Hospital

Down East Community Hospital

Down East Community Hospital in Machias, ME publishes cash prices for 373 common procedures listed here, from its own machine-readable price file (the file does not say when it was last updated). Compared with other hospitals in the state, its outpatient cash prices are above the Maine median for 229 of 351 procedures and below it for 106. By typical cash price it ranks #19 of 28 Maine hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

11 Hospital Drive, Machias, ME 04654 Collected Sep 27, 2026 Source price file (207) 255-3356

Critical access hospital (rural, 25 beds or fewer) Emergency department CMS star rating 4 of 5 CCN 201311 · CMS hospital register

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Maine	Off list
Ankle X-ray, complete, 3 or more views one side CPT 73610 Xr Ankle Complete 3+ Views Right	$338.00	$450.00	$198.00–$412.00	29% above	25%
Ankle X-ray, complete, 3 or more views one side CPT 73610 Xr Ankle Complete 3+ Views Left	$338.00	$450.00	$198.00–$412.00	29% above	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 93922 Limited Bilateral Noninvasive Physiologic Studies Of Upper Or Lower Extremity Arteries	$205.00	$273.00	$120.00–$250.00	—	25%
Bone scan, whole body (nuclear medicine) CPT 78306 Nm Bone Imaging Whole Bodyreport	$232.00	$309.00	$136.00–$283.00	82% below	25%
Bone scan, whole body (nuclear medicine) CPT 78306 Nm Bone Imaging Whole Body	$1,328.00	$1,770.00	$779.00–$1,620.00	1% above	25%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 Us Breast Limited Left.	$530.00	$707.00	$311.00–$647.00	31% above	25%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 Us Breast Limited Right.	$530.00	$707.00	$311.00–$647.00	31% above	25%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 Ct Angio Chest Pe	$1,700.00	$2,266.00	$997.00–$2,073.00	10% below	25%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 Ct Abdomen And Pelvis W/o Contrast	$2,861.00	$3,814.00	$1,678.00–$3,490.00	106% above	25%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT scan of abdomen and pelvis with contrast	$3,399.00	$4,532.00	$1,994.00–$4,147.00	79% above	25%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 Ct Ivpreport	$342.00	$456.00	$201.00–$417.00	84% below	25%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 Ct Abdomen And Pelvis W/ + W/o Contrast Add-on Pc	$700.00	$933.00	$411.00–$854.00	67% below	25%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 Ct Abdomen And Pelvis W/ + W/o Contrastreport	$728.00	$970.00	$427.00–$888.00	66% below	25%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 Ct Ivp	$2,020.00	$2,693.00	$1,185.00–$2,464.00	4% below	25%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 Ct Abdomen And Pelvis W/ + W/o Contrast Add-on	$4,040.00	$5,387.00	$2,370.00–$4,929.00	91% above	25%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 Ct Abdomen And Pelvis W/ + W/o Contrast	$4,202.00	$5,602.00	$2,465.00–$5,126.00	99% above	25%
CT scan of the abdomen with contrast CPT 74160 Ct Abdomen W/ Contrastreport	$338.00	$450.00	$198.00–$412.00	75% below	25%
CT scan of the abdomen with contrast CPT 74160 Ct Renal W/ Contrastreport	$338.00	$450.00	$198.00–$412.00	75% below	25%
CT scan of the abdomen with contrast CPT 74160 Ct Renal W/ Contrast	$922.00	$1,229.00	$541.00–$1,125.00	30% below	25%
CT scan of the abdomen with contrast CPT 74160 Ct Abdomen W/ Contrast	$1,700.00	$2,266.00	$997.00–$2,073.00	28% above	25%
CT scan of the abdomen without contrast CPT 74150 Ct Abdomen W/o Contrastreport	$315.00	$420.00	$185.00–$384.00	63% below	25%
CT scan of the abdomen without contrast CPT 74150 Ct Abdomen W/o Contrast	$1,430.00	$1,907.00	$839.00–$1,745.00	66% above	25%
CT scan of the face and sinuses, no contrast dye CPT 70486 Ct Maxillofacial W/o Contrastreport	$305.00	$407.00	$179.00–$372.00	68% below	25%
CT scan of the face and sinuses, no contrast dye CPT 70486 Ct Sinus W/o Contrastreport	$305.00	$407.00	$179.00–$372.00	68% below	25%
CT scan of the face and sinuses, no contrast dye CPT 70486 Ct Sinus W/o Contrast	$1,005.00	$1,340.00	$590.00–$1,226.00	7% above	25%
CT scan of the face and sinuses, no contrast dye CPT 70486 Ct Head/facial/spine Cervical W/o Cont Tech Add On	$1,376.00	$1,834.00	$807.00–$1,678.00	47% above	25%
CT scan of the face and sinuses, no contrast dye CPT 70486 Ct Maxillofacial W/o Contrast	$1,430.00	$1,907.00	$839.00–$1,745.00	52% above	25%
CT scan of the head or brain, no contrast dye CPT 70450 CT scan	$1,430.00	$1,907.00	$839.00–$1,745.00	18% above	25%
CT scan of the head with contrast CPT 70460 Ct Brain/head W/ Contrastreport	$297.00	$396.00	$174.00–$362.00	78% below	25%
CT scan of the head with contrast CPT 70460 Ct Brain/head W/ Contrast	$1,700.00	$2,266.00	$997.00–$2,073.00	28% above	25%
CT scan of the head without and with contrast CPT 70470 Ct Brain/head W/ + W/o Contrastreport	$368.00	$491.00	$216.00–$449.00	78% below	25%
CT scan of the head without and with contrast CPT 70470 Ct Brain/head W/ + W/o Contrast	$2,101.00	$2,801.00	$1,232.00–$2,563.00	28% above	25%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 Bill Only Ct L-spine Reconstruction, Read Only	$308.00	$411.00	$181.00–$376.00	76% below	25%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 Ct Spine Lumbar W/o Contrastreport	$308.00	$411.00	$181.00–$376.00	76% below	25%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 Ct Spine Lumbar W/o Contrast	$1,430.00	$1,907.00	$839.00–$1,745.00	14% above	25%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 Ct Spine Cervical W/o Contrast	$1,430.00	$1,907.00	$839.00–$1,745.00	30% above	25%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 Ct Head/neck W/o Contrast	$1,430.00	$1,907.00	$839.00–$1,745.00	30% above	25%
CT scan of the pelvis, with contrast dye CPT 72193 CT scan of pelvis with contrast	$1,700.00	$2,266.00	$997.00–$2,073.00	31% above	25%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 Us Carotid Duplex Bilateral	$1,122.00	$1,496.00	$658.00–$1,369.00	—	25%
Chest X-ray, 2 views CPT 71046 Xr Chest 2 Views	$368.00	$491.00	$216.00–$449.00	64% above	25%
Chest X-ray, single view CPT 71045 Xr Chest 1 View	$293.00	$391.00	$172.00–$358.00	42% above	25%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 Us Renal	$749.00	$998.00	$439.00–$913.00	10% above	25%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 Bd Bone Density Dexa Axial Skeleton	$368.00	$491.00	$216.00–$449.00	2% above	25%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 Us Ob Detailed Complete First Gestreport	$224.00	$298.00	$131.00–$273.00	51% below	25%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 Us Ob Detailed Complete First Gest	$951.00	$1,268.00	$558.00–$1,160.00	107% above	25%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 Ct Chest W/o Contrast	$1,430.00	$1,907.00	$839.00–$1,745.00	52% above	25%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 Ct Chest/abd/pelvis W/ Contrast	$1,634.00	$2,179.00	$959.00–$1,994.00	20% above	25%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 Ct Chest W/ Contrast	$1,700.00	$2,266.00	$997.00–$2,073.00	25% above	25%
Diagnostic mammogram, both breasts CPT 77066 Mammography of both breasts	$450.00	$600.00	$264.00–$549.00	—	25%
Diagnostic mammogram, one breast CPT 77065 Mammography of one breast	$338.00	$451.00	$198.00–$413.00	21% above	25%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 Us Lower Ext Arterial Duplex Bilateral	$1,294.00	$1,725.00	$759.00–$1,578.00	—	25%
Duplex ultrasound of the leg arteries, both legs CPT 93925 Us Lower Ext Arterial Duplex Bilateralreport	$230.00	$306.00	$135.00–$280.00	48% below	25%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 93970 Duplex Scan Of Extremity Veins; Complete Bilateral Study	$425.00	$566.00	$249.00–$518.00	—	25%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 Us Lower Ext Venous Duplex Bilateral	$1,122.00	$1,496.00	$658.00–$1,369.00	—	25%
Duplex ultrasound of the leg veins, both legs CPT 93970 Us Lower Ext Venous Duplex Bilateralreport	$208.00	$277.00	$122.00–$253.00	83% below	25%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Us Echo 2d Limited Eo	$497.00	$663.00	$292.00–$607.00	63% below	25%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Rt Echocardiogram Charge	$2,684.00	$3,579.00	$1,575.00–$3,275.00	97% above	25%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Us Echo 2d Comp W/ Color Flow Doppler Eo	$2,684.00	$3,579.00	$1,575.00–$3,275.00	97% above	25%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 Nm Hepatobiliary Imaging W/ Ejectionreport	$224.00	$298.00	$131.00–$273.00	83% below	25%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 Nm Hepatobiliary Imagingreport	$224.00	$298.00	$131.00–$273.00	83% below	25%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 Nm Hepatobiliary Imaging	$1,176.00	$1,568.00	$690.00–$1,435.00	13% below	25%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 Nm Hepatobiliary Imaging W/ Ejection	$1,383.00	$1,844.00	$811.00–$1,687.00	3% above	25%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 Home Sleep Study	$232.00	$309.00	$136.00–$283.00	25% below	25%
Knee X-ray, 3 views one side CPT 73562 Xr Knee 3 Views Right	$476.00	$635.00	$279.00–$581.00	79% above	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Us Abdomen Limited	$693.00	$924.00	$407.00–$845.00	45% above	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder one side CPT 76705 Us Ruq Right Upper Quadrant	$693.00	$924.00	$407.00–$845.00	45% above	25%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 Ct Low Dose Lung Screening	$626.00	$835.00	$367.00–$764.00	171% above	25%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI scan of leg joint	$2,729.00	$3,639.00	$1,601.00–$3,330.00	65% above	25%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Mri Le Joint W/ + W/o Contrast Right	$2,603.00	$3,470.00	$1,527.00–$3,175.00	13% below	25%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Mri Le Joint W/ + W/o Contrast Left	$2,603.00	$3,470.00	$1,527.00–$3,175.00	13% below	25%
MRI of the abdomen without contrast CPT 74181 Mri Abdomen W/o Contrastreport	$235.00	$313.00	$138.00–$286.00	86% below	25%
MRI of the abdomen without contrast CPT 74181 Mri Mrcp W/o Contrast	$1,820.00	$2,426.00	$1,067.00–$2,220.00	9% above	25%
MRI of the abdomen without contrast CPT 74181 Mri Abdomen W/o Contrast	$1,820.00	$2,426.00	$1,067.00–$2,220.00	9% above	25%
MRI of the abdomen, without and then with contrast dye CPT 74183 Mri Mrcp W/ + W/o Contrast	$1,820.00	$2,426.00	$1,067.00–$2,220.00	39% below	25%
MRI of the abdomen, without and then with contrast dye CPT 74183 Mri Abdomen W/ + W/o Contrast	$2,603.00	$3,470.00	$1,527.00–$3,175.00	13% below	25%
MRI of the brain, no contrast dye CPT 70551 Mri Brain W/o Contrast	$1,820.00	$2,426.00	$1,067.00–$2,220.00	20% above	25%
MRI of the brain, with and without contrast dye CPT 70553 MRI Scan	$2,603.00	$3,470.00	$1,527.00–$3,175.00	at median	25%
MRI of the lower back, no contrast dye CPT 72148 MRI scan of lower spinal canal	$1,820.00	$2,426.00	$1,067.00–$2,220.00	24% above	25%
MRI of the lower back, without and then with contrast dye CPT 72158 Mri Spine Lumbar W/ + W/o Contrastreport	$718.00	$957.00	$421.00–$876.00	72% below	25%
MRI of the lower back, without and then with contrast dye CPT 72158 Mri Spine Lumbar W/ + W/o Contrast	$2,603.00	$3,470.00	$1,527.00–$3,175.00	at median	25%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 Mri Spine Thoracic W/o Contrastreport	$485.00	$646.00	$284.00–$591.00	69% below	25%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 Mri Spine Thoracic W/o Contrast	$1,820.00	$2,426.00	$1,067.00–$2,220.00	16% above	25%
MRI of the neck (cervical spine) without and with contrast CPT 72156 Mri Spine Cervical W/ + W/o Contrastreport	$664.00	$885.00	$389.00–$810.00	69% below	25%
MRI of the neck (cervical spine) without and with contrast CPT 72156 Mri Spine Cervical W/ + W/o Contrast	$2,603.00	$3,470.00	$1,527.00–$3,175.00	22% above	25%
MRI of the neck (cervical spine), no contrast dye CPT 72141 Mri Spine Cervical W/o Contrast	$1,820.00	$2,426.00	$1,067.00–$2,220.00	26% above	25%
