Hospital

Crawford Memorial Hospital

Listed in its price file as “Crawford Hospital District”.

Crawford Memorial Hospital in Robinson, IL publishes cash prices for 301 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 Illinois median for 225 of 300 procedures and below it for 70. By typical cash price it ranks #70 of 115 Illinois hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

1000 North Allen, St. Robinson, IL 62454 Collected Sep 27, 2026 Source price file (618) 544-3131

Critical access hospital (rural, 25 beds or fewer) Emergency department CMS star rating 4 of 5 CCN 141343 · CMS hospital register NPI 1265493720

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Illinois	Off list
Abdominal CT scan without and with contrast CPT 74170 CT Abdomen w/ + w/o Cont	$3,240.80	$4,051.00	$680.83–$3,356.46	11% above	20%
Abdominal CT scan without and with contrast inpatient CPT 74170 CT Abdomen w/ + w/o Cont	$3,240.80	$4,051.00	$680.83–$3,356.46	—	20%
Abdominal X-ray, 2 views CPT 74019 XR Abdomen 2 Views	$357.60	$447.00	$122.48–$369.75	1% above	20%
Abdominal X-ray, 2 views inpatient CPT 74019 XR Abdomen 2 Views	$357.60	$447.00	$122.48–$369.75	—	20%
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR Ankle Comp Min 3 Views Lt	$439.20	$549.00	$62.89–$477.63	28% above	20%
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR Ankle Comp Min 3 Views Rt	$439.20	$549.00	$62.89–$477.63	28% above	20%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR Ankle Comp Min 3 Views Lt	$439.20	$549.00	$62.89–$477.63	—	20%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR Ankle Comp Min 3 Views Rt	$439.20	$549.00	$62.89–$477.63	—	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 US Ankle Brachial Index	$588.00	$735.00	$201.74–$244.80	44% above	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 US Ankle Brachial Index	$588.00	$735.00	$201.74–$244.80	—	20%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Shoulder w/o Cont Lt	$2,644.80	$3,306.00	$238.78–$971.96	43% above	20%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Forearm w/o Cont Rt	$2,644.80	$3,306.00	$238.78–$971.96	43% above	20%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Wrist w/o Cont Rt	$2,644.80	$3,306.00	$238.78–$971.96	43% above	20%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Clavicle w/o Cont Rt	$2,644.80	$3,306.00	$238.78–$971.96	43% above	20%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Clavicle w/o Cont Lt	$2,644.80	$3,306.00	$238.78–$971.96	43% above	20%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Elbow w/o Cont Rt	$2,644.80	$3,306.00	$238.78–$971.96	43% above	20%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Shoulder w/o Cont Rt	$2,644.80	$3,306.00	$238.78–$971.96	43% above	20%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Wrist w/o Cont Lt	$2,644.80	$3,306.00	$238.78–$971.96	43% above	20%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Elbow w/o Cont Lt	$2,644.80	$3,306.00	$238.78–$971.96	43% above	20%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Hand w/o Cont Rt	$2,644.80	$3,306.00	$238.78–$971.96	43% above	20%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Humerus w/o Cont Lt	$2,644.80	$3,306.00	$238.78–$971.96	43% above	20%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Humerus w/o Cont Rt	$2,644.80	$3,306.00	$238.78–$971.96	43% above	20%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Forearm w/o Cont Lt	$2,644.80	$3,306.00	$238.78–$971.96	43% above	20%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Hand w/o Cont Lt	$2,644.80	$3,306.00	$238.78–$971.96	43% above	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Shoulder w/o Cont Rt	$2,644.80	$3,306.00	$238.78–$971.96	—	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Wrist w/o Cont Rt	$2,644.80	$3,306.00	$238.78–$971.96	—	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Forearm w/o Cont Lt	$2,644.80	$3,306.00	$238.78–$971.96	—	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Elbow w/o Cont Rt	$2,644.80	$3,306.00	$238.78–$971.96	—	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Forearm w/o Cont Rt	$2,644.80	$3,306.00	$238.78–$971.96	—	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Shoulder w/o Cont Lt	$2,644.80	$3,306.00	$238.78–$971.96	—	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Humerus w/o Cont Rt	$2,644.80	$3,306.00	$238.78–$971.96	—	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Humerus w/o Cont Lt	$2,644.80	$3,306.00	$238.78–$971.96	—	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Hand w/o Cont Rt	$2,644.80	$3,306.00	$238.78–$971.96	—	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Clavicle w/o Cont Rt	$2,644.80	$3,306.00	$238.78–$971.96	—	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Hand w/o Cont Lt	$2,644.80	$3,306.00	$238.78–$971.96	—	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Elbow w/o Cont Lt	$2,644.80	$3,306.00	$238.78–$971.96	—	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Clavicle w/o Cont Lt	$2,644.80	$3,306.00	$238.78–$971.96	—	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Wrist w/o Cont Lt	$2,644.80	$3,306.00	$238.78–$971.96	—	20%
Barium swallow (esophagus X-ray with contrast) CPT 74220 XR Esophagus	$685.60	$857.00	$125.78–$251.16	5% above	20%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 XR Esophagus	$685.60	$857.00	$125.78–$251.16	—	20%
Bone scan, whole body (nuclear medicine) CPT 78306 NM Bone Whole Body	$1,855.20	$2,319.00	$634.42–$683.99	17% above	20%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM Bone Whole Body	$1,855.20	$2,319.00	$634.42–$683.99	—	20%
Breast ultrasound, complete, one breast one side CPT 76641 US Breast Lt.	$810.40	$1,013.00	$244.57–$881.31	52% above	20%
Breast ultrasound, complete, one breast one side CPT 76641 US Breast Rt.	$810.40	$1,013.00	$244.57–$881.31	52% above	20%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US Breast Lt.	$810.40	$1,013.00	$244.57–$881.31	—	20%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US Breast Rt.	$810.40	$1,013.00	$244.57–$881.31	—	20%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US Breast Ltd Rt	$788.00	$985.00	$142.58–$856.95	80% above	20%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US Breast Ltd Lt	$788.00	$985.00	$142.58–$856.95	80% above	20%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US Breast Ltd Rt	$788.00	$985.00	$142.58–$856.95	—	20%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US Breast Ltd Lt	$788.00	$985.00	$142.58–$856.95	—	20%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CT Angio Abdomen Pelvis	$3,732.00	$4,665.00	$831.85–$3,864.54	5% below	20%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CT Angio Abdomen Pelvis	$3,732.00	$4,665.00	$831.85–$3,864.54	—	20%
CT angiography (CTA) of the head CPT 70496 CT Angio Head	$2,838.40	$3,548.00	$973.83–$3,379.00	10% above	20%
