,157.60–$2,427.30	—	25%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 HC CT LUMBAR SPINE W/O CONTRAST	$1,974.75	$2,633.00	$1,184.85–$2,369.70	1% above	25%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 HC CT LUMBAR SPINE W/O CONTRAST	$1,974.75	$2,633.00	$2,106.40–$2,369.70	—	25%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 HC CT CERVICAL SPINE W/O CONTRAST	$1,974.75	$2,633.00	$1,184.85–$2,369.70	at median	25%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 HC CT CERVICAL SPINE W/O CONTRAST	$1,974.75	$2,633.00	$2,106.40–$2,369.70	—	25%
CT scan of the pelvis, with contrast dye CPT 72193 HC CT PELVIS W/CONTRAST	$1,628.25	$2,171.00	$976.95–$1,953.90	11% below	25%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT PELVIS W/CONTRAST	$1,628.25	$2,171.00	$1,736.80–$1,953.90	—	25%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 HC DUPLEX EXTRACRANIAL/CAROTID BILAT	$907.50	$1,210.00	$544.50–$1,089.00	—	25%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 HC DUPLEX EXTRACRANIAL/CAROTID BILAT	$907.50	$1,210.00	$968.00–$1,089.00	—	25%
Chest X-ray, 2 views CPT 71046 HC XR CHEST 2 VIEWS	$218.25	$291.00	$130.95–$261.90	23% below	25%
Chest X-ray, 2 views inpatient CPT 71046 HC XR CHEST 2 VIEWS	$218.25	$291.00	$232.80–$261.90	—	25%
Chest X-ray, single view CPT 71045 HC XR CHEST 1 VIEW	$150.75	$201.00	$90.45–$180.90	36% below	25%
Chest X-ray, single view inpatient CPT 71045 HC XR CHEST 1 VIEW	$150.75	$201.00	$160.80–$180.90	—	25%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HC US RETROPERITIONEAL COMPLETE	$522.75	$697.00	$313.65–$627.30	34% below	25%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 HC US RETROPERITIONEAL COMPLETE	$522.75	$697.00	$557.60–$627.30	—	25%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 HC XR BONE DENSITY DUAL ENERGY (DXA) AXIAL	$504.75	$673.00	$302.85–$605.70	20% above	25%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 HC XR BONE DENSITY DUAL ENERGY (DXA) AXIAL	$504.75	$673.00	$538.40–$605.70	—	25%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 HC XR BONE DENSITY DUAL ENERGY (DEXA) APPENDICULAR	$245.25	$327.00	$147.15–$294.30	7% above	25%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 HC XR BONE DENSITY DUAL ENERGY (DEXA) APPENDICULAR	$245.25	$327.00	$261.60–$294.30	—	25%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 HC OB US DETAILED SINGLE FETUS	$559.50	$746.00	$335.70–$671.40	40% below	25%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 HC OB US DETAILED SINGLE FETUS	$559.50	$746.00	$596.80–$671.40	—	25%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT LOW DOSE LUNG DIAGNOSTIC - FOLLOW UP	$1,386.00	$1,848.00	$831.60–$1,663.20	11% above	25%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT THORAX DIAG W/O CONTRAST	$1,482.75	$1,977.00	$889.65–$1,779.30	19% above	25%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT LOW DOSE LUNG DIAGNOSTIC - FOLLOW UP	$1,386.00	$1,848.00	$1,478.40–$1,663.20	—	25%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT THORAX DIAG W/O CONTRAST	$1,482.75	$1,977.00	$1,581.60–$1,779.30	—	25%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 HC CT THORAX DIAG W/CONTRAST	$1,736.25	$2,315.00	$1,041.75–$2,083.50	14% below	25%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 HC CT THORAX DIAG W/CONTRAST	$1,736.25	$2,315.00	$1,852.00–$2,083.50	—	25%
Diagnostic mammogram, both breasts both sides CPT 77066 HC MAMMOGRAM DIAGNOSTIC BILATERAL W/DIGITAL IMAGES W CAD	$379.50	$506.00	$227.70–$455.40	—	25%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC MAMMOGRAM DIAGNOSTIC BILATERAL W/DIGITAL IMAGES W CAD	$379.50	$506.00	$404.80–$455.40	—	25%
Diagnostic mammogram, one breast one side CPT 77065 HC MAMMOGRAM DIAGNOSTIC UNILATERAL W/DIGITAL IMAGES W CAD	$279.75	$373.00	$167.85–$335.70	1% below	25%
Diagnostic mammogram, one breast inpatient one side CPT 77065 HC MAMMOGRAM DIAGNOSTIC UNILATERAL W/DIGITAL IMAGES W CAD	$279.75	$373.00	$298.40–$335.70	—	25%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 HC DUPLEX ARTERIAL LOWER EXTREMITY BILAT	$894.75	$1,193.00	$536.85–$1,073.70	—	25%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 HC CARD DUPLEX ARTERIAL LOWER EXTREMITY BILAT	$894.75	$1,193.00	$536.85–$1,073.70	—	25%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 HC DUPLEX ARTERIAL LOWER EXTREMITY BILAT	$894.75	$1,193.00	$954.40–$1,073.70	—	25%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 HC CARD DUPLEX ARTERIAL LOWER EXTREMITY BILAT	$894.75	$1,193.00	$954.40–$1,073.70	—	25%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HC CARD DUPLEX VENOUS EXTREMITY BILAT	$762.75	$1,017.00	$457.65–$915.30	—	25%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HC DUPLEX VENOUS EXTREMITY BILAT	$762.75	$1,017.00	$457.65–$915.30	—	25%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 HC CARD DUPLEX VENOUS EXTREMITY BILAT	$762.75	$1,017.00	$813.60–$915.30	—	25%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 HC DUPLEX VENOUS EXTREMITY BILAT	$762.75	$1,017.00	$813.60–$915.30	—	25%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 PR ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D	$187.50	$250.00	$112.50–$393.29	90% below	25%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC ECHO 2D WITH SPEC/COLOR FLOW M-MODE COMPLETE	$1,390.50	$1,854.00	$834.30–$1,668.60	23% below	25%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 PR ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D	$187.50	$250.00	$112.50–$393.29	—	25%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HC ECHO 2D WITH SPEC/COLOR FLOW M-MODE COMPLETE	$1,390.50	$1,854.00	$1,483.20–$1,668.60	—	25%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HC NM HEPATOBILIARY SYSTEM IMAGING INC GALLBLADDER	$1,168.50	$1,558.00	$701.10–$1,402.20	9% below	25%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HC NM HEPATOBILIARY SYSTEM IMAGING INC GALLBLADDER	$1,168.50	$1,558.00	$1,246.40–$1,402.20	—	25%
Knee X-ray, 3 views CPT 73562 HC XR KNEE 3 VIEWS	$191.25	$255.00	$114.75–$229.50	42% below	25%
Knee X-ray, 3 views inpatient CPT 73562 HC XR KNEE 3 VIEWS	$191.25	$255.00	$204.00–$229.50	—	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US ABDOMEN LIMITED	$361.50	$482.00	$216.90–$433.80	37% below	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC US ABDOMEN LIMITED	$361.50	$482.00	$385.60–$433.80	—	25%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 HC LOW DOSE LUNG CT SCREENING	$497.25	$663.00	$298.35–$596.70	9% below	25%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 HC LOW DOSE LUNG CT SCREENING	$497.25	$663.00	$530.40–$596.70	—	25%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI LOWER EXTREMITY JOINT W/O CONTRAST	$2,112.00	$2,816.00	$1,267.20–$2,534.40	12% below	25%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MRI LOWER EXTREMITY JOINT W/O CONTRAST	$2,112.00	$2,816.00	$2,252.80–$2,534.40	—	25%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI LOWER EXTREMITY JOINT W&W/O CONTRAST	$2,412.00	$3,216.00	$1,447.20–$2,894.40	25% below	25%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HC MRI LOWER EXTREMITY JOINT W&W/O CONTRAST	$2,412.00	$3,216.00	$2,572.80–$2,894.40	—	25%
MRI of the abdomen without contrast CPT 74181 HC MRI ABDOMEN W/O CONTRAST	$2,007.75	$2,677.00	$1,204.65–$2,409.30	3% below	25%
MRI of the abdomen without contrast inpatient CPT 74181 HC MRI ABDOMEN W/O CONTRAST	$2,007.75	$2,677.00	$2,141.60–$2,409.30	—	25%
MRI of the abdomen, without and then with contrast dye CPT 74183 HC MRI ABDOMEN W&W/O CONTRAST	$2,658.75	$3,545.00	$1,595.25–$3,190.50	14% below	25%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 HC MRI ABDOMEN W&W/O CONTRAST	$2,658.75	$3,545.00	$2,836.00–$3,190.50	—	25%
MRI of the brain, no contrast dye CPT 70551 HC MRI BRAIN W/O CONTRAST	$1,934.25	$2,579.00	$1,160.55–$2,321.10	12% below	25%
MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI BRAIN W/O CONTRAST	$1,934.25	$2,579.00	$2,063.20–$2,321.10	—	25%
MRI of the brain, with and without contrast dye CPT 70553 HC MRI BRAIN W&W/O CONTRAST	$2,767.50	$3,690.00	$1,660.50–$3,321.00	15% below	25%
MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI BRAIN W&W/O CONTRAST	$2,767.50	$3,690.00	$2,952.00–$3,321.00	—	25%
MRI of the lower back, no contrast dye CPT 72148 HC MRI LUMBAR SPINE W/O CONTRAST	$2,747.25	$3,663.00	$1,648.35–$3,296.70	8% above	25%
MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI LUMBAR SPINE W/O CONTRAST	$2,747.25	$3,663.00	$2,930.40–$3,296.70	—	25%
MRI of the lower back, without and then with contrast dye CPT 72158 HC MRI LUMBAR SPINE W&W/O CONTRAST	$2,767.50	$3,690.00	$1,660.50–$3,321.00	15% below	25%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 HC MRI LUMBAR SPINE W&W/O CONTRAST	$2,767.50	$3,690.00	$2,952.00–$3,321.00	—	25%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 HC MRI THORACIC SPINE W/O CONTRAST	$2,568.75	$3,425.00	$1,541.25–$3,082.50	1% above	25%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 HC MRI THORACIC SPINE W/O CONTRAST	$2,568.75	$3,425.00	$2,740.00–$3,082.50	—	25%
MRI of the neck (cervical spine) without and with contrast CPT 72156 HC MRI CERVICAL SPINE W&W/O CONTRAST	$2,610.00	$3,480.00	$1,566.00–$3,132.00	19% below	25%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 HC MRI CERVICAL SPINE W&W/O CONTRAST	$2,610.00	$3,480.00	$2,784.00–$3,132.00	—	25%
MRI of the neck (cervical spine), no contrast dye CPT 72141 HC MRI CERVICAL SPINE W/O CONTRAST	$2,502.75	$3,337.00	$1,501.65–$3,003.30	9% above	25%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 HC MRI CERVICAL SPINE W/O CONTRAST	$2,502.75	$3,337.00	$2,669.60–$3,003.30	—	25%
MRI of the pelvis without and with contrast CPT 72197 HC MRI PELVIS W&W/O CONTRAST	$2,412.00	$3,216.00	$1,447.20–$2,894.40	14% below	25%
MRI of the pelvis without and with contrast inpatient CPT 72197 HC MRI PELVIS W&W/O CONTRAST	$2,412.00	$3,216.00	$2,572.80–$2,894.40	—	25%
MRI of the pelvis, no contrast dye CPT 72195 HC MRI PELVIS W/O CONTRAST	$1,772.25	$2,363.00	$1,063.35–$2,126.70	18% below	25%
MRI of the pelvis, no contrast dye inpatient CPT 72195 HC MRI PELVIS W/O CONTRAST	$1,772.25	$2,363.00	$1,890.40–$2,126.70	—	25%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 HC MRI UPPER EXTREMITY JOINT W/O CONTRAST	$1,952.25	$2,603.00	$1,171.35–$2,342.70	24% below	25%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 HC MRI UPPER EXTREMITY JOINT W/O CONTRAST	$1,952.25	$2,603.00	$2,082.40–$2,342.70	—	25%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC NM MYOCARDIAL PERFUSION MULTIPLE SPECT	$2,892.75	$3,857.00	$1,735.65–$3,471.30	11% below	25%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HC NM MYOCARDIAL PERFUSION MULTIPLE SPECT	$2,892.75	$3,857.00	$3,085.60–$3,471.30	—	25%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC US PELVIS NON OB LIMITED	$348.00	$464.00	$208.80–$417.60	19% below	25%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC US PELVIS NON OB LIMITED	$348.00	$464.00	$371.20–$417.60	—	25%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HC US PELVIS NON OB	$644.25	$859.00	$386.55–$773.10	2% above	25%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 HC US PELVIS NON OB	$644.25	$859.00	$687.20–$773.10	—	25%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC OB ULTRASOUND >= 14 WEEKS	$487.50	$650.00	$292.50–$585.00	20% below	25%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US PREGNANCY > 14 WEEKS SINGLE/FIRST GEST	$521.25	$695.00	$312.75–$625.50	14% below	25%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC OB ULTRASOUND >= 14 WEEKS	$487.50	$650.00	$520.00–$585.00	—	25%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC US PREGNANCY > 14 WEEKS SINGLE/FIRST GEST	$521.25	$695.00	$556.00–$625.50	—	25%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 HC US PREGNANCY < 14 WEEKS SINGLE/FIRST GEST	$191.25	$255.00	$114.75–$229.50	66% below	25%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 HC OB ULTRASOUND < 14 WEEKS	$487.50	$650.00	$292.50–$585.00	12% below	25%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 HC US PREGNANCY < 14 WEEKS SINGLE/FIRST GEST	$191.25	$255.00	$204.00–$229.50	—	25%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 HC OB ULTRASOUND < 14 WEEKS	$487.50	$650.00	$520.00–$585.00	—	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC US PREGNANCY 1 OR MORE FETUSES LIMITED	$273.00	$364.00	$71.90–$327.60	33% below	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC OB ULTRASOUND LIMITED	$298.50	$398.00	$179.10–$358.20	27% below	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC US PREGNANCY 1 OR MORE FETUSES LIMITED	$273.00	$364.00	$71.90–$327.60	—	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC OB ULTRASOUND LIMITED	$298.50	$398.00	$318.40–$358.20	—	25%
Screening mammogram, both breasts both sides CPT 77067 HC MAMMOGRAM SCREENING BILATERAL W/DIGITAL IMAGES W CAD	$324.75	$433.00	$194.85–$389.70	—	25%
Screening mammogram, both breasts inpatient both sides CPT 77067 HC MAMMOGRAM SCREENING BILATERAL W/DIGITAL IMAGES W CAD	$324.75	$433.00	$346.40–$389.70	—	25%
Shoulder X-ray, complete, 2 or more views CPT 73030 HC XR SHOULDER COMPLETE 2+ VIEWS	$234.75	$313.00	$140.85–$281.70	27% below	25%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 HC XR SHOULDER COMPLETE 2+ VIEWS	$234.75	$313.00	$250.40–$281.70	—	25%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 HC ECHO REST & STRESS	$1,646.25	$2,195.00	$987.75–$1,975.50	21% above	25%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 HC ECHO REST & STRESS	$1,646.25	$2,195.00	$1,756.00–$1,975.50	—	25%
Swallow study (modified barium swallow, video X-ray) CPT 74230 HC XR EXAM SWLNG FUNCJ CNTRST STUDY	$379.50	$506.00	$227.70–$455.40	30% below	25%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 HC XR EXAM SWLNG FUNCJ CNTRST STUDY	$379.50	$506.00	$404.80–$455.40	—	25%
Transvaginal pelvic ultrasound CPT 76830 HC US TRANSVAGINAL	$495.00	$660.00	$297.00–$594.00	10% below	25%
Transvaginal pelvic ultrasound inpatient CPT 76830 HC US TRANSVAGINAL	$495.00	$660.00	$528.00–$594.00	—	25%
Transvaginal ultrasound during pregnancy CPT 76817 HC OB US TRANSVAGINAL	$333.00	$444.00	$199.80–$399.60	29% below	25%
Transvaginal ultrasound during pregnancy CPT 76817 HC US PREGNANCY TRANSVAGINAL	$345.75	$461.00	$207.45–$414.90	27% below	25%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 HC OB US TRANSVAGINAL	$333.00	$444.00	$355.20–$399.60	—	25%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 HC US PREGNANCY TRANSVAGINAL	$345.75	$461.00	$368.80–$414.90	—	25%
Ultrasound of the abdomen, complete CPT 76700 HC US ABDOMEN COMPLETE	$673.50	$898.00	$404.10–$808.20	30% below	25%
Ultrasound of the abdomen, complete inpatient CPT 76700 HC US ABDOMEN COMPLETE	$673.50	$898.00	$718.40–$808.20	—	25%
Ultrasound of the scrotum and testicles CPT 76870 HC US SCROTUM	$488.25	$651.00	$292.95–$585.90	26% below	25%
Ultrasound of the scrotum and testicles inpatient CPT 76870 HC US SCROTUM	$488.25	$651.00	$520.80–$585.90	—	25%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC US SOFT TISSUE HEAD/NECK	$468.00	$624.00	$280.80–$561.60	24% below	25%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HC US SOFT TISSUE HEAD/NECK	$468.00	$624.00	$499.20–$561.60	—	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 HC DUPLEX VENOUS EXTREMITY UNILATERAL/LIMITED	$683.25	$911.00	$409.95–$819.90	7% above	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 HC DUPLEX VENOUS EXTREMITY UNILATERAL/LIMITED	$683.25	$911.00	$728.80–$819.90	—	25%
Wrist X-ray, complete, 3 or more views CPT 73110 HC XR WRIST COMPLETE 3+ VIEWS	$204.75	$273.00	$122.85–$245.70	34% below	25%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 HC XR WRIST COMPLETE 3+ VIEWS	$204.75	$273.00	$218.40–$245.70	—	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HC XR HIP UNILATERAL W/PELVIS 2-3 VIEWS	$232.50	$310.00	$139.50–$279.00	15% below	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HC XR HIP UNILATERAL W/PELVIS 2-3 VIEWS	$232.50	$310.00	$248.00–$279.00	—	25%
X-ray of the abdomen, 1 view CPT 74018 HC XR ABDOMEN 1 VIEW	$192.75	$257.00	$115.65–$231.30	26% below	25%
X-ray of the abdomen, 1 view inpatient CPT 74018 HC XR ABDOMEN 1 VIEW	$192.75	$257.00	$205.60–$231.30	—	25%
X-ray of the ankle, 2 views CPT 73600 HC XR ANKLE 2 VIEWS	$176.25	$235.00	$105.75–$211.50	38% below	25%
X-ray of the ankle, 2 views inpatient CPT 73600 HC XR ANKLE 2 VIEWS	$176.25	$235.00	$188.00–$211.50	—	25%
X-ray of the finger(s), 2 or more views CPT 73140 HC XR FINGER(S) 2+ VIEWS	$132.75	$177.00	$79.65–$159.30	45% below	25%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 HC XR FINGER(S) 2+ VIEWS	$132.75	$177.00	$141.60–$159.30	—	25%
X-ray of the foot, 2 views CPT 73620 HC XR FOOT 2 VIEWS	$176.25	$235.00	$105.75–$211.50	33% below	25%
X-ray of the foot, 2 views inpatient CPT 73620 HC XR FOOT 2 VIEWS	$176.25	$235.00	$188.00–$211.50	—	25%
X-ray of the foot, complete, 3 or more views CPT 73630 HC XR FOOT COMPLETE 3+ VIEWS	$213.75	$285.00	$128.25–$256.50	33% below	25%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 HC XR FOOT COMPLETE 3+ VIEWS	$213.75	$285.00	$228.00–$256.50	—	25%
X-ray of the hand, 3 or more views CPT 73130 HC XR HAND COMPLETE 3+ VIEWS	$204.75	$273.00	$122.85–$245.70	37% below	25%
X-ray of the hand, 3 or more views inpatient CPT 73130 HC XR HAND COMPLETE 3+ VIEWS	$204.75	$273.00	$218.40–$245.70	—	25%
X-ray of the knee, 1 or 2 views CPT 73560 HC XR KNEE 1 OR 2 VIEWS	$176.25	$235.00	$105.75–$211.50	35% below	25%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 HC XR KNEE 1 OR 2 VIEWS	$176.25	$235.00	$188.00–$211.50	—	25%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HC XR LUMBAR SPINE 2 OR 3 VIEWS	$249.00	$332.00	$149.40–$298.80	38% below	25%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 HC XR LUMBAR SPINE 2 OR 3 VIEWS	$249.00	$332.00	$265.60–$298.80	—	25%
X-ray of the lower back, 4 or more views CPT 72110 HC XR LUMBAR SPINE 4+ VIEWS	$339.75	$453.00	$203.85–$407.70	36% below	25%
X-ray of the lower back, 4 or more views inpatient CPT 72110 HC XR LUMBAR SPINE 4+ VIEWS	$339.75	$453.00	$362.40–$407.70	—	25%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 HC XR THORACIC SPINE 2 VIEWS	$213.75	$285.00	$128.25–$256.50	40% below	25%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 HC XR THORACIC SPINE 2 VIEWS	$213.75	$285.00	$228.00–$256.50	—	25%
X-ray of the nasal bones, 3 or more views CPT 70160 HC XR NASAL BONES COMPLETE 3+ VIEWS	$230.25	$307.00	$138.15–$276.30	21% below	25%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 HC XR NASAL BONES COMPLETE 3+ VIEWS	$230.25	$307.00	$245.60–$276.30	—	25%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 HC XR CERVICAL SPINE 2 OR 3 VIEWS	$242.25	$323.00	$145.35–$290.70	26% below	25%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 HC XR CERVICAL SPINE 2 OR 3 VIEWS	$242.25	$323.00	$258.40–$290.70	—	25%