MRI of the pelvis without and with contrast CPT 72197 Mri Pelvis W/ + W/o Contrastreport	$485.00	$646.00	$284.00–$591.00	80% below	25%
MRI of the pelvis without and with contrast CPT 72197 Mri Sacrum/coccyx W/ + W/o Contrastreport	$485.00	$646.00	$284.00–$591.00	80% below	25%
MRI of the pelvis without and with contrast CPT 72197 Mri Pelvis W/ + W/o Contrast	$2,603.00	$3,470.00	$1,527.00–$3,175.00	6% above	25%
MRI of the pelvis without and with contrast CPT 72197 Mri Sacrum/coccyx W/ + W/o Contrast	$2,603.00	$3,470.00	$1,527.00–$3,175.00	6% above	25%
MRI of the pelvis, no contrast dye CPT 72195 Mri Sacrum/coccyx W/o Contrastreport	$485.00	$646.00	$284.00–$591.00	73% below	25%
MRI of the pelvis, no contrast dye CPT 72195 Mri Pelvis W/o Contrastreport	$485.00	$646.00	$284.00–$591.00	73% below	25%
MRI of the pelvis, no contrast dye CPT 72195 Mri Sacrum/coccyx W/o Contrast	$1,820.00	$2,426.00	$1,067.00–$2,220.00	at median	25%
MRI of the pelvis, no contrast dye CPT 72195 Mri Pelvis W/o Contrast	$1,820.00	$2,426.00	$1,067.00–$2,220.00	at median	25%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 Mri Ue Joint W/o Contrast Rightreport	$287.00	$383.00	$169.00–$350.00	82% below	25%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 Mri Ue Joint W/o Contrast Leftreport	$287.00	$383.00	$169.00–$350.00	82% below	25%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mri Ue Joint W/o Contrast Right	$1,820.00	$2,426.00	$1,067.00–$2,220.00	17% above	25%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mri Ue Joint W/o Contrast Left	$1,820.00	$2,426.00	$1,067.00–$2,220.00	17% above	25%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Nm Myocardial Spect Rest And Stress	$5,333.00	$7,111.00	$3,129.00–$6,507.00	91% above	25%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 Us Pelvic Non Ob Limited W/ Transvag	$623.00	$830.00	$365.00–$759.00	394% above	25%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 Us Pelvic Non Obreport	$189.00	$252.00	$111.00–$231.00	62% below	25%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 76856 ñ Us Pelvic, Complete, Non Ob	$385.00	$513.00	$226.00–$469.00	23% below	25%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 Us Pelvic Non Ob	$822.00	$1,096.00	$482.00–$1,003.00	65% above	25%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 Abdomial ultrasound of pregnant uterus	$905.00	$1,207.00	$531.00–$1,104.00	82% above	25%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 76801 Ultrasound, Pregnant Uterus, Real-time With Image Documentation, Fetal And Maternal Evaluation	$67.00	$89.00	$39.00–$81.00	80% below	25%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 Us Ob Less Than 14 Weeks Singlereport	$139.00	$185.00	$81.00–$169.00	59% below	25%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 Us Ob Less Than 14 Weeks Single	$229.00	$305.00	$134.00–$279.00	33% below	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Us Ob Ltd W/ Bpp + Umb Dop + Mid Cer Dopreport	$173.00	$230.00	$101.00–$210.00	7% above	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Us Ob Limited W/ Biophysical Prof Multireport	$173.00	$230.00	$101.00–$210.00	7% above	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Us Ob Limited W/ Biophysical Profilereport	$173.00	$230.00	$101.00–$210.00	7% above	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Us Ob Limitedreport	$173.00	$230.00	$101.00–$210.00	7% above	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 76815 Us Ob Limited W/ Biophysical Profile Multi	$173.00	$230.00	$101.00–$210.00	7% above	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Us Ob Limited 76815, 1 Or More Fetus	$357.00	$476.00	$209.00–$436.00	120% above	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Us Ob Limited W/ Biophysical Profile	$548.00	$731.00	$322.00–$669.00	238% above	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Us Ob Limited	$548.00	$731.00	$322.00–$669.00	238% above	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 76815 Us Ob Limited W/ Biophysical Profile	$548.00	$731.00	$322.00–$669.00	238% above	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Us Ob Ltd W/ Bpp + Umb Dop + Mid Cer Dop	$548.00	$731.00	$322.00–$669.00	238% above	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Us Ob Limited W/ Biophysical Prof Multi	$548.00	$731.00	$322.00–$669.00	238% above	25%
Screening mammogram, both breasts both sides CPT 77067 Mammography, screening, bilateral	$411.00	$548.00	$241.00–$501.00	—	25%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 Xr Shoulder Complete 2+ Views Left	$401.00	$535.00	$235.00–$490.00	68% above	25%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 Xr Shoulder Complete 2+ Views Right	$401.00	$535.00	$235.00–$490.00	68% above	25%
Transvaginal pelvic ultrasound CPT 76830 Ultrasound pelvis through vagina	$422.00	$563.00	$248.00–$515.00	95% above	25%
Transvaginal ultrasound during pregnancy CPT 76817 Us Ob Transvaginalreport	$154.00	$205.00	$90.00–$188.00	20% below	25%
Transvaginal ultrasound during pregnancy CPT 76817 Us Ob 76817 Transvaginal	$277.00	$369.00	$162.00–$338.00	44% above	25%
Transvaginal ultrasound during pregnancy CPT 76817 Us Ob Transvaginal	$461.00	$615.00	$271.00–$563.00	140% above	25%
Transvaginal ultrasound during pregnancy CPT 76817 Bill Only Us Ob Transvaginal	$461.00	$615.00	$271.00–$563.00	140% above	25%
Ultrasound of the abdomen, complete CPT 76700 Ultrasound of abdomen	$842.00	$1,122.00	$494.00–$1,027.00	10% above	25%
Ultrasound of the scrotum and testicles CPT 76870 Us Scrotum (Contents)report	$170.00	$226.00	$99.00–$207.00	63% below	25%
Ultrasound of the scrotum and testicles CPT 76870 Us Scrotum (Contents)	$693.00	$924.00	$407.00–$845.00	50% above	25%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Us Thyroid	$548.00	$731.00	$322.00–$669.00	77% above	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Us Lower Ext Venous Duplex Left	$646.00	$861.00	$379.00–$788.00	at median	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Us Lower Ext Venous Duplex Right	$646.00	$861.00	$379.00–$788.00	at median	25%
Wrist X-ray, complete, 3 or more views CPT 73110 Bill Only Xr Wrist	$338.00	$450.00	$198.00–$412.00	27% above	25%
Wrist X-ray, complete, 3 or more views one side CPT 73110 Xr Wrist Complete 3+ Views Right	$338.00	$450.00	$198.00–$412.00	27% above	25%
Wrist X-ray, complete, 3 or more views one side CPT 73110 Xr Wrist Complete 3+ Views Left	$338.00	$450.00	$198.00–$412.00	27% above	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 Xr Hip 2-3 Views Right	$163.00	$217.00	$95.00–$199.00	19% below	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 Xr Hip 2-3 Views Left	$163.00	$217.00	$95.00–$199.00	19% below	25%
X-ray of the abdomen, 1 view CPT 74018 Xr Abdomen 1 View	$293.00	$391.00	$172.00–$358.00	26% above	25%
X-ray of the ankle, 2 views both sides CPT 73600 Xr Ankle 2 Views Bilateral	$565.00	$753.00	$331.00–$689.00	—	25%
X-ray of the ankle, 2 views CPT 73600 Xr Ankle 2 Views Rightreport	$41.00	$54.00	$24.00–$49.00	80% below	24%
X-ray of the ankle, 2 views CPT 73600 Xr Ankle 2 Views Leftreport	$41.00	$54.00	$24.00–$49.00	80% below	24%
X-ray of the ankle, 2 views CPT 73600 Xr Ankle 2 Views Bilateralreport	$82.00	$109.00	$48.00–$100.00	60% below	25%
X-ray of the ankle, 2 views CPT 73600 Bill Only Xr Ankle	$293.00	$391.00	$172.00–$358.00	42% above	25%
X-ray of the ankle, 2 views one side CPT 73600 Xr Ankle 2 Views Left	$293.00	$391.00	$172.00–$358.00	42% above	25%
X-ray of the ankle, 2 views one side CPT 73600 Xr Ankle 2 Views Right	$293.00	$391.00	$172.00–$358.00	42% above	25%
X-ray of the finger(s), 2 or more views CPT 73140 Xr Finger(3rd Digit) 2+ Views Rightreport	$36.00	$48.00	$21.00–$44.00	83% below	25%
X-ray of the finger(s), 2 or more views CPT 73140 Xr Finger(5th Digit) 2+ Views Rightreport	$36.00	$48.00	$21.00–$44.00	83% below	25%
X-ray of the finger(s), 2 or more views CPT 73140 Xr Finger(5th Digit) 2+ Views Leftreport	$36.00	$48.00	$21.00–$44.00	83% below	25%
X-ray of the finger(s), 2 or more views CPT 73140 Xr Finger(4th Digit) 2+ Views Rightreport	$36.00	$48.00	$21.00–$44.00	83% below	25%
X-ray of the finger(s), 2 or more views CPT 73140 Xr Finger(4th Digit) 2+ Views Leftreport	$36.00	$48.00	$21.00–$44.00	83% below	25%
X-ray of the finger(s), 2 or more views CPT 73140 Xr Finger(3rd Digit) 2+ Views Leftreport	$36.00	$48.00	$21.00–$44.00	83% below	25%
X-ray of the finger(s), 2 or more views CPT 73140 Xr Finger(2nd Digit) 2+ Views Rightreport	$36.00	$48.00	$21.00–$44.00	83% below	25%
X-ray of the finger(s), 2 or more views CPT 73140 Xr Finger(2nd Digit) 2+ Views Leftreport	$36.00	$48.00	$21.00–$44.00	83% below	25%
X-ray of the finger(s), 2 or more views CPT 73140 Xr Finger(1st Digit) 2+ Views Rightreport	$36.00	$48.00	$21.00–$44.00	83% below	25%
X-ray of the finger(s), 2 or more views CPT 73140 Xr Finger(1st Digit) 2+ Views Leftreport	$36.00	$48.00	$21.00–$44.00	83% below	25%
X-ray of the finger(s), 2 or more views CPT 73140 Bill Only Xr Finger 5th Digit	$149.00	$198.00	$87.00–$181.00	31% below	25%
X-ray of the finger(s), 2 or more views CPT 73140 Bill Only Xr Finger 1st Digit	$149.00	$198.00	$87.00–$181.00	31% below	25%
X-ray of the finger(s), 2 or more views CPT 73140 Bill Only Xr Finger 2nd Digit	$149.00	$198.00	$87.00–$181.00	31% below	25%
X-ray of the finger(s), 2 or more views CPT 73140 Bill Only Xr Finger 3rd Digit	$149.00	$198.00	$87.00–$181.00	31% below	25%
X-ray of the finger(s), 2 or more views CPT 73140 Bill Only Xr Finger 4th Digit	$149.00	$198.00	$87.00–$181.00	31% below	25%
X-ray of the finger(s), 2 or more views one side CPT 73140 Xr Finger(4th Digit) 2+ Views Left	$149.00	$198.00	$87.00–$181.00	31% below	25%
X-ray of the finger(s), 2 or more views one side CPT 73140 Xr Finger(4th Digit) 2+ Views Right	$149.00	$198.00	$87.00–$181.00	31% below	25%
X-ray of the finger(s), 2 or more views one side CPT 73140 Xr Finger(5th Digit) 2+ Views Left	$149.00	$198.00	$87.00–$181.00	31% below	25%
X-ray of the finger(s), 2 or more views one side CPT 73140 Xr Finger(5th Digit) 2+ Views Right	$149.00	$198.00	$87.00–$181.00	31% below	25%
X-ray of the finger(s), 2 or more views one side CPT 73140 Xr Finger(3rd Digit) 2+ Views Left	$149.00	$198.00	$87.00–$181.00	31% below	25%
X-ray of the finger(s), 2 or more views one side CPT 73140 Xr Finger(1st Digit) 2+ Views Right	$149.00	$198.00	$87.00–$181.00	31% below	25%
X-ray of the finger(s), 2 or more views one side CPT 73140 Xr Finger(1st Digit) 2+ Views Left	$149.00	$198.00	$87.00–$181.00	31% below	25%
X-ray of the finger(s), 2 or more views one side CPT 73140 Xr Finger(2nd Digit) 2+ Views Right	$149.00	$198.00	$87.00–$181.00	31% below	25%
X-ray of the finger(s), 2 or more views one side CPT 73140 Xr Finger(2nd Digit) 2+ Views Left	$149.00	$198.00	$87.00–$181.00	31% below	25%
X-ray of the finger(s), 2 or more views one side CPT 73140 Xr Finger(3rd Digit) 2+ Views Right	$149.00	$198.00	$87.00–$181.00	31% below	25%
X-ray of the foot, 2 views both sides CPT 73620 Xr Foot 2 Views Bilateral	$565.00	$753.00	$331.00–$689.00	—	25%
X-ray of the foot, 2 views CPT 73620 Xr Foot 2 Views Leftreport	$41.00	$54.00	$24.00–$49.00	79% below	24%
X-ray of the foot, 2 views CPT 73620 Xr Foot 2 Views Rightreport	$41.00	$54.00	$24.00–$49.00	79% below	24%
X-ray of the foot, 2 views CPT 73620 Xr Foot 2 Views Bilateralreport	$78.00	$104.00	$46.00–$95.00	60% below	25%
X-ray of the foot, 2 views CPT 73620 Bill Only Xr Foot	$293.00	$391.00	$172.00–$358.00	50% above	25%
X-ray of the foot, 2 views one side CPT 73620 Xr Foot 2 Views Left	$293.00	$391.00	$172.00–$358.00	50% above	25%
X-ray of the foot, 2 views one side CPT 73620 Xr Foot 2 Views Right	$293.00	$391.00	$172.00–$358.00	50% above	25%
X-ray of the foot, complete, 3 or more views both sides CPT 73630 Xr Foot Complete 3+ Views Bilateral	$650.00	$866.00	$381.00–$792.00	—	25%
X-ray of the foot, complete, 3 or more views one side CPT 73630 Xr Foot Complete 3+ Views Right	$338.00	$450.00	$198.00–$412.00	30% above	25%
X-ray of the foot, complete, 3 or more views one side CPT 73630 Xr Foot Complete 3+ Views Left	$338.00	$450.00	$198.00–$412.00	30% above	25%