CT angiography (CTA) of the head inpatient CPT 70496 CT Angio Head	$2,838.40	$3,548.00	$973.83–$3,379.00	—	20%
CT angiography (CTA) of the neck CPT 70498 CT Angio Neck	$2,838.40	$3,548.00	$831.85–$3,379.00	5% above	20%
CT angiography (CTA) of the neck inpatient CPT 70498 CT Angio Neck	$2,838.40	$3,548.00	$831.85–$3,379.00	—	20%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT Angio Chest	$2,952.80	$3,691.00	$831.85–$3,211.17	at median	20%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT Angio Chest	$2,952.80	$3,691.00	$831.85–$3,211.17	—	20%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Abdomen +Pelvis w/o Cont	$3,920.80	$4,901.00	$618.53–$5,801.16	5% above	20%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT Abdomen +Pelvis w/o Cont	$3,920.80	$4,901.00	$618.53–$5,801.16	—	20%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abdomen +Pelvis w/ Cont	$5,894.40	$7,368.00	$680.83–$6,410.16	31% above	20%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abdomen +Pelvis w/ Cont	$5,894.40	$7,368.00	$680.83–$6,410.16	—	20%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT Abdomen +Pelvis w/ + w/o Cont	$6,119.20	$7,649.00	$680.83–$6,654.63	18% above	20%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT Abdomen +Pelvis w/ + w/o Cont	$6,119.20	$7,649.00	$680.83–$6,654.63	—	20%
CT scan of the abdomen with contrast CPT 74160 CT Abdomen w/ Cont	$3,020.00	$3,775.00	$680.19–$3,055.75	24% above	20%
CT scan of the abdomen with contrast inpatient CPT 74160 CT Abdomen w/ Cont	$3,020.00	$3,775.00	$680.19–$3,055.75	—	20%
CT scan of the abdomen without contrast CPT 74150 CT Abdomen w/o Cont	$2,868.00	$3,585.00	$238.78–$1,033.20	45% above	20%
CT scan of the abdomen without contrast inpatient CPT 74150 CT Abdomen w/o Cont	$2,868.00	$3,585.00	$238.78–$1,033.20	—	20%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT Sinus or Facial w/o Cont	$2,251.20	$2,814.00	$239.01–$2,331.60	31% above	20%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT Sinus or Facial w/o Cont	$2,251.20	$2,814.00	$239.01–$2,331.60	—	20%
CT scan of the head or brain, no contrast dye CPT 70450 CT Head or Brain w/o Cont	$2,304.80	$2,881.00	$680.83–$2,688.14	21% above	20%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Head or Brain w/o Cont	$2,304.80	$2,881.00	$680.83–$2,688.14	—	20%
CT scan of the head with contrast CPT 70460 CT Head or Brain w/ Cont	$2,564.80	$3,206.00	$939.71	24% above	20%
CT scan of the head with contrast inpatient CPT 70460 CT Head or Brain w/ Cont	$2,564.80	$3,206.00	$939.71	—	20%
CT scan of the head without and with contrast CPT 70470 CT Head or Brain w/ + w/o Cont	$2,758.40	$3,448.00	$680.83–$1,015.28	11% above	20%
CT scan of the head without and with contrast inpatient CPT 70470 CT Head or Brain w/ + w/o Cont	$2,758.40	$3,448.00	$680.83–$1,015.28	—	20%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT Spine Lumbar w/o Cont	$2,696.80	$3,371.00	$238.78–$991.07	20% above	20%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT Spine Lumbar w/o Cont	$2,696.80	$3,371.00	$238.78–$991.07	—	20%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT Spine Cervical w/o Cont	$2,653.60	$3,317.00	$239.01–$2,748.33	12% above	20%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT Spine Cervical w/o Cont	$2,653.60	$3,317.00	$239.01–$2,748.33	—	20%
CT scan of the pelvis, with contrast dye CPT 72193 CT Pelvis w/ Cont	$2,949.60	$3,687.00	$680.83–$1,052.83	34% above	20%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Pelvis w/ Cont	$2,949.60	$3,687.00	$680.83–$1,052.83	—	20%
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 US Carotid Duplex Bil	$912.00	$1,140.00	$159.99–$618.95	5% above	20%
Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 US Carotid Duplex Bil	$912.00	$1,140.00	$159.99–$618.95	—	20%
Chest CT scan without and with contrast CPT 71270 CT Chest w/ + w/o Cont	$3,081.60	$3,852.00	$680.19–$3,191.16	5% above	20%
Chest CT scan without and with contrast inpatient CPT 71270 CT Chest w/ + w/o Cont	$3,081.60	$3,852.00	$680.19–$3,191.16	—	20%
Chest X-ray, 2 views CPT 71046 XR Chest 2 Views	$393.60	$492.00	$125.78–$428.04	28% above	20%
Chest X-ray, 2 views inpatient CPT 71046 XR Chest 2 Views	$393.60	$492.00	$125.78–$428.04	—	20%
Chest X-ray, single view CPT 71045 XR Chest Special Views	$249.60	$312.00	$84.58–$297.00	at median	20%
Chest X-ray, single view CPT 71045 CHEST 1V	$249.60	$312.00	$84.58–$297.00	at median	20%
Chest X-ray, single view inpatient CPT 71045 XR Chest Special Views	$249.60	$312.00	$84.58–$297.00	—	20%
Chest X-ray, single view inpatient CPT 71045 CHEST 1V	$249.60	$312.00	$84.58–$297.00	—	20%
Collarbone (clavicle) X-ray, complete one side CPT 73000 XR Clavicle Comp Lt	$451.20	$564.00	$125.78–$537.00	50% above	20%
Collarbone (clavicle) X-ray, complete one side CPT 73000 XR Clavicle Comp Rt	$451.20	$564.00	$125.78–$537.00	50% above	20%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 XR Clavicle Comp Lt	$451.20	$564.00	$125.78–$537.00	—	20%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 XR Clavicle Comp Rt	$451.20	$564.00	$125.78–$537.00	—	20%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US Retroperitoneal Comp	$695.20	$869.00	$238.34–$377.17	17% below	20%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US Retroperitoneal Comp	$695.20	$869.00	$238.34–$377.17	—	20%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 BD DEXA Bone Density Scan FAMC	$592.00	$740.00	$176.60–$673.41	20% above	20%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 BD DEXA Bone Density Scan FAMC	$592.00	$740.00	$176.60–$673.41	—	20%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Chest w/o Cont	$2,022.40	$2,528.00	$238.78–$2,199.36	7% above	20%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Chest w/o Cont	$2,022.40	$2,528.00	$238.78–$2,199.36	—	20%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Chest w/ Cont	$2,868.00	$3,585.00	$544.92–$3,585.00	18% above	20%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Chest w/ Cont	$2,868.00	$3,585.00	$544.92–$3,585.00	—	20%
Diagnostic mammogram, both breasts CPT 77066 MAMMOGRAM DIAGNOSTIC	$340.00	$425.00	$106.96–$404.00	2% above	20%
Diagnostic mammogram, both breasts inpatient CPT 77066 MAMMOGRAM DIAGNOSTIC	$340.00	$425.00	$106.96–$404.00	—	20%
Diagnostic mammogram, one breast one side CPT 77065 MA Diag Lt w/ Cad	$90.40	$113.00	$91.98–$298.03	72% below	20%
Diagnostic mammogram, one breast one side CPT 77065 MA Diag Rt w/ Cad	$90.40	$113.00	$91.98–$298.03	72% below	20%
Diagnostic mammogram, one breast one side CPT 77065 MA Diag Rt w/ Cad.	$272.00	$340.00	$91.98–$298.03	14% below	20%
Diagnostic mammogram, one breast one side CPT 77065 MA Diag Lt w/ Cad.	$272.00	$340.00	$91.98–$298.03	14% below	20%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Diag Lt w/ Cad	$90.40	$113.00	$91.98–$298.03	—	20%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Diag Rt w/ Cad	$90.40	$113.00	$91.98–$298.03	—	20%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Diag Rt w/ Cad.	$272.00	$340.00	$91.98–$298.03	—	20%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Diag Lt w/ Cad.	$272.00	$340.00	$91.98–$298.03	—	20%