X-ray of the pelvis, 1 or 2 views CPT 72170 HC XR PELVIS 1 OR 2 VIEWS	$185.25	$247.00	$111.15–$222.30	42% below	25%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 HC XR PELVIS 1 OR 2 VIEWS	$185.25	$247.00	$197.60–$222.30	—	25%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 HC XR SACRUM/COCCYX 2+ VIEWS	$216.00	$288.00	$129.60–$259.20	24% below	25%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 HC XR SACRUM/COCCYX 2+ VIEWS	$216.00	$288.00	$230.40–$259.20	—	25%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Illinois	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC FIBROMETER ALT SGPT	$61.50	$82.00	$36.90–$73.80	17% above	25%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC ALT SGPT B	$61.50	$82.00	$36.90–$73.80	17% above	25%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 HC FIBROMETER ALT SGPT	$61.50	$82.00	$65.60–$73.80	—	25%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 HC ALT SGPT B	$61.50	$82.00	$65.60–$73.80	—	25%
AST (aspartate aminotransferase) enzyme test CPT 84450 HC FIBROMETER AST SGOT	$61.50	$82.00	$36.90–$73.80	17% above	25%
AST (aspartate aminotransferase) enzyme test CPT 84450 HC AST SGOT B	$61.50	$82.00	$36.90–$73.80	17% above	25%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 HC AST SGOT B	$61.50	$82.00	$65.60–$73.80	—	25%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 HC FIBROMETER AST SGOT	$61.50	$82.00	$65.60–$73.80	—	25%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HC HEPATITIS PANEL ACUTE	$146.25	$195.00	$87.75–$175.50	40% below	25%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HC HEPATITIS PANEL ACUTE	$146.25	$195.00	$156.00–$175.50	—	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD TROUT IGE	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD SALMON IGE	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD HALIBUT IGE	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD MACKEREL IGE	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD POPPY SEED IGE	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD FLAXSEED LINSEED IGE	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD GULF FLOUNDER IGE	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD ONION IGE	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC SHORT RAGWEED IGE	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN AMPICIILLIN	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN AMOXICILLIN	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD DILL IGE	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN DOG DANDER	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC FOOD RED DYE IGE ALLERGEN	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD GREEN PEPPER UNRIPE	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN GRASS ORCHARD GRASS COCKSFOOT IGE	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD BASS BLACK IGE	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD PERCH IGE	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN GRASS MEADOW FESCUE IGE	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD OREGANO IGE	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN GRASS BENT/REDTOP GRASS IGE	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FUNGI MOLD EPICOCCUM IGE	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FUNGI MOLD R NIGRICANS IGE	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FUNGI MOLD HELMINTHOSPOR IGE	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FUNGI MOLD A PULLULANS IGE	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FUNGI MOLD C IUNATA IGE	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FUNGI MOLD F MONILIFORME IGE	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN TREE WILLOW TREE IGE	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD THYME IGE	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN TREE EUCALYPTUS TREE IGE	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD NUTMEG IGE	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD BASIL IGE	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD BAY LEAF IGE	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD MUSTARD	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD C. PEPPER FRUTESCENS IGE	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD GINGER IGE	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD BLACK PEPPER	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD SAGE IGE	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD BELL PEPPER IGE	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD MACADAMIA NUT IGE	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD APPLE	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN GARLIC	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN COCONUT	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD CLOVE IGE	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN CHOCOLATE	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN AVOCADO	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD PISTACHIO IGE	$39.00	$52.00	$23.40–$46.80	42% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD CLAM IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD CASHEW IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD ALMOND IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD LOBSTER IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD BLUE MUSSEL IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN WEED LAMBS QUARTERS IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN WEED ENGLISH PLANTAIN IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN GRASS JOHNSON GRASS IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN TREE MESQUITE TREE IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN INSECT COCKROACH AMERICAN IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD CABBAGE IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD TUNA IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD BARLEY IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD RICE IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD POTATO IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD OAT IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD CODFISH IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD SHRIMP IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD RYE IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD LETTUCE IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD NAVY BEAN IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD GRAPE IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD CRAB IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD CARROT IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD C. PEPPER ANNUUM IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN TREE OLIVE TREE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FUNGI MOLD HORMODENDRUM IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN GRASS PERENNIAL RYE GRASS IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN GRASS JUNE GRASS KY BLUEGRASS IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD CINNAMON	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD PECAN IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD WALNUT IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD BRAZIL NUT IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD CHESTNUT IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD HAZELNUT IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD CHICKEN IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD TOMATO IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD BEEF IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD PORK IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN EGG WHOLE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FUNGI/MOLD A ALTERNATA IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN TREE BOX ELDER/MAPLE TREE IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN ANIMAL CAT DANDER IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN TREE MOUNTAIN CEDAR TREE IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN TREE COTTONWOOD TREE IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD SOYBEAN IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN EGG YOLK	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD MILK (COW) IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD CORN IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD PEANUT IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN WEED PIGWEED IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN WEED RUSSIAN THISTLE IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN GRASS TIMOTHY GRASS IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FUNGI/MOLD HORMODENDRUM IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN TREE ELM TREE IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN TREE OAK TREE IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN TREE BIRCH TREE IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FUNGI/MOLD A FUMIGATUS IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN MITES D PTERONYSSINUS IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN MITES D FARINAE IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN GRASS BERMUDA GRASS IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN TREE WHITE ASH TREE IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FUNGI/MOLD P NOTATUM IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN WEED COMMON/SHORT RAGWEED IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN INSECT COCKROACH GERMAN IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN TREE SYCAMORE TREE IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN TREE WALNUT TREE IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN TREE PECAN TREE IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN ANIMAL MOUSE EPITHELIUM IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FUNGI/MOLD M RACEMOSUS IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN TREE WHITE MULBERRY TREE IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN ANIMAL DOG DANDER IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN WEED SHEEP SORREL IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD GELATIN BOVINE IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD GELATIN PORCINE IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD ORANGE IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD EGG WHITE IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD WHEAT IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC CLADOSPORIUM IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD LAMB IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN ANIMAL COW HAIR DANDER IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD OYSTER IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN FOOD SCALLOP IGE	$41.25	$55.00	$24.75–$49.50	50% above	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FUNGI MOLD EPICOCCUM IGE	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD MACADAMIA NUT IGE	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN CHOCOLATE	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN AMPICIILLIN	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN AMOXICILLIN	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN DOG DANDER	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC FOOD RED DYE IGE ALLERGEN	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD BASS BLACK IGE	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD PERCH IGE	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD APPLE	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN AVOCADO	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN COCONUT	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN GARLIC	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD BELL PEPPER IGE	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD SAGE IGE	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD GINGER IGE	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD MUSTARD	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD BAY LEAF IGE	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD BASIL IGE	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD DILL IGE	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD GREEN PEPPER UNRIPE	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC SHORT RAGWEED IGE	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD PISTACHIO IGE	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD TROUT IGE	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD SALMON IGE	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD HALIBUT IGE	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD MACKEREL IGE	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD POPPY SEED IGE	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD FLAXSEED LINSEED IGE	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD GULF FLOUNDER IGE	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD ONION IGE	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN GRASS BENT/REDTOP GRASS IGE	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FUNGI MOLD R NIGRICANS IGE	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FUNGI MOLD HELMINTHOSPOR IGE	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FUNGI MOLD A PULLULANS IGE	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FUNGI MOLD C IUNATA IGE	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FUNGI MOLD F MONILIFORME IGE	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD C. PEPPER FRUTESCENS IGE	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD CLOVE IGE	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD BLACK PEPPER	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD NUTMEG IGE	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN TREE WILLOW TREE IGE	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN TREE EUCALYPTUS TREE IGE	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD THYME IGE	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD OREGANO IGE	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN GRASS MEADOW FESCUE IGE	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN GRASS ORCHARD GRASS COCKSFOOT IGE	$39.00	$52.00	$41.60–$46.80	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN WEED PIGWEED IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD MILK (COW) IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN TREE COTTONWOOD TREE IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN TREE MOUNTAIN CEDAR TREE IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN ANIMAL CAT DANDER IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN TREE BOX ELDER/MAPLE TREE IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FUNGI/MOLD A ALTERNATA IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FUNGI/MOLD M RACEMOSUS IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN ANIMAL MOUSE EPITHELIUM IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN TREE PECAN TREE IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN TREE WALNUT TREE IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN TREE SYCAMORE TREE IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN INSECT COCKROACH GERMAN IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN WEED COMMON/SHORT RAGWEED IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FUNGI/MOLD P NOTATUM IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN TREE WHITE ASH TREE IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN GRASS BERMUDA GRASS IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN MITES D FARINAE IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN MITES D PTERONYSSINUS IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FUNGI/MOLD A FUMIGATUS IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN TREE BIRCH TREE IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN TREE OAK TREE IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN TREE ELM TREE IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FUNGI/MOLD HORMODENDRUM IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN GRASS TIMOTHY GRASS IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN WEED RUSSIAN THISTLE IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD PEANUT IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN EGG WHOLE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD PORK IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD BEEF IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD TOMATO IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD CHICKEN IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD HAZELNUT IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD CHESTNUT IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD BRAZIL NUT IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD WALNUT IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD PECAN IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD ALMOND IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD CASHEW IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD WHEAT IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD EGG WHITE IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD CORN IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN EGG YOLK	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD SOYBEAN IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN TREE MESQUITE TREE IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC CLADOSPORIUM IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN INSECT COCKROACH AMERICAN IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD LAMB IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD CABBAGE IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD TUNA IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD BARLEY IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD RICE IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD POTATO IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD OAT IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD CODFISH IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD SHRIMP IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN ANIMAL COW HAIR DANDER IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD OYSTER IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD SCALLOP IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD CLAM IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD LOBSTER IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD BLUE MUSSEL IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN WEED LAMBS QUARTERS IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN WEED ENGLISH PLANTAIN IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD RYE IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN GRASS JOHNSON GRASS IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FUNGI MOLD HORMODENDRUM IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD NAVY BEAN IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD LETTUCE IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD GRAPE IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD CRAB IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD CARROT IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD C. PEPPER ANNUUM IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN TREE OLIVE TREE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN GRASS PERENNIAL RYE GRASS IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN GRASS JUNE GRASS KY BLUEGRASS IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD CINNAMON	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD ORANGE IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD GELATIN PORCINE IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN FOOD GELATIN BOVINE IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN WEED SHEEP SORREL IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN ANIMAL DOG DANDER IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN TREE WHITE MULBERRY TREE IGE	$41.25	$55.00	$44.00–$49.50	—	25%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 HC CYCLIC CITRUL PEPTIDE AB IGG	$87.00	$116.00	$52.20–$104.40	4% above	25%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 HC CYCLIC CITRUL PEPTIDE AB IGG	$87.00	$116.00	$92.80–$104.40	—	25%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC LUPUS COMP RFLX PAN	$76.50	$102.00	$45.90–$91.80	15% below	25%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANA WITH REFLEX	$108.00	$144.00	$64.80–$129.60	20% above	25%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC LUPUS COMP RFLX PAN	$76.50	$102.00	$81.60–$91.80	—	25%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC ANA WITH REFLEX	$108.00	$144.00	$115.20–$129.60	—	25%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HC BN PEPTIDE BNP	$142.50	$190.00	$85.50–$171.00	17% below	25%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 HC BN PEPTIDE BNP	$142.50	$190.00	$152.00–$171.00	—	25%