X-ray of the hand, 3 or more views one side CPT 73130 Xr Hand Complete 3+ Views Left	$338.00	$450.00	$198.00–$412.00	47% above	25%
X-ray of the hand, 3 or more views one side CPT 73130 Xr Hand Complete 3+ Views Right	$338.00	$450.00	$198.00–$412.00	47% above	25%
X-ray of the knee, 1 or 2 views both sides CPT 73560 Xr Knee 1 Or 2 Views Bilateral	$650.00	$866.00	$381.00–$792.00	—	25%
X-ray of the knee, 1 or 2 views CPT 73560 Xr Knee 1 Or 2 Views Leftreport	$44.00	$59.00	$26.00–$54.00	80% below	25%
X-ray of the knee, 1 or 2 views CPT 73560 Xr Knee 1 Or 2 Views Rightreport	$44.00	$59.00	$26.00–$54.00	80% below	25%
X-ray of the knee, 1 or 2 views CPT 73560 Xr Knee 1 Or 2 Views Bilateralreport	$88.00	$117.00	$51.00–$107.00	61% below	25%
X-ray of the knee, 1 or 2 views CPT 73560 Bill Only Xr Knee	$338.00	$450.00	$198.00–$412.00	51% above	25%
X-ray of the knee, 1 or 2 views one side CPT 73560 Xr Knee 1 Or 2 Views Right	$338.00	$450.00	$198.00–$412.00	51% above	25%
X-ray of the knee, 1 or 2 views one side CPT 73560 Xr Knee 1 Or 2 Views Left	$338.00	$450.00	$198.00–$412.00	51% above	25%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 Xr Spine Lumbosacral 2 Or 3 Viewsreport	$59.00	$78.00	$34.00–$71.00	78% below	24%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 Bill Only Xr L-spine	$393.00	$524.00	$231.00–$479.00	49% above	25%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 Xr Spine Lumbosacral 2 Or 3 Views	$393.00	$524.00	$231.00–$479.00	49% above	25%
X-ray of the lower back, 4 or more views CPT 72110 X-Ray of lower back	$496.00	$661.00	$291.00–$605.00	25% above	25%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 Xr Spine Thoracic 2 Viewsreport	$59.00	$78.00	$34.00–$71.00	75% below	24%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 Bill Only Xr T-spine	$367.00	$489.00	$215.00–$447.00	53% above	25%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 Xr Spine Thoracic 2 Views	$367.00	$489.00	$215.00–$447.00	53% above	25%
X-ray of the nasal bones, 3 or more views CPT 70160 Xr Nasal Bones 3+ Viewsreport	$46.00	$61.00	$27.00–$56.00	82% below	25%
X-ray of the nasal bones, 3 or more views CPT 70160 Xr Nasal Bones 3+ Views	$293.00	$391.00	$172.00–$358.00	14% above	25%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 Xr Spine Cervical 2 Or 3 Viewsreport	$65.00	$87.00	$38.00–$80.00	77% below	25%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 Bill Only Xr C-spine	$393.00	$524.00	$231.00–$479.00	39% above	25%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 Xr Spine Cervical 2 Or 3 Views	$393.00	$524.00	$231.00–$479.00	39% above	25%
X-ray of the pelvis, 1 or 2 views CPT 72170 Xr Pelvis 1 Or 2 Viewsreport	$44.00	$59.00	$26.00–$54.00	79% below	25%
X-ray of the pelvis, 1 or 2 views CPT 72170 Xr Pelvis 1 Or 2 Views	$293.00	$391.00	$172.00–$358.00	40% above	25%
X-ray of the pelvis, 1 or 2 views CPT 72170 Bill Only Xr Pelvis	$293.00	$391.00	$172.00–$358.00	40% above	25%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 Xr Sacrum/coccyx 2+ Viewsreport	$50.00	$67.00	$29.00–$61.00	80% below	25%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 Xr Sacrum/coccyx 2+ Views	$338.00	$450.00	$198.00–$412.00	33% above	25%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Maine	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 Alanine Aminotransferase	$26.00	$34.00	$15.00–$31.00	19% below	24%
AST (aspartate aminotransferase) enzyme test CPT 84450 Aspartate Aminotransferase	$26.00	$34.00	$15.00–$31.00	10% below	24%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Acute Hepatitis Panel W/rfx To Confirm. Qst	$572.00	$762.00	$335.00–$697.00	250% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Egg Yolk (F75) Ige Qst	$127.00	$169.00	$74.00–$155.00	530% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Cow's Milk (F2) Ige Qst	$127.00	$169.00	$74.00–$155.00	530% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Timothy Grass (G6) Ige Qst	$127.00	$169.00	$74.00–$155.00	530% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Shrimp (F24) Ige Qst	$127.00	$169.00	$74.00–$155.00	530% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Sheep Sorrel (W18) Ige Qst	$127.00	$169.00	$74.00–$155.00	530% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Penicillium Notatum (M1) Ige Qst	$127.00	$169.00	$74.00–$155.00	530% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Oak (T7) Ige Qst	$127.00	$169.00	$74.00–$155.00	530% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Dermatophagoides Farinae (D2) Ige Qst	$127.00	$169.00	$74.00–$155.00	530% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Dog Dander (E5) Ige Qst	$127.00	$169.00	$74.00–$155.00	530% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Egg White (F1) Ige Qst	$127.00	$169.00	$74.00–$155.00	530% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Elm (T8) Ige Qst	$127.00	$169.00	$74.00–$155.00	530% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Alternaria Alternata (M6) Ige Qst	$127.00	$169.00	$74.00–$155.00	530% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Aspergillus Fumigatus (M3) Ige Qst	$127.00	$169.00	$74.00–$155.00	530% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Bermuda Grass (G2) Ige Qst	$127.00	$169.00	$74.00–$155.00	530% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Cat Dander (E1) Ige Qst	$127.00	$169.00	$74.00–$155.00	530% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Cockroach (I6) Ige Qst	$127.00	$169.00	$74.00–$155.00	530% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Common Ragweed (Short) (W1) Ige Qst	$127.00	$169.00	$74.00–$155.00	530% above	25%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Ccp Ab (Igg) Qst	$236.00	$314.00	$138.00–$287.00	242% above	25%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Ana Scr, Ifa W/rfx Titer/pattern & Rfx Mpl X 11 Ab Cascade Qst	$182.00	$242.00	$106.00–$221.00	278% above	25%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Ana Screen, Ifa, W/refl Tit &Pattern Qst	$182.00	$242.00	$106.00–$221.00	278% above	25%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 B-type Natriuretic Peptide	$290.00	$386.00	$170.00–$353.00	105% above	25%
Basic metabolic panel (blood test) CPT 80048 Basic metabolic panel	$76.00	$101.00	$44.00–$92.00	3% below	25%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Bill Only Tissue Exam Level Iv Multiple	$147.00	$196.00	$86.00–$179.00	1% above	25%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Bill Only Tissue Exam Level Iv	$147.00	$196.00	$86.00–$179.00	1% above	25%
Blood culture for bacteria CPT 87040 Culture Blood Mb Qst	$223.00	$297.00	$131.00–$272.00	140% above	25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 36415 Collection Of Venous Blood By Venipuncture	$17.00	$22.00	$10.00–$20.00	35% above	23%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Collection: Venous Draw	$17.00	$22.00	$10.00–$20.00	35% above	23%
Blood glucose (sugar) test CPT 82947 .Gtt 1 Hr	$26.00	$34.00	$15.00–$31.00	8% above	24%
Blood glucose (sugar) test CPT 82947 Glucose Level	$26.00	$34.00	$15.00–$31.00	8% above	24%
Blood glucose (sugar) test CPT 82947 Glucose Fasting	$26.00	$34.00	$15.00–$31.00	8% above	24%
Blood lead test CPT 83655 Lead, Blood Qst	$83.00	$110.00	$48.00–$101.00	84% above	25%
Blood lead test CPT 83655 Lead Qst	$83.00	$110.00	$48.00–$101.00	84% above	25%
Blood lead test CPT 83655 Hetl Lead, Capillary Qst	$86.00	$115.00	$51.00–$105.00	91% above	25%
Blood lead test CPT 83655 Hetl Lead Qst	$86.00	$115.00	$51.00–$105.00	91% above	25%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Pregnancy Test Serum Qual	$121.00	$161.00	$71.00–$147.00	192% above	25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Abo/rh Retype	$101.00	$135.00	$59.00–$124.00	97% above	25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 .Pre Tr Abo/rh	$101.00	$135.00	$59.00–$124.00	97% above	25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Bill Only Abo Discrepancy Solution	$101.00	$135.00	$59.00–$124.00	97% above	25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Cord Abo/rh	$101.00	$135.00	$59.00–$124.00	97% above	25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 .Post Tr Abo/rh	$101.00	$135.00	$59.00–$124.00	97% above	25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Abo/rh	$101.00	$135.00	$59.00–$124.00	97% above	25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Abo Only	$101.00	$135.00	$59.00–$124.00	97% above	25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-reactive Protein	$68.00	$90.00	$40.00–$82.00	69% above	24%
C. difficile toxin gene test (stool PCR) CPT 87493 Clostridium Difficile (Genexpert)	$173.00	$230.00	$101.00–$210.00	89% above	25%
CA 19-9 blood test (tumor marker) CPT 86301 Ca 19-9 Qst	$258.00	$344.00	$151.00–$315.00	459% above	25%
CA-125 blood test (ovarian cancer marker) CPT 86304 Ca 125 Qst	$483.00	$644.00	$283.00–$589.00	449% above	25%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Sars-cov-2 Rna (Covid-19), Qualitative Naat Qst	$89.00	$119.00	$52.00–$109.00	27% above	25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 C. Trachomatis, Urogenital Qst	$122.00	$163.00	$72.00–$149.00	65% above	25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia Trachomatis Rna, Tma Qst	$122.00	$163.00	$72.00–$149.00	65% above	25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia Trachomatis	$131.00	$174.00	$77.00–$159.00	77% above	25%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Blood test, lipids	$95.00	$127.00	$56.00–$116.00	34% above	25%
Complete blood count (CBC) with differential CPT 85025 Complete blood cell count (CBC), with differential white blood cells, automated	$99.00	$132.00	$58.00–$121.00	131% above	25%
Complete blood count (CBC), no differential CPT 85027 Complete blood cell count (CBC), automated	$80.00	$106.00	$47.00–$97.00	159% above	25%
Comprehensive metabolic panel (blood test) CPT 80053 Blood test, comprehensive group of blood chemicals	$98.00	$130.00	$57.00–$119.00	7% below	25%
DHEA sulfate (DHEA-S) blood test CPT 82627 Dhea Sulfate Qst	$466.00	$621.00	$273.00–$568.00	428% above	25%
Estradiol blood test CPT 82670 Estradiol Qst	$535.00	$713.00	$314.00–$652.00	430% above	25%
FSH (follicle-stimulating hormone) test CPT 83001 Fsh Qst	$183.00	$244.00	$107.00–$223.00	125% above	25%
Fecal calprotectin (stool inflammation test) CPT 83993 Calprotectin, Stool Qst	$174.00	$232.00	$102.00–$212.00	8% above	25%
Ferritin blood test (iron stores) CPT 82728 Ferritin Level	$321.00	$428.00	$188.00–$392.00	357% above	25%
Ferritin blood test (iron stores) CPT 82728 Ferritin	$321.00	$428.00	$188.00–$392.00	357% above	25%
Folate (folic acid) blood test CPT 82746 Folate Level	$242.00	$322.00	$142.00–$295.00	251% above	25%
Free T3 thyroid hormone test CPT 84481 T3, Free Qst	$138.00	$184.00	$81.00–$168.00	68% above	25%
Free T4 (free thyroxine) thyroid blood test CPT 84439 Thyroxine (T4) Free	$88.00	$117.00	$51.00–$107.00	54% above	25%
Free T4 (free thyroxine) thyroid blood test CPT 84439 Free T4 Level	$88.00	$117.00	$51.00–$107.00	54% above	25%
Free testosterone test CPT 84402 Testosterone, Free Qst	$271.00	$361.00	$159.00–$330.00	209% above	25%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 Bill Only General Health Panel	$296.00	$394.00	$173.00–$361.00	26% below	25%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 .Gtt 2 Hr	$31.00	$41.00	$18.00–$38.00	15% below	24%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Gtt 2 Hr 75 Gm	$55.00	$73.00	$32.00–$67.00	51% above	25%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Gestational Diabetes Screen	$57.00	$76.00	$33.00–$70.00	56% above	25%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 .Gtt 2 Hr 75gm	$57.00	$76.00	$33.00–$70.00	56% above	25%
Glucose tolerance test, 3 samples CPT 82951 Z Glucose Tolerance 3 Specimen	$117.00	$156.00	$69.00–$143.00	75% above	25%
Glucose tolerance test, 3 samples CPT 82951 Bill Only Glucose Tolerance 3 Specimen	$117.00	$156.00	$69.00–$143.00	75% above	25%
Glucose tolerance test, 3 samples CPT 82951 .Gtt 3 Hr 100gm	$117.00	$156.00	$69.00–$143.00	75% above	25%