Duplex ultrasound of the leg arteries, both legs CPT 93925 US LE Art Duplex Bil	$1,301.60	$1,627.00	$235.45–$1,415.49	18% above	20%
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 US LE Art Duplex Bil	$1,301.60	$1,627.00	$235.45–$1,415.49	—	20%
Duplex ultrasound of the leg veins, both legs CPT 93970 US LE Veins Duplex Bil	$1,262.40	$1,578.00	$188.41–$1,565.13	12% below	20%
Duplex ultrasound of the leg veins, both legs CPT 93970 US UE Veins Duplex Bil	$1,262.40	$1,578.00	$188.41–$1,565.13	12% below	20%
Duplex ultrasound of the leg veins, both legs CPT 93970 US Venous Reflux Study Bil	$1,439.20	$1,799.00	$188.41–$1,565.13	at median	20%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 US LE Veins Duplex Bil	$1,262.40	$1,578.00	$188.41–$1,565.13	—	20%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 US UE Veins Duplex Bil	$1,262.40	$1,578.00	$188.41–$1,565.13	—	20%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 US Venous Reflux Study Bil	$1,439.20	$1,799.00	$188.41–$1,565.13	—	20%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 US Echo 2D Comp w/ Color Flow Doppler	$2,145.60	$2,682.00	$727.35–$2,333.34	at median	20%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 US Echo 2D Comp w/ Color Flow Doppler	$2,145.60	$2,682.00	$727.35–$2,333.34	—	20%
Elbow X-ray, 2 views one side CPT 73070 XR Elbow 2 Views Lt	$376.80	$471.00	$57.17–$177.12	32% above	20%
Elbow X-ray, 2 views one side CPT 73070 XR Elbow 2 Views Rt	$376.80	$471.00	$57.17–$177.12	32% above	20%
Elbow X-ray, 2 views inpatient one side CPT 73070 XR Elbow 2 Views Rt	$376.80	$471.00	$57.17–$177.12	—	20%
Elbow X-ray, 2 views inpatient one side CPT 73070 XR Elbow 2 Views Lt	$376.80	$471.00	$57.17–$177.12	—	20%
Elbow X-ray, complete, 3 or more views one side CPT 73080 XR Elbow Comp Min 3 Views Lt	$439.20	$549.00	$125.78–$466.65	27% above	20%
Elbow X-ray, complete, 3 or more views one side CPT 73080 XR Elbow Comp Min 3 Views Rt	$439.20	$549.00	$125.78–$466.65	27% above	20%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 XR Elbow Comp Min 3 Views Lt	$439.20	$549.00	$125.78–$466.65	—	20%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 XR Elbow Comp Min 3 Views Rt	$439.20	$549.00	$125.78–$466.65	—	20%
Eye socket (orbit) CT scan without contrast CPT 70480 CT Orbit Sella etc. or IAC w/o Cont	$2,304.80	$2,881.00	$239.01–$2,506.47	33% above	20%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT Orbit Sella etc. or IAC w/o Cont	$2,304.80	$2,881.00	$239.01–$2,506.47	—	20%
Facial bones X-ray, complete, 3 or more views CPT 70150 XR Facial Bones Comp Min 3 Views	$529.60	$662.00	$125.78–$181.57	22% above	20%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 XR Facial Bones Comp Min 3 Views	$529.60	$662.00	$125.78–$181.57	—	20%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 XR Forearm 2 Views Rt	$439.20	$549.00	$125.78–$466.65	36% above	20%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 XR Forearm 2 Views Lt	$439.20	$549.00	$125.78–$466.65	36% above	20%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 XR Forearm 2 Views Lt	$439.20	$549.00	$125.78–$466.65	—	20%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 XR Forearm 2 Views Rt	$439.20	$549.00	$125.78–$466.65	—	20%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM HEPATOBILIARY SCAN	$2,220.00	$2,775.00	$799.75–$813.21	47% above	20%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM HEPATOBILIARY SCAN	$2,220.00	$2,775.00	$799.75–$813.21	—	20%
Hand X-ray, 2 views one side CPT 73120 XR Hand 2 Views Rt	$380.80	$476.00	$125.66–$404.60	32% above	20%
Hand X-ray, 2 views one side CPT 73120 XR Hand 2 Views Lt	$380.80	$476.00	$125.66–$404.60	32% above	20%
Hand X-ray, 2 views inpatient one side CPT 73120 XR Hand 2 Views Rt	$380.80	$476.00	$125.66–$404.60	—	20%
Hand X-ray, 2 views inpatient one side CPT 73120 XR Hand 2 Views Lt	$380.80	$476.00	$125.66–$404.60	—	20%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 XR Heel Min 2 Views Rt	$347.20	$434.00	$121.42–$359.31	32% above	20%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 XR Heel Min 2 Views Lt	$347.20	$434.00	$121.42–$359.31	32% above	20%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 XR Heel Min 2 Views Rt	$347.20	$434.00	$121.42–$359.31	—	20%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 XR Heel Min 2 Views Lt	$347.20	$434.00	$121.42–$359.31	—	20%
Knee X-ray, 3 views one side CPT 73562 XR Knee 3 Views Lt	$464.00	$580.00	$125.78–$504.60	21% above	20%
Knee X-ray, 3 views one side CPT 73562 XR Knee 3 Views Rt	$464.00	$580.00	$125.78–$504.60	21% above	20%
Knee X-ray, 3 views inpatient one side CPT 73562 XR Knee 3 Views Lt	$464.00	$580.00	$125.78–$504.60	—	20%
Knee X-ray, 3 views inpatient one side CPT 73562 XR Knee 3 Views Rt	$464.00	$580.00	$125.78–$504.60	—	20%
Knee X-ray, complete, 4 or more views one side CPT 73564 XR Knee Comp Min 4 Views Rt	$485.60	$607.00	$125.78–$528.09	6% above	20%
Knee X-ray, complete, 4 or more views one side CPT 73564 XR Knee Comp Min 4 Views Lt	$485.60	$607.00	$125.78–$528.09	6% above	20%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 XR Knee Comp Min 4 Views Rt	$485.60	$607.00	$125.78–$528.09	—	20%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 XR Knee Comp Min 4 Views Lt	$485.60	$607.00	$125.78–$528.09	—	20%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT Knee w/o Cont Bil	$2,716.80	$3,396.00	$239.01–$2,813.58	49% above	20%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT Femur w/o Cont Bil	$2,716.80	$3,396.00	$239.01–$2,813.58	49% above	20%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT Hip w/o Cont Bil	$2,716.80	$3,396.00	$239.01–$2,813.58	49% above	20%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT Foot w/o Cont Bil	$2,716.80	$3,396.00	$239.01–$2,813.58	49% above	20%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT Ankle w/o Cont Bil	$2,716.80	$3,396.00	$239.01–$2,813.58	49% above	20%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT Tibia/Fibula w/o Cont Bil	$2,716.80	$3,396.00	$239.01–$2,813.58	49% above	20%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Knee w/o Cont Rt	$2,716.80	$3,396.00	$239.01–$2,813.58	49% above	20%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Ankle w/o Cont Lt	$2,716.80	$3,396.00	$239.01–$2,813.58	49% above	20%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Femur w/o Cont Lt	$2,716.80	$3,396.00	$239.01–$2,813.58	49% above	20%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Toes w/o Cont Lt	$2,716.80	$3,396.00	$239.01–$2,813.58	49% above	20%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Tibia/Fibula w/o Cont Lt	$2,716.80	