Basic metabolic panel (blood test) CPT 80048 HC BASIC METABOLIC PROF CHEM8	$138.75	$185.00	$83.25–$166.50	8% above	25%
Basic metabolic panel (blood test) inpatient CPT 80048 HC BASIC METABOLIC PROF CHEM8	$138.75	$185.00	$148.00–$166.50	—	25%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC TISSUE LEVEL IV	$216.00	$288.00	$129.60–$259.20	10% below	25%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC TISSUE LEVEL IV	$216.00	$288.00	$230.40–$259.20	—	25%
Blood culture for bacteria CPT 87040 HC CULTURE BLOOD	$111.00	$148.00	$66.60–$133.20	26% below	25%
Blood culture for bacteria inpatient CPT 87040 HC CULTURE BLOOD	$111.00	$148.00	$118.40–$133.20	—	25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 PR COLLECTION VENOUS BLOOD VENIPUNCTURE	$15.00	$20.00	$6.18–$18.00	33% below	25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE	$24.00	$32.00	$14.40–$28.80	7% above	25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC VENIPUNCTURE	$25.50	$34.00	$15.30–$30.60	13% above	25%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 PR COLLECTION VENOUS BLOOD VENIPUNCTURE	$15.00	$20.00	$6.18–$18.00	—	25%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE	$24.00	$32.00	$25.60–$28.80	—	25%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC VENIPUNCTURE	$25.50	$34.00	$27.20–$30.60	—	25%
Blood glucose (sugar) test CPT 82947 HC FIBROMETER GLUCOSE	$61.50	$82.00	$36.90–$73.80	87% above	25%
Blood glucose (sugar) test CPT 82947 HC GLUCOSE B	$61.50	$82.00	$36.90–$73.80	87% above	25%
Blood glucose (sugar) test inpatient CPT 82947 HC FIBROMETER GLUCOSE	$61.50	$82.00	$65.60–$73.80	—	25%
Blood glucose (sugar) test inpatient CPT 82947 HC GLUCOSE B	$61.50	$82.00	$65.60–$73.80	—	25%
Blood lead test CPT 83655 POCT BLOOD LEAD	$27.00	$36.00	$8.99–$32.40	53% below	25%
Blood lead test CPT 83655 HC HEAVY METAL LEAD BLOOD	$32.25	$43.00	$19.35–$38.70	44% below	25%
Blood lead test CPT 83655 HC LEAD WHOLE BLOOD	$32.25	$43.00	$19.35–$38.70	44% below	25%
Blood lead test inpatient CPT 83655 POCT BLOOD LEAD	$27.00	$36.00	$8.99–$32.40	—	25%
Blood lead test inpatient CPT 83655 HC HEAVY METAL LEAD BLOOD	$32.25	$43.00	$34.40–$38.70	—	25%
Blood lead test inpatient CPT 83655 HC LEAD WHOLE BLOOD	$32.25	$43.00	$34.40–$38.70	—	25%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HC HCG SERUM PREGNANCY	$93.00	$124.00	$55.80–$111.60	29% above	25%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HC HCG SERUM PREGNANCY	$93.00	$124.00	$99.20–$111.60	—	25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HC ABO TYPING	$49.50	$66.00	$29.70–$59.40	40% below	25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HC ARC ABO TYPE	$49.50	$66.00	$29.70–$59.40	40% below	25%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HC ARC ABO TYPE	$49.50	$66.00	$52.80–$59.40	—	25%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HC ABO TYPING	$49.50	$66.00	$52.80–$59.40	—	25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC C REACTIVE PROTEIN	$67.50	$90.00	$40.50–$81.00	at median	25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 HC C REACTIVE PROTEIN	$67.50	$90.00	$72.00–$81.00	—	25%
C. difficile toxin gene test (stool PCR) CPT 87493 HC CLOSTRIDIUM BY PCR	$88.50	$118.00	$53.10–$106.20	52% below	25%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 HC CLOSTRIDIUM BY PCR	$88.50	$118.00	$94.40–$106.20	—	25%
CA 19-9 blood test (tumor marker) CPT 86301 HC CARBOHYDRATE ANTIGEN 19 9	$122.25	$163.00	$73.35–$146.70	16% above	25%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 HC CARBOHYDRATE ANTIGEN 19 9	$122.25	$163.00	$130.40–$146.70	—	25%
CA-125 blood test (ovarian cancer marker) CPT 86304 HC CA 125 ANTIGEN	$122.25	$163.00	$73.35–$146.70	22% below	25%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 HC CA 125 ANTIGEN	$122.25	$163.00	$130.40–$146.70	—	25%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC COVID PCR INSTITUTIONAL ONLY	$31.50	$42.00	$18.90–$37.80	69% below	25%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC SARS CORONAVIRUS 2 RNA DETECTION	$106.50	$142.00	$63.90–$127.80	6% above	25%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HC COVID PCR INSTITUTIONAL ONLY	$31.50	$42.00	$33.60–$37.80	—	25%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HC SARS CORONAVIRUS 2 RNA DETECTION	$106.50	$142.00	$113.60–$127.80	—	25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC CHLAMYDIA TRACHOMATIS BY TMA	$27.00	$36.00	$16.20–$32.40	80% below	25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC C TRACHOMATIS	$67.50	$90.00	$40.50–$81.00	49% below	25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HC CHLAMYDIA TRACHOMATIS BY TMA	$27.00	$36.00	$28.80–$32.40	—	25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HC C TRACHOMATIS	$67.50	$90.00	$72.00–$81.00	—	25%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PROFILE CORONARY RISK	$157.50	$210.00	$94.50–$189.00	42% above	25%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC LIPID PROFILE CORONARY RISK	$157.50	$210.00	$168.00–$189.00	—	25%
Complete blood count (CBC) with differential CPT 85025 HC CBC W AUTO DIFF	$87.75	$117.00	$52.65–$105.30	12% above	25%
Complete blood count (CBC) with differential inpatient CPT 85025 HC CBC W AUTO DIFF	$87.75	$117.00	$93.60–$105.30	—	25%
Complete blood count (CBC), no differential CPT 85027 HC CBC W MANUAL DIFF	$57.00	$76.00	$34.20–$68.40	11% below	25%
Complete blood count (CBC), no differential inpatient CPT 85027 HC CBC W MANUAL DIFF	$57.00	$76.00	$60.80–$68.40	—	25%
Comprehensive metabolic panel (blood test) CPT 80053 HC COMPREHENSIVE METABOLIC PROFILE	$167.25	$223.00	$100.35–$200.70	11% above	25%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC COMPREHENSIVE METABOLIC PROFILE	$167.25	$223.00	$178.40–$200.70	—	25%
D-dimer blood test (blood clot marker) CPT 85379 HC D DIMER QUANTITATIVE	$86.25	$115.00	$51.75–$103.50	18% below	25%
D-dimer blood test (blood clot marker) inpatient CPT 85379 HC D DIMER QUANTITATIVE	$86.25	$115.00	$92.00–$103.50	—	25%
DHEA sulfate (DHEA-S) blood test CPT 82627 HC DHEA SULFATE	$78.75	$105.00	$47.25–$94.50	27% below	25%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 HC DHEA SULFATE	$78.75	$105.00	$84.00–$94.50	—	25%
Estradiol blood test CPT 82670 HC ESTRADIOL B	$95.25	$127.00	$57.15–$114.30	10% below	25%
Estradiol blood test inpatient CPT 82670 HC ESTRADIOL B	$95.25	$127.00	$101.60–$114.30	—	25%
FSH (follicle-stimulating hormone) test CPT 83001 HC FSH FOLLICLE STIM HORMONE	$162.75	$217.00	$97.65–$195.30	42% above	25%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 HC FSH FOLLICLE STIM HORMONE	$162.75	$217.00	$173.60–$195.30	—	25%
Fecal calprotectin (stool inflammation test) CPT 83993 HC CALPROTECTIN FECAL	$367.50	$490.00	$220.50–$441.00	116% above	25%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 HC CALPROTECTIN FECAL	$367.50	$490.00	$392.00–$441.00	—	25%
Ferritin blood test (iron stores) CPT 82728 HC FERRITIN	$32.25	$43.00	$19.35–$38.70	75% below	25%
Ferritin blood test (iron stores) CPT 82728 HC FIBROMETER FERRITIN	$32.25	$43.00	$19.35–$38.70	75% below	25%
Ferritin blood test (iron stores) inpatient CPT 82728 HC FIBROMETER FERRITIN	$32.25	$43.00	$34.40–$38.70	—	25%
Ferritin blood test (iron stores) inpatient CPT 82728 HC FERRITIN	$32.25	$43.00	$34.40–$38.70	—	25%
Folate (folic acid) blood test CPT 82746 HC FOLATE	$58.50	$78.00	$35.10–$70.20	44% below	25%
Folate (folic acid) blood test inpatient CPT 82746 HC FOLATE	$58.50	$78.00	$62.40–$70.20	—	25%
Free T3 thyroid hormone test CPT 84481 HC FREE T3	$70.50	$94.00	$42.30–$84.60	25% below	25%
Free T3 thyroid hormone test inpatient CPT 84481 HC FREE T3	$70.50	$94.00	$75.20–$84.60	—	25%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HC FREE T4	$108.00	$144.00	$64.80–$129.60	6% below	25%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HC FREE T4	$108.00	$144.00	$115.20–$129.60	—	25%
Free testosterone test CPT 84402 HC TESTOSTERONE FREE	$72.00	$96.00	$43.20–$86.40	41% below	25%
Free testosterone test CPT 84402 HC TESTOS FREE FE CHILD	$72.00	$96.00	$43.20–$86.40	41% below	25%
Free testosterone test inpatient CPT 84402 HC TESTOSTERONE FREE	$72.00	$96.00	$76.80–$86.40	—	25%
Free testosterone test inpatient CPT 84402 HC TESTOS FREE FE CHILD	$72.00	$96.00	$76.80–$86.40	—	25%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC GLUCOSE 1 HOUR PC 50G GLUCOLA	$75.00	$100.00	$45.00–$90.00	88% above	25%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 HC GLUCOSE 1 HOUR PC 50G GLUCOLA	$75.00	$100.00	$80.00–$90.00	—	25%
Glucose tolerance test, 3 samples CPT 82951 HC GLUCOSE 0	$186.00	$248.00	$111.60–$223.20	49% above	25%
Glucose tolerance test, 3 samples inpatient CPT 82951 HC GLUCOSE 0	$186.00	$248.00	$198.40–$223.20	—	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC N GONORRHOEAE BY TMA	$78.75	$105.00	$47.25–$94.50	45% below	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC N GONORRHOEAE	$78.75	$105.00	$47.25–$94.50	45% below	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC N GONORRHOEAE BY TMA	$78.75	$105.00	$84.00–$94.50	—	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC N GONORRHOEAE	$78.75	$105.00	$84.00–$94.50	—	25%
H. pylori antibody blood test CPT 86677 HC H PYLORI AB IGA	$108.75	$145.00	$65.25–$130.50	5% below	25%
H. pylori antibody blood test inpatient CPT 86677 HC H PYLORI AB IGA	$108.75	$145.00	$116.00–$130.50	—	25%
H. pylori stool antigen test CPT 87338 HC H PILORI ANTIGEN	$99.75	$133.00	$59.85–$119.70	3% above	25%
H. pylori stool antigen test CPT 87338 HC HELICOBACTOR PYLORI AG	$106.50	$142.00	$63.90–$127.80	10% above	25%
H. pylori stool antigen test inpatient CPT 87338 HC H PILORI ANTIGEN	$99.75	$133.00	$106.40–$119.70	—	25%
H. pylori stool antigen test inpatient CPT 87338 HC HELICOBACTOR PYLORI AG	$106.50	$142.00	$113.60–$127.80	—	25%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HC HIV RNA BY PCR	$165.00	$220.00	$99.00–$198.00	45% below	25%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HC VIRAL LOAD HIV	$213.75	$285.00	$128.25–$256.50	29% below	25%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HC HIV RNA BY PCR	$165.00	$220.00	$176.00–$198.00	—	25%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HC VIRAL LOAD HIV	$213.75	$285.00	$228.00–$256.50	—	25%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HC HIV ANTIBODY 1 PLUS 2	$66.00	$88.00	$39.60–$79.20	41% below	25%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HC HIV 1/2 COMBO ANTIGEN AND ANTIBODY WITH REFLEX	$70.50	$94.00	$42.30–$84.60	37% below	25%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HC HIV ANTIBODY 1 PLUS 2	$66.00	$88.00	$70.40–$79.20	—	25%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HC HIV 1/2 COMBO ANTIGEN AND ANTIBODY WITH REFLEX	$70.50	$94.00	$75.20–$84.60	—	25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC GLYCATED HEMOGLOBIN	$87.75	$117.00	$52.65–$105.30	8% above	25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC HGB A1C	$111.75	$149.00	$67.05–$134.10	37% above	25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HC GLYCATED HEMOGLOBIN	$87.75	$117.00	$93.60–$105.30	—	25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HC HGB A1C	$111.75	$149.00	$119.20–$134.10	—	25%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HC HEPATITIS B SURFACE ANTIBO	$26.25	$35.00	$15.75–$31.50	69% below	25%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HC HEP B SURF ANTB TITER	$48.75	$65.00	$29.25–$58.50	43% below	25%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HC HEPATITIS B SURFACE ANTIBO	$26.25	$35.00	$28.00–$31.50	—	25%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HC HEP B SURF ANTB TITER	$48.75	$65.00	$52.00–$58.50	—	25%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HC HEPATITIS B SURFACE ANTIGEN	$61.50	$82.00	$36.90–$73.80	23% below	25%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HC HEPATITIS B SURFACE ANTIGEN	$61.50	$82.00	$65.60–$73.80	—	25%
Hepatitis C antibody blood test (screening) CPT 86803 HC HEPATITIS C ANTIBODY	$112.50	$150.00	$67.50–$135.00	4% above	25%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HC HEPATITIS C ANTIBODY	$112.50	$150.00	$120.00–$135.00	—	25%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC HEPATITIS C RNA QUANT BY PCR	$339.75	$453.00	$203.85–$407.70	36% above	25%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC HEPATITIS C RNA QUANT REF	$339.75	$453.00	$203.85–$407.70	36% above	25%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC HEPATITIS C VIRUS RNA QUANT	$339.75	$453.00	$203.85–$407.70	36% above	25%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HC HEPATITIS C RNA QUANT BY PCR	$339.75	$453.00	$362.40–$407.70	—	25%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HC HEPATITIS C VIRUS RNA QUANT	$339.75	$453.00	$362.40–$407.70	—	25%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HC HEPATITIS C RNA QUANT REF	$339.75	$453.00	$362.40–$407.70	—	25%
Herpes blood test, HSV-1 antibody CPT 86695 HC HSV TYPE1 G SPEC IGG	$78.75	$105.00	$47.25–$94.50	21% above	25%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HC HSV TYPE1 G SPEC IGG	$78.75	$105.00	$84.00–$94.50	—	25%
Herpes blood test, HSV-2 antibody CPT 86696 HC HSV TYPE2 G SPEC IGG	$78.75	$105.00	$47.25–$94.50	12% below	25%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HC HSV TYPE2 G SPEC IGG	$78.75	$105.00	$84.00–$94.50	—	25%
High-sensitivity CRP (hs-CRP) test CPT 86141 HC CRP HIGH SENSITIVE	$111.00	$148.00	$66.60–$133.20	24% above	25%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 HC CRP HIGH SENSITIVE	$111.00	$148.00	$118.40–$133.20	—	25%
Homocysteine blood test CPT 83090 HC HOMOCYSTEINE REF	$52.50	$70.00	$31.50–$63.00	50% below	25%
Homocysteine blood test CPT 83090 HC HOMOCYSTEINE B	$85.50	$114.00	$51.30–$102.60	19% below	25%
Homocysteine blood test inpatient CPT 83090 HC HOMOCYSTEINE REF	$52.50	$70.00	$56.00–$63.00	—	25%
Homocysteine blood test inpatient CPT 83090 HC HOMOCYSTEINE B	$85.50	$114.00	$91.20–$102.60	—	25%
Insulin blood test CPT 83525 HC INSULIN FASTING	$25.50	$34.00	$15.30–$30.60	65% below	25%
Insulin blood test CPT 83525 HC INSULIN RANDOM	$84.00	$112.00	$50.40–$100.80	15% above	25%
Insulin blood test inpatient CPT 83525 HC INSULIN FASTING	$25.50	$34.00	$27.20–$30.60	—	25%
Insulin blood test inpatient CPT 83525 HC INSULIN RANDOM	$84.00	$112.00	$89.60–$100.80	—	25%
Iron blood test (serum iron) CPT 83540 HC IRON B	$61.50	$82.00	$36.90–$73.80	16% below	25%
Iron blood test (serum iron) inpatient CPT 83540 HC IRON B	$61.50	$82.00	$65.60–$73.80	—	25%
Iron-binding capacity (TIBC) test CPT 83550 HC IRON AND IRON BIND CAP	$61.50	$82.00	$36.90–$73.80	10% below	25%
Iron-binding capacity (TIBC) test inpatient CPT 83550 HC IRON AND IRON BIND CAP	$61.50	$82.00	$65.60–$73.80	—	25%
Kidney function blood test panel CPT 80069 HC RENAL PROFILE	$84.75	$113.00	$50.85–$101.70	41% below	25%
Kidney function blood test panel inpatient CPT 80069 HC RENAL PROFILE	$84.75	$113.00	$90.40–$101.70	—	25%
LH (luteinizing hormone) test CPT 83002 HC LH LUTEINIZING HORMONE	$107.25	$143.00	$64.35–$128.70	13% above	25%
LH (luteinizing hormone) test inpatient CPT 83002 HC LH LUTEINIZING HORMONE	$107.25	$143.00	$114.40–$128.70	—	25%
Lipase blood test (pancreas enzyme) CPT 83690 HC LIPASE B	$61.50	$82.00	$36.90–$73.80	23% below	25%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 HC LIPASE B	$61.50	$82.00	$65.60–$73.80	—	25%
Liver function blood test panel CPT 80076 HC LIVER HEPATIC PROFILE	$93.00	$124.00	$55.80–$111.60	23% below	25%
Liver function blood test panel inpatient CPT 80076 HC LIVER HEPATIC PROFILE	$93.00	$124.00	$99.20–$111.60	—	25%
Lyme disease antibody test CPT 86618 HC LYME DIS ACUT RFLX PANL	$30.75	$41.00	$18.45–$36.90	57% below	25%
Lyme disease antibody test CPT 86618 HC LYME DISEASE ANTIBODY	$89.25	$119.00	$53.55–$107.10	26% above	25%
Lyme disease antibody test CPT 86618 HC LYME DIS CHRN RFLX PANL	$89.25	$119.00	$53.55–$107.10	26% above	25%
Lyme disease antibody test CPT 86618 HC LYME MODIFIED 2 TIER TESTING 1ST TIER	$123.75	$165.00	$74.25–$148.50	75% above	25%
Lyme disease antibody test inpatient CPT 86618 HC LYME DIS ACUT RFLX PANL	$30.75	$41.00	$32.80–$36.90	—	25%
Lyme disease antibody test inpatient CPT 86618 HC LYME DISEASE ANTIBODY	$89.25	$119.00	$95.20–$107.10	—	25%
Lyme disease antibody test inpatient CPT 86618 HC LYME DIS CHRN RFLX PANL	$89.25	$119.00	$95.20–$107.10	—	25%
Lyme disease antibody test inpatient CPT 86618 HC LYME MODIFIED 2 TIER TESTING 1ST TIER	$123.75	$165.00	$132.00–$148.50	—	25%
Magnesium blood test CPT 83735 HC MAGNESIUM 24 HR URINE	$32.25	$43.00	$19.35–$38.70	55% below	25%
Magnesium blood test CPT 83735 HC MAGNESIUM B	$61.50	$82.00	$36.90–$73.80	14% below	25%
Magnesium blood test CPT 83735 HC MAGNESIUM INTRACELLULAR RBC	$61.50	$82.00	$36.90–$73.80	14% below	25%
Magnesium blood test inpatient CPT 83735 HC MAGNESIUM 24 HR URINE	$32.25	$43.00	$34.40–$38.70	—	25%
Magnesium blood test inpatient CPT 83735 HC MAGNESIUM INTRACELLULAR RBC	$61.50	$82.00	$65.60–$73.80	—	25%
Magnesium blood test inpatient CPT 83735 HC MAGNESIUM B	$61.50	$82.00	$65.60–$73.80	—	25%
Measles (rubeola) antibody test CPT 86765 HC MEASLES ATB IGM	$70.50	$94.00	$42.30–$84.60	3% below	25%
Measles (rubeola) antibody test CPT 86765 HC MEASLES ATB IGG	$70.50	$94.00	$42.30–$84.60	3% below	25%
Measles (rubeola) antibody test inpatient CPT 86765 HC MEASLES ATB IGG	$70.50	$94.00	$75.20–$84.60	—	25%
Measles (rubeola) antibody test inpatient CPT 86765 HC MEASLES ATB IGM	$70.50	$94.00	$75.20–$84.60	—	25%
Mono test (heterophile antibody, Monospot) CPT 86308 HC MONO	$75.00	$100.00	$45.00–$90.00	4% above	25%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HC MONO	$75.00	$100.00	$80.00–$90.00	—	25%