Glucose tolerance test, 3 samples CPT 82951 .Gtt 3 Hr	$122.00	$163.00	$72.00–$149.00	83% above	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 N.gonorrhoeae Rna, Urogen Qst	$116.00	$155.00	$68.00–$142.00	89% above	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Neisseria Gonorrhoeae Rna, Tma Qst	$116.00	$155.00	$68.00–$142.00	89% above	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Neisseria Gonorrhoeae	$131.00	$174.00	$77.00–$159.00	113% above	25%
H. pylori stool antigen test CPT 87338 Helicobacter Pylori Ag, Eia, Stool Mb Qst	$221.00	$295.00	$130.00–$270.00	81% above	25%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 Hiv 1 Rna, Quant Real Time Pcr Qst	$574.00	$765.00	$337.00–$700.00	177% above	25%
HIV-1 and HIV-2 antibody test CPT 86703 Hiv 1/2 Antibody Screen	$167.00	$223.00	$98.00–$204.00	377% above	25%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 Hiv 1/2 Ag/ab, Fourth Gen W/rfl Qst	$147.00	$196.00	$86.00–$179.00	216% above	25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hgb A1c	$98.00	$131.00	$58.00–$120.00	132% above	25%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hep B Surface Ab Ql Qst	$143.00	$190.00	$84.00–$174.00	203% above	25%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hep B Surface Antibody Ql Qst	$143.00	$190.00	$84.00–$174.00	203% above	25%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hep B Surface Ag W/refl Confirm Qst	$143.00	$190.00	$84.00–$174.00	199% above	25%
Hepatitis C antibody blood test (screening) CPT 86803 Hep C Ab W/refl To Hcv Rna, Qn, Pcr Qst	$216.00	$288.00	$127.00–$264.00	206% above	25%
Hepatitis C viral load (HCV RNA) test CPT 87522 Hcv Rna, Quantitative Real Time Pcr Qst	$476.00	$634.00	$279.00–$580.00	176% above	25%
Hepatitis C viral load (HCV RNA) test CPT 87522 .Hcv Rna, Quant Real Time Pcr Qst	$476.00	$634.00	$279.00–$580.00	176% above	25%
Herpes blood test, HSV-1 antibody CPT 86695 Hsv 1 Igg Index Csf: Qst	$36.00	$48.00	$21.00–$44.00	14% below	25%
Herpes blood test, HSV-1 antibody CPT 86695 Hsv 1 Igg, Type Specific Ab Qst	$179.00	$238.00	$105.00–$218.00	329% above	25%
Herpes blood test, HSV-2 antibody CPT 86696 Hsv 2 Igg Index Csf: Qst	$36.00	$48.00	$21.00–$44.00	37% below	25%
Herpes blood test, HSV-2 antibody CPT 86696 Hsv 2 Igg, Type Specific Ab Qst	$179.00	$238.00	$105.00–$218.00	215% above	25%
High-sensitivity CRP (hs-CRP) test CPT 86141 Hs Crp Qst	$415.00	$553.00	$243.00–$506.00	730% above	25%
Homocysteine blood test CPT 83090 Homocysteine Qst	$227.00	$303.00	$133.00–$277.00	195% above	25%
Insulin blood test CPT 83525 Insulin Qst	$250.00	$333.00	$147.00–$305.00	386% above	25%
Iron blood test (serum iron) CPT 83540 Iron Level	$84.00	$112.00	$49.00–$102.00	140% above	25%
Iron-binding capacity (TIBC) test CPT 83550 Total Iron Binding Capacity	$59.00	$79.00	$35.00–$72.00	49% above	25%
Kidney function blood test panel CPT 80069 Kidney function panel test	$97.00	$129.00	$57.00–$118.00	43% above	25%
LH (luteinizing hormone) test CPT 83002 Lh Qst	$322.00	$429.00	$189.00–$393.00	274% above	25%
Lipase blood test (pancreas enzyme) CPT 83690 Lipase Level	$182.00	$242.00	$106.00–$221.00	295% above	25%
Liver function blood test panel CPT 80076 Liver function blood test	$73.00	$97.00	$43.00–$89.00	12% below	25%
Lyme disease antibody test CPT 86618 Lyme Disease Ab W/rfx Blot (Igg,igm) Qst	$143.00	$191.00	$84.00–$175.00	93% above	25%
Lyme disease antibody test CPT 86618 Lyme Disease (Borrelia Burgdorferi Abs)	$143.00	$191.00	$84.00–$175.00	93% above	25%
Magnesium blood test CPT 83735 Magnesium Level	$30.00	$40.00	$18.00–$37.00	21% below	25%
Measles (rubeola) antibody test CPT 86765 Measles (Rubeola) Igm,ifa Qst	$36.00	$48.00	$21.00–$44.00	13% above	25%
Measles (rubeola) antibody test CPT 86765 Measles (Rubeola) Igg,ifa Qst	$36.00	$48.00	$21.00–$44.00	13% above	25%
Measles (rubeola) antibody test CPT 86765 Measles Ab (Igg) Qst	$111.00	$148.00	$65.00–$135.00	247% above	25%
Mono test (heterophile antibody, Monospot) CPT 86308 Mononucleosis Screen	$77.00	$103.00	$45.00–$94.00	118% above	25%
Mono test (heterophile antibody, Monospot) CPT 86308 Monospot Clinic Poc (Re)	$77.00	$103.00	$45.00–$94.00	118% above	25%
Obstetric blood test panel CPT 80055 Obstetric blood test panel	$807.00	$1,076.00	$473.00–$985.00	467% above	25%
PSA (prostate-specific antigen) blood test, free CPT 84154 Total prostate-specific antigen (PSA) test	$278.00	$371.00	$163.00–$339.00	193% above	25%
PSA (prostate-specific antigen) blood test, total CPT 84153 Total prostate-specific antigen (PSA) test	$72.00	$96.00	$42.00–$88.00	7% above	25%
Pap test (liquid-based, automated screening with review) CPT 88175 Bill Only Thin Prep Pap Test Imaging	$89.00	$118.00	$52.00–$108.00	36% above	25%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 Bill Only Pap Smear Sure Path Diagnostic	$85.00	$113.00	$50.00–$103.00	21% above	25%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 Bill Only Pap Smear Sure Path Screening	$85.00	$113.00	$50.00–$103.00	21% above	25%
Parathyroid hormone (PTH) blood test CPT 83970 Parathyroid Hormone,intact Qst	$408.00	$544.00	$239.00–$498.00	341% above	25%
Parathyroid hormone (PTH) blood test CPT 83970 Pth, Intact W/o Calcium Qst	$408.00	$544.00	$239.00–$498.00	341% above	25%
Partial thromboplastin time (PTT) clotting test CPT 85730 Coagulation assessment blood test	$130.00	$173.00	$76.00–$158.00	210% above	25%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 Fish Prenatal Screen Qst	$2,064.00	$2,752.00	$1,211.00–$2,518.00	69% above	25%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 Qnatal(tm) Advanced Qst	$2,064.00	$2,752.00	$1,211.00–$2,518.00	69% above	25%
Progesterone blood test CPT 84144 Progesterone Qst	$354.00	$472.00	$208.00–$432.00	299% above	25%
Prolactin blood test CPT 84146 Prolactin Qst	$234.00	$312.00	$137.00–$285.00	215% above	25%
Prothrombin time (PT/INR) clotting test CPT 85610 Blood test, clotting time	$74.00	$98.00	$43.00–$90.00	160% above	24%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 Urine Drug Screen Clinic Poc (Re)	$22.00	$29.00	$13.00–$27.00	33% below	24%
Rapid flu test (influenza antigen) CPT 87804 Influenza A/b	$88.00	$117.00	$51.00–$107.00	26% above	25%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Strep A Screen	$53.00	$70.00	$31.00–$64.00	28% above	24%
Rheumatoid factor (RF) test CPT 86431 Rheumatoid Factor Qst	$151.00	$201.00	$88.00–$184.00	369% above	25%
Rubella antibody test (immunity check) CPT 86762 Rubella Immune Status Qst	$70.00	$93.00	$41.00–$85.00	64% above	25%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 Sed Rate (Esr) Auto	$113.00	$151.00	$66.00–$138.00	211% above	25%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 Sedimentation Rate (Esr)	$113.00	$151.00	$66.00–$138.00	211% above	25%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 Bill Only Sperm Morphometry	$15.00	$20.00	$9.00–$18.00	73% below	25%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 Semen Analysis	$354.00	$472.00	$208.00–$432.00	529% above	25%
Stool ova and parasites exam CPT 87177 Ova & Parasites, Conc & Perm Smr Mb Qst	$250.00	$333.00	$147.00–$305.00	580% above	25%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 Fecal Occult Blood (Ifobt) Clinic Poc (Re)	$41.00	$55.00	$24.00–$50.00	at median	25%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 Occult Blood Diagnostic 1st Spec	$52.00	$69.00	$30.00–$63.00	27% above	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Rpr (Monitor) W/ Rfx To Titer Qst	$87.00	$116.00	$51.00–$106.00	185% above	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Vdrl, Csf Qst	$95.00	$127.00	$56.00–$116.00	211% above	25%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Quantiferon Tb Gold Plus, 4t, Incubated Qst	$203.00	$270.00	$119.00–$247.00	86% above	25%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone, Total, Lc/ms/ms Qst	$271.00	$361.00	$159.00–$330.00	236% above	25%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone,bioavailable Qst	$271.00	$361.00	$159.00–$330.00	236% above	25%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone, Bioavailable Qst	$271.00	$361.00	$159.00–$330.00	236% above	25%
Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroid Peroxidase Abs Qst	$220.00	$293.00	$129.00–$268.00	162% above	25%
Thyroid peroxidase (TPO) antibody test CPT 86376 Liver Kidney Microsome Ab (Igg) Qst	$367.00	$489.00	$215.00–$447.00	338% above	25%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Blood test, thyroid stimulating hormone (TSH)	$98.00	$131.00	$58.00–$120.00	35% above	25%
Trichomonas test (NAAT) CPT 87661 Trichomonas Vaginalis Rna, Ql, Tma Qst	$116.00	$155.00	$68.00–$142.00	34% above	25%
Uric acid blood test CPT 84550 Uric Acid	$28.00	$37.00	$16.00–$34.00	1% below	24%
Urinalysis with microscope exam, automated CPT 81001 Urinalysis test using microscope	$48.00	$64.00	$28.00–$59.00	37% above	25%
Urinalysis without microscope exam, automated CPT 81003 Urinalysis test	$34.00	$45.00	$20.00–$41.00	71% above	24%
Urine culture for bacteria, with colony count CPT 87086 Culture Urine Special Mb Qst	$144.00	$192.00	$84.00–$176.00	124% above	25%
Urine culture for bacteria, with colony count CPT 87086 Culture Urine Mb Qst	$144.00	$192.00	$84.00–$176.00	124% above	25%
Urine pregnancy test, read by color change CPT 81025 Urine Pregnancy Qual Poc (Re)	$80.00	$106.00	$47.00–$97.00	180% above	25%
Urine pregnancy test, read by color change CPT 81025 Pregnancy Test Urine Qual	$83.00	$110.00	$48.00–$101.00	191% above	25%
Urine pregnancy test, read by color change CPT 81025 Urine Pregnancy Test Poc	$86.00	$115.00	$51.00–$105.00	201% above	25%
Urine pregnancy test, read by color change CPT 81025 Urine Pregnancy Test Clinic Poc (Re)	$86.00	$115.00	$51.00–$105.00	201% above	25%
Urine pregnancy test, read by color change CPT 81025 81025 Urine Pregnancy Test, By Visual Color Comparison Methods	$86.00	$115.00	$51.00–$105.00	201% above	25%
Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B12 Level	$254.00	$338.00	$149.00–$309.00	202% above	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D 25 Hydroxy Level	$125.00	$167.00	$73.00–$153.00	12% above	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 25-oh Vit D (D2,d3), Lc/ms/ms Qst	$125.00	$167.00	$73.00–$153.00	12% above	25%
Zinc blood test CPT 84630 Zinc Qst	$163.00	$217.00	$95.00–$199.00	330% above	25%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Beta-hcg Quantitative	$224.00	$299.00	$132.00–$274.00	229% above	25%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Hcg, Total, Qn Qst	$224.00	$299.00	$132.00–$274.00	229% above	25%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Beta Hcg Quantitative	$224.00	$299.00	$132.00–$274.00	229% above	25%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Maine	Off list
Adenoid removal (adenoidectomy), child under 12 CPT 42830 42830 Adenoidectomy, Primary; Younger Than Age 12	$479.00	$639.00	$281.00–$585.00	—	25%
Appendectomy for a ruptured appendix with abscess or peritonitis CPT 44960 44960 Appendectomy; For Ruptured Appendix With Abscess Or Generalized Peritonitis	$2,981.00	$3,975.00	$1,749.00–$3,637.00	31% above	25%
Arthroscopic ACL reconstruction or repair of the knee CPT 29888 29888 Arthroscopically Aided Anterior Cruciate Ligament Repair/augmentation Or Reconstruction	$1,858.00	$2,477.00	$1,090.00–$2,266.00	22% below	25%
Arthroscopic rotator cuff repair of the shoulder CPT 29827 29827 Arthroscopy, Shoulder, Surgical; With Rotator Cuff Repair	$2,016.00	$2,688.00	$1,183.00–$2,460.00	at median	25%
Balloon dilation of the maxillary sinus opening, one side CPT 31295 31295 Nasal/sinus Endoscopy, Surgical; With Dilation Of Maxillary Sinus Ostium (Eg, Balloon Dilation	$2,563.00	$3,417.00	$1,503.00–$3,127.00	—	25%