$3,396.00	$239.01–$2,813.58	49% above	20%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Hip w/o Cont Rt	$2,716.80	$3,396.00	$239.01–$2,813.58	49% above	20%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Heel w/o Cont Rt	$2,716.80	$3,396.00	$239.01–$2,813.58	49% above	20%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Heel w/o Cont Lt	$2,716.80	$3,396.00	$239.01–$2,813.58	49% above	20%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Foot w/o Cont Lt	$2,716.80	$3,396.00	$239.01–$2,813.58	49% above	20%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Tibia/Fibula w/o Cont Rt	$2,716.80	$3,396.00	$239.01–$2,813.58	49% above	20%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Knee w/o Cont Lt	$2,716.80	$3,396.00	$239.01–$2,813.58	49% above	20%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Hip w/o Cont Lt	$2,716.80	$3,396.00	$239.01–$2,813.58	49% above	20%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Toes w/o Cont Rt	$2,716.80	$3,396.00	$239.01–$2,813.58	49% above	20%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Ankle w/o Cont Rt	$2,716.80	$3,396.00	$239.01–$2,813.58	49% above	20%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Foot w/o Cont Rt	$2,716.80	$3,396.00	$239.01–$2,813.58	49% above	20%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Femur w/o Cont Rt	$2,716.80	$3,396.00	$239.01–$2,813.58	49% above	20%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 CT Ankle w/o Cont Bil	$2,716.80	$3,396.00	$239.01–$2,813.58	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 CT Tibia/Fibula w/o Cont Bil	$2,716.80	$3,396.00	$239.01–$2,813.58	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 CT Hip w/o Cont Bil	$2,716.80	$3,396.00	$239.01–$2,813.58	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 CT Femur w/o Cont Bil	$2,716.80	$3,396.00	$239.01–$2,813.58	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 CT Knee w/o Cont Bil	$2,716.80	$3,396.00	$239.01–$2,813.58	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 CT Foot w/o Cont Bil	$2,716.80	$3,396.00	$239.01–$2,813.58	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Toes w/o Cont Rt	$2,716.80	$3,396.00	$239.01–$2,813.58	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Toes w/o Cont Lt	$2,716.80	$3,396.00	$239.01–$2,813.58	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Heel w/o Cont Rt	$2,716.80	$3,396.00	$239.01–$2,813.58	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Hip w/o Cont Lt	$2,716.80	$3,396.00	$239.01–$2,813.58	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Knee w/o Cont Rt	$2,716.80	$3,396.00	$239.01–$2,813.58	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Femur w/o Cont Rt	$2,716.80	$3,396.00	$239.01–$2,813.58	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Hip w/o Cont Rt	$2,716.80	$3,396.00	$239.01–$2,813.58	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Tibia/Fibula w/o Cont Lt	$2,716.80	$3,396.00	$239.01–$2,813.58	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Knee w/o Cont Lt	$2,716.80	$3,396.00	$239.01–$2,813.58	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Femur w/o Cont Lt	$2,716.80	$3,396.00	$239.01–$2,813.58	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Ankle w/o Cont Lt	$2,716.80	$3,396.00	$239.01–$2,813.58	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Ankle w/o Cont Rt	$2,716.80	$3,396.00	$239.01–$2,813.58	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Foot w/o Cont Lt	$2,716.80	$3,396.00	$239.01–$2,813.58	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Heel w/o Cont Lt	$2,716.80	$3,396.00	$239.01–$2,813.58	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Foot w/o Cont Rt	$2,716.80	$3,396.00	$239.01–$2,813.58	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Tibia/Fibula w/o Cont Rt	$2,716.80	$3,396.00	$239.01–$2,813.58	—	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Pancreas FAMC	$804.80	$1,006.00	$244.80–$875.22	13% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Gallbladder FAMC	$804.80	$1,006.00	$244.80–$875.22	13% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Abdomen Ltd	$804.80	$1,006.00	$244.80–$875.22	13% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Liver FAMC	$804.80	$1,006.00	$244.80–$875.22	13% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Spleen FAMC	$804.80	$1,006.00	$244.80–$875.22	13% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Liver FAMC	$804.80	$1,006.00	$244.80–$875.22	—	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Pancreas FAMC	$804.80	$1,006.00	$244.80–$875.22	—	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Gallbladder FAMC	$804.80	$1,006.00	$244.80–$875.22	—	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Abdomen Ltd	$804.80	$1,006.00	$244.80–$875.22	—	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Spleen FAMC	$804.80	$1,006.00	$244.80–$875.22	—	20%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US Extremity Nonvascular Lt	$602.40	$753.00	$217.01–$351.66	49% above	20%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US Extremity Nonvascular Rt	$602.40	$753.00	$217.01–$351.66	49% above	20%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US Extremity Nonvascular Lt	$602.40	$753.00	$217.01–$351.66	—	20%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US Extremity Nonvascular Rt	$602.40	$753.00	$217.01–$351.66	—	20%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT Low Dose Lung Screening	$441.60	$552.00	$149.20–$469.20	22% below	20%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT Low Dose Lung Screening	$441.60	$552.00	$149.20–$469.20	—	20%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 XR Tibia +Fibula 2 Views Rt	$439.20	$549.00	$62.89–$477.63	35% above	20%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 XR Tibia +Fibula 2 Views Lt	$439.20	$549.00	$62.89–$477.63	35% above	20%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 XR Tibia +Fibula 2 Views Lt	$439.20	$549.00	$62.89–$477.63	—	20%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 XR Tibia +Fibula 2 Views Rt	$439.20	$549.00	$62.89–$477.63	—	20%