Obstetric blood test panel CPT 80055 HC OBSTETRIC PANEL	$472.50	$630.00	$283.50–$567.00	152% above	25%
Obstetric blood test panel inpatient CPT 80055 HC OBSTETRIC PANEL	$472.50	$630.00	$504.00–$567.00	—	25%
PSA (prostate-specific antigen) blood test, free CPT 84154 HC PROSTATE SPECIFIC ANTIGEN FREE	$105.00	$140.00	$63.00–$126.00	2% above	25%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC PROSTATE SPECIFIC ANTIGEN FREE	$105.00	$140.00	$112.00–$126.00	—	25%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC PSA DIAGNOSTIC	$121.50	$162.00	$72.90–$145.80	13% above	25%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC PROSTATE SPECIFIC ANTIGEN TOTAL	$121.50	$162.00	$72.90–$145.80	13% above	25%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC PSA DIAGNOSTIC	$121.50	$162.00	$129.60–$145.80	—	25%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC PROSTATE SPECIFIC ANTIGEN TOTAL	$121.50	$162.00	$129.60–$145.80	—	25%
Pap test (liquid-based, automated screening with review) CPT 88175 HC CYTO PAP THIN LAYER C/V AUTO & RESCREEN DIAG	$132.75	$177.00	$79.65–$159.30	1% below	25%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 HC CYTO PAP THIN LAYER C/V AUTO & RESCREEN DIAG	$132.75	$177.00	$141.60–$159.30	—	25%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 HC CYTO PAP THIN LAYER C/V MANUAL DIAG	$54.75	$73.00	$32.85–$65.70	50% below	25%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 HC CYTO PAP THIN LAYER C/V MANUAL DIAG	$54.75	$73.00	$58.40–$65.70	—	25%
Parathyroid hormone (PTH) blood test CPT 83970 HC PTH INTACT SURGERY USE ONLY	$66.00	$88.00	$39.60–$79.20	70% below	25%
Parathyroid hormone (PTH) blood test CPT 83970 HC PARATHYROID HORMONE	$70.50	$94.00	$42.30–$84.60	68% below	25%
Parathyroid hormone (PTH) blood test CPT 83970 HC PTH WITH CALCIUM	$70.50	$94.00	$42.30–$84.60	68% below	25%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 HC PTH INTACT SURGERY USE ONLY	$66.00	$88.00	$70.40–$79.20	—	25%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 HC PARATHYROID HORMONE	$70.50	$94.00	$75.20–$84.60	—	25%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 HC PTH WITH CALCIUM	$70.50	$94.00	$75.20–$84.60	—	25%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC LUPUS ANTICOAG THROMBOPLASTIN TIME PARTIAL	$33.75	$45.00	$20.25–$40.50	39% below	25%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC LUPUS ANTICOAGULANT	$55.50	$74.00	$33.30–$66.60	1% above	25%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC PTT PARTIAL THROMB TIME APTT REF	$55.50	$74.00	$33.30–$66.60	1% above	25%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC PTT PLASMA 85730PTT PLASMA 85730	$76.50	$102.00	$45.90–$91.80	39% above	25%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC APTT B	$76.50	$102.00	$45.90–$91.80	39% above	25%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC ANTIPHOSPHOLIPID SYN THROMBOPLASTIN TIME PARTIAL	$76.50	$102.00	$45.90–$91.80	39% above	25%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC PTT PLASMA OR WB	$76.50	$102.00	$45.90–$91.80	39% above	25%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC LUPUS ANTICOAG THROMBOPLASTIN TIME PARTIAL	$33.75	$45.00	$36.00–$40.50	—	25%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC PTT PARTIAL THROMB TIME APTT REF	$55.50	$74.00	$59.20–$66.60	—	25%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC LUPUS ANTICOAGULANT	$55.50	$74.00	$59.20–$66.60	—	25%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC ANTIPHOSPHOLIPID SYN THROMBOPLASTIN TIME PARTIAL	$76.50	$102.00	$81.60–$91.80	—	25%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC PTT PLASMA 85730PTT PLASMA 85730	$76.50	$102.00	$81.60–$91.80	—	25%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC APTT B	$76.50	$102.00	$81.60–$91.80	—	25%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC PTT PLASMA OR WB	$76.50	$102.00	$81.60–$91.80	—	25%
Progesterone blood test CPT 84144 HC PROGESTERONE	$93.00	$124.00	$55.80–$111.60	30% below	25%
Progesterone blood test inpatient CPT 84144 HC PROGESTERONE	$93.00	$124.00	$99.20–$111.60	—	25%
Prolactin blood test CPT 84146 HC PROLACTIN B	$100.50	$134.00	$60.30–$120.60	13% below	25%
Prolactin blood test inpatient CPT 84146 HC PROLACTIN B	$100.50	$134.00	$107.20–$120.60	—	25%
Prothrombin time (PT/INR) clotting test CPT 85610 CHG PROTHROMBIN TIME	$26.25	$35.00	$3.16–$31.50	16% below	25%
Prothrombin time (PT/INR) clotting test CPT 85610 HC LUPUS ANTICOAG PROTHROMBIN TIME	$44.25	$59.00	$26.55–$53.10	42% above	25%
Prothrombin time (PT/INR) clotting test CPT 85610 HC ANTIPHOSPHOLIPID SYN PROTHROMBIN TIME	$55.50	$74.00	$33.30–$66.60	78% above	25%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME	$55.50	$74.00	$33.30–$66.60	78% above	25%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 CHG PROTHROMBIN TIME	$26.25	$35.00	$3.16–$31.50	—	25%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC LUPUS ANTICOAG PROTHROMBIN TIME	$44.25	$59.00	$47.20–$53.10	—	25%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME	$55.50	$74.00	$59.20–$66.60	—	25%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC ANTIPHOSPHOLIPID SYN PROTHROMBIN TIME	$55.50	$74.00	$59.20–$66.60	—	25%
Rapid flu test (influenza antigen) CPT 87804 CHG IAADIADOO INFLUENZA	$63.75	$85.00	$12.39–$76.50	12% above	25%
Rapid flu test (influenza antigen) CPT 87804 HC INFLUENZA A AND B ANTIGEN	$70.50	$94.00	$42.30–$84.60	24% above	25%
Rapid flu test (influenza antigen) inpatient CPT 87804 CHG IAADIADOO INFLUENZA	$63.75	$85.00	$12.39–$76.50	—	25%
Rapid flu test (influenza antigen) inpatient CPT 87804 HC INFLUENZA A AND B ANTIGEN	$70.50	$94.00	$75.20–$84.60	—	25%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 CHG IAADIADOO STREPTOCOCCUS GROUP A	$21.75	$29.00	$12.14–$31.40	60% below	25%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC RAPID STREP CLINIC	$67.50	$90.00	$40.50–$81.00	24% above	25%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 CHG IAADIADOO STREPTOCOCCUS GROUP A	$21.75	$29.00	$12.14–$31.40	—	25%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HC RAPID STREP CLINIC	$67.50	$90.00	$72.00–$81.00	—	25%
Rheumatoid factor (RF) test CPT 86431 HC RHEUMATOID FACTOR	$67.50	$90.00	$40.50–$81.00	26% above	25%
Rheumatoid factor (RF) test inpatient CPT 86431 HC RHEUMATOID FACTOR	$67.50	$90.00	$72.00–$81.00	—	25%
Rubella antibody test (immunity check) CPT 86762 HC RUBELLA	$70.50	$94.00	$42.30–$84.60	8% below	25%
Rubella antibody test (immunity check) inpatient CPT 86762 HC RUBELLA	$70.50	$94.00	$75.20–$84.60	—	25%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 HC SED RATE WESTERGREN	$85.50	$114.00	$51.30–$102.60	93% above	25%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 HC SED RATE AUTOMATED	$85.50	$114.00	$51.30–$102.60	93% above	25%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 HC SED RATE WESTERGREN	$85.50	$114.00	$91.20–$102.60	—	25%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 HC SED RATE AUTOMATED	$85.50	$114.00	$91.20–$102.60	—	25%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 HC SEMEN ANALYSIS	$19.50	$26.00	$11.70–$23.40	83% below	25%
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 HC SEMEN ANALYSIS	$19.50	$26.00	$20.80–$23.40	—	25%
Stool ova and parasites exam CPT 87177 HC OVA AND PARASITE	$113.25	$151.00	$67.95–$135.90	55% above	25%
Stool ova and parasites exam inpatient CPT 87177 HC OVA AND PARASITE	$113.25	$151.00	$120.80–$135.90	—	25%
Stool test for hidden blood (guaiac FOBT) CPT 82270 CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER	$17.25	$23.00	$3.07–$20.70	33% below	25%
Stool test for hidden blood (guaiac FOBT) CPT 82270 HC OCCULT BLOOD SCREEN	$55.50	$74.00	$33.30–$66.60	114% above	25%
Stool test for hidden blood (guaiac FOBT) CPT 82270 HC OCCULT BLOOD FECES	$55.50	$74.00	$33.30–$66.60	114% above	25%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER	$17.25	$23.00	$3.07–$20.70	—	25%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HC OCCULT BLOOD FECES	$55.50	$74.00	$59.20–$66.60	—	25%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HC OCCULT BLOOD SCREEN	$55.50	$74.00	$59.20–$66.60	—	25%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 HC OCCULT BLOOD FECAL BY IMMUNOASSAY	$67.50	$90.00	$40.50–$81.00	9% below	25%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 HC OCCULT BLOOD FECAL BY IMMUNOASSAY	$67.50	$90.00	$72.00–$81.00	—	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC RPR QUALITATIVE	$37.50	$50.00	$22.50–$45.00	27% below	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC RPR REVERSE WITH REFLEX TO TITER	$41.25	$55.00	$24.75–$49.50	19% below	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC RPR QUALITATIVE	$37.50	$50.00	$40.00–$45.00	—	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC RPR REVERSE WITH REFLEX TO TITER	$41.25	$55.00	$44.00–$49.50	—	25%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC QUANTIFERON TB GOLD	$186.00	$248.00	$111.60–$223.20	20% below	25%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HC QUANTIFERON TB GOLD	$186.00	$248.00	$198.40–$223.20	—	25%
Testosterone blood test, total (not free testosterone) CPT 84403 HC TESTO BIOAVAIL SHGB FE AND CHILD	$67.50	$90.00	$40.50–$81.00	46% below	25%
Testosterone blood test, total (not free testosterone) CPT 84403 HC TESTOSTERONE TOTAL	$72.00	$96.00	$43.20–$86.40	42% below	25%
Testosterone blood test, total (not free testosterone) CPT 84403 HC TESTOS TOTAL FE CHILD	$72.00	$96.00	$43.20–$86.40	42% below	25%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC TESTO BIOAVAIL SHGB FE AND CHILD	$67.50	$90.00	$72.00–$81.00	—	25%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC TESTOS TOTAL FE CHILD	$72.00	$96.00	$76.80–$86.40	—	25%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC TESTOSTERONE TOTAL	$72.00	$96.00	$76.80–$86.40	—	25%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC LIVER KIDNEY MICROSOME ABS IGG	$51.75	$69.00	$31.05–$62.10	42% below	25%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC ANTI THYROID ANTIBODIES MI	$63.75	$85.00	$38.25–$76.50	29% below	25%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC ANTI-MICROSOMAL (TPO) AB	$145.50	$194.00	$87.30–$174.60	62% above	25%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC THYROID PEROXIDASE AB TPO	$153.00	$204.00	$91.80–$183.60	70% above	25%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC LIVER KIDNEY MICROSOME ABS IGG	$51.75	$69.00	$55.20–$62.10	—	25%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC ANTI THYROID ANTIBODIES MI	$63.75	$85.00	$68.00–$76.50	—	25%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC ANTI-MICROSOMAL (TPO) AB	$145.50	$194.00	$155.20–$174.60	—	25%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC THYROID PEROXIDASE AB TPO	$153.00	$204.00	$163.20–$183.60	—	25%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC TSH	$110.25	$147.00	$66.15–$132.30	16% below	25%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC TSH	$110.25	$147.00	$117.60–$132.30	—	25%
Trichomonas test (NAAT) CPT 87661 HC TRICHOMONAS VAGINALIS BY TMA	$116.25	$155.00	$69.75–$139.50	7% below	25%
Trichomonas test (NAAT) CPT 87661 HC TRICHOMONAS VAGINALIS (TMA)	$122.25	$163.00	$73.35–$146.70	2% below	25%
Trichomonas test (NAAT) inpatient CPT 87661 HC TRICHOMONAS VAGINALIS BY TMA	$116.25	$155.00	$124.00–$139.50	—	25%
Trichomonas test (NAAT) inpatient CPT 87661 HC TRICHOMONAS VAGINALIS (TMA)	$122.25	$163.00	$130.40–$146.70	—	25%
Uric acid blood test CPT 84550 HC URIC ACID	$61.50	$82.00	$36.90–$73.80	13% below	25%
Uric acid blood test inpatient CPT 84550 HC URIC ACID	$61.50	$82.00	$65.60–$73.80	—	25%
Urinalysis with microscope exam, automated CPT 81001 HC UA	$57.00	$76.00	$34.20–$68.40	5% below	25%
Urinalysis with microscope exam, automated CPT 81001 HC UA AUTO WITH MICRO 81001	$57.00	$76.00	$34.20–$68.40	5% below	25%
Urinalysis with microscope exam, automated CPT 81001 HC URINALYSIS W MICRO	$60.75	$81.00	$36.45–$72.90	2% above	25%
Urinalysis with microscope exam, automated CPT 81001 HC URINALYSIS W/MICRO CULTURE	$60.75	$81.00	$36.45–$72.90	2% above	25%
Urinalysis with microscope exam, automated inpatient CPT 81001 HC UA AUTO WITH MICRO 81001	$57.00	$76.00	$60.80–$68.40	—	25%
Urinalysis with microscope exam, automated inpatient CPT 81001 HC UA	$57.00	$76.00	$60.80–$68.40	—	25%
Urinalysis with microscope exam, automated inpatient CPT 81001 HC URINALYSIS W MICRO	$60.75	$81.00	$64.80–$72.90	—	25%
Urinalysis with microscope exam, automated inpatient CPT 81001 HC URINALYSIS W/MICRO CULTURE	$60.75	$81.00	$64.80–$72.90	—	25%
Urinalysis with microscope exam, manual CPT 81000 CHG URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY	$11.25	$15.00	$2.91–$13.50	45% below	25%
Urinalysis with microscope exam, manual inpatient CPT 81000 CHG URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY	$11.25	$15.00	$2.91–$13.50	—	25%
Urinalysis without microscope exam, automated CPT 81003 CHG URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY	$53.25	$71.00	$1.70–$63.90	197% above	25%
Urinalysis without microscope exam, automated CPT 81003 HC UA AUTO WITHOUT MICRO 81003	$54.75	$73.00	$32.85–$65.70	206% above	25%
Urinalysis without microscope exam, automated inpatient CPT 81003 CHG URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY	$53.25	$71.00	$1.70–$63.90	—	25%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC UA AUTO WITHOUT MICRO 81003	$54.75	$73.00	$58.40–$65.70	—	25%
Urinalysis without microscope exam, manual CPT 81002 CHG URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP	$7.50	$10.00	$2.67–$9.00	69% below	25%
Urinalysis without microscope exam, manual inpatient CPT 81002 CHG URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP	$7.50	$10.00	$2.67–$9.00	—	25%
Urine culture for bacteria, with colony count CPT 87086 HC CULTURE URINE	$89.25	$119.00	$53.55–$107.10	at median	25%
Urine culture for bacteria, with colony count inpatient CPT 87086 HC CULTURE URINE	$89.25	$119.00	$95.20–$107.10	—	25%
Urine pregnancy test, read by color change CPT 81025 CHG URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS	$22.50	$30.00	$6.03–$27.00	67% below	25%
Urine pregnancy test, read by color change CPT 81025 HC PREGNANCY TEST URINE	$93.00	$124.00	$55.80–$111.60	37% above	25%
Urine pregnancy test, read by color change inpatient CPT 81025 CHG URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS	$22.50	$30.00	$6.03–$27.00	—	25%
Urine pregnancy test, read by color change inpatient CPT 81025 HC PREGNANCY TEST URINE	$93.00	$124.00	$99.20–$111.60	—	25%
Vitamin B12 (cobalamin) blood test CPT 82607 HC B12	$70.50	$94.00	$42.30–$84.60	44% below	25%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 HC B12	$70.50	$94.00	$75.20–$84.60	—	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC VITAMIN D 25 HYDROXY	$70.50	$94.00	$42.30–$84.60	62% below	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC 25 OH VITAMIN D	$72.00	$96.00	$43.20–$86.40	61% below	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC 25-HYDROXYVITAMIN D2 AND D3	$76.50	$102.00	$45.90–$91.80	59% below	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HC VITAMIN D 25 HYDROXY	$70.50	$94.00	$75.20–$84.60	—	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HC 25 OH VITAMIN D	$72.00	$96.00	$76.80–$86.40	—	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HC 25-HYDROXYVITAMIN D2 AND D3	$76.50	$102.00	$81.60–$91.80	—	25%
Zinc blood test CPT 84630 HC ZINC RBC	$95.25	$127.00	$57.15–$114.30	52% above	25%
Zinc blood test CPT 84630 HC ZINC BLOOD	$95.25	$127.00	$57.15–$114.30	52% above	25%
Zinc blood test inpatient CPT 84630 HC ZINC BLOOD	$95.25	$127.00	$101.60–$114.30	—	25%
Zinc blood test inpatient CPT 84630 HC ZINC RBC	$95.25	$127.00	$101.60–$114.30	—	25%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC HCG QUANTITATIVE TUMOR MAR	$37.50	$50.00	$22.50–$45.00	64% below	25%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC HCG QUANTITATIVE PREGNANCY	$70.50	$94.00	$42.30–$84.60	33% below	25%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC HCG QUANTITATIVE TUMOR MAR	$37.50	$50.00	$40.00–$45.00	—	25%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC HCG QUANTITATIVE PREGNANCY	$70.50	$94.00	$75.20–$84.60	—	25%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Illinois	Off list
Adenoid removal (adenoidectomy), child under 12 CPT 42830 PR ADENOIDECTOMY PRIMARY <AGE 12	$562.50	$750.00	$145.20–$675.00	92% below	25%
Adenoid removal (adenoidectomy), child under 12 inpatient CPT 42830 PR ADENOIDECTOMY PRIMARY <AGE 12	$562.50	$750.00	$145.20–$675.00	—	25%
Appendectomy for a ruptured appendix with abscess or peritonitis CPT 44960 PR APPENDEC RPTD APPENDIX ABSC/PRITONITIS	$1,622.25	$2,163.00	$619.09–$1,946.70	52% below	25%
Appendectomy for a ruptured appendix with abscess or peritonitis inpatient CPT 44960 PR APPENDEC RPTD APPENDIX ABSC/PRITONITIS	$1,622.25	$2,163.00	$619.09–$1,946.70	—	25%
Appendectomy, open surgery CPT 44950 PR APPENDECTOMY	$1,390.50	$1,854.00	$453.30–$1,668.60	56% below	25%
Appendectomy, open surgery inpatient CPT 44950 PR APPENDECTOMY	$1,390.50	$1,854.00	$453.30–$1,668.60	—	25%
Arthroscopic rotator cuff repair of the shoulder CPT 29827 PR SURGICAL ARTHROSCOPY SHOULDER W/ROTATOR CUFF RPR	$3,000.00	$4,000.00	$738.81–$3,600.00	72% below	25%
Arthroscopic rotator cuff repair of the shoulder inpatient CPT 29827 PR SURGICAL ARTHROSCOPY SHOULDER W/ROTATOR CUFF RPR	$3,000.00	$4,000.00	$738.81–$3,600.00	—	25%
Balloon dilation of the maxillary sinus opening, one side CPT 31295 PR NASAL/SINUS NDSC SURG W/DILATION MAXILLARY SINUS	$1,050.00	$1,400.00	$108.09–$2,818.12	73% below	25%
Balloon dilation of the maxillary sinus opening, one side inpatient CPT 31295 PR NASAL/SINUS NDSC SURG W/DILATION MAXILLARY SINUS	$1,050.00	$1,400.00	$108.09–$2,818.12	—	25%
Botox injections for chronic migraine CPT 64615 PR CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE	$412.50	$550.00	$87.85–$495.00	22% above	25%
Botox injections for chronic migraine CPT 64615 HC CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE	$604.50	$806.00	$362.70–$725.40	78% above	25%
Botox injections for chronic migraine inpatient CPT 64615 PR CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE	$412.50	$550.00	$87.85–$495.00	—	25%
Botox injections for chronic migraine inpatient CPT 64615 HC CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE	$604.50	$806.00	$644.80–$8,299.85	—	25%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 PR CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ	$787.50	$1,050.00	$199.40–$945.00	128% above	25%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 PR CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ	$787.50	$1,050.00	$199.40–$945.00	—	25%
Bunion correction with a bone cut near the head of the first metatarsal CPT 28296 PR CORRJ HALLUX VALGUS W/SESMDC W/DIST METAR OSTEOT	$746.25	$995.00	$358.20–$1,846.98	79% below	25%
Bunion correction with a bone cut near the head of the first metatarsal inpatient CPT 28296 PR CORRJ HALLUX VALGUS W/SESMDC W/DIST METAR OSTEOT	$746.25	$995.00	$358.20–$1,846.98	—	25%