Botox injections for chronic migraine both sides CPT 64615 64615 Chemodenervation Of Muscle(s); Muscle(s) Innervated Nerves, Bilateral	$450.00	$600.00	$264.00–$549.00	—	25%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 27786 Cltx Dstl Fibular Fx Lat Malls W/o Manj Techfee	$371.00	$494.00	$217.00–$452.00	29% above	25%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 27786 Closed Treatment Of Distal Fibular Fracture (Lateral Malleolus); Without Manipulation	$603.00	$804.00	$354.00–$736.00	110% above	25%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 28470 Closed Tx Metatarsal Fracture W/o Manipulation Techfee	$371.00	$494.00	$217.00–$452.00	53% above	25%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 28470 Closed Treatment Of Metatarsal Fracture; Without Manipulation, Each	$632.00	$842.00	$370.00–$770.00	160% above	25%
Bunion correction with a bone cut near the head of the first metatarsal CPT 28296 28296 Correction, Hallux Valgus (Bunion), With Or Without Sesamoidectomy; With Metatarsal Osteotomy	$1,447.00	$1,929.00	$849.00–$1,765.00	at median	25%
Bunion correction with removal of part of the big toe joint CPT 28292 28292 Correction, Hallux Valgus (Bunion), W/ Or W/o Sesamoidectomy; Keller, Mayo Type Procedure	$1,238.00	$1,651.00	$726.00–$1,511.00	—	25%
Cardioversion, elective (restoring heart rhythm) CPT 92960 92960 Cardioversion Elective Arrhythmia External Techfee	$327.00	$436.00	$192.00–$399.00	23% below	25%
Carpal tunnel release, open surgery CPT 64721 64721 Neuroplasty And/or Transposition; Median Nerve At Carpal Tunnel	$1,078.00	$1,437.00	$632.00–$1,315.00	20% above	25%
Cataract surgery with lens implant CPT 66984 Removal of cataract with insertion of lens	$4,532.00	$6,042.00	$2,658.00–$5,528.00	—	25%
Cervical biopsy CPT 57500 57500 Biopsy Of Cervix, Single Or Multiple, Or Local Excision Of Lesion, W/ Or W/o Fulguration	$247.00	$329.00	$145.00–$301.00	32% below	25%
Cesarean delivery, including prenatal and postpartum care CPT 59510 Obstetric care, planned cesarean delivery	$27,016.00	$36,021.00	$15,849.00–$32,959.00	431% above	25%
Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 54161 Circumcision, Surgical Excision Other Than Clamp Or Device; Older Than 28 Days Of Age	$896.00	$1,194.00	$525.00–$1,093.00	19% above	25%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 54150 Circumcision, Using Clamp Or Other Device With Regional Dorsal Penile Or Ring Block	$176.00	$235.00	$103.00–$215.00	38% below	25%
Circumcision, surgical, older than a newborn CPT 54160 54160 Circumcision, Surgical Excision Other Than Clamp, Device, Or Dorsal Slit; Neonate (28 Days Of	$233.00	$310.00	$136.00–$284.00	1% above	25%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 25600 Cltx Dstl Radial Fx/epiphysl Sep W/o Manj Techfee	$371.00	$494.00	$217.00–$452.00	35% above	25%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 25600 Closed Treatment Of Distal Radial Fracture; Without Manipulation	$580.00	$773.00	$340.00–$707.00	110% above	25%
Colonoscopy with polyp removal CPT 45385 Removal of polyps or growths of large bowel using an endoscope	$19,386.00	$25,848.00	$11,373.00–$23,651.00	1150% above	25%
Colonoscopy with tissue sample CPT 45380 Biopsy exam of large bowel using an endoscope	$14,341.00	$19,121.00	$8,413.00–$17,496.00	883% above	25%
Colonoscopy, diagnostic CPT 45378 Diagnostic exam of large bowel using an endoscope	$5,477.00	$7,303.00	$3,213.00–$6,682.00	383% above	25%
Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 57460 Colposcopy Of The Cervix Incl. Upper Vagina; With Loop Electrode Biopsy(s) Of The Cervix	$712.00	$949.00	$418.00–$868.00	at median	25%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 57454 Colposcopy Of The Cervix Incl. Vagina; W/ Biopsy Of Cervix And Endocervical Curettage	$405.00	$540.00	$238.00–$494.00	74% above	25%
Cystoscopy with ureteral stent placement CPT 52332 52332 Cystourethroscopy, With Insertion Of Indwelling Ureteral Stent (Eg, Gibbons Or Double-j Type)	$2,156.00	$2,874.00	$1,265.00–$2,630.00	41% below	25%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 52000 Cystourethroscopy (Separate Procedure)	$616.00	$821.00	$361.00–$751.00	26% above	25%
D&C (dilation and curettage), not related to pregnancy CPT 58120 58120 Dilation And Curettage, Diagnostic And/or Therapeutic (Nonobstetrical)	$841.00	$1,121.00	$493.00–$1,026.00	29% below	25%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 17000 Destruction (Eg, Laser Surgery, Electrosurgery, Cryosurgery, Chemosurgery, Surgical Curettemen	$277.00	$369.00	$162.00–$338.00	173% above	25%
Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 69436 Tympanostomy (Requiring Insertion Of Ventilating Tube), General Anesthesia	$411.00	$548.00	$241.00–$501.00	—	25%
Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 69433 Tympanostomy (Requiring Insertion Of Ventilating Tube), Local Or Topical Anesthesia	$392.00	$522.00	$230.00–$478.00	4% above	25%
Earwax removal by irrigation (rinsing), one ear CPT 69209 Ear, Leftear Irrigation Route	$72.00	$96.00	$42.00–$88.00	62% above	25%
Earwax removal by irrigation (rinsing), one ear CPT 69209 69209 Ear Irrigation Poc	$72.00	$96.00	$42.00–$88.00	62% above	25%
Earwax removal by irrigation (rinsing), one ear CPT 69209 Ear, Rightear Irrigation Route	$72.00	$96.00	$42.00–$88.00	62% above	25%
Earwax removal by irrigation (rinsing), one ear CPT 69209 Ear, Bilateralear Irrigation Route	$145.00	$193.00	$85.00–$177.00	226% above	25%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 69209 Removal Impacted Cerumen Using Irrigation/lavage, Unilateral Pro	$23.00	$30.00	$13.00–$27.00	48% below	23%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 69209 Removal Impacted Cerumen Using Irrigation/lavage, Unilateral Techfee	$101.00	$134.00	$59.00–$123.00	127% above	25%
Earwax removal with instruments, one ear both sides CPT 69210 69210 Removal Impacted Cerumen Requiring Instrumentation, Bilat	$145.00	$193.00	$85.00–$177.00	—	25%
Earwax removal with instruments, one ear one side CPT 69210 69210 Removal Impacted Cerumen Requiring Instrumentation, Unilateral	$72.00	$96.00	$42.00–$88.00	24% above	25%
Earwax removal with instruments, one ear one side CPT 69210 69210 Removal Impacted Cerumen Requiring Instrumentation, Lt	$72.00	$96.00	$42.00–$88.00	24% above	25%
Earwax removal with instruments, one ear one side CPT 69210 69210 Removal Impacted Cerumen Requiring Instrumentation, Rt	$72.00	$96.00	$42.00–$88.00	24% above	25%
Earwax removal with instruments, one ear one side CPT 69210 69210 Removal Impacted Cerumen Instrumentation Unilat Techfee	$111.00	$148.00	$65.00–$135.00	91% above	25%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 58100 Endometrial Biopsy With Or W/o Endocer Biopsy, W/o Cervical Dilation, Any Method	$224.00	$298.00	$131.00–$273.00	13% above	25%
Endoscopic sinus surgery: full ethmoid sinus opening CPT 31255 31255 Nasal/sinus Endoscopy, Surgical; With Ethmoidectomy, Total (Anterior And Posterior)	$993.00	$1,324.00	$583.00–$1,211.00	—	25%
Endoscopic sinus surgery: opening the frontal sinus CPT 31276 31276 Nasal/sinus Endoscopy, Surgical With Frontal Sinus Exploration	$1,160.00	$1,546.00	$680.00–$1,415.00	—	25%
Endoscopic sinus surgery: opening the maxillary (cheek) sinus CPT 31256 31256 Nasal/sinus Endoscopy, Surgical, With Maxillary Antrostomy	$522.00	$696.00	$306.00–$637.00	—	25%
Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue CPT 31267 31267 Nasal/sinus Endoscopy, Surgical, W/ Maxillary Antrostomy; W/ Removal Of Tissue From Sinus	$752.00	$1,003.00	$441.00–$918.00	—	25%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 62321 Esi Cervical Or Thoracic With Fluoroscopy	$587.00	$783.00	$345.00–$716.00	21% below	25%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 64493 Injection Paravertebral Facet Jointsingle Level	$754.00	$1,005.00	$442.00–$920.00	15% below	25%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 Repair Of Anterior Abdominal Hernia, Initial, Including Mesh; Less Than 3 Cm	$542.00	$723.00	$318.00–$662.00	33% below	25%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 45330 Sigmoidoscopy, Flexible; Dx, With Or Without Collection Of Specimen(s) By Brushing Or Washing	$154.00	$205.00	$90.00–$188.00	57% below	25%
Gallbladder removal, laparoscopic CPT 47562 Removal of gallbladder using an endoscope	$19,114.00	$25,485.00	$11,213.00–$23,319.00	711% above	25%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 47563 Lap, Cholecystectomy W/ Cholangiography	$3,635.00	$4,846.00	$2,132.00–$4,434.00	59% above	25%
Hammertoe correction surgery CPT 28285 28285 Correction, Hammertoe (Eg, Interphalangeal Fusion, Partial Or Total Phalangectomy)	$845.00	$1,126.00	$495.00–$1,030.00	1% below	25%
Hemorrhoid banding (rubber band ligation) CPT 46221 46221 Hemorrhoidectomy, Internal, By Rubber Band Ligation(s)	$419.00	$559.00	$246.00–$511.00	44% below	25%
Hemorrhoidectomy (internal and external), one area CPT 46255 46255 Hemorrhoidectomy, Internal And External, Single Column/group	$1,538.00	$2,050.00	$902.00–$1,876.00	22% above	25%
Hip replacement after an earlier hip surgery (conversion to total hip) CPT 27132 27132 Conversion Of Previous Hip Surgery To Total Hip Arthroplasty	$3,131.00	$4,174.00	$1,837.00–$3,819.00	—	25%
Hysterectomy through an abdominal incision (total) CPT 58150 58150 Total Abdominal Hysterectomy, With Or W/o Removal Of Tube(s), With Or W/o Removal Of Ovary(s)	$3,632.00	$4,843.00	$2,131.00–$4,431.00	23% above	25%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 58340 Catheterization And Introduction Of Saline Or Contrast Material For Infusion	$318.00	$424.00	$187.00–$388.00	21% above	25%
Hysteroscopy with endometrial ablation CPT 58563 58563 Hysteroscopy, Surgical; With Endometrial Ablation	$5,204.00	$6,939.00	$3,053.00–$6,349.00	132% above	25%
Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 58558 Hysteroscopy, Surgical; W/ Biopsy Of Endometrium And/or Polypectomy, With Or W/o D & C	$987.00	$1,316.00	$579.00–$1,204.00	6% below	25%
IUD insertion (the device itself billed separately) CPT 58300 58300 Insertion Of Intrauterine Device (Iud)	$240.00	$320.00	$141.00–$293.00	144% above	25%
Incision and drainage of a simple or single skin abscess CPT 10060 10060 Incision & Drainage Abscess Simple/single Techfee	$147.00	$196.00	$86.00–$179.00	at median	25%
Incision and drainage of a simple or single skin abscess CPT 10060 10060 Incision And Drainage Of Abscess; Simple Or Single	$398.00	$530.00	$233.00–$485.00	171% above	25%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 Repair of groin hernia patient age 5 years or older	$33,578.00	$44,771.00	$19,699.00–$40,965.00	2372% above	25%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 20550 Injection(s); Single Tendon Sheath, Or Ligament, Aponeurosis (Eg, Plantar Fascia)	$189.00	$252.00	$111.00–$231.00	11% above	25%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 20550 Injection 1 Tendon Sheath/ligament Aponeurosis Techfee	$297.00	$396.00	$174.00–$362.00	75% above	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 20610 Arthrocentesis Aspiration And/or Injection Major Joint Or Bursa Without Ultrasound Guidance	$208.00	$277.00	$122.00–$253.00	4% above	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 20610 Arthrocentesis Aspir&/inj Major Jt/bursa W/o Us Techfee	$371.00	$494.00	$217.00–$452.00	86% above	25%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 11981 Insertion, Non-biodegradable Drug Delivery Implantamb Implant Admin Charge	$308.00	$410.00	$180.00–$375.00	168% above	25%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 11981 Insertion, Non-biodegradable Drug Delivery Implant	$308.00	$410.00	$180.00–$375.00	168% above	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 20605 Arthrocentesis, Aspiration And/or Injection, Intermediate Joint Or Bursa	$179.00	$238.00	$105.00–$218.00	1% below	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 20605 Arthrocentesis Aspir&/inj Interm Jt/burs W/o Us Techfee	$323.00	$431.00	$190.00–$394.00	79% above	25%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 20600 Arthrocentesis, Aspiration And/or Injection, Small Joint Or Bursa (Eg, Fingers, Toes)	$167.00	$222.00	$98.00–$203.00	11% below	25%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 20600 Arthrocentesis Aspir&/inj Small Jt/bursa W/o Us Techfee	$297.00	$396.00	$174.00–$362.00	59% above	25%
Knee arthroscopy with meniscus repair (one side of the knee) CPT 29882 Arthroscopy, Knee, Surgical; With Meniscus Repair (Medial Or Lateral)	$1,024.00	$1,365.00	$601.00–$1,249.00	13% below	25%