MR angiography (MRA) of the head without contrast CPT 70544 MRA Head w/o Cont	$2,899.20	$3,624.00	$550.85–$1,101.26	5% above	20%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRA Head w/o Cont	$2,899.20	$3,624.00	$550.85–$1,101.26	—	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Hip w/o Cont Lt	$3,030.40	$3,788.00	$17.47–$3,788.00	6% above	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Ankle w/o Cont Rt	$3,030.40	$3,788.00	$17.47–$3,788.00	6% above	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Hip w/o Cont Rt	$3,030.40	$3,788.00	$17.47–$3,788.00	6% above	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Knee w/o Cont Rt	$3,030.40	$3,788.00	$17.47–$3,788.00	6% above	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Knee w/o Cont Lt	$3,030.40	$3,788.00	$17.47–$3,788.00	6% above	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Ankle w/o Cont Lt	$3,030.40	$3,788.00	$17.47–$3,788.00	6% above	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Knee w/o Cont Lt	$3,030.40	$3,788.00	$17.47–$3,788.00	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Hip w/o Cont Lt	$3,030.40	$3,788.00	$17.47–$3,788.00	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Ankle w/o Cont Rt	$3,030.40	$3,788.00	$17.47–$3,788.00	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Hip w/o Cont Rt	$3,030.40	$3,788.00	$17.47–$3,788.00	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Knee w/o Cont Rt	$3,030.40	$3,788.00	$17.47–$3,788.00	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Ankle w/o Cont Lt	$3,030.40	$3,788.00	$17.47–$3,788.00	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Ankle w/ + w/o Cont Rt	$3,744.00	$4,680.00	$355.68–$3,788.45	1% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Knee w/ + w/o Cont Rt	$3,744.00	$4,680.00	$355.68–$3,788.45	1% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Knee w/ + w/o Cont Lt	$3,744.00	$4,680.00	$355.68–$3,788.45	1% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Hip w/ + w/o Cont Rt	$3,744.00	$4,680.00	$355.68–$3,788.45	1% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Hip w/ + w/o Cont Lt	$3,744.00	$4,680.00	$355.68–$3,788.45	1% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Ankle w/ + w/o Cont Lt	$3,744.00	$4,680.00	$355.68–$3,788.45	1% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Ankle w/ + w/o Cont Rt	$3,744.00	$4,680.00	$355.68–$3,788.45	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Hip w/ + w/o Cont Rt	$3,744.00	$4,680.00	$355.68–$3,788.45	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Ankle w/ + w/o Cont Lt	$3,744.00	$4,680.00	$355.68–$3,788.45	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Knee w/ + w/o Cont Lt	$3,744.00	$4,680.00	$355.68–$3,788.45	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Knee w/ + w/o Cont Rt	$3,744.00	$4,680.00	$355.68–$3,788.45	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Hip w/ + w/o Cont Lt	$3,744.00	$4,680.00	$355.68–$3,788.45	—	20%
MRI of the abdomen without contrast CPT 74181 MRI Abdomen w/o Cont	$2,609.60	$3,262.00	$540.42–$956.03	6% below	20%
MRI of the abdomen without contrast CPT 74181 MRI MRCP	$2,609.60	$3,262.00	$540.42–$956.03	6% below	20%
MRI of the abdomen without contrast inpatient CPT 74181 MRI MRCP	$2,609.60	$3,262.00	$540.42–$956.03	—	20%
MRI of the abdomen without contrast inpatient CPT 74181 MRI Abdomen w/o Cont	$2,609.60	$3,262.00	$540.42–$956.03	—	20%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI Abdomen w/ + w/o Cont	$3,857.60	$4,822.00	$911.79–$3,995.04	3% above	20%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI Abdomen w/ + w/o Cont	$3,857.60	$4,822.00	$911.79–$3,995.04	—	20%
MRI of the brain, no contrast dye CPT 70551 MRI Pituitary Gland w/o Cont	$2,781.60	$3,477.00	$540.42–$3,024.99	5% below	20%
MRI of the brain, no contrast dye CPT 70551 MRI IAC w/o Contrast	$2,781.60	$3,477.00	$540.42–$3,024.99	5% below	20%
MRI of the brain, no contrast dye CPT 70551 MRI HEAD WO	$2,781.60	$3,477.00	$540.42–$3,024.99	5% below	20%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI IAC w/o Contrast	$2,781.60	$3,477.00	$540.42–$3,024.99	—	20%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI HEAD WO	$2,781.60	$3,477.00	$540.42–$3,024.99	—	20%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI Pituitary Gland w/o Cont	$2,781.60	$3,477.00	$540.42–$3,024.99	—	20%
MRI of the brain, with and without contrast dye CPT 70553 MRI Brain w/ + w/o Cont	$4,052.00	$5,065.00	$769.88–$4,538.35	3% below	20%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI Brain w/ + w/o Cont	$4,052.00	$5,065.00	$769.88–$4,538.35	—	20%
MRI of the lower back, no contrast dye CPT 72148 MRI Spine Lumbar w/out contrast	$2,996.00	$3,745.00	$540.42–$3,258.15	2% below	20%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI Spine Lumbar w/out contrast	$2,996.00	$3,745.00	$540.42–$3,258.15	—	20%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI Spine Lumbar w/ + w/o Cont	$3,922.40	$4,903.00	$709.69–$3,968.65	6% below	20%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI Spine Lumbar w/ + w/o Cont	$3,922.40	$4,903.00	$709.69–$3,968.65	—	20%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI Spine Thoracic w/o Cont	$2,996.00	$3,745.00	$540.42–$1,072.13	at median	20%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI Spine Thoracic w/o Cont	$2,996.00	$3,745.00	$540.42–$1,072.13	—	20%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI Spine Cervical w/ + w/o Cont	$4,094.40	$5,118.00	$1,404.69–$4,142.90	at median	20%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI Spine Cervical w/ + w/o Cont	$4,094.40	$5,118.00	$1,404.69–$4,142.90	—	20%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI Spine Cervical w/o Cont	$3,308.80	$4,136.00	$540.42–$3,598.32	10% above	20%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI Spine Cervical w/o Cont	$3,308.80	$4,136.00	$540.42–$3,598.32	—	20%
MRI of the pelvis without and with contrast CPT 72197 MRI Pelvis w/ + w/o Cont	$3,550.40	$4,438.00	$911.79–$1,304.77	5% below	20%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI Pelvis w/ + w/o Cont	$3,550.40	$4,438.00	$911.79–$1,304.77	—	20%
MRI of the pelvis, no contrast dye CPT 72195 MRI Pelvis w/o Cont	$2,560.80	$3,201.00	$878.43	6% below	20%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI Pelvis w/o Cont	$2,560.80	$3,201.00	$878.43	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Shoulder w/o Cont Lt	$3,258.40	$4,073.00	$539.91–$3,879.00	12% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Elbow w/o Cont Rt	$3,258.40	$4,073.00	$539.91–$3,879.00	12% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Shoulder w/o Cont Rt	$3,258.40	$4,073.00	$539.91–$3,879.00	12% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Wrist w/o Cont Lt	$3,258.40	$4,073.00	$539.91–$3,879.00	12% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Elbow w/o Cont Lt	$3,258.40	$4,073.00	$539.91–$3,879.00	12% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Wrist w/o Cont Rt	$3,258.40	$4,073.00	$539.91–$3,879.00	12% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Shoulder w/o Cont Lt	$3,258.40	$4,073.00	$539.91–$3,879.00	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Wrist w/o Cont Lt	$3,258.40	$4,073.00	$539.91–$3,879.00	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Wrist w/o Cont Rt	$3,258.40	$4,073.00	$539.91–$3,879.00	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Elbow w/o Cont Lt	$3,258.40	$4,073.00	$539.91–$3,879.00	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Elbow w/o Cont Rt	$3,258.40	$4,073.00	$539.91–$3,879.00	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Shoulder w/o Cont Rt	$3,258.40	$4,073.00	$539.91–$3,879.00	—	20%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 XR Spine Cerv Min 4 Views	$591.20	$739.00	$125.66–$642.93	8% above	20%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 XR Spine Cerv Min 4 Views	$591.20	$739.00	$125.66–$642.93	—	20%