Bunion correction with removal of part of the big toe joint CPT 28292 PR CORRJ HALLUX VALGUS W/SESMDC W/RESCJ PROX PHAL	$1,575.00	$2,100.00	$359.30–$1,890.00	55% below	25%
Bunion correction with removal of part of the big toe joint inpatient CPT 28292 PR CORRJ HALLUX VALGUS W/SESMDC W/RESCJ PROX PHAL	$1,575.00	$2,100.00	$359.30–$1,890.00	—	25%
Cardioversion, elective (restoring heart rhythm) CPT 92960 HC CARDIOVERSION ELECTIVE EXTERNAL	$1,281.00	$1,708.00	$768.60–$1,537.20	12% above	25%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC CARDIOVERSION ELECTIVE EXTERNAL	$1,281.00	$1,708.00	$1,366.40–$1,537.20	—	25%
Carpal tunnel release, open surgery CPT 64721 PR NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE	$1,185.75	$1,581.00	$429.10–$1,422.90	61% below	25%
Carpal tunnel release, open surgery inpatient CPT 64721 PR NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE	$1,185.75	$1,581.00	$429.10–$1,422.90	—	25%
Cervical biopsy CPT 57500 PR BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX	$206.25	$275.00	$83.52–$283.58	77% below	25%
Cervical biopsy inpatient CPT 57500 PR BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX	$206.25	$275.00	$83.52–$283.58	—	25%
Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 PR CIRCUMCISION AGE >28 DAYS	$562.50	$750.00	$146.70–$675.00	76% below	25%
Circumcision by surgical excision, older than 28 days (children and adults) inpatient CPT 54161 PR CIRCUMCISION AGE >28 DAYS	$562.50	$750.00	$146.70–$675.00	—	25%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 HC CLOSED RX DIST RAD/ULNA FX	$522.75	$697.00	$313.65–$627.30	at median	25%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 PR CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ	$900.00	$1,200.00	$224.22–$1,080.00	72% above	25%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 HC CLOSED RX DIST RAD/ULNA FX	$522.75	$697.00	$557.60–$8,299.85	—	25%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 PR CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ	$900.00	$1,200.00	$224.22–$1,080.00	—	25%
Colonoscopy with polyp removal CPT 45385 PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ	$849.75	$1,133.00	$245.44–$1,019.70	66% below	25%
Colonoscopy with polyp removal inpatient CPT 45385 PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ	$849.75	$1,133.00	$245.44–$1,019.70	—	25%
Colonoscopy with tissue sample CPT 45380 PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE	$734.25	$979.00	$193.80–$881.10	60% below	25%
Colonoscopy with tissue sample inpatient CPT 45380 PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE	$734.25	$979.00	$193.80–$881.10	—	25%
Colonoscopy, diagnostic CPT 45378 PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD	$618.00	$824.00	$178.60–$741.60	67% below	25%
Colonoscopy, diagnostic inpatient CPT 45378 PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD	$618.00	$824.00	$178.60–$741.60	—	25%
Cystoscopy with ureteral stent placement CPT 52332 PR CYSTO W/INSERT URETERAL STENT	$562.50	$750.00	$138.90–$905.62	87% below	25%
Cystoscopy with ureteral stent placement inpatient CPT 52332 PR CYSTO W/INSERT URETERAL STENT	$562.50	$750.00	$138.90–$905.62	—	25%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 PR CYSTOURETHROSCOPY	$468.75	$625.00	$78.40–$562.50	57% below	25%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 PR CYSTOURETHROSCOPY	$468.75	$625.00	$78.40–$562.50	—	25%
D&C (dilation and curettage), not related to pregnancy CPT 58120 PR DILATION & CURETTAGE DX&/THER NONOBSTETRIC	$463.50	$618.00	$206.85–$565.85	84% below	25%
D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 PR DILATION & CURETTAGE DX&/THER NONOBSTETRIC	$463.50	$618.00	$206.85–$565.85	—	25%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 PR DESTRUCTION PREMALIGNANT LESION 1ST	$96.75	$129.00	$46.44–$116.10	43% below	25%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 PR DESTRUCTION PREMALIGNANT LESION 1ST	$96.75	$129.00	$46.44–$116.10	—	25%
Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 PR TYMPANOSTOMY GENERAL ANESTHESIA	$337.50	$450.00	$108.35–$405.00	81% below	25%
Ear tube placement (tympanostomy) under general anesthesia, one ear inpatient CPT 69436 PR TYMPANOSTOMY GENERAL ANESTHESIA	$337.50	$450.00	$108.35–$405.00	—	25%
Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 PR TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA	$450.00	$600.00	$89.67–$540.00	18% below	25%
Ear tube placement (tympanostomy) with local anesthesia, one ear inpatient CPT 69433 PR TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA	$450.00	$600.00	$89.67–$540.00	—	25%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 PR REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT	$42.75	$57.00	$10.14–$51.30	62% below	25%
Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 PR REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT	$42.75	$57.00	$10.14–$51.30	—	25%
Earwax removal with instruments, one ear one side CPT 69210 PR REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT	$123.75	$165.00	$22.37–$148.50	1% below	25%
Earwax removal with instruments, one ear one side CPT 69210 HC REMOVE CERUMEN IMPACTED REQUIRING INSTR UNILAT	$131.25	$175.00	$78.75–$157.50	5% above	25%
Earwax removal with instruments, one ear inpatient one side CPT 69210 PR REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT	$123.75	$165.00	$22.37–$148.50	—	25%
Earwax removal with instruments, one ear inpatient one side CPT 69210 HC REMOVE CERUMEN IMPACTED REQUIRING INSTR UNILAT	$131.25	$175.00	$140.00–$157.50	—	25%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 PR ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX	$201.75	$269.00	$52.90–$242.10	41% below	25%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 PR ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX	$201.75	$269.00	$52.90–$242.10	—	25%
Endoscopic sinus surgery: opening the maxillary (cheek) sinus CPT 31256 PR NASAL/SINUS ENDOSCOPY W/MAXILLARY ANTROSTOMY	$506.25	$675.00	$176.08–$607.50	87% below	25%
Endoscopic sinus surgery: opening the maxillary (cheek) sinus inpatient CPT 31256 PR NASAL/SINUS ENDOSCOPY W/MAXILLARY ANTROSTOMY	$506.25	$675.00	$176.08–$607.50	—	25%
Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue CPT 31267 PR NSL/SINUS NDSC MAX ANTROST W/RMVL TISS MAX SINUS	$675.00	$900.00	$224.70–$810.00	91% below	25%
Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue inpatient CPT 31267 PR NSL/SINUS NDSC MAX ANTROST W/RMVL TISS MAX SINUS	$675.00	$900.00	$224.70–$810.00	—	25%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 PR NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN	$675.00	$900.00	$72.87–$810.00	60% below	25%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 HC EPIDURAL NECK CHEST W/IMAGING	$1,459.50	$1,946.00	$875.70–$1,751.40	14% below	25%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 PR NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN	$675.00	$900.00	$72.87–$810.00	—	25%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 HC EPIDURAL NECK CHEST W/IMAGING	$1,459.50	$1,946.00	$1,556.80–$8,299.85	—	25%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL	$1,050.00	$1,400.00	$61.12–$1,260.00	30% below	25%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 HC INJ PV FACET JNT L/S W/ IMAGE GUIDANCE 1 LEV	$1,891.50	$2,522.00	$1,134.90–$2,269.80	27% above	25%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 HC INJ PV FACET JNT L/S 1 LEV	$1,920.75	$2,561.00	$1,152.45–$2,304.90	29% above	25%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL	$1,050.00	$1,400.00	$61.12–$1,260.00	—	25%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 HC INJ PV FACET JNT L/S W/ IMAGE GUIDANCE 1 LEV	$1,891.50	$2,522.00	$2,017.60–$2,269.80	—	25%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 HC INJ PV FACET JNT L/S 1 LEV	$1,920.75	$2,561.00	$1,579.00–$8,299.85	—	25%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 PR RPR AA HERNIA 1ST 3-10 CM REDUCIBLE	$1,612.50	$2,150.00	$406.71–$1,935.00	77% below	25%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm inpatient CPT 49593 PR RPR AA HERNIA 1ST 3-10 CM REDUCIBLE	$1,612.50	$2,150.00	$406.71–$1,935.00	—	25%
First repair of a front abdominal hernia larger than 10 cm CPT 49595 PR RPR AA HERNIA 1ST > 10 CM REDUCIBLE	$1,215.00	$1,620.00	$547.46–$1,458.00	80% below	25%
First repair of a front abdominal hernia larger than 10 cm inpatient CPT 49595 PR RPR AA HERNIA 1ST > 10 CM REDUCIBLE	$1,215.00	$1,620.00	$547.46–$1,458.00	—	25%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 PR RPR AA HERNIA 1ST < 3 CM REDUCIBLE	$900.00	$1,200.00	$242.31–$1,080.00	76% below	25%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm inpatient CPT 49591 PR RPR AA HERNIA 1ST < 3 CM REDUCIBLE	$900.00	$1,200.00	$242.31–$1,080.00	—	25%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 PR SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD	$351.75	$469.00	$54.73–$422.10	62% below	25%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 PR SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD	$351.75	$469.00	$54.73–$422.10	—	25%
Gallbladder removal, laparoscopic CPT 47562 PR LAPAROSCOPY SURG CHOLECYSTECTOMY	$1,931.25	$2,575.00	$647.90–$2,317.50	70% below	25%
Gallbladder removal, laparoscopic inpatient CPT 47562 PR LAPAROSCOPY SURG CHOLECYSTECTOMY	$1,931.25	$2,575.00	$647.90–$2,317.50	—	25%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 PR LAPS SURG CHOLECYSTECTOMY W/CHOLANGIOGRAPHY	$2,124.75	$2,833.00	$506.77–$2,549.70	85% below	25%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery inpatient CPT 47563 PR LAPS SURG CHOLECYSTECTOMY W/CHOLANGIOGRAPHY	$2,124.75	$2,833.00	$506.77–$2,549.70	—	25%
Gallbladder removal, open surgery through a larger incision CPT 47600 PR CHOLECYSTECTOMY	$2,511.00	$3,348.00	$754.39–$3,013.20	52% below	25%
Gallbladder removal, open surgery through a larger incision inpatient CPT 47600 PR CHOLECYSTECTOMY	$2,511.00	$3,348.00	$754.39–$3,013.20	—	25%
Hammertoe correction surgery CPT 28285 PR CORRECTION HAMMERTOE	$390.00	$520.00	$187.20–$1,138.08	85% below	25%
Hammertoe correction surgery inpatient CPT 28285 PR CORRECTION HAMMERTOE	$390.00	$520.00	$187.20–$1,138.08	—	25%
Hemorrhoid banding (rubber band ligation) CPT 46221 PR HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS	$393.75	$525.00	$129.77–$485.32	50% below	25%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 PR HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS	$393.75	$525.00	$129.77–$485.32	—	25%
Hemorrhoidectomy (internal and external), one area CPT 46255 PR HEMORRHOIDECTOMY NTRNL & XTRNL 1 COLUMN/GROUP	$927.00	$1,236.00	$342.65–$1,112.40	66% below	25%
Hemorrhoidectomy (internal and external), one area inpatient CPT 46255 PR HEMORRHOIDECTOMY NTRNL & XTRNL 1 COLUMN/GROUP	$927.00	$1,236.00	$342.65–$1,112.40	—	25%
Hysterectomy through an abdominal incision (total) CPT 58150 PR TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY	$2,124.75	$2,833.00	$772.70–$2,549.70	64% below	25%
Hysterectomy through an abdominal incision (total) inpatient CPT 58150 PR TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY	$2,124.75	$2,833.00	$772.70–$2,549.70	—	25%
IUD insertion (the device itself billed separately) CPT 58300 PR INSERTION INTRAUTERINE DEVICE IUD	$150.00	$200.00	$55.56–$193.37	48% below	25%
IUD insertion (the device itself billed separately) inpatient CPT 58300 PR INSERTION INTRAUTERINE DEVICE IUD	$150.00	$200.00	$55.56–$193.37	—	25%
Incision and drainage of a simple or single skin abscess CPT 10060 PR INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE	$253.50	$338.00	$71.17–$304.20	37% below	25%
Incision and drainage of a simple or single skin abscess CPT 10060 HC I&D ABSCESS SIMPLE	$261.00	$348.00	$156.60–$313.20	35% below	25%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 PR INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE	$253.50	$338.00	$71.17–$304.20	—	25%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC I&D ABSCESS SIMPLE	$261.00	$348.00	$278.40–$313.20	—	25%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 PR RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE	$1,352.25	$1,803.00	$387.05–$1,622.70	65% below	25%
Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 PR RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE	$1,352.25	$1,803.00	$387.05–$1,622.70	—	25%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 PR INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS	$135.00	$180.00	$31.75–$162.00	65% below	25%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC INJECTION TENDON SHEATH W/FLUORO	$600.00	$800.00	$360.00–$720.00	57% above	25%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 PR INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS	$135.00	$180.00	$31.75–$162.00	—	25%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 HC INJECTION TENDON SHEATH W/FLUORO	$600.00	$800.00	$640.00–$8,299.85	—	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US	$165.75	$221.00	$31.80–$198.90	63% below	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC ARTHROCENTESIS ASP/INJ JOINT/BURSA MAJOR	$600.00	$800.00	$360.00–$720.00	33% above	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC ARTHROCEN ASP/INJ JOINT/BURSA MAJOR W/O US	$600.00	$800.00	$360.00–$720.00	33% above	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US	$165.75	$221.00	$31.80–$198.90	—	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC ARTHROCEN ASP/INJ JOINT/BURSA MAJOR W/O US	$600.00	$800.00	$640.00–$720.00	—	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC ARTHROCENTESIS ASP/INJ JOINT/BURSA MAJOR	$600.00	$800.00	$640.00–$8,299.85	—	25%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 PR INSERTION DRUG DELIVERY IMPLANT	$165.00	$220.00	$62.35–$198.00	7% below	25%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 PR INSERTION DRUG DELIVERY IMPLANT	$165.00	$220.00	$62.35–$198.00	—	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 PR ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US	$135.00	$180.00	$33.00–$162.00	64% below	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC ARTHROCEN ASP/INJ JOINT/BURSA INTERMEDIATE W/O US	$600.00	$800.00	$360.00–$720.00	59% above	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC ARTHROCENTESIS ASPI JOINT - INTERMEDIATE	$600.00	$800.00	$360.00–$720.00	59% above	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC ARTHROCENTESIS ASP/INJ JOINT/BURSA INTERMEDIATE	$600.00	$800.00	$360.00–$720.00	59% above	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 PR ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US	$135.00	$180.00	$33.00–$162.00	—	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC ARTHROCENTESIS ASP/INJ JOINT/BURSA INTERMEDIATE	$600.00	$800.00	$640.00–$8,299.85	—	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC ARTHROCENTESIS ASPI JOINT - INTERMEDIATE	$600.00	$800.00	$640.00–$720.00	—	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC ARTHROCEN ASP/INJ JOINT/BURSA INTERMEDIATE W/O US	$600.00	$800.00	$640.00–$720.00	—	25%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 PR ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US	$96.75	$129.00	$30.40–$116.10	67% below	25%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC ARTHROCENTESIS ASP/INJ JOINT/BURSA SMALL	$600.00	$800.00	$360.00–$720.00	103% above	25%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC ARTHROCEN ASP/INJ JOINT/BURSA SMALL W/O US	$642.00	$856.00	$385.20–$770.40	117% above	25%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 PR ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US	$96.75	$129.00	$30.40–$116.10	—	25%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC ARTHROCENTESIS ASP/INJ JOINT/BURSA SMALL	$600.00	$800.00	$640.00–$8,299.85	—	25%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC ARTHROCEN ASP/INJ JOINT/BURSA SMALL W/O US	$642.00	$856.00	$684.80–$770.40	—	25%
Knee arthroscopy with meniscus trim CPT 29881 PR ARTHRS KNE SURG W/MENISCECTOMY MED/LAT W/SHVG	$1,350.00	$1,800.00	$534.49–$1,620.00	76% below	25%
Knee arthroscopy with meniscus trim inpatient CPT 29881 PR ARTHRS KNE SURG W/MENISCECTOMY MED/LAT W/SHVG	$1,350.00	$1,800.00	$534.49–$1,620.00	—	25%
Knee arthroscopy with removal of both torn meniscus parts CPT 29880 PR ARTHRS KNEE W/MENISCECTOMY MED&LAT W/SHAVING	$1,500.00	$2,000.00	$555.27–$1,800.00	67% below	25%
Knee arthroscopy with removal of both torn meniscus parts inpatient CPT 29880 PR ARTHRS KNEE W/MENISCECTOMY MED&LAT W/SHAVING	$1,500.00	$2,000.00	$555.27–$1,800.00	—	25%
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 PR LAPAROSCOPIC APPENDECTOMY	$1,275.00	$1,700.00	$424.25–$1,530.00	80% below	25%
Laparoscopic appendectomy (appendix removal through small cuts) inpatient CPT 44970 PR LAPAROSCOPIC APPENDECTOMY	$1,275.00	$1,700.00	$424.25–$1,530.00	—	25%
Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 PR LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA	$927.00	$1,236.00	$387.05–$1,112.40	87% below	25%
Laparoscopic inguinal (groin) hernia repair, first repair on that side inpatient CPT 49650 PR LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA	$927.00	$1,236.00	$387.05–$1,112.40	—	25%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 PR LAPS SURG RPR RECURRENT INGUINAL HERNIA	$1,236.00	$1,648.00	$409.20–$1,483.20	83% below	25%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia inpatient CPT 49651 PR LAPS SURG RPR RECURRENT INGUINAL HERNIA	$1,236.00	$1,648.00	$409.20–$1,483.20	—	25%
Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 PR LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES	$1,293.75	$1,725.00	$480.00–$1,552.50	78% below	25%
Laparoscopic removal of fallopian tubes and/or ovaries inpatient CPT 58661 PR LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES	$1,293.75	$1,725.00	$480.00–$1,552.50	—	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 PR REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<	$297.75	$397.00	$101.63–$432.79	50% below	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC REPAIR LAC INTERMED SCALP/AXIL/TRUNK <2.5CM	$480.75	$641.00	$288.45–$576.90	20% below	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 PR REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<	$297.75	$397.00	$101.63–$432.79	—	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HC REPAIR LAC INTERMED SCALP/AXIL/TRUNK <2.5CM	$480.75	$641.00	$512.80–$576.90	—	25%
Lower-back epidural injection, with imaging guidance CPT 62323 PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN	$600.00	$800.00	$67.44–$720.00	58% below	25%
Lower-back epidural injection, with imaging guidance CPT 62323 HC EPIDURAL LUMBAR SACRAL W IMAGING	$1,459.50	$1,946.00	$875.70–$1,751.40	2% above	25%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN	$600.00	$800.00	$67.44–$720.00	—	25%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC EPIDURAL LUMBAR SACRAL W IMAGING	$1,459.50	$1,946.00	$1,556.80–$8,299.85	—	25%
Lower-back epidural injection, without imaging guidance CPT 62322 PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN	$618.75	$825.00	$54.29–$742.50	57% below	25%