Knee arthroscopy with meniscus trim CPT 29881 Removal of one knee cartilage using an endoscope	$12,830.00	$17,107.00	$7,527.00–$15,653.00	853% above	25%
Knee arthroscopy with removal of both torn meniscus parts CPT 29880 29880 Arthroscopy, Knee, Surgical; With Meniscectomy (Medial And Lateral) Including Chondroplasty	$1,733.00	$2,310.00	$1,016.00–$2,114.00	12% above	25%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 29877 Arthroscopy, Knee, Surgical; Debridement/shaving Of Articular Cartilage (Chondroplasty)	$1,540.00	$2,053.00	$903.00–$1,878.00	13% below	25%
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 44970 Laparoscopy, Surgical, Appendectomy	$2,324.00	$3,098.00	$1,363.00–$2,835.00	29% above	25%
Laparoscopic hysterectomy (uterus 250 g or less) CPT 58570 58570 Laparoscopy, Surgical, With Total Hysterectomy, For Uterus 250 G Or Less;	$1,254.00	$1,672.00	$736.00–$1,530.00	—	25%
Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries CPT 58571 58571 Laparoscopy, Surgical, W/ Total Hysterectomy, For Uterus 250 G Or Less; W/ Remvl Tubes/ovaries	$1,693.00	$2,257.00	$993.00–$2,065.00	1% below	25%
Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 49650 Laparoscopy, Surgical; Repair Initial Inguinal Hernia	$1,538.00	$2,050.00	$902.00–$1,876.00	59% above	25%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 49651 Laparoscopy, Surgical; Repair Recurrent Inguinal Hernia	$2,237.00	$2,982.00	$1,312.00–$2,729.00	34% above	25%
Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 58661 Laparoscopy, Surgical; With Removal Of Adnexal Structures	$1,655.00	$2,207.00	$971.00–$2,019.00	6% above	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 12031 Repair Intermediate S/a/t/e 2.5 Cm/< Techfee	$278.00	$370.00	$163.00–$339.00	6% below	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 12031 Repair, Intermediate; Wounds Of Scalp, Axillae, Trunk, Extremities; <2.5cm	$431.00	$574.00	$253.00–$525.00	45% above	25%
Lower-back epidural injection, with imaging guidance CPT 62323 Injection(s) of therapeutic substance	$3,392.00	$4,523.00	$1,990.00–$4,139.00	269% above	25%
Lower-back epidural injection, without imaging guidance CPT 62322 Injection(s) of therapeutic substance	$4,382.00	$5,843.00	$2,571.00–$5,346.00	455% above	25%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Injection(s) of anesthetic into lower spine using imaging guidance	$4,726.00	$6,301.00	$2,772.00–$5,765.00	414% above	25%
Lumpectomy (partial mastectomy) CPT 19301 19301 Mastectomy, Partial	$1,957.00	$2,609.00	$1,148.00–$2,387.00	16% above	25%
Mastectomy (total removal of the breast) CPT 19303 19303 Mastectomy, Simple, Complete	$2,656.00	$3,541.00	$1,558.00–$3,240.00	at median	25%
Miscarriage treatment with D&C, first trimester CPT 59820 59820 Treatment Of Missed Abortion, Completed Surgically; First Trimester	$1,265.00	$1,686.00	$742.00–$1,543.00	15% below	25%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 11400 Excision, Benign Lesion Including Margins; Trunk, Arms Or Legs; < 0.5cm	$218.00	$291.00	$128.00–$266.00	40% above	25%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 11400 Excision, Benign Lesion Including Margins, Except Skin Tag (Unless Listed Elsewhere), Trunk, A	$218.00	$291.00	$128.00–$266.00	40% above	25%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 11400 Exc B9 Lesion Mrgn Xcp Sk Tg T/a/l 0.5 Cm/ Techfee	$511.00	$681.00	$300.00–$623.00	227% above	25%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 11440 Excision, Benign Lesion Including Margins; Face, Ears, Eyelids, Nose, Lips; < 0.5cm	$296.00	$395.00	$174.00–$361.00	16% above	25%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 11440 Exc B9 Lesion Mrgn Xcp Sk Tg F/e/e/n/l/m 0.5cm/< Techfee	$511.00	$681.00	$300.00–$623.00	100% above	25%
Nail removal (partial or complete), one nail CPT 11730 11730 Avulsion Nail Plate Partial/complete Simple 1 Techfee	$140.00	$187.00	$82.00–$171.00	14% above	25%
Nail removal (partial or complete), one nail CPT 11730 11730 Avulsion Of Nail Plate, Partial Or Complete, Simple; Single	$193.00	$257.00	$113.00–$235.00	57% above	25%
Occipital nerve block (injection for headaches) CPT 64405 64405 Injection, Anesthetic Agent; Greater Occipital Nerve	$254.00	$339.00	$149.00–$310.00	7% above	25%
Occipital nerve block (injection for headaches) CPT 64405 64405 Injection Anesthetic Agent Greater Occipital Nrv Techfee	$510.00	$680.00	$299.00–$622.00	115% above	25%
Paracentesis with imaging guidance CPT 49083 49083 Ed Abdominal Paracentesis W Guide Charge	$786.00	$1,048.00	$461.00–$959.00	1% above	25%
Paracentesis with imaging guidance CPT 49083 49083 Abdominal Paracentesis With Imaging Guidance; (Diagnostic Or Therapeutic)	$1,154.00	$1,539.00	$677.00–$1,408.00	49% above	25%
Partial knee replacement (one compartment) CPT 27446 27446 Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment	$2,987.00	$3,983.00	$1,753.00–$3,644.00	at median	25%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 11750 Excision Nail Matrix Permanent Removal Techfee	$557.00	$742.00	$326.00–$679.00	94% above	25%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 11750 Excision Of Nail And Nail Matrix, Partial Or Complete, For Permanent Removal	$1,230.00	$1,640.00	$722.00–$1,501.00	329% above	25%
Prostate biopsy CPT 55700 Biopsy of prostate gland	$1,703.00	$2,271.00	$999.00–$2,078.00	92% above	25%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 64635 Destruction,neurolytic,paravertebral Facet Joint Nerve,w/imaging;lumb/sac,single Facet	$422.00	$563.00	$248.00–$515.00	75% below	25%
Removal of a breast lump, open surgery CPT 19120 Removal of one or more breast growth, open procedure	$10,176.00	$13,568.00	$5,970.00–$12,415.00	703% above	25%
Removal of a foreign object under the skin, simple CPT 10120 10120 Incision And Removal Of Foreign Body, Subcutaneous Tissues; Simple	$305.00	$407.00	$179.00–$372.00	62% above	25%
Removal of a foreign object under the skin, simple CPT 10120 10120 Incision & Removal Foreign Body Subq Tiss Simple Techfee	$371.00	$494.00	$217.00–$452.00	97% above	25%
Removal of one lobe of the thyroid (lobectomy) one side CPT 60220 60220 Total Thyroid Lobectomy, Unilateral; With Or Without Isthmusectomy	$3,071.00	$4,094.00	$1,801.00–$3,746.00	68% above	25%
Septoplasty to straighten the nasal septum CPT 30520 30520 Septoplasty Or Submucous Resection, W/ Or W/o Cartilage Scoring/contouring/replcmnt W/ Graft	$1,096.00	$1,461.00	$643.00–$1,337.00	18% below	25%
Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 50590 Lithotripsy, Extracorporeal Shock Wave	$1,268.00	$1,690.00	$744.00–$1,546.00	47% below	25%
Short arm cast (elbow to hand) CPT 29075 29075 Application Cast Elbow Finger Short Arm Techfee	$131.00	$174.00	$77.00–$159.00	25% below	25%
Short arm cast (elbow to hand) CPT 29075 29075 Application, Cast; Elbow To Finger (Short Arm)	$157.00	$209.00	$92.00–$191.00	11% below	25%
Short arm splint (forearm and hand) CPT 29125 29125 Application Short Arm Splint Forearm-hand Static Techfee	$131.00	$174.00	$77.00–$159.00	19% above	25%
Short arm splint (forearm and hand) CPT 29125 29125 Application Of Short Arm Splint (Forearm To Hand); Static	$159.00	$212.00	$93.00–$194.00	45% above	25%
Short arm splint (forearm and hand) CPT 29125 29125 Ot Splints Forearm Static Charge	$194.00	$259.00	$114.00–$237.00	76% above	25%
Short arm splint (forearm and hand) CPT 29125 29125 Ot Splint Static Forearm-hand Charge	$194.00	$259.00	$114.00–$237.00	76% above	25%
Short leg cast (below the knee) CPT 29405 29405 Application Short Leg Cast Below Knee-toe Techfee	$131.00	$174.00	$77.00–$159.00	18% below	25%
Short leg cast (below the knee) CPT 29405 29405 Application Of Short Leg Cast (Below Knee To Toes);	$137.00	$183.00	$81.00–$167.00	15% below	25%
Short leg splint (calf to foot) CPT 29515 29515 Application Short Leg Splint Calf Foot Techfee	$131.00	$174.00	$77.00–$159.00	27% above	25%
Short leg splint (calf to foot) CPT 29515 29515 Application Of Short Leg Splint (Calf To Foot)	$145.00	$193.00	$85.00–$177.00	41% above	25%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 29824 Arthroscopy, Shoulder, Surgical; Distal Claviculectomy Including Distal Articular Surface	$1,274.00	$1,698.00	$747.00–$1,554.00	11% above	25%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 Shaving of shoulder bone using endoscope	$29,033.00	$38,710.00	$17,032.00–$35,420.00	4795% above	25%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 12001 Simple Repair Of Wounds; Scalp, Neck, Axillae, Genitalia, Trunk, Extremeties; <2.5cm	$266.00	$354.00	$156.00–$324.00	100% above	25%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 12001 Simple Repair Scalp/neck/ax/genit/trunk 2.5cm/< Techfee	$278.00	$370.00	$163.00–$339.00	109% above	25%
Skin biopsy, punch, one lesion CPT 11104 11104 Punch Biopsy, Single Lesion	$344.00	$459.00	$202.00–$420.00	36% above	25%
Skin biopsy, punch, one lesion CPT 11104 11104 Biopsy Of Skin, Subcutaneous Tissue And/or Mucous Membrane; Single Lesion	$344.00	$459.00	$202.00–$420.00	36% above	25%
Skin tag removal, up to 15 tags CPT 11200 11200 Removal Skn Tags Mlt Fibrq Tags Any Area Upw/15 Techfee	$140.00	$187.00	$82.00–$171.00	14% above	25%
Skin tag removal, up to 15 tags CPT 11200 11200 Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Including 15 Lesions	$317.00	$423.00	$186.00–$387.00	157% above	25%
Spinal tap (lumbar puncture), diagnostic CPT 62270 62270 Diagnostic Spinal Tap	$317.00	$422.00	$186.00–$386.00	30% below	25%
Spinal tap (lumbar puncture), diagnostic CPT 62270 62270 Diagnostic Lumbar Puncture	$317.00	$422.00	$186.00–$386.00	30% below	25%
Spinal tap (lumbar puncture), diagnostic CPT 62270 62270 Spinal Puncture Lumbar-er Serv Procedure	$406.00	$541.00	$238.00–$495.00	10% below	25%
Spinal tap (lumbar puncture), diagnostic CPT 62270 62270 Spinal Puncture Lumbar Diagnostic Techfee	$668.00	$890.00	$392.00–$814.00	48% above	25%
Spinal tap (lumbar puncture), diagnostic CPT 62270 62270 Lumbar Puncture Charge	$668.00	$890.00	$392.00–$814.00	48% above	25%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 12002 Smpl Repair Scalp/neck/ax/genit/trunk 2.6-7.5cm Techfee	$278.00	$370.00	$163.00–$339.00	52% above	25%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 12002 Simple Repair Of Wounds; Scalp, Neck, Axillae, Genitalia, Trunk, Extremeties; 2.6-7.5cm	$292.00	$389.00	$171.00–$356.00	59% above	25%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 12011 Simple Repair F/e/e/n/l/m 2.5cm/< Techfee	$278.00	$370.00	$163.00–$339.00	68% above	25%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 12011 Simple Repair Of Wounds Of Face, Ears, Eyelids, Nose, Lips, Mucous Membra; <2.5cm	$478.00	$637.00	$280.00–$583.00	189% above	25%
TURP (transurethral resection of the prostate) CPT 52601 52601 Transurethral Electrosurgical Resection Of Prostate, Incld Control Of Postoperative Bleeding	$2,002.00	$2,669.00	$1,174.00–$2,442.00	3% above	25%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 11102 Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion	$332.00	$442.00	$194.00–$404.00	77% above	25%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 11102 Tangential Biopsy Skin Single Lesion(shave, Scoop, Saucerize, Curette)	$344.00	$459.00	$202.00–$420.00	83% above	25%
Tonsil and adenoid removal, age 12 or older CPT 42821 42821 Tonsillectomy And Adenoidectomy; Age 12 Or Over	$685.00	$913.00	$402.00–$835.00	—	25%
Tonsil and adenoid removal, child under 12 CPT 42820 Removal of tonsils and adenoid glands, patient younger than age 12	$11,755.00	$15,673.00	$6,896.00–$14,341.00	—	25%
Tonsil removal (tonsillectomy) only, age 12 or older CPT 42826 42826 Tonsillectomy, Primary Or Secondary; Age 12 Or Over	$603.00	$804.00	$354.00–$736.00	—	25%
Tonsil removal (tonsillectomy) only, child under 12 CPT 42825 42825 Tonsillectomy, Primary Or Secondary; Younger Than Age 12	$620.00	$826.00	$363.00–$756.00	—	25%
Total hip replacement CPT 27130 27130 Arthroplasty, Acetabular And Proximal Femoral Prosthetic Replacement	$3,711.00	$4,948.00	$2,177.00–$4,527.00	7% above	25%