Neck soft tissue CT scan with contrast CPT 70491 CT Soft Tissue Neck w/ Cont	$2,801.60	$3,502.00	$482.75–$3,046.74	27% above	20%
Neck soft tissue CT scan with contrast inpatient CPT 70491 CT Soft Tissue Neck w/ Cont	$2,801.60	$3,502.00	$482.75–$3,046.74	—	20%
Neck soft tissue CT scan without contrast CPT 70490 CT ST NECK WO	$2,264.00	$2,830.00	$238.78–$815.61	23% above	20%
Neck soft tissue CT scan without contrast inpatient CPT 70490 CT ST NECK WO	$2,264.00	$2,830.00	$238.78–$815.61	—	20%
Neck soft tissue X-ray CPT 70360 XR Neck Soft Tissue	$397.60	$497.00	$75.54	49% above	20%
Neck soft tissue X-ray inpatient CPT 70360 XR Neck Soft Tissue	$397.60	$497.00	$75.54	—	20%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM Myocard Perf Spect Mult Rest+Stress	$4,254.40	$5,318.00	$1,459.44–$4,405.68	13% above	20%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM Myocard Perf Spect Mult Rest+Stress	$4,254.40	$5,318.00	$1,459.44–$4,405.68	—	20%
Pelvic CT scan without contrast CPT 72192 CT Pelvis w/o Cont	$2,732.80	$3,416.00	$239.01–$1,691.43	43% above	20%
Pelvic CT scan without contrast inpatient CPT 72192 CT Pelvis w/o Cont	$2,732.80	$3,416.00	$239.01–$1,691.43	—	20%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US Pelvis Non-OB Comp	$904.80	$1,131.00	$310.39–$961.35	10% above	20%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US Bladder FAMC	$904.80	$1,131.00	$310.39–$961.35	10% above	20%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US Pelvis Non-OB Comp	$904.80	$1,131.00	$310.39–$961.35	—	20%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US Bladder FAMC	$904.80	$1,131.00	$310.39–$961.35	—	20%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US Pregnant > 14 Weeks 1st Gest	$810.40	$1,013.00	$225.49–$881.31	9% above	20%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US Pregnant > 14 Weeks Ea Addl Gest	$810.40	$1,013.00	$225.49–$881.31	9% above	20%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US Pregnant > 14 Weeks 1st Gest	$810.40	$1,013.00	$225.49–$881.31	—	20%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US Pregnant > 14 Weeks Ea Addl Gest	$810.40	$1,013.00	$225.49–$881.31	—	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US Pregnant Ltd	$406.40	$508.00	$225.49–$431.80	20% below	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US Pregnant Ltd	$406.40	$508.00	$225.49–$431.80	—	20%
Rib X-ray, one side, 2 views one side CPT 71100 XR Ribs 2 Views Rt	$509.60	$637.00	$125.66–$463.89	43% above	20%
Rib X-ray, one side, 2 views one side CPT 71100 XR Ribs 2 Views Lt	$509.60	$637.00	$125.66–$463.89	43% above	20%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 XR Ribs 2 Views Lt	$509.60	$637.00	$125.66–$463.89	—	20%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 XR Ribs 2 Views Rt	$509.60	$637.00	$125.66–$463.89	—	20%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 XR Ribs Min 3 Views Lt w/ PA Chest	$577.60	$722.00	$125.78–$610.83	20% above	20%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 XR Ribs Min 3 Views Rt w/ PA Chest	$577.60	$722.00	$125.78–$610.83	20% above	20%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 XR Ribs Min 3 Views Rt w/ PA Chest	$577.60	$722.00	$125.78–$610.83	—	20%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 XR Ribs Min 3 Views Lt w/ PA Chest	$577.60	$722.00	$125.78–$610.83	—	20%
Screening mammogram, both breasts CPT 77067 MA Routine Screen Bil w/ Cad.	$296.00	$370.00	$80.23–$321.90	9% above	20%
Screening mammogram, both breasts inpatient CPT 77067 MA Routine Screen Bil w/ Cad.	$296.00	$370.00	$80.23–$321.90	—	20%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR Shoulder Comp Min 2 Views Lt	$439.20	$549.00	$83.45–$603.21	21% above	20%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR Shoulder Comp Min 2 Views Rt	$439.20	$549.00	$83.45–$603.21	21% above	20%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR Shoulder Comp Min 2 Views Lt	$439.20	$549.00	$83.45–$603.21	—	20%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR Shoulder Comp Min 2 Views Rt	$439.20	$549.00	$83.45–$603.21	—	20%
Sinus X-ray, complete, 3 or more views CPT 70220 XR Sinuses Paranasal Comp Min 3 Views	$451.20	$564.00	$154.76–$165.29	6% above	20%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 XR Sinuses Paranasal Comp Min 3 Views	$451.20	$564.00	$154.76–$165.29	—	20%
Swallow study (modified barium swallow, video X-ray) CPT 74230 XR Swallowing Funct w/ Video	$579.20	$724.00	$198.57–$403.71	12% below	20%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 XR Swallowing Funct w/ Video	$579.20	$724.00	$198.57–$403.71	—	20%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 XR Femur 2 Views Rt	$405.60	$507.00	$62.89–$419.34	44% above	20%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 XR Femur 2 Views Lt	$405.60	$507.00	$62.89–$419.34	44% above	20%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 XR Femur 2 Views Rt	$405.60	$507.00	$62.89–$419.34	—	20%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 XR Femur 2 Views Lt	$405.60	$507.00	$62.89–$419.34	—	20%
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT Spine Thoracic w/o Cont	$2,716.80	$3,396.00	$238.78–$998.42	26% above	20%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT Spine Thoracic w/o Cont	$2,716.80	$3,396.00	$238.78–$998.42	—	20%
Toe X-ray, 2 or more views one side CPT 73660 XR Toe(s) Min 2 Views Rt	$289.60	$362.00	$15.00–$125.78	20% above	20%
Toe X-ray, 2 or more views one side CPT 73660 XR Toe(s) Min 2 Views Lt	$289.60	$362.00	$15.00–$125.78	20% above	20%
Toe X-ray, 2 or more views one side CPT 73660 TOES RT 2V	$289.60	$362.00	$15.00–$125.78	20% above	20%
Toe X-ray, 2 or more views inpatient one side CPT 73660 TOES RT 2V	$289.60	$362.00	$15.00–$125.78	—	20%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toe(s) Min 2 Views Lt	$289.60	$362.00	$15.00–$125.78	—	20%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toe(s) Min 2 Views Rt	$289.60	$362.00	$15.00–$125.78	—	20%
Transvaginal pelvic ultrasound CPT 76830 US Pelvis Non-OB Transvaginal	$948.00	$1,185.00	$244.80–$1,030.95	43% above	20%
Transvaginal pelvic ultrasound inpatient CPT 76830 US Pelvis Non-OB Transvaginal	$948.00	$1,185.00	$244.80–$1,030.95	—	20%
Transvaginal ultrasound during pregnancy CPT 76817 US Pregnant Transvaginal	$948.00	$1,185.00	$225.49–$1,128.00	81% above	20%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US Pregnant Transvaginal	$948.00	$1,185.00	$225.49–$1,128.00	—	20%
Ultrasound of the abdomen, complete CPT 76700 US Abdomen Comp	$1,262.40	$1,578.00	$377.17–$1,306.74	19% above	20%