Lower-back epidural injection, without imaging guidance CPT 62322 HC EPIDURAL LUMBAR SACRAL WO IMAGING	$1,459.50	$1,946.00	$875.70–$1,751.40	1% above	25%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN	$618.75	$825.00	$54.29–$742.50	—	25%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 HC EPIDURAL LUMBAR SACRAL WO IMAGING	$1,459.50	$1,946.00	$1,556.80–$8,299.85	—	25%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 PR NJX AA&/STRD TFRML EPI LUMBAR/SACRAL 1 LEVEL	$825.00	$1,100.00	$88.25–$990.00	41% below	25%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC INJECT FORAMEN EPIDURAL L/S SINGLE	$1,891.50	$2,522.00	$1,134.90–$2,269.80	35% above	25%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 PR NJX AA&/STRD TFRML EPI LUMBAR/SACRAL 1 LEVEL	$825.00	$1,100.00	$88.25–$990.00	—	25%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HC INJECT FORAMEN EPIDURAL L/S SINGLE	$1,891.50	$2,522.00	$1,579.00–$8,299.85	—	25%
Lumpectomy (partial mastectomy) CPT 19301 PR MASTECTOMY PARTIAL	$1,293.75	$1,725.00	$464.57–$1,552.50	69% below	25%
Lumpectomy (partial mastectomy) inpatient CPT 19301 PR MASTECTOMY PARTIAL	$1,293.75	$1,725.00	$464.57–$1,552.50	—	25%
Mastectomy (total removal of the breast) CPT 19303 PR MASTECTOMY SIMPLE COMPLETE	$1,981.50	$2,642.00	$674.49–$2,377.80	58% below	25%
Mastectomy (total removal of the breast) inpatient CPT 19303 PR MASTECTOMY SIMPLE COMPLETE	$1,981.50	$2,642.00	$674.49–$2,377.80	—	25%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/<	$154.50	$206.00	$56.41–$211.28	78% below	25%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/<	$154.50	$206.00	$56.41–$211.28	—	25%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<	$165.75	$221.00	$71.03–$235.96	70% below	25%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<	$165.75	$221.00	$71.03–$235.96	—	25%
Nail removal (partial or complete), one nail CPT 11730 PR AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1	$96.75	$129.00	$36.53–$189.68	67% below	25%
Nail removal (partial or complete), one nail CPT 11730 HC AVULSION NAIL PLATE 1 NAIL	$237.00	$316.00	$142.20–$284.40	19% below	25%
Nail removal (partial or complete), one nail inpatient CPT 11730 PR AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1	$96.75	$129.00	$36.53–$189.68	—	25%
Nail removal (partial or complete), one nail inpatient CPT 11730 HC AVULSION NAIL PLATE 1 NAIL	$237.00	$316.00	$252.80–$284.40	—	25%
Occipital nerve block (injection for headaches) CPT 64405 PR INJECTION AA&/STRD GREATER OCCIPITAL NERVE	$225.00	$300.00	$53.27–$270.00	54% below	25%
Occipital nerve block (injection for headaches) CPT 64405 HC NERVE BLOCK INJ OCCIPITAL	$1,038.75	$1,385.00	$623.25–$1,246.50	113% above	25%
Occipital nerve block (injection for headaches) inpatient CPT 64405 PR INJECTION AA&/STRD GREATER OCCIPITAL NERVE	$225.00	$300.00	$53.27–$270.00	—	25%
Occipital nerve block (injection for headaches) inpatient CPT 64405 HC NERVE BLOCK INJ OCCIPITAL	$1,038.75	$1,385.00	$1,108.00–$1,246.50	—	25%
Paracentesis with imaging guidance CPT 49083 PR ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE	$221.25	$295.00	$71.41–$497.32	84% below	25%
Paracentesis with imaging guidance CPT 49083 HC ABDOMINAL PARACENTESIS W IMAGING	$1,008.00	$1,344.00	$604.80–$1,209.60	27% below	25%
Paracentesis with imaging guidance inpatient CPT 49083 PR ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE	$221.25	$295.00	$71.41–$497.32	—	25%
Paracentesis with imaging guidance inpatient CPT 49083 HC ABDOMINAL PARACENTESIS W IMAGING	$1,008.00	$1,344.00	$1,075.20–$8,299.85	—	25%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 PR EXCISION NAIL MATRIX PERMANENT REMOVAL	$266.25	$355.00	$68.55–$319.50	50% below	25%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC EXCISION NAIL & MATRIX	$403.50	$538.00	$242.10–$484.20	24% below	25%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 PR EXCISION NAIL MATRIX PERMANENT REMOVAL	$266.25	$355.00	$68.55–$319.50	—	25%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 HC EXCISION NAIL & MATRIX	$403.50	$538.00	$430.40–$484.20	—	25%
Prostate biopsy CPT 55700 PR PROSTATE NEEDLE BIOPSY ANY APPROACH	$356.25	$475.00	$113.60–$478.72	83% below	25%
Prostate biopsy CPT 55700 ZZZHC BIOPSY PROSTATE NEEDLE SINGLE OR MULTI	$1,462.50	$1,950.00	$877.50–$1,755.00	32% below	25%
Prostate biopsy inpatient CPT 55700 PR PROSTATE NEEDLE BIOPSY ANY APPROACH	$356.25	$475.00	$113.60–$478.72	—	25%
Prostate biopsy inpatient CPT 55700 ZZZHC BIOPSY PROSTATE NEEDLE SINGLE OR MULTI	$1,462.50	$1,950.00	$1,560.00–$8,299.85	—	25%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL	$1,725.00	$2,300.00	$135.68–$2,070.00	25% below	25%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 HC DEST NRV LUMB/SACR SGL	$2,794.50	$3,726.00	$1,676.70–$3,353.40	22% above	25%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 HC DESTRUCTION BY NEUROLYTIC AGENT LUMBAR SACRAL SINGLE	$4,035.00	$5,380.00	$2,421.00–$4,842.00	75% above	25%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL	$1,725.00	$2,300.00	$135.68–$2,070.00	—	25%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 HC DEST NRV LUMB/SACR SGL	$2,794.50	$3,726.00	$1,579.00–$8,299.85	—	25%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 HC DESTRUCTION BY NEUROLYTIC AGENT LUMBAR SACRAL SINGLE	$4,035.00	$5,380.00	$1,579.00–$8,299.85	—	25%
Removal of a breast lump, open surgery CPT 19120 PR EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION	$861.00	$1,148.00	$292.39–$1,033.20	51% below	25%
Removal of a breast lump, open surgery inpatient CPT 19120 PR EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION	$861.00	$1,148.00	$292.39–$1,033.20	—	25%
Removal of a foreign object under the skin, simple CPT 10120 PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE	$204.75	$273.00	$70.76–$251.57	56% below	25%
Removal of a foreign object under the skin, simple CPT 10120 HC INCISION/REMOVAL FOREIGN BODY SUBQ SIMPLE	$282.00	$376.00	$169.20–$338.40	39% below	25%
Removal of a foreign object under the skin, simple inpatient CPT 10120 PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE	$204.75	$273.00	$70.76–$251.57	—	25%
Removal of a foreign object under the skin, simple inpatient CPT 10120 HC INCISION/REMOVAL FOREIGN BODY SUBQ SIMPLE	$282.00	$376.00	$300.80–$338.40	—	25%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 PR COLON CA SCRN NOT HI RSK IND	$618.00	$824.00	$174.14–$741.60	75% below	25%
Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 PR COLON CA SCRN NOT HI RSK IND	$618.00	$824.00	$174.14–$741.60	—	25%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 PR COLORECTAL SCRN; HI RISK IND	$618.00	$824.00	$173.75–$741.60	74% below	25%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 PR COLORECTAL SCRN; HI RISK IND	$618.00	$824.00	$173.75–$741.60	—	25%
Septoplasty to straighten the nasal septum CPT 30520 PR SEPTOPLASTY/SUBMUCOUS RESECJ W/WO CARTILAGE GRF	$600.00	$800.00	$288.00–$1,225.85	95% below	25%
Septoplasty to straighten the nasal septum inpatient CPT 30520 PR SEPTOPLASTY/SUBMUCOUS RESECJ W/WO CARTILAGE GRF	$600.00	$800.00	$288.00–$1,225.85	—	25%
Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 PR LITHOTRIPSY XTRCORP SHOCK WAVE	$817.50	$1,090.00	$392.40–$1,577.91	87% below	25%
Shock-wave lithotripsy to break up kidney stones (from outside the body) inpatient CPT 50590 PR LITHOTRIPSY XTRCORP SHOCK WAVE	$817.50	$1,090.00	$392.40–$1,577.91	—	25%
Short arm cast (elbow to hand) CPT 29075 PR APPLICATION CAST ELBOW FINGER SHORT ARM	$161.25	$215.00	$59.45–$193.50	48% below	25%
Short arm cast (elbow to hand) CPT 29075 HC SHORT ARM CAST APPLIC	$171.00	$228.00	$102.60–$205.20	44% below	25%
Short arm cast (elbow to hand) inpatient CPT 29075 PR APPLICATION CAST ELBOW FINGER SHORT ARM	$161.25	$215.00	$59.45–$193.50	—	25%
Short arm cast (elbow to hand) inpatient CPT 29075 HC SHORT ARM CAST APPLIC	$171.00	$228.00	$182.40–$205.20	—	25%
Short arm splint (forearm and hand) CPT 29125 PR APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC	$93.75	$125.00	$32.15–$142.93	62% below	25%
Short arm splint (forearm and hand) CPT 29125 HC APPLY SPLINT SHORT ARM	$99.75	$133.00	$59.85–$119.70	60% below	25%
Short arm splint (forearm and hand) inpatient CPT 29125 PR APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC	$93.75	$125.00	$32.15–$142.93	—	25%
Short arm splint (forearm and hand) inpatient CPT 29125 HC APPLY SPLINT SHORT ARM	$99.75	$133.00	$106.40–$119.70	—	25%
Short leg cast (below the knee) CPT 29405 PR APPLICATION SHORT LEG CAST BELOW KNEE-TOE	$187.50	$250.00	$57.16–$225.00	40% below	25%
Short leg cast (below the knee) inpatient CPT 29405 PR APPLICATION SHORT LEG CAST BELOW KNEE-TOE	$187.50	$250.00	$57.16–$225.00	—	25%
Short leg splint (calf to foot) CPT 29515 PR APPLICATION SHORT LEG SPLINT CALF FOOT	$153.75	$205.00	$35.85–$184.50	42% below	25%
Short leg splint (calf to foot) CPT 29515 HC APPLY SPLINT SHORT LEG	$173.25	$231.00	$103.95–$207.90	35% below	25%
Short leg splint (calf to foot) inpatient CPT 29515 PR APPLICATION SHORT LEG SPLINT CALF FOOT	$153.75	$205.00	$35.85–$184.50	—	25%
Short leg splint (calf to foot) inpatient CPT 29515 HC APPLY SPLINT SHORT LEG	$173.25	$231.00	$184.80–$207.90	—	25%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 PR SURGICAL ARTHROSCOPY SHOULDER DSTL CLAVICULC	$1,875.00	$2,500.00	$526.45–$2,250.00	70% below	25%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) inpatient CPT 29824 PR SURGICAL ARTHROSCOPY SHOULDER DSTL CLAVICULC	$1,875.00	$2,500.00	$526.45–$2,250.00	—	25%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 PR SURGICAL ARTHROSCOPY SHO W/CORACOACRM LIGM RLS	$450.00	$600.00	$169.85–$540.00	99% below	25%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 PR SURGICAL ARTHROSCOPY SHO W/CORACOACRM LIGM RLS	$450.00	$600.00	$169.85–$540.00	—	25%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 PR SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<	$189.00	$252.00	$44.89–$226.80	49% below	25%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC REPAIR LAC SIMPLE SCALP/HAND/FT/GEN <2.5CM	$382.50	$510.00	$229.50–$459.00	4% above	25%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 PR SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<	$189.00	$252.00	$44.89–$226.80	—	25%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HC REPAIR LAC SIMPLE SCALP/HAND/FT/GEN <2.5CM	$382.50	$510.00	$408.00–$459.00	—	25%
Skin biopsy, punch, one lesion CPT 11104 PR PUNCH BIOPSY SKIN SINGLE LESION	$140.25	$187.00	$31.81–$204.60	59% below	25%
Skin biopsy, punch, one lesion inpatient CPT 11104 PR PUNCH BIOPSY SKIN SINGLE LESION	$140.25	$187.00	$31.81–$204.60	—	25%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 PR EXCISION MAL LESION TRUNK/ARM/LEG 0.5 CM/<	$289.50	$386.00	$82.58–$347.40	32% below	25%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 PR EXCISION MAL LESION TRUNK/ARM/LEG 0.5 CM/<	$289.50	$386.00	$82.58–$347.40	—	25%
Skin tag removal, up to 15 tags CPT 11200 PR REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15	$174.00	$232.00	$50.91–$208.80	30% below	25%
Skin tag removal, up to 15 tags inpatient CPT 11200 PR REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15	$174.00	$232.00	$50.91–$208.80	—	25%
Spinal tap (lumbar puncture), diagnostic CPT 62270 PR DIAGNOSTIC LUMBAR SPINAL PUNCTURE	$337.50	$450.00	$53.70–$405.00	58% below	25%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC LUMBAR PUNCTURE DIAGNOSTIC	$1,459.50	$1,946.00	$875.70–$1,751.40	83% above	25%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 PR DIAGNOSTIC LUMBAR SPINAL PUNCTURE	$337.50	$450.00	$53.70–$405.00	—	25%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC LUMBAR PUNCTURE DIAGNOSTIC	$1,459.50	$1,946.00	$1,556.80–$1,751.40	—	25%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 PR SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM	$201.00	$268.00	$58.40–$241.20	51% below	25%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC REPAIR LAC SIMPLE SCALP/HAND/FT/GEN 2.6-7.5CM	$421.50	$562.00	$252.90–$505.80	2% above	25%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 PR SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM	$201.00	$268.00	$58.40–$241.20	—	25%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 HC REPAIR LAC SIMPLE SCALP/HAND/FT/GEN 2.6-7.5CM	$421.50	$562.00	$449.60–$505.80	—	25%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 PR SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<	$143.25	$191.00	$55.88–$188.82	65% below	25%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HC REPAIR LAC SIMPLE FACE/EAR/LIPS <2.5CM	$399.75	$533.00	$239.85–$479.70	2% below	25%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 PR SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<	$143.25	$191.00	$55.88–$188.82	—	25%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 HC REPAIR LAC SIMPLE FACE/EAR/LIPS <2.5CM	$399.75	$533.00	$426.40–$479.70	—	25%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 PR TANGENTIAL BIOPSY SKIN SINGLE LESION	$117.75	$157.00	$25.49–$164.02	56% below	25%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 PR TANGENTIAL BIOPSY SKIN SINGLE LESION	$117.75	$157.00	$25.49–$164.02	—	25%
Thoracentesis with imaging guidance CPT 32555 PR THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING	$328.50	$438.00	$73.84–$548.44	70% below	25%
Thoracentesis with imaging guidance inpatient CPT 32555 PR THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING	$328.50	$438.00	$73.84–$548.44	—	25%
Tonsil removal (tonsillectomy) only, age 12 or older CPT 42826 PR TONSILLECTOMY PRIMARY/SECONDARY AGE 12/>	$529.50	$706.00	$202.50–$635.40	85% below	25%
Tonsil removal (tonsillectomy) only, age 12 or older inpatient CPT 42826 PR TONSILLECTOMY PRIMARY/SECONDARY AGE 12/>	$529.50	$706.00	$202.50–$635.40	—	25%
Tonsil removal (tonsillectomy) only, child under 12 CPT 42825 PR TONSILLECTOMY PRIMARY/SECONDARY <AGE 12	$564.00	$752.00	$194.20–$676.80	84% below	25%
Tonsil removal (tonsillectomy) only, child under 12 inpatient CPT 42825 PR TONSILLECTOMY PRIMARY/SECONDARY <AGE 12	$564.00	$752.00	$194.20–$676.80	—	25%
Total hip replacement CPT 27130 PR ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT	$3,375.00	$4,500.00	$1,271.96–$4,050.00	46% below	25%
Total hip replacement inpatient CPT 27130 PR ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT	$3,375.00	$4,500.00	$1,271.96–$4,050.00	—	25%
Total knee replacement CPT 27447 PR ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS	$3,375.00	$4,500.00	$1,269.86–$4,050.00	55% below	25%
Total knee replacement inpatient CPT 27447 PR ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS	$3,375.00	$4,500.00	$1,269.86–$4,050.00	—	25%
Total shoulder replacement CPT 23472 PR ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER	$3,375.00	$4,500.00	$1,427.97–$4,050.00	58% below	25%
Total shoulder replacement inpatient CPT 23472 PR ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER	$3,375.00	$4,500.00	$1,427.97–$4,050.00	—	25%
Trigger finger release surgery CPT 26055 PR TENDON SHEATH INCISION	$1,575.00	$2,100.00	$235.80–$1,890.00	19% above	25%
Trigger finger release surgery inpatient CPT 26055 PR TENDON SHEATH INCISION	$1,575.00	$2,100.00	$235.80–$1,890.00	—	25%
Trigger point injections, 1 or 2 muscles CPT 20552 PR INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES	$193.50	$258.00	$31.75–$232.20	61% below	25%
Trigger point injections, 1 or 2 muscles CPT 20552 HC TRIGGER PT 1-2 MUSCLE	$253.50	$338.00	$152.10–$304.20	49% below	25%
Trigger point injections, 1 or 2 muscles CPT 20552 HC INJX TRIGGER POINT 1/2 MUSCL	$600.00	$800.00	$360.00–$720.00	22% above	25%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 PR INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES	$193.50	$258.00	$31.75–$232.20	—	25%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC TRIGGER PT 1-2 MUSCLE	$253.50	$338.00	$270.40–$8,299.85	—	25%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC INJX TRIGGER POINT 1/2 MUSCL	$600.00	$800.00	$640.00–$8,299.85	—	25%
Tubal ligation, laparoscopic (tubes sealed by cautery) CPT 58670 PR LAPAROSCOPY FULGURATION OVIDUCTS	$857.25	$1,143.00	$363.45–$1,028.70	70% below	25%
Tubal ligation, laparoscopic (tubes sealed by cautery) inpatient CPT 58670 PR LAPAROSCOPY FULGURATION OVIDUCTS	$857.25	$1,143.00	$363.45–$1,028.70	—	25%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 PR BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID	$332.25	$443.00	$107.27–$802.79	85% below	25%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 HC BX BREAST 1ST LESION US IMAG	$2,299.50	$3,066.00	$1,379.70–$2,759.40	3% above	25%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 PR BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID	$332.25	$443.00	$107.27–$802.79	—	25%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 HC BX BREAST 1ST LESION US IMAG	$2,299.50	$3,066.00	$2,452.80–$2,759.40	—	25%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM	$382.50	$510.00	$113.40–$1,763.27	83% below	25%
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM	$382.50	$510.00	$113.40–$1,763.27	—	25%
Upper endoscopy (EGD) with biopsy CPT 43239 PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE	$502.50	$670.00	$133.93–$753.52	70% below	25%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE	$502.50	$670.00	$133.93–$753.52	—	25%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 PR EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH	$657.00	$876.00	$189.06–$843.93	79% below	25%
Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 PR EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH	$657.00	$876.00	$189.06–$843.93	—	25%
Upper endoscopy (EGD), diagnostic CPT 43235 PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC	$425.25	$567.00	$118.42–$510.30	80% below	25%
Upper endoscopy (EGD), diagnostic CPT 43235 HC EGD	$535.50	$714.00	$321.30–$642.60	75% below	25%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC	$425.25	$567.00	$118.42–$510.30	—	25%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 HC EGD	$535.50	$714.00	$571.20–$8,299.85	—	25%
Vasectomy, one or both sides, including follow-up semen testing both sides CPT 55250 PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS	$618.00	$824.00	$222.80–$805.22	—	25%
Vasectomy, one or both sides, including follow-up semen testing inpatient both sides CPT 55250 PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS	$618.00	$824.00	$222.80–$805.22	—	25%
Wart removal, up to 14 warts CPT 17110 PR DESTRUCTION BENIGN LESIONS UP TO 14	$135.00	$180.00	$64.80–$185.78	42% below	25%
Wart removal, up to 14 warts inpatient CPT 17110 PR DESTRUCTION BENIGN LESIONS UP TO 14	$135.00	$180.00	$64.80–$185.78	—	25%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 PR DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<	$120.00	$160.00	$57.60–$213.69	82% below	25%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC DEBRIDE SKIN/SUBQ TISSUE 1ST 20 SQ CM	$123.75	$165.00	$74.25–$148.50	81% below	25%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 PR DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<	$120.00	$160.00	$57.60–$213.69	—	25%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HC DEBRIDE SKIN/SUBQ TISSUE 1ST 20 SQ CM	$123.75	$165.00	$132.00–$148.50	—	25%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Illinois	Off list