Total knee replacement CPT 27447 27447 Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compartments	$3,888.00	$5,184.00	$2,281.00–$4,743.00	5% above	25%
Total shoulder replacement CPT 23472 23472 Arthroplasty, Glenohumeral Joint; Total Shoulder	$3,850.00	$5,133.00	$2,259.00–$4,697.00	21% above	25%
Total thyroid removal (thyroidectomy) CPT 60240 60240 Thyroidectomy, Total Or Complete	$3,974.00	$5,299.00	$2,332.00–$4,849.00	26% above	25%
Trigger finger release surgery CPT 26055 26055 Tendon Sheath Incision (Eg, For Trigger Finger)	$1,370.00	$1,826.00	$803.00–$1,671.00	41% above	25%
Trigger point injections, 1 or 2 muscles CPT 20552 20552 Injection(s); Single Or Multiple Trigger Point(s), 1 Or 2 Muscle(s)	$170.00	$226.00	$99.00–$207.00	23% above	25%
Trigger point injections, 1 or 2 muscles CPT 20552 20552 Injection Single/mlt Trigger Point 1/2 Muscles Techfee	$297.00	$396.00	$174.00–$362.00	115% above	25%
Tubal ligation, laparoscopic (tubes sealed by cautery) CPT 58670 58670 Laparoscopy, Surgical; With Fulguration Of Oviducts (With Or W/o Transection)	$1,404.00	$1,872.00	$824.00–$1,713.00	21% above	25%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 19083 Biopsy, Breast, W/ Localization Device; First Lesion, Including Ultrasound Guidance	$2,280.00	$3,040.00	$1,338.00–$2,782.00	25% above	25%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 43249 Esophagogastroduodenoscop >30 Mm Diameter, Balloon Dilation Of Esophagus	$839.00	$1,118.00	$492.00–$1,023.00	22% below	25%
Upper endoscopy (EGD) with biopsy CPT 43239 Biopsy exam of esophagus, stomach or small bowel using an endoscope	$16,787.00	$22,383.00	$9,849.00–$20,480.00	1510% above	25%
Upper endoscopy (EGD) with injection into the lining CPT 43236 43236 Esophagogastroduodenoscopy, Flexible,transoral; W/ Directed Submucosal Injection(s), Any Subst	$815.00	$1,086.00	$478.00–$994.00	9% below	25%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 43251 Esophagogastroduodenoscopy Removal Of Tumor(s) W/ Snare Technique	$1,937.00	$2,583.00	$1,137.00–$2,363.00	131% above	25%
Upper endoscopy (EGD), diagnostic CPT 43235 Diagnostic exam of esophagus, stomach or small bowel using an endoscope	$3,448.00	$4,597.00	$2,023.00–$4,206.00	286% above	25%
Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 52353 Cystourethroscopy With Ureteroscopy And/or Pyeloscopy With Lithotripsy	$718.00	$957.00	$421.00–$876.00	at median	25%
Ureteroscopy with laser stone breaking and stent placement CPT 52356 52356 Cystourethroscopy With Ureteroscopy And/or Pyeloscopy With Lithotripsy Incld Insert Of Stent	$591.00	$788.00	$347.00–$721.00	38% below	25%
Vaginal birth after cesarean (VBAC), including prenatal and postpartum care CPT 59610 Obstetric care, planned vaginal delivery (post delivery by cesarean section)	$13,695.00	$18,260.00	$8,034.00–$16,708.00	—	25%
Vaginal delivery, including prenatal and postpartum care CPT 59400 Obstetric care, planned vaginal delivery	$17,573.00	$23,431.00	$10,310.00–$21,439.00	209% above	25%
Vasectomy, one or both sides, including follow-up semen testing both sides CPT 55250 55250 Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(s)	$1,232.00	$1,643.00	$723.00–$1,503.00	—	25%
Wart removal, up to 14 warts CPT 17110 17110 Destruction Of Benign Lesions; 1-14 Lesions	$139.00	$185.00	$81.00–$169.00	14% above	25%
Wart removal, up to 14 warts CPT 17110 17110 Destruct Benign Lesion Other Than Skin Tag Up To 14 Lesion Techfee	$140.00	$187.00	$82.00–$171.00	15% above	25%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 11042 Debridement Skin/subcut Charge	$95.00	$126.00	$55.00–$115.00	45% below	25%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 11042 Debridement, Subcutaneous Tissue; First 20 Sq Cm Or Less	$348.00	$464.00	$204.00–$425.00	102% above	25%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 11042 Debridement Subcutaneous Tissue 20 Sq Cm/< Techfee	$390.00	$520.00	$229.00–$476.00	127% above	25%
Wrist fracture surgery (plate and screws), distal radius CPT 25607 25607 Open Tx Distal Radial Extra-articular Fx Or Epiphyseal Separation, With Internal Fixation	$1,090.00	$1,453.00	$639.00–$1,329.00	at median	25%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Maine	Off list
Blood transfusion (giving blood or blood components) CPT 36430 Transfuse Cryoprecipitate Product	$408.00	$544.00	$239.00–$498.00	16% below	25%
Blood transfusion (giving blood or blood components) CPT 36430 Transfuse Platelet Product	$408.00	$544.00	$239.00–$498.00	16% below	25%
Blood transfusion (giving blood or blood components) CPT 36430 Transfuse Red Blood Cells Leukoreduced	$408.00	$544.00	$239.00–$498.00	16% below	25%
Blood transfusion (giving blood or blood components) CPT 36430 Transfuse Fresh Frozen Plasma	$408.00	$544.00	$239.00–$498.00	16% below	25%
Blood transfusion (giving blood or blood components) CPT 36430 Transfuse Red Blood Cells	$408.00	$544.00	$239.00–$498.00	16% below	25%
Blood transfusion (giving blood or blood components) CPT 36430 36430 Transfusion Blood/blood Components Techfee	$481.00	$641.00	$282.00–$587.00	1% below	25%
Blood transfusion (giving blood or blood components) CPT 36430 36430 Blood Administration Charge	$481.00	$641.00	$282.00–$587.00	1% below	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 94640: Inhalation/aerosolamb Nebulizer Admin Charge	$26.00	$34.00	$15.00–$31.00	86% below	24%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Rt Ippb Initial Charge	$75.00	$100.00	$44.00–$92.00	60% below	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 94640 Aerosol Treatment Initial Charge	$75.00	$100.00	$44.00–$92.00	60% below	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Rt Aerosol Subsequent Charge	$92.00	$122.00	$54.00–$112.00	51% below	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 94640 Med Neb Initial Charge	$92.00	$122.00	$54.00–$112.00	51% below	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Rt Aerosol Initial Charge	$92.00	$122.00	$54.00–$112.00	51% below	25%
Chemotherapy IV infusion, first hour CPT 96413 96413 Chemo Admin Iv Infusion Initial Hour Charge	$108.00	$144.00	$63.00–$132.00	72% below	25%
Critical care, first 30 to 74 minutes CPT 99291 99291 Critical Care, First 30-74 Min	$968.00	$1,290.00	$568.00–$1,180.00	at median	25%
Critical care, first 30 to 74 minutes CPT 99291 99291facility Level Critical Care Ill/injured Patient Init 30-74 Min	$1,261.00	$1,681.00	$740.00–$1,538.00	30% above	25%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 Electrocardiogram, routine, with interpretation and report	$125.00	$167.00	$73.00–$153.00	19% above	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Rt Electrocardiogram (Ekg) Charge	$264.00	$352.00	$155.00–$322.00	135% above	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Cv Ecg Acquisition	$264.00	$352.00	$155.00–$322.00	135% above	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Electrocardiogram 12 Lead	$264.00	$352.00	$155.00–$322.00	135% above	25%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 99281 Emergency Department Visit, Level 1	$50.00	$67.00	$29.00–$61.00	44% below	25%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 99281-e&m That May Not Require The Presence Of A Physician Or Other Qualified Healthcare Prof.	$50.00	$67.00	$29.00–$61.00	44% below	25%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 99281 Ed Visit For E&m Patient, Lev 1, May Not Req Presence Of Physician Or Other, Cc	$186.00	$248.00	$109.00–$227.00	107% above	25%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 99282 Ed Visit Straightforward Mdm	$64.00	$85.00	$37.00–$78.00	64% below	25%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 99282 Emergency Department Visit, Level 2	$105.00	$140.00	$62.00–$128.00	41% below	25%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 99282-e&m Req. A Medically Appropriate Hx And/or Exam And Straightforward Medical Decision Making	$154.00	$205.00	$90.00–$188.00	13% below	25%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 99282 Ed Visit E&m Patient, Lev 2, Req Med Approp Hstry/exam/mdm, Cc	$232.00	$309.00	$136.00–$283.00	31% above	25%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 99283 Ed Visit Low Mdm	$115.00	$153.00	$67.00–$140.00	66% below	25%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 99283 Emergency Department Visit, Level 3	$152.00	$203.00	$89.00–$186.00	54% below	25%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 99283-e&m Req. A Medically Appropriate Hx And/or Exam And Low Level Medical Decision Making	$197.00	$263.00	$116.00–$241.00	41% below	25%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 99283 Ed Visit E&m Patient, Lev 3, Req Med Approp Hstry/exam/low Mdm, Cc	$371.00	$494.00	$217.00–$452.00	11% above	25%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 99284 Ed Visit Moderate Mdm	$195.00	$260.00	$114.00–$238.00	67% below	25%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 99284 Emergency Department Visit, Level 4	$209.00	$279.00	$123.00–$255.00	64% below	25%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 99284-e&m Req. A Medically Appropriate Hx And/or Exam And Moderate Level Of Medical Decision Making	$235.00	$313.00	$138.00–$286.00	60% below	25%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 99284 Ed Visit E&m Patient, Lev 4, Req Med Approp Hstry/exam/moderate Mdm, Cc	$557.00	$742.00	$326.00–$679.00	5% below	25%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 99285 Emergency Department Visit, Level 5	$246.00	$328.00	$144.00–$300.00	74% below	25%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 99285 Ed Visit High Mdm	$279.00	$372.00	$164.00–$340.00	71% below	25%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 99285-e&m Req. A Medically Appropriate Hx And/or Exam And High Level Of Medical Decision Making	$310.00	$413.00	$182.00–$378.00	68% below	25%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 99285 Ed Visit E M Patient, Lev 5, Req Med Approp Hstry/exam/high Mdm, Cc	$650.00	$866.00	$381.00–$792.00	32% below	25%
Exercise stress test, tracing only, the hospital charge CPT 93017 Cardiac Stress Test	$385.00	$513.00	$226.00–$469.00	30% below	25%
Family therapy with the patient, 50 minutes CPT 90847 Family psychotherapy, including patient, 50 min	$164.00	$219.00	$96.00–$200.00	at median	25%
Group psychotherapy session CPT 90853 Group psychotherapy	$82.00	$109.00	$48.00–$100.00	31% above	25%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360 Hydrate Iv Infuse 1st Hr Charge	$212.00	$283.00	$125.00–$259.00	2% above	25%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360ed Hydration, First Hour	$212.00	$283.00	$125.00–$259.00	2% above	25%
IV infusion of a medicine, first hour CPT 96365 96365 Infusion Ther Drug/1 Hr Charge	$212.00	$283.00	$125.00–$259.00	33% below	25%
IV infusion of a medicine, first hour CPT 96365 96365- Ed Iv Tx, First Hour	$212.00	$283.00	$125.00–$259.00	33% below	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372: Subq/imamb Only Admin Charge	$17.00	$23.00	$10.00–$21.00	74% below	26%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 Therapeutic Injection; Subcutaneous Or Intramuscularamb Only Inj Med Admin Charge	$38.00	$51.00	$22.00–$47.00	42% below	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 Therapeutic, Prophylactic, Or Diagnostic Injection; Subcutaneous Or Intramuscular:	$38.00	$51.00	$22.00–$47.00	42% below	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 Ed Subq/im Injection	$74.00	$98.00	$43.00–$90.00	13% above	24%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 Inj Im Or Subq Charge	$85.00	$113.00	$50.00–$103.00	30% above	25%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 90791 Psychiatric Diagnostic Evaluationno Medical Services Charge	$218.00	$291.00	$128.00–$266.00	14% above	25%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 90791 Psychiatric Diagnostic Evaluation	$218.00	$291.00	$128.00–$266.00	14% above	25%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 95910 Nerve Conduction Studies 7-8 Studies	$287.00	$383.00	$169.00–$350.00	at median	25%