Ultrasound of the abdomen, complete inpatient CPT 76700 US Abdomen Comp	$1,262.40	$1,578.00	$377.17–$1,306.74	—	20%
Ultrasound of the scrotum and testicles CPT 76870 US Scrotum +Contents	$763.20	$954.00	$244.57–$810.90	1% above	20%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US Scrotum +Contents	$763.20	$954.00	$244.57–$810.90	—	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Thyroid	$810.40	$1,013.00	$244.80–$881.31	18% above	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Head +Neck Soft Tissue	$810.40	$1,013.00	$244.80–$881.31	18% above	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US Head +Neck Soft Tissue	$810.40	$1,013.00	$244.80–$881.31	—	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US Thyroid	$810.40	$1,013.00	$244.80–$881.31	—	20%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 XR UGI w/o KUB	$1,084.00	$1,355.00	$265.06–$1,151.75	38% above	20%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 XR UGI w/o KUB	$1,084.00	$1,355.00	$265.06–$1,151.75	—	20%
Upper arm X-ray (humerus), 2 views one side CPT 73060 XR Humerus Min 2 Views Lt	$439.20	$549.00	$125.66–$447.36	40% above	20%
Upper arm X-ray (humerus), 2 views one side CPT 73060 XR Humerus Min 2 Views Rt	$439.20	$549.00	$125.66–$447.36	40% above	20%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 XR Humerus Min 2 Views Lt	$439.20	$549.00	$125.66–$447.36	—	20%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 XR Humerus Min 2 Views Rt	$439.20	$549.00	$125.66–$447.36	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 US VENOUS DUPLEX UNIL	$815.20	$1,019.00	$244.80–$886.53	7% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US UE Veins Duplex Lt	$815.20	$1,019.00	$244.80–$886.53	7% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US UE Veins Duplex Rt	$815.20	$1,019.00	$244.80–$886.53	7% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Venous Reflux Study Lt	$1,016.00	$1,270.00	$188.41–$1,565.13	33% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Venous Reflux Study Rt	$1,016.00	$1,270.00	$188.41–$1,565.13	33% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 US VENOUS DUPLEX UNIL	$815.20	$1,019.00	$244.80–$886.53	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US UE Veins Duplex Rt	$815.20	$1,019.00	$244.80–$886.53	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US UE Veins Duplex Lt	$815.20	$1,019.00	$244.80–$886.53	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Venous Reflux Study Lt	$1,016.00	$1,270.00	$188.41–$1,565.13	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Venous Reflux Study Rt	$1,016.00	$1,270.00	$188.41–$1,565.13	—	20%
Wrist X-ray, 2 views one side CPT 73100 XR Wrist 2 Views Lt	$347.20	$434.00	$62.89–$359.31	25% above	20%
Wrist X-ray, 2 views one side CPT 73100 XR Wrist 2 Views Rt	$347.20	$434.00	$62.89–$359.31	25% above	20%
Wrist X-ray, 2 views inpatient one side CPT 73100 XR Wrist 2 Views Lt	$347.20	$434.00	$62.89–$359.31	—	20%
Wrist X-ray, 2 views inpatient one side CPT 73100 XR Wrist 2 Views Rt	$347.20	$434.00	$62.89–$359.31	—	20%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR Wrist Comp Min 3 Views Rt	$439.20	$549.00	$114.23–$466.65	32% above	20%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR Wrist Comp Min 3 Views Lt	$439.20	$549.00	$114.23–$466.65	32% above	20%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR Wrist Comp Min 3 Views Rt	$439.20	$549.00	$114.23–$466.65	—	20%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR Wrist Comp Min 3 Views Lt	$439.20	$549.00	$114.23–$466.65	—	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip Comp Min 2 Views Rt	$344.00	$430.00	$62.89–$400.82	11% above	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP LT AP/LAT	$344.00	$430.00	$62.89–$400.82	11% above	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip 2-3 Views Lt w/ Pelvis	$344.00	$430.00	$62.89–$400.82	11% above	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip 2-3 Views Rt w/ Pelvis	$344.00	$430.00	$62.89–$400.82	11% above	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP LT AP/LAT	$344.00	$430.00	$62.89–$400.82	—	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR Hip 2-3 Views Rt w/ Pelvis	$344.00	$430.00	$62.89–$400.82	—	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR Hip 2-3 Views Lt w/ Pelvis	$344.00	$430.00	$62.89–$400.82	—	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR Hip Comp Min 2 Views Rt	$344.00	$430.00	$62.89–$400.82	—	20%
X-ray of the abdomen, 1 view CPT 74018 XR Abdomen 1 View	$280.00	$350.00	$95.97–$304.50	5% above	20%
X-ray of the abdomen, 1 view inpatient CPT 74018 XR Abdomen 1 View	$280.00	$350.00	$95.97–$304.50	—	20%
X-ray of the ankle, 2 views one side CPT 73600 XR Ankle 2 Views Lt	$347.20	$434.00	$31.39–$359.31	23% above	20%
X-ray of the ankle, 2 views one side CPT 73600 XR Ankle 2 Views Rt	$347.20	$434.00	$31.39–$359.31	23% above	20%
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR Ankle 2 Views Rt	$347.20	$434.00	$31.39–$359.31	—	20%
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR Ankle 2 Views Lt	$347.20	$434.00	$31.39–$359.31	—	20%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Fingers Min 2 Views Lt	$292.80	$366.00	$105.48–$311.10	10% above	20%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Fingers Min 2 Views Rt	$292.80	$366.00	$105.48–$311.10	10% above	20%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Fingers Min 2 Views Rt	$292.80	$366.00	$105.48–$311.10	—	20%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Fingers Min 2 Views Lt	$292.80	$366.00	$105.48–$311.10	—	20%
X-ray of the foot, 2 views one side CPT 73620 XR Foot 2 Views Lt	$374.40	$468.00	$125.78–$436.10	35% above	20%
X-ray of the foot, 2 views one side CPT 73620 XR Foot 2 Views Rt	$374.40	$468.00	$125.78–$436.10	35% above	20%
X-ray of the foot, 2 views inpatient one side CPT 73620 XR Foot 2 Views Rt	$374.40	$468.00	$125.78–$436.10	—	20%
X-ray of the foot, 2 views inpatient one side CPT 73620 XR Foot 2 Views Lt	$374.40	$468.00	$125.78–$436.10	—	20%
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR Foot Comp Min 3 Views Rt	$439.20	$549.00	$125.78–$477.63	27% above	20%
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR Foot Comp Min 3 Views Lt	$439.20	$549.00	$125.78–$477.63	27% above	20%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR Foot Comp Min 3 Views Rt	$439.20	$549.00	$125.78–$477.63	—	20%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR Foot Comp Min 3 Views Lt	$439.20	$549.00	$125.78–$477.63	—	20%
X-ray of the hand, 3 or more views one side CPT 73130 XR Hand Min 3 Views Rt	$439.20	$549.00	$125.78–$477.63	26% above	20%
X-ray of the hand, 3 or more views one side CPT 73130 XR Hand Min 3 Views Lt	$439.20	$549.00	$125.78–$477.63	26% above	20%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 XR Hand Min 3 Views Lt	$439.20	$549.00	$125.78–$477.63	—	20%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 XR Hand Min 3 Views Rt	$439.20	$549.00	$125.78–$477.63	—	20%