Blood transfusion (giving blood or blood components) CPT 36430 HC TRANSFUSION BLOOD/BLOOD COMPONENTS	$729.75	$973.00	$437.85–$875.70	20% below	25%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC TRANSFUSION BLOOD/BLOOD COMPONENTS	$729.75	$973.00	$778.40–$875.70	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 PR PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT	$27.75	$37.00	$7.32–$33.30	85% below	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC INHAL RX AIRWAY OBST/DX SPUTUM INDUCT NMDI	$57.00	$76.00	$34.20–$68.40	70% below	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC INHAL RX AIRWAY OBST/DX SPUTUM INDUCT NEB	$92.25	$123.00	$55.35–$110.70	51% below	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 PR PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT	$27.75	$37.00	$7.32–$33.30	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC INHAL RX AIRWAY OBST/DX SPUTUM INDUCT NMDI	$57.00	$76.00	$60.80–$68.40	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC INHAL RX AIRWAY OBST/DX SPUTUM INDUCT NEB	$92.25	$123.00	$98.40–$110.70	—	25%
Chemotherapy IV infusion, first hour CPT 96413 HC IV CHEMOTHERAPY INFUSION - INITIAL UP TO 1 HOUR	$332.25	$443.00	$199.35–$398.70	46% below	25%
Chemotherapy IV infusion, first hour inpatient CPT 96413 HC IV CHEMOTHERAPY INFUSION - INITIAL UP TO 1 HOUR	$332.25	$443.00	$354.40–$398.70	—	25%
Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 PR COMPRE AUDIOMETRY THRESHOLD EVAL SP RECOGNIJ	$78.75	$105.00	$30.11–$94.50	69% below	25%
Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 HC COMPREHENSIVE HEARING TEST	$83.25	$111.00	$49.95–$99.90	67% below	25%
Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 PR COMPRE AUDIOMETRY THRESHOLD EVAL SP RECOGNIJ	$78.75	$105.00	$30.11–$94.50	—	25%
Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 HC COMPREHENSIVE HEARING TEST	$83.25	$111.00	$88.80–$99.90	—	25%
Critical care, first 30 to 74 minutes CPT 99291 PR CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN	$300.00	$400.00	$145.50–$360.00	83% below	25%
Critical care, first 30 to 74 minutes CPT 99291 HC CRITICAL CARE 30 - 74 MIN	$2,743.50	$3,658.00	$1,646.10–$3,292.20	54% above	25%
Critical care, first 30 to 74 minutes inpatient CPT 99291 PR CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN	$300.00	$400.00	$145.50–$360.00	—	25%
Critical care, first 30 to 74 minutes inpatient CPT 99291 HC CRITICAL CARE 30 - 74 MIN	$2,743.50	$3,658.00	$2,926.40–$3,292.20	—	25%
EEG (brain wave test), awake and drowsy, routine CPT 95816 HC EEG AWAKE AND DROWSY	$816.75	$1,089.00	$490.05–$980.10	2% below	25%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 HC EEG AWAKE AND DROWSY	$816.75	$1,089.00	$871.20–$980.10	—	25%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 PR ECG ROUTINE ECG W/LEAST 12 LDS W/I&R	$33.75	$45.00	$15.39–$40.92	39% below	25%
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 PR ECG ROUTINE ECG W/LEAST 12 LDS W/I&R	$33.75	$45.00	$15.39–$40.92	—	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC EKG	$237.00	$316.00	$142.20–$284.40	8% above	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 HC EKG	$237.00	$316.00	$252.80–$284.40	—	25%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 HC ED LEVEL 1 VISIT 99281	$178.50	$238.00	$107.10–$214.20	at median	25%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 HC ED LEVEL 1 VISIT 99281	$178.50	$238.00	$190.40–$214.20	—	25%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 PR ED VISIT STRAIGHTFORWARD MDM	$130.50	$174.00	$28.88–$156.60	65% below	25%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 HC ED LEVEL 2 VISIT 99282	$219.75	$293.00	$131.85–$263.70	41% below	25%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 PR ED VISIT STRAIGHTFORWARD MDM	$130.50	$174.00	$28.88–$156.60	—	25%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 HC ED LEVEL 2 VISIT 99282	$219.75	$293.00	$234.40–$263.70	—	25%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 HC ED LEVEL 3 VISIT 99283	$271.50	$362.00	$162.90–$325.80	57% below	25%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 HC ED LEVEL 3 VISIT 99283	$271.50	$362.00	$289.60–$325.80	—	25%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 PR ED VISIT MODERATE MDM	$428.25	$571.00	$83.69–$513.90	58% below	25%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC ED LEVEL 4 VISIT 99284	$444.00	$592.00	$266.40–$532.80	56% below	25%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 PR ED VISIT MODERATE MDM	$428.25	$571.00	$83.69–$513.90	—	25%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HC ED LEVEL 4 VISIT 99284	$444.00	$592.00	$473.60–$532.80	—	25%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC ED LEVEL 5 VISIT 99285	$1,159.50	$1,546.00	$695.70–$1,391.40	22% below	25%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HC ED LEVEL 5 VISIT 99285	$1,159.50	$1,546.00	$1,236.80–$1,391.40	—	25%
Exercise stress test, tracing only, the hospital charge CPT 93017 HC STRESS TEST TREADML OR BIKE/PHARM	$375.00	$500.00	$225.00–$450.00	55% below	25%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HC STRESS TEST TREADML OR BIKE/PHARM	$375.00	$500.00	$400.00–$450.00	—	25%
Family therapy with the patient, 50 minutes CPT 90847 PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS	$195.00	$260.00	$112.51–$698.00	21% above	25%
Family therapy with the patient, 50 minutes CPT 90847 HC FAMILY THERAPY W PT	$366.00	$488.00	$219.60–$439.20	127% above	25%
Family therapy with the patient, 50 minutes inpatient CPT 90847 PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS	$195.00	$260.00	$112.51–$698.00	—	25%
Family therapy with the patient, 50 minutes inpatient CPT 90847 HC FAMILY THERAPY W PT	$366.00	$488.00	$390.40–$439.20	—	25%
Family therapy without the patient, 50 minutes CPT 90846 PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS	$157.50	$210.00	$94.50–$195.25	at median	25%
Family therapy without the patient, 50 minutes CPT 90846 HC FAMILY THERAPY WO PT	$321.00	$428.00	$192.60–$385.20	104% above	25%
Family therapy without the patient, 50 minutes inpatient CPT 90846 PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS	$157.50	$210.00	$94.50–$195.25	—	25%
Family therapy without the patient, 50 minutes inpatient CPT 90846 HC FAMILY THERAPY WO PT	$321.00	$428.00	$342.40–$385.20	—	25%
Group psychotherapy session CPT 90853 HC GROUP PSYCHOTHERAPY SESSION - MH	$295.50	$394.00	$177.30–$354.60	166% above	25%
Group psychotherapy session inpatient CPT 90853 HC GROUP PSYCHOTHERAPY SESSION - MH	$295.50	$394.00	$315.20–$354.60	—	25%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC IV HYDRATION INFUSION - INITIAL 31 MINUTES TO 1 HOUR	$211.50	$282.00	$126.90–$253.80	34% below	25%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 PR IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR	$211.50	$282.00	$20.73–$253.80	34% below	25%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC IV HYDRATION INFUSION - INITIAL 31 MINUTES TO 1 HOUR	$211.50	$282.00	$225.60–$8,299.85	—	25%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 PR IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR	$211.50	$282.00	$20.73–$253.80	—	25%
IV infusion of a medicine, first hour CPT 96365 HC IV THERAPEUTIC INFUSION - INITIAL UP TO 1 HOUR	$231.75	$309.00	$139.05–$278.10	41% below	25%
IV infusion of a medicine, first hour inpatient CPT 96365 HC IV THERAPEUTIC INFUSION - INITIAL UP TO 1 HOUR	$231.75	$309.00	$247.20–$8,299.85	—	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 PR THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM	$13.50	$18.00	$8.10–$33.42	87% below	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC INJECTION SQ/IM	$188.25	$251.00	$112.95–$225.90	79% above	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC IM/SC THERAPEUTIC ADMINISTRATION	$188.25	$251.00	$112.95–$225.90	79% above	25%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 PR THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM	$13.50	$18.00	$8.10–$33.42	—	25%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC INJECTION SQ/IM	$188.25	$251.00	$200.80–$8,299.85	—	25%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC IM/SC THERAPEUTIC ADMINISTRATION	$188.25	$251.00	$200.80–$8,299.85	—	25%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 PR PSYCHIATRIC DIAGNOSTIC EVALUATION	$154.50	$206.00	$92.70–$261.97	27% below	25%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC PSYCH DIAGNOSTIC EVALUATION	$401.25	$535.00	$240.75–$481.50	91% above	25%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 PR PSYCHIATRIC DIAGNOSTIC EVALUATION	$154.50	$206.00	$92.70–$261.97	—	25%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC PSYCH DIAGNOSTIC EVALUATION	$401.25	$535.00	$428.00–$481.50	—	25%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 PR NERVE CONDUCTION STUDIES 7-8 STUDIES	$262.50	$350.00	$114.74–$315.00	58% below	25%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 HC NCS 7 OR 8 STUDIES	$487.50	$650.00	$292.50–$585.00	21% below	25%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 PR NERVE CONDUCTION STUDIES 7-8 STUDIES	$262.50	$350.00	$114.74–$315.00	—	25%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 HC NCS 7 OR 8 STUDIES	$487.50	$650.00	$520.00–$585.00	—	25%
Neuromuscular re-education, 15 minutes CPT 97112 HC OT NEUROMUSCULAR RE ED 15 MIN	$107.25	$143.00	$64.35–$128.70	at median	25%
Neuromuscular re-education, 15 minutes CPT 97112 HC PT NEUROMUSCULAR RE ED 15 MIN	$107.25	$143.00	$64.35–$128.70	at median	25%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC PT NEUROMUSCULAR RE ED 15 MIN	$107.25	$143.00	$114.40–$128.70	—	25%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC OT NEUROMUSCULAR RE ED 15 MIN	$107.25	$143.00	$114.40–$128.70	—	25%
New patient office visit, about 30 minutes CPT 99203 PR OFFICE/OUTPATIENT NEW LOW MDM 30-44 MINUTES	$120.00	$160.00	$55.95–$144.00	44% below	25%
New patient office visit, about 30 minutes CPT 99203 HC FH PRO FEE 99203	$261.75	$349.00	$157.05–$314.10	22% above	25%
New patient office visit, about 30 minutes inpatient CPT 99203 PR OFFICE/OUTPATIENT NEW LOW MDM 30-44 MINUTES	$120.00	$160.00	$55.95–$144.00	—	25%
New patient office visit, about 30 minutes inpatient CPT 99203 HC FH PRO FEE 99203	$261.75	$349.00	$279.20–$314.10	—	25%
New patient office visit, about 45 minutes CPT 99204 PR OFFICE/OUTPATIENT NEW MODERATE MDM 45-59 MINUTES	$186.00	$248.00	$90.81–$223.20	34% below	25%
New patient office visit, about 45 minutes CPT 99204 HC FH PRO FEE 99204	$297.75	$397.00	$178.65–$357.30	6% above	25%
New patient office visit, about 45 minutes inpatient CPT 99204 PR OFFICE/OUTPATIENT NEW MODERATE MDM 45-59 MINUTES	$186.00	$248.00	$90.81–$223.20	—	25%
New patient office visit, about 45 minutes inpatient CPT 99204 HC FH PRO FEE 99204	$297.75	$397.00	$317.60–$357.30	—	25%
New patient office visit, about 60 minutes CPT 99205 PR OFFICE/OUTPATIENT NEW HIGH MDM 60-74 MINUTES	$230.25	$307.00	$123.49–$276.30	39% below	25%
New patient office visit, about 60 minutes CPT 99205 HC FH PRO FEE 99205	$319.50	$426.00	$191.70–$383.40	15% below	25%
New patient office visit, about 60 minutes inpatient CPT 99205 PR OFFICE/OUTPATIENT NEW HIGH MDM 60-74 MINUTES	$230.25	$307.00	$123.49–$276.30	—	25%
New patient office visit, about 60 minutes inpatient CPT 99205 HC FH PRO FEE 99205	$319.50	$426.00	$340.80–$383.40	—	25%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 PR OFFICE/OUTPATIENT NEW SF MDM 15-29 MINUTES	$84.75	$113.00	$32.21–$101.70	44% below	25%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC FH PRO FEE 99202	$207.00	$276.00	$124.20–$248.40	38% above	25%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 PR OFFICE/OUTPATIENT NEW SF MDM 15-29 MINUTES	$84.75	$113.00	$32.21–$101.70	—	25%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC FH PRO FEE 99202	$207.00	$276.00	$220.80–$248.40	—	25%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC MED NUTR THER 1ST INDIV EA 15 MIN	$81.00	$108.00	$48.60–$97.20	47% above	25%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HC MED NUTR THER 1ST INDIV EA 15 MIN	$81.00	$108.00	$86.40–$97.20	—	25%
Occupational therapy evaluation, low complexity CPT 97165 HC OT EVALUATION 45 MIN LOW COMPLEX	$279.00	$372.00	$167.40–$334.80	9% above	25%
Occupational therapy evaluation, low complexity CPT 97165 HC OT EVALUATION 15 MIN LOW COMPLEX	$279.00	$372.00	$167.40–$334.80	9% above	25%
Occupational therapy evaluation, low complexity CPT 97165 HC OT EVALUATION 60 MIN LOW COMPLEX	$279.00	$372.00	$167.40–$334.80	9% above	25%
Occupational therapy evaluation, low complexity CPT 97165 HC OT EVALUATION 30 MIN LOW COMPLEX	$279.00	$372.00	$167.40–$334.80	9% above	25%
Occupational therapy evaluation, low complexity inpatient CPT 97165 HC OT EVALUATION 45 MIN LOW COMPLEX	$279.00	$372.00	$297.60–$334.80	—	25%
Occupational therapy evaluation, low complexity inpatient CPT 97165 HC OT EVALUATION 30 MIN LOW COMPLEX	$279.00	$372.00	$297.60–$334.80	—	25%
Occupational therapy evaluation, low complexity inpatient CPT 97165 HC OT EVALUATION 60 MIN LOW COMPLEX	$279.00	$372.00	$297.60–$334.80	—	25%
Occupational therapy evaluation, low complexity inpatient CPT 97165 HC OT EVALUATION 15 MIN LOW COMPLEX	$279.00	$372.00	$297.60–$334.80	—	25%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC PT EVALUATION 15 MIN HIGH COMPLEX	$329.25	$439.00	$197.55–$395.10	1% above	25%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC PT EVALUATION 30 MIN HIGH COMPLEX	$329.25	$439.00	$197.55–$395.10	1% above	25%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC PT EVALUATION 45 MIN HIGH COMPLEX	$329.25	$439.00	$197.55–$395.10	1% above	25%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC PT EVALUATION 60 MIN HIGH COMPLEX	$329.25	$439.00	$197.55–$395.10	1% above	25%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC PT EVALUATION 30 MIN HIGH COMPLEX	$329.25	$439.00	$351.20–$395.10	—	25%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC PT EVALUATION 15 MIN HIGH COMPLEX	$329.25	$439.00	$351.20–$395.10	—	25%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC PT EVALUATION 45 MIN HIGH COMPLEX	$329.25	$439.00	$351.20–$395.10	—	25%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC PT EVALUATION 60 MIN HIGH COMPLEX	$329.25	$439.00	$351.20–$395.10	—	25%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC PT EVALUATION 60 MIN LOW COMPLX	$274.50	$366.00	$164.70–$329.40	15% above	25%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC PT EVALUATION 45 MIN LOW COMPLX	$274.50	$366.00	$164.70–$329.40	15% above	25%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC PT EVALUATION 15 MIN LOW COMPLX	$274.50	$366.00	$164.70–$329.40	15% above	25%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC PT EVALUATION 30 MIN LOW COMPLX	$274.50	$366.00	$164.70–$329.40	15% above	25%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HC PT EVALUATION 15 MIN LOW COMPLX	$274.50	$366.00	$292.80–$329.40	—	25%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HC PT EVALUATION 30 MIN LOW COMPLX	$274.50	$366.00	$292.80–$329.40	—	25%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HC PT EVALUATION 45 MIN LOW COMPLX	$274.50	$366.00	$292.80–$329.40	—	25%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HC PT EVALUATION 60 MIN LOW COMPLX	$274.50	$366.00	$292.80–$329.40	—	25%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC PT EVALUATION 30 MIN MOD COMPLEX	$316.50	$422.00	$189.90–$379.80	7% above	25%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC PT EVALUATION 15 MIN MOD COMPLEX	$316.50	$422.00	$189.90–$379.80	7% above	25%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC PT EVALUATION 60 MIN MOD COMPLEX	$316.50	$422.00	$189.90–$379.80	7% above	25%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC PT EVALUATION 45 MIN MOD COMPLEX	$316.50	$422.00	$189.90–$379.80	7% above	25%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC PT EVALUATION 45 MIN MOD COMPLEX	$316.50	$422.00	$337.60–$379.80	—	25%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC PT EVALUATION 15 MIN MOD COMPLEX	$316.50	$422.00	$337.60–$379.80	—	25%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC PT EVALUATION 30 MIN MOD COMPLEX	$316.50	$422.00	$337.60–$379.80	—	25%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC PT EVALUATION 60 MIN MOD COMPLEX	$316.50	$422.00	$337.60–$379.80	—	25%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PR MANUAL THERAPY TQS 1/> REGIONS EACH 15 MINUTES	$45.00	$60.00	$17.91–$54.00	60% below	25%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC PT MANUAL THERAPY 15 MIN	$104.25	$139.00	$62.55–$125.10	8% below	25%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC OT MANUIAL THERAPY 15 MIN	$104.25	$139.00	$62.55–$125.10	8% below	25%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 PR MANUAL THERAPY TQS 1/> REGIONS EACH 15 MINUTES	$45.00	$60.00	$17.91–$54.00	—	25%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC PT MANUAL THERAPY 15 MIN	$104.25	$139.00	$111.20–$125.10	—	25%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC OT MANUIAL THERAPY 15 MIN	$104.25	$139.00	$111.20–$125.10	—	25%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC OT THERAPEUTIC EXERCISE 15 MIN	$100.50	$134.00	$60.30–$120.60	at median	25%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC PT THERAPEUTIC EXERCISE 15 MIN	$100.50	$134.00	$60.30–$120.60	at median	25%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC OT THERAPEUTIC EXERCISE 15 MIN	$100.50	$134.00	$107.20–$120.60	—	25%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC PT THERAPEUTIC EXERCISE 15 MIN	$100.50	$134.00	$107.20–$120.60	—	25%
Preventive checkup, new patient aged 18–39 CPT 99385 PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS	$123.75	$165.00	$32.15–$184.88	31% below	25%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS	$123.75	$165.00	$32.15–$184.88	—	25%
Preventive checkup, new patient aged 40–64 CPT 99386 PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS	$123.75	$165.00	$66.40–$213.61	44% below	25%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS	$123.75	$165.00	$66.40–$213.61	—	25%
Preventive checkup, new patient aged 65 or older CPT 99387 PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&>	$123.75	$165.00	$66.40–$229.95	28% below	25%
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&>	$123.75	$165.00	$66.40–$229.95	—	25%
Preventive checkup, returning patient aged 18–39 CPT 99395 PR PERIODIC PREVENTIVE MED EST PATIENT 18-39 YRS	$102.75	$137.00	$32.15–$165.63	42% below	25%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 PR PERIODIC PREVENTIVE MED EST PATIENT 18-39 YRS	$102.75	$137.00	$32.15–$165.63	—	25%
Preventive checkup, returning patient aged 40–64 CPT 99396 PR PERIODIC PREVENTIVE MED EST PATIENT 40-64YRS	$102.75	$137.00	$42.50–$178.76	48% below	25%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 PR PERIODIC PREVENTIVE MED EST PATIENT 40-64YRS	$102.75	$137.00	$42.50–$178.76	—	25%