Neuromuscular re-education, 15 minutes CPT 97112 Ot Neuromuscular Reeducation Charges	$135.00	$180.00	$79.00–$165.00	38% above	25%
Neuromuscular re-education, 15 minutes CPT 97112 Neuromuscular Reeducation Charges	$135.00	$180.00	$79.00–$165.00	38% above	25%
New patient office visit, about 30 minutes CPT 99203 New patient office or other outpatient visit, 30 min	$239.00	$318.00	$140.00–$291.00	117% above	25%
New patient office visit, about 45 minutes CPT 99204 New patient office or other outpatient visit, 45 min	$278.00	$370.00	$163.00–$339.00	70% above	25%
New patient office visit, about 60 minutes CPT 99205 New patient office or other outpatient visit, 60 min	$329.00	$439.00	$193.00–$402.00	11% above	25%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 99202 Office/outpatient Visitnew Patient, Level 2 (15-29 Mins)	$152.00	$203.00	$89.00–$186.00	120% above	25%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Rdn Initial Visit, Individual Ea 15min	$38.00	$50.00	$22.00–$46.00	17% below	24%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 97802 Initial Assessment Charge	$38.00	$50.00	$22.00–$46.00	17% below	24%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 97802 Medical Nutrition Therapy; Initial Assessment And Intervention, Each 15 Minutes	$110.00	$146.00	$64.00–$134.00	139% above	25%
Occupational therapy evaluation, low complexity CPT 97165 Ot Low Complex Units	$201.00	$268.00	$118.00–$245.00	10% below	25%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 Pt High Complex Units	$268.00	$357.00	$157.00–$327.00	2% above	25%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Pt Low Complex Units	$135.00	$180.00	$79.00–$165.00	39% below	25%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Pt Moderate Complex Units	$201.00	$268.00	$118.00–$245.00	19% below	25%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Manual Traction Charge	$130.00	$173.00	$76.00–$158.00	38% above	25%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Ot Manual Therapy Charge Units	$131.00	$174.00	$77.00–$159.00	39% above	25%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Manual Therapy Charge Units	$131.00	$174.00	$77.00–$159.00	39% above	25%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Physical therapy, therapeutic exercise	$135.00	$180.00	$79.00–$165.00	111% above	25%
Preventive checkup, new patient aged 18–39 CPT 99385 Initial new patient preventative medicine evaluation (18-39 years)	$240.00	$320.00	$141.00–$293.00	110% above	25%
Preventive checkup, new patient aged 40–64 CPT 99386 Initial new patient preventative medicine evaluation (40-64 years)	$257.00	$343.00	$151.00–$314.00	64% above	25%
Preventive checkup, new patient aged 65 or older CPT 99387 99387 Preventive Evaluation, New Pt; 65+ Yrs	$281.00	$374.00	$165.00–$342.00	91% above	25%
Preventive checkup, returning patient aged 18–39 CPT 99395 99395 Preventive Evaluation, Established Pt; 18-39 Yrs	$225.00	$300.00	$132.00–$275.00	92% above	25%
Preventive checkup, returning patient aged 40–64 CPT 99396 99396 Preventive Evaluation, Established Pt; 40-64 Yrs	$240.00	$320.00	$141.00–$293.00	113% above	25%
Preventive checkup, returning patient aged 65 or older CPT 99397 99397 Spi Physical 65+.	$265.00	$353.00	$155.00–$323.00	128% above	25%
Psychiatric evaluation with medical services CPT 90792 90792 Psychiatric Diagnostic Evaluation With Medical Services	$246.00	$328.00	$144.00–$300.00	13% above	25%
Psychotherapy session, 30 minutes CPT 90832 Psychotherapy, 30 min	$110.00	$146.00	$64.00–$134.00	at median	25%
Psychotherapy session, 45 minutes CPT 90834 Psychotherapy, 45 min	$164.00	$219.00	$96.00–$200.00	1% above	25%
Psychotherapy session, 60 minutes CPT 90837 Psychotherapy, 60 min	$218.00	$291.00	$128.00–$266.00	30% above	25%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 99406 Smoking/tobacco Cessation Counseling; 3-10 Min	$41.00	$54.00	$24.00–$49.00	65% above	24%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 G0436 Smoking And Tobacco Cessation Counseling; Intermediate, 3 To 10 Minutes	$41.00	$54.00	$24.00–$49.00	65% above	24%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 99406 Behav Chng Smoking 310 Min	$42.00	$56.00	$25.00–$51.00	69% above	25%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 99215 Office/outpatient Visitestablished Patient, Level 5 (40-54 Min)	$257.00	$343.00	$151.00–$314.00	88% above	25%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 99215 Office/outpatient Visitestablished Patient, Level 5 (40-54 Min).	$257.00	$343.00	$151.00–$314.00	88% above	25%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 99215 Nurse Office/outpatient Visitestablished Patient, Level 5 (40 Min)	$272.00	$363.00	$160.00–$332.00	99% above	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 99213 Office/outpatient Visitestablished Patient, Level 3 (Dech)	$79.00	$105.00	$46.00–$96.00	16% above	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 99213 Office/outpatient Visitestablished Patient, Level 3	$113.00	$150.00	$66.00–$137.00	66% above	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 99213 Office/outpatient Visitestablished Patient,level 3 (20-29 Min)	$113.00	$150.00	$66.00–$137.00	66% above	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 99213 Nurse Office/outpatient Visitestablished Patient, Level 3 (15 Min)	$119.00	$159.00	$70.00–$145.00	75% above	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 99213 Est Patient Office Or Other Outpatient Services Techfee	$152.00	$202.00	$89.00–$185.00	123% above	25%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214 Office/outpatient Visitestablished Patient,level 4 (30-39 Min)	$177.00	$236.00	$104.00–$216.00	90% above	25%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214 Office/outpatient Visitestablished Patient, Level 4	$177.00	$236.00	$104.00–$216.00	90% above	25%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214 Office/outpatient Visitestablished Patient, Level 4 (30-44 Min)	$177.00	$236.00	$104.00–$216.00	90% above	25%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214 Nurse Office/outpatient Visitestablished Patient, Level 4 (25 Min)	$272.00	$363.00	$160.00–$332.00	192% above	25%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212 Nurse Office/outpatient Visitestablished Patient, Level 2 (10 Min)	$80.00	$106.00	$47.00–$97.00	47% above	25%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212 Office/outpatient Visitestablished Patient, Level 2	$85.00	$113.00	$50.00–$103.00	57% above	25%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212 Office/outpatient Visitestablished Patient, Level 2 (10-19 Min)	$85.00	$113.00	$50.00–$103.00	57% above	25%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212 Est Patient Office Or Other Outpatient Services Techfee	$152.00	$202.00	$89.00–$185.00	180% above	25%
Specialist consultation, low complexity or 30+ minutes CPT 99243 Patient office consultation, 40 min	$293.00	$391.00	$172.00–$358.00	158% above	25%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 Patient office consultation, 60 min	$411.00	$548.00	$241.00–$501.00	158% above	25%
Speech and language evaluation CPT 92523 Speech Sound Prod W/ Language Charge	$125.00	$167.00	$73.00–$153.00	58% below	25%
Speech therapy session, individual CPT 92507 Tx Of Speech/lang/voice/comm/auditory Chg	$131.00	$174.00	$77.00–$159.00	14% below	25%
Spirometry (breathing test) CPT 94010 Pft Screen	$152.00	$202.00	$89.00–$185.00	1% above	25%
Spirometry before and after a bronchodilator CPT 94060 Pulmonary Function Test Complete	$326.00	$435.00	$191.00–$398.00	6% below	25%
Spirometry before and after a bronchodilator CPT 94060 Pulmonary Function Test Pre And Post	$326.00	$435.00	$191.00–$398.00	6% below	25%
Therapeutic activities (functional training), 15 minutes CPT 97530 Therapeutic Activities Charge	$135.00	$180.00	$79.00–$165.00	40% above	25%
Therapeutic activities (functional training), 15 minutes CPT 97530 Ot Therapeutic Activities Charges	$135.00	$180.00	$79.00–$165.00	40% above	25%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 99195 Therapeutic Phlebotomy Infusion Charge	$282.00	$376.00	$165.00–$344.00	84% above	25%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Phlebotomytherapeutic	$293.00	$391.00	$172.00–$358.00	92% above	25%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Maine	Off list
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 91322 Moderna (12y+)amb Sars-cov-2 (Covid-19) Mrna (Cvx 312)	$141.00	$188.00	$83.00–$172.00	6% below	25%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 90656 No Prsv 3+>amb Influenza Vacc Charge	$54.00	$72.00	$32.00–$66.00	144% above	25%
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 Hep A/b Vaccineamb Hep A/b Charge	$158.00	$211.00	$93.00–$193.00	at median	25%
Hepatitis A vaccine, adult dose CPT 90632 0.5 Ml Hepatitis A Vaccineamb Hepatitis A Vaccine Charge	$269.00	$359.00	$158.00–$328.00	224% above	25%
Hepatitis A vaccine, adult dose CPT 90632 1 Ml Hepatitis A Vaccineamb Hepatitis A Vaccine Charge	$538.00	$717.00	$315.00–$656.00	549% above	25%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 Amb Hepatitis B Vaccine Charge -> 1ml Hepatitis B Vaccine, Pediatricamb Hepatitis B Vaccine Charge	$347.00	$462.00	$203.00–$423.00	463% above	25%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 10mcg/0.5ml Hepatitis B Vaccineamb Hepatitis B Vaccine Charge	$347.00	$462.00	$203.00–$423.00	463% above	25%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 90662 Prsv Free Inc Antigamb Influenza Vacc Charge	$74.00	$99.00	$44.00–$91.00	22% below	25%
MMR vaccine (measles, mumps and rubella), live CPT 90707 0.5 Ml Mmramb Measles-mumps-rubella Vaccine Charge	$374.00	$499.00	$220.00–$457.00	213% above	25%
MMR vaccine (measles, mumps and rubella), live CPT 90707 0.5 Ml Mmrvamb Measles-mumps-rubella-varicella Vaccine Charge	$374.00	$499.00	$220.00–$457.00	213% above	25%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 0.5 Ml Meningococcal Group Bamb Meningococcal Group B Vac Charge	$62.00	$82.00	$36.00–$75.00	56% below	24%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 Pneumococcal 20-valent Conjugate Vaccineamb Pneumococcal 20-valent Conjugate Vac Charge	$203.00	$271.00	$119.00–$248.00	42% below	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 0.5 Ml Pneumococcal 23-valent Conjugateamb Pneumococcal 23-valent Vaccine Charge	$488.00	$650.00	$286.00–$595.00	408% above	25%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 0.5 Ml Td Toxoidsamb Tetanus Diptheria Toxoids Charge	$153.00	$204.00	$90.00–$187.00	240% above	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Boostrixamb Tdap Charge	$279.00	$372.00	$164.00–$340.00	543% above	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 0.5 Ml Tdapamb Tdap Charge	$279.00	$372.00	$164.00–$340.00	543% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Initial Admin Charge 90471amb Only Admin Charge	$17.00	$23.00	$10.00–$21.00	1% above	26%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471 Immunization Admin One Charge	$17.00	$23.00	$10.00–$21.00	1% above	26%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 First Vaccine 90471admin Immunization Charge	$17.00	$23.00	$10.00–$21.00	1% above	26%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471 Im Adm Prq Id Subq Im Njxs 1 Vaccine Techfee	$66.00	$88.00	$39.00–$81.00	291% above	25%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Addl Admin Charge 90472amb Only Admin Charge	$17.00	$23.00	$10.00–$21.00	at median	26%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Each Additional 90472admin Immunization Charge	$17.00	$23.00	$10.00–$21.00	at median	26%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 90472††im Adm Prq Id Subq/im Njxs Ea Vaccine Techfee	$54.00	$72.00	$32.00–$66.00	218% above	25%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 90472 Immunization Admin Vac Ea Additional Charge	$54.00	$72.00	$32.00–$66.00	218% above	25%

Source file: https://secure.claraprice.net/price-transparency/BEUN-1748023745659/machine-readable/010263198_down-east-community-hospital_standardcharges.json