Preventive checkup, returning patient aged 65 or older CPT 99397 PR PERIODIC PREVENTIVE MED EST PATIENT 65YRS& OLDER	$102.75	$137.00	$42.50–$190.62	49% below	25%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 PR PERIODIC PREVENTIVE MED EST PATIENT 65YRS& OLDER	$102.75	$137.00	$42.50–$190.62	—	25%
Psychiatric evaluation with medical services CPT 90792 HC PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES	$401.25	$535.00	$240.75–$481.50	59% above	25%
Psychiatric evaluation with medical services CPT 90792 HC FH PRO FEE PSYCHIATRIC DIAGNOSTIC EVAL W/ MEDICAL SERVICES	$401.25	$535.00	$240.75–$481.50	59% above	25%
Psychiatric evaluation with medical services inpatient CPT 90792 HC PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES	$401.25	$535.00	$428.00–$481.50	—	25%
Psychiatric evaluation with medical services inpatient CPT 90792 HC FH PRO FEE PSYCHIATRIC DIAGNOSTIC EVAL W/ MEDICAL SERVICES	$401.25	$535.00	$428.00–$481.50	—	25%
Psychotherapy session, 30 minutes CPT 90832 PR PSYCHOTHERAPY W/PATIENT 30 MINUTES	$108.00	$144.00	$46.98–$129.60	32% below	25%
Psychotherapy session, 30 minutes CPT 90832 HC PSYCH W/PATIENT 30 MINUTES	$189.75	$253.00	$113.85–$227.70	19% above	25%
Psychotherapy session, 30 minutes inpatient CPT 90832 PR PSYCHOTHERAPY W/PATIENT 30 MINUTES	$108.00	$144.00	$46.98–$129.60	—	25%
Psychotherapy session, 30 minutes inpatient CPT 90832 HC PSYCH W/PATIENT 30 MINUTES	$189.75	$253.00	$202.40–$227.70	—	25%
Psychotherapy session, 45 minutes CPT 90834 PR PSYCHOTHERAPY W/PATIENT 45 MINUTES	$143.25	$191.00	$85.95–$171.90	20% below	25%
Psychotherapy session, 45 minutes CPT 90834 HC PSYCH W/PATIENT 45 MINUTES	$274.50	$366.00	$164.70–$329.40	53% above	25%
Psychotherapy session, 45 minutes inpatient CPT 90834 PR PSYCHOTHERAPY W/PATIENT 45 MINUTES	$143.25	$191.00	$85.95–$171.90	—	25%
Psychotherapy session, 45 minutes inpatient CPT 90834 HC PSYCH W/PATIENT 45 MINUTES	$274.50	$366.00	$292.80–$329.40	—	25%
Psychotherapy session, 60 minutes CPT 90837 PR PSYCHOTHERAPY W/PATIENT 60 MINUTES	$216.00	$288.00	$129.60–$259.20	2% below	25%
Psychotherapy session, 60 minutes CPT 90837 HC PSYCH W/PATIENT 60 MINUTES	$443.25	$591.00	$265.95–$531.90	101% above	25%
Psychotherapy session, 60 minutes inpatient CPT 90837 PR PSYCHOTHERAPY W/PATIENT 60 MINUTES	$216.00	$288.00	$129.60–$259.20	—	25%
Psychotherapy session, 60 minutes inpatient CPT 90837 HC PSYCH W/PATIENT 60 MINUTES	$443.25	$591.00	$472.80–$531.90	—	25%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 PR TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES	$41.25	$55.00	$8.02–$49.50	24% above	25%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 HC SMOKING CESSATION 3-10 MIN	$60.75	$81.00	$36.45–$72.90	83% above	25%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 PR TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES	$41.25	$55.00	$8.02–$49.50	—	25%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 HC SMOKING CESSATION 3-10 MIN	$60.75	$81.00	$64.80–$72.90	—	25%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 PR OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40-54 MIN	$166.50	$222.00	$97.69–$199.80	37% below	25%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC FH PRO FEE 99215	$257.25	$343.00	$97.69–$308.70	3% below	25%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 PR OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40-54 MIN	$166.50	$222.00	$97.69–$199.80	—	25%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC FH PRO FEE 99215	$257.25	$343.00	$97.69–$308.70	—	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 PR OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20-29 MIN	$93.00	$124.00	$44.67–$111.60	37% below	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC FH PRO FEE 99213	$105.00	$140.00	$44.67–$126.00	29% below	25%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 PR OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20-29 MIN	$93.00	$124.00	$44.67–$111.60	—	25%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC FH PRO FEE 99213	$105.00	$140.00	$44.67–$126.00	—	25%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 PR OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30-39 MIN	$127.50	$170.00	$65.79–$153.00	28% below	25%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC FH PRO FEE 99214	$235.50	$314.00	$65.79–$282.60	33% above	25%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 PR OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30-39 MIN	$127.50	$170.00	$65.79–$153.00	—	25%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC FH PRO FEE 99214	$235.50	$314.00	$65.79–$282.60	—	25%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 PR OFFICE/OUTPATIENT ESTABLISHED SF MDM 10-19 MIN	$57.75	$77.00	$24.25–$69.30	49% below	25%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC FH PRO FEE 99212	$165.75	$221.00	$99.45–$198.90	45% above	25%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 PR OFFICE/OUTPATIENT ESTABLISHED SF MDM 10-19 MIN	$57.75	$77.00	$24.25–$69.30	—	25%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC FH PRO FEE 99212	$165.75	$221.00	$176.80–$198.90	—	25%
Specialist consultation, low complexity or 30+ minutes CPT 99243 PR OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES	$131.25	$175.00	$51.30–$161.46	32% below	25%
Specialist consultation, low complexity or 30+ minutes CPT 99243 HC OFFICE OP VISIT CONSULT 99243	$147.75	$197.00	$88.65–$177.30	24% below	25%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 PR OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES	$131.25	$175.00	$51.30–$161.46	—	25%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 HC OFFICE OP VISIT CONSULT 99243	$147.75	$197.00	$157.60–$177.30	—	25%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 PR OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES	$231.75	$309.00	$71.40–$278.10	32% below	25%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 HC OFFICE OP VISIT CONSULT 99244	$261.00	$348.00	$156.60–$313.20	23% below	25%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 PR OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES	$231.75	$309.00	$71.40–$278.10	—	25%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 HC OFFICE OP VISIT CONSULT 99244	$261.00	$348.00	$278.40–$313.20	—	25%
Speech and language evaluation CPT 92523 HC ST SPEECH SOUND LANG COMPREHEN 30 MIN	$486.75	$649.00	$292.05–$584.10	28% above	25%
Speech and language evaluation CPT 92523 HC ST SPEECH SOUND LANG COMPREHEN 75 MIN	$486.75	$649.00	$292.05–$584.10	28% above	25%
Speech and language evaluation CPT 92523 HC ST SPEECH SOUND LANG COMPREHEN 60 MIN	$486.75	$649.00	$292.05–$584.10	28% above	25%
Speech and language evaluation CPT 92523 HC ST SPEECH SOUND LANG COMPREHEN 45 MIN	$486.75	$649.00	$292.05–$584.10	28% above	25%
Speech and language evaluation CPT 92523 HC ST SPEECH SOUND LANG COMPREHEN 15 MIN	$486.75	$649.00	$292.05–$584.10	28% above	25%
Speech and language evaluation inpatient CPT 92523 HC ST SPEECH SOUND LANG COMPREHEN 45 MIN	$486.75	$649.00	$519.20–$584.10	—	25%
Speech and language evaluation inpatient CPT 92523 HC ST SPEECH SOUND LANG COMPREHEN 60 MIN	$486.75	$649.00	$519.20–$584.10	—	25%
Speech and language evaluation inpatient CPT 92523 HC ST SPEECH SOUND LANG COMPREHEN 75 MIN	$486.75	$649.00	$519.20–$584.10	—	25%
Speech and language evaluation inpatient CPT 92523 HC ST SPEECH SOUND LANG COMPREHEN 30 MIN	$486.75	$649.00	$519.20–$584.10	—	25%
Speech and language evaluation inpatient CPT 92523 HC ST SPEECH SOUND LANG COMPREHEN 15 MIN	$486.75	$649.00	$519.20–$584.10	—	25%
Speech therapy session, individual CPT 92507 HC ST SPEECH/HEARING THERAPY 15 MIN	$270.75	$361.00	$162.45–$324.90	29% above	25%
Speech therapy session, individual CPT 92507 HC ST SPEECH TREATMENT	$285.75	$381.00	$171.45–$342.90	36% above	25%
Speech therapy session, individual CPT 92507 HC ST SPEECH/HEARING THERAPY 30 MIN	$285.75	$381.00	$171.45–$342.90	36% above	25%
Speech therapy session, individual CPT 92507 HC ST SPEECH/HEARING THERAPY 45 MIN	$301.50	$402.00	$180.90–$361.80	44% above	25%
Speech therapy session, individual CPT 92507 HC ST SPEECH/HEARING THERAPY 60 MIN	$316.50	$422.00	$189.90–$379.80	51% above	25%
Speech therapy session, individual inpatient CPT 92507 HC ST SPEECH/HEARING THERAPY 15 MIN	$270.75	$361.00	$288.80–$324.90	—	25%
Speech therapy session, individual inpatient CPT 92507 HC ST SPEECH/HEARING THERAPY 30 MIN	$285.75	$381.00	$304.80–$342.90	—	25%
Speech therapy session, individual inpatient CPT 92507 HC ST SPEECH TREATMENT	$285.75	$381.00	$304.80–$342.90	—	25%
Speech therapy session, individual inpatient CPT 92507 HC ST SPEECH/HEARING THERAPY 45 MIN	$301.50	$402.00	$321.60–$361.80	—	25%
Speech therapy session, individual inpatient CPT 92507 HC ST SPEECH/HEARING THERAPY 60 MIN	$316.50	$422.00	$337.60–$379.80	—	25%
Spirometry (breathing test) CPT 94010 HC PFT SPIROMETRY WO BRONCHODILATOR	$245.25	$327.00	$147.15–$294.30	18% below	25%
Spirometry (breathing test) inpatient CPT 94010 HC PFT SPIROMETRY WO BRONCHODILATOR	$245.25	$327.00	$261.60–$294.30	—	25%
Spirometry before and after a bronchodilator CPT 94060 HC PFT SPIROMETRY W BRONCHODILATOR	$93.75	$125.00	$56.25–$112.50	82% below	25%
Spirometry before and after a bronchodilator CPT 94060 HC PFT SPIROMETRY W BRONCHODILATOR BEDSIDE	$384.00	$512.00	$230.40–$460.80	27% below	25%
Spirometry before and after a bronchodilator inpatient CPT 94060 HC PFT SPIROMETRY W BRONCHODILATOR	$93.75	$125.00	$100.00–$112.50	—	25%
Spirometry before and after a bronchodilator inpatient CPT 94060 HC PFT SPIROMETRY W BRONCHODILATOR BEDSIDE	$384.00	$512.00	$409.60–$460.80	—	25%
Therapeutic activities (functional training), 15 minutes CPT 97530 HC OT THERAPEUTIC ACTIVITY 15 MIN	$100.50	$134.00	$60.30–$120.60	21% below	25%
Therapeutic activities (functional training), 15 minutes CPT 97530 HC PT THERAPEUTIC ACTIVITY 15 MIN	$100.50	$134.00	$60.30–$120.60	21% below	25%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC OT THERAPEUTIC ACTIVITY 15 MIN	$100.50	$134.00	$107.20–$120.60	—	25%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC PT THERAPEUTIC ACTIVITY 15 MIN	$100.50	$134.00	$107.20–$120.60	—	25%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HC PHLEBOTOMY THERAPEUTIC	$226.50	$302.00	$135.90–$271.80	9% above	25%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 HC PHLEBOTOMY THERAPEUTIC	$226.50	$302.00	$241.60–$271.80	—	25%
Treadmill or drug stress test with ECG, supervision and report CPT 93015 HC AFF STRESS TST TREADML/BIKE PHARM	$549.00	$732.00	$329.40–$658.80	27% above	25%
Treadmill or drug stress test with ECG, supervision and report inpatient CPT 93015 HC AFF STRESS TST TREADML/BIKE PHARM	$549.00	$732.00	$585.60–$658.80	—	25%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Illinois	Off list
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 PR IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE	$63.75	$85.00	$1.05–$76.50	23% below	25%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 INFLUENZA VAC A&B SURF ANT ADJ 0.5 ML IM SUSY	$208.28	$277.70	$124.97–$249.93	150% above	25%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 PR IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE	$63.75	$85.00	$1.05–$76.50	—	25%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 INFLUENZA VAC A&B SURF ANT ADJ 0.5 ML IM SUSY	$208.28	$277.70	—	—	25%
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 PR SARSCOV2 VACC LNP-S PF 50 MCG/.05 ML DOSE IM USE	$142.50	$190.00	$85.50–$204.29	37% below	25%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 PR SARSCOV2 VACC LNP-S PF 50 MCG/.05 ML DOSE IM USE	$142.50	$190.00	$85.50–$204.29	—	25%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 PR SARSCOV2 VACC TRIS-SUCROSE 30MCG/0.3 ML IM USE	$123.75	$165.00	$74.25–$183.54	35% below	25%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 PR SARSCOV2 VACC TRIS-SUCROSE 30MCG/0.3 ML IM USE	$123.75	$165.00	$74.25–$183.54	—	25%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 PR VAR VACCINE LIVE FOR SUBCUTANEOUS USE	$195.00	$260.00	$117.00–$248.75	17% below	25%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VIRUS VACCINE LIVE 1350 PFU/0.5ML IJ SUSR	$398.88	$531.83	$239.32–$478.65	71% above	25%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 PR VAR VACCINE LIVE FOR SUBCUTANEOUS USE	$195.00	$260.00	$117.00–$248.75	—	25%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA VIRUS VACCINE LIVE 1350 PFU/0.5ML IJ SUSR	$398.88	$531.83	—	—	25%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 PR IIV3 VACC PRESERVATIVE FREE 0.5 ML DOSAGE IM USE	$18.75	$25.00	$11.25–$24.77	47% below	25%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 INFLUENZA VIRUS VACC SPLIT PF 0.5 ML IM SUSY	$23.82	$31.76	$14.29–$28.58	32% below	25%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 PR IIV3 VACC PRESERVATIVE FREE 0.5 ML DOSAGE IM USE	$18.75	$25.00	$11.25–$24.77	—	25%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 INFLUENZA VIRUS VACC SPLIT PF 0.5 ML IM SUSY	$23.82	$31.76	—	—	25%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 PR 9VHPV VACC 2/3 DOSE SCHED IM USE	$197.25	$263.00	$118.35–$410.42	60% below	25%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HPV 9-VALENT RECOMB VACCINE IM SUSP	$663.28	$884.37	$397.97–$795.93	35% above	25%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HPV 9-VALENT RECOMB VACCINE IM SUSY	$663.28	$884.37	$397.97–$795.93	35% above	25%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 PR 9VHPV VACC 2/3 DOSE SCHED IM USE	$197.25	$263.00	$118.35–$410.42	—	25%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HPV 9-VALENT RECOMB VACCINE IM SUSY	$663.28	$884.37	—	—	25%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HPV 9-VALENT RECOMB VACCINE IM SUSP	$663.28	$884.37	—	—	25%
Hepatitis A vaccine, adult dose CPT 90632 PR HEPA VACCINE ADULT DOSE FOR INTRAMUSCULAR USE	$102.75	$137.00	$61.65–$123.30	5% below	25%
Hepatitis A vaccine, adult dose inpatient CPT 90632 PR HEPA VACCINE ADULT DOSE FOR INTRAMUSCULAR USE	$102.75	$137.00	$61.65–$123.30	—	25%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 PR HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE	$77.25	$103.00	$46.35–$98.53	21% below	25%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B VAC RECOMBINANT 20 MCG/ML IJ SUSP (WRAPPER)	$188.25	$250.99	$112.95–$225.89	93% above	25%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 PR HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE	$77.25	$103.00	$46.35–$98.53	—	25%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B VAC RECOMBINANT 20 MCG/ML IJ SUSP (WRAPPER)	$188.25	$250.99	—	—	25%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 PR IIV VACCINE PRESERV FREE INCREASED AG CONTENT IM	$63.75	$85.00	$5.00–$102.76	5% below	25%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 PR IIV VACCINE PRESERV FREE INCREASED AG CONTENT IM	$63.75	$85.00	$5.00–$102.76	—	25%
MMR vaccine (measles, mumps and rubella), live CPT 90707 PR MEASLES MUMPS RUBELLA VIRUS VACCINE LIVE SUBQ	$102.75	$137.00	$61.65–$136.19	48% below	25%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES, MUMPS & RUBELLA VAC IJ SOLR	$229.00	$305.33	$137.40–$274.80	15% above	25%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 PR MEASLES MUMPS RUBELLA VIRUS VACCINE LIVE SUBQ	$102.75	$137.00	$61.65–$136.19	—	25%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES, MUMPS & RUBELLA VAC IJ SOLR	$229.00	$305.33	—	—	25%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 PR MENACWYD/MENACWY-CRM CONJ VACC GRPS ACWY IM USE	$237.75	$317.00	$142.20–$285.30	at median	25%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENING ACY&W-135 DIPHTH CONJ IM SOLN	$320.82	$427.75	$192.49–$384.98	35% above	25%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 PR MENACWYD/MENACWY-CRM CONJ VACC GRPS ACWY IM USE	$237.75	$317.00	$142.20–$285.30	—	25%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENING ACY&W-135 DIPHTH CONJ IM SOLN	$320.82	$427.75	—	—	25%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PR PCV20 VACCINE FOR INTRAMUSCULAR USE	$330.00	$440.00	$198.00–$417.26	8% below	25%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PR PCV20 VACCINE FOR INTRAMUSCULAR USE	$330.00	$440.00	$198.00–$417.26	—	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PR PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE	$170.25	$227.00	$102.15–$204.30	3% above	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL VAC POLYVALENT 25 MCG/0.5ML IJ SOSY	$264.03	$352.04	$158.42–$316.84	61% above	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PR PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE	$170.25	$227.00	$102.15–$204.30	—	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL VAC POLYVALENT 25 MCG/0.5ML IJ SOSY	$264.03	$352.04	—	—	25%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE, PCEC IM SUSR	$884.73	$1,179.63	$530.83–$1,061.67	18% above	25%
Rabies vaccine, one dose CPT 90675 RABIES VIRUS VACCINE, HDC IM SUSR	$915.72	$1,220.95	$549.43–$1,098.86	22% above	25%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE, PCEC IM SUSR	$884.73	$1,179.63	—	—	25%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VIRUS VACCINE, HDC IM SUSR	$915.72	$1,220.95	—	—	25%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS-DIPHTHERIA TOXOIDS TD 5-2 LF/0.5ML IM SUSP	$135.48	$180.64	$81.29–$162.58	76% above	25%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS-DIPHTHERIA TOXOIDS TD 5-2 LF/0.5ML IM SUSP	$135.48	$180.64	—	—	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 PR TDAP VACCINE 7 YRS/> IM	$93.75	$125.00	$39.09–$112.50	9% below	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2.5-18.5 LF-MCG/0.5 IM SUSP (WRAPPER)	$142.87	$190.49	$85.72–$171.44	39% above	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 PR TDAP VACCINE 7 YRS/> IM	$93.75	$125.00	$39.09–$112.50	—	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2.5-18.5 LF-MCG/0.5 IM SUSP (WRAPPER)	$142.87	$190.49	—	—	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 PR IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE	$15.75	$21.00	$9.45–$19.48	72% below	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC VACCINE ADMIN SINGLE	$18.75	$25.00	$11.25–$22.50	67% below	25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 PR IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE	$15.75	$21.00	$9.45–$19.48	—	25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC VACCINE ADMIN SINGLE	$18.75	$25.00	$20.00–$22.50	—	25%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 PR IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE	$15.75	$21.00	$8.00–$18.90	59% below	25%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 HC VACCINE ADMIN EA ADDL	$18.75	$25.00	$11.25–$22.50	51% below	25%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 PR IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE	$15.75	$21.00	$8.00–$18.90	—	25%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 HC VACCINE ADMIN EA ADDL	$18.75	$25.00	$20.00–$22.50	—	25%

Source file: https://sthpiprd.blob.core.windows.net/machine-readable-files/8309/201244058_ferrell-hospital-community-foundation_standardcharges.csv