X-ray of the knee, 1 or 2 views one side CPT 73560 XR Knee 1 or 2 Views Rt	$458.40	$573.00	$120.19–$498.51	53% above	20%
X-ray of the knee, 1 or 2 views one side CPT 73560 XR Knee 1 or 2 Views Lt	$458.40	$573.00	$120.19–$498.51	53% above	20%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR Knee 1 or 2 Views Lt	$458.40	$573.00	$120.19–$498.51	—	20%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR Knee 1 or 2 Views Rt	$458.40	$573.00	$120.19–$498.51	—	20%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XR Spine Lumbosacral 2 or 3 Views	$526.40	$658.00	$125.78–$572.46	16% above	20%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 XR Spine Lumbosacral 2 or 3 Views	$526.40	$658.00	$125.78–$572.46	—	20%
X-ray of the lower back, 4 or more views CPT 72110 XR Spine Lumbosacral Min 4 Views w/ Obl	$746.40	$933.00	$125.66–$478.24	29% above	20%
X-ray of the lower back, 4 or more views inpatient CPT 72110 XR Spine Lumbosacral Min 4 Views w/ Obl	$746.40	$933.00	$125.66–$478.24	—	20%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 XR Spine Thoracic 2 Views	$458.40	$573.00	$62.83–$165.14	21% above	20%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 XR Spine Thoracic 2 Views	$458.40	$573.00	$62.83–$165.14	—	20%
X-ray of the nasal bones, 3 or more views CPT 70160 XR Nasal Bones Comp Min 3 Views	$516.80	$646.00	$125.66–$522.75	71% above	20%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 XR Nasal Bones Comp Min 3 Views	$516.80	$646.00	$125.66–$522.75	—	20%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XR Spine Cerv 2 or 3 Views	$408.00	$510.00	$57.17–$443.70	11% above	20%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 XR Spine Cerv 2 or 3 Views	$408.00	$510.00	$57.17–$443.70	—	20%
X-ray of the pelvis, 1 or 2 views CPT 72170 XR Pelvis 1 or 2 Views	$349.60	$437.00	$62.89–$128.04	at median	20%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 XR Pelvis 1 or 2 Views	$349.60	$437.00	$62.89–$128.04	—	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XR Sacrum +Coccyx Min 2 Views	$451.20	$564.00	$125.78–$467.19	25% above	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 XR Sacrum +Coccyx Min 2 Views	$451.20	$564.00	$125.78–$467.19	—	20%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Illinois	Off list
ACTH blood test CPT 82024 ACTH, Plasma LC	$258.40	$323.00	$63.47–$274.55	33% above	20%
ACTH blood test inpatient CPT 82024 ACTH, Plasma LC	$258.40	$323.00	$63.47–$274.55	—	20%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 SGPT/ALT	$126.40	$158.00	$8.92–$9.80	141% above	20%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 SGPT/ALT	$126.40	$158.00	$8.92–$9.80	—	20%
AST (aspartate aminotransferase) enzyme test CPT 84450 AST 84450	$126.40	$158.00	$4.46–$4.90	141% above	20%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 AST 84450	$126.40	$158.00	$4.46–$4.90	—	20%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Hepatitis Acute LC	$132.00	$165.00	$8.20–$143.55	49% below	20%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Hepatitis Panel, Acute LC	$425.60	$532.00	$8.20–$143.55	63% above	20%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 Hepatitis Acute LC	$132.00	$165.00	$8.20–$143.55	—	20%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 Hepatitis Panel, Acute LC	$425.60	$532.00	$8.20–$143.55	—	20%
Aldosterone blood test CPT 82088 Aldosterone, Urine LC	$46.40	$58.00	$49.30	71% below	20%
Aldosterone blood test CPT 82088 82088 Component LC	$69.60	$87.00	$23.30–$31.74	56% below	20%
Aldosterone blood test inpatient CPT 82088 Aldosterone, Urine LC	$46.40	$58.00	$49.30	—	20%
Aldosterone blood test inpatient CPT 82088 82088 Component LC	$69.60	$87.00	$23.30–$31.74	—	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN, EACH	$6.40	$8.00	$0.52–$147.17	75% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 86003 Allergen specific IgE; quantitative or semiquantitative, crude allergen extract, each	$9.60	$12.00	$0.52–$0.84	63% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen each	$9.60	$12.00	$0.52–$0.84	63% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Profile, Nut, IgE With Component Reflexes LC	$13.60	$17.00	$0.52–$0.84	48% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 86003 Allergen Nut Profile	$13.60	$17.00	$0.52–$0.84	48% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergens	$15.20	$19.00	$0.52–$0.84	42% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergens, Zone 10 LC	$15.20	$19.00	$0.52–$147.17	42% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 86003-Allergen Profile, Nut, IgE With Component Reflexes LC	$123.20	$154.00	$0.52–$0.84	374% above	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN, EACH	$6.40	$8.00	$0.52–$147.17	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 86003 Allergen specific IgE; quantitative or semiquantitative, crude allergen extract, each	$9.60	$12.00	$0.52–$0.84	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen each	$9.60	$12.00	$0.52–$0.84	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Profile, Nut, IgE With Component Reflexes LC	$13.60	$17.00	$0.52–$0.84	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 86003 Allergen Nut Profile	$13.60	$17.00	$0.52–$0.84	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergens, Zone 10 LC	$15.20	$19.00	$0.52–$147.17	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergens	$15.20	$19.00	$0.52–$0.84	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 86003-Allergen Profile, Nut, IgE With Component Reflexes LC	$123.20	$154.00	$0.52–$0.84	—	20%
Alpha-fetoprotein (AFP) blood test CPT 82105 82105 Alpha Fetoprotein	$132.80	$166.00	$21.69–$134.30	18% above	20%
Alpha-fetoprotein (AFP) blood test CPT 82105 AFP, Serum, Tumor Marker LC	$132.80	$166.00	$21.69–$134.30	18% above	20%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 82105 Alpha Fetoprotein	$132.80	$166.00	$21.69–$134.30	—	20%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 AFP, Serum, Tumor Marker LC	$132.80	$166.00	$21.69–$134.30	—	20%
Ammonia blood test CPT 82140 KIDNEY STONE, AMMONIA	$14.40	$18.00	$6.82–$10.86	86% below	20%
Ammonia blood test CPT 82140 82140 LC	$18.40	$23.00	$2.73–$37.24	83% below	20%
Ammonia blood test CPT 82140 Ammonium, Urine, LC	$21.60	$27.00	$4.91–$37.24	80% below	20%
Ammonia blood test CPT 82140 AMMONIA - 82140	$394.40	$493.00	$21.71–$461.50	270% above	20%
Ammonia blood test inpatient CPT 82140 KIDNEY STONE, AMMONIA	$14.40	$18.00	$6.82–$10.86	—	20%
Ammonia blood test inpatient CPT 82140 82140 LC	$18.40	$23.00	$2.73–$37.24	—	20%
Ammonia blood test inpatient CPT 82140 Ammonium, Urine, LC	$21.60	$27.00	$4.91–$37.24	—	20%
Ammonia blood test inpatient CPT 82140 AMMONIA - 82140	$394.40	$493.00	$21.71–$461.50	—	20%
Amylase blood test CPT 82150 Amylase, Synovial SBL	$134.40	$168.00	$4.46–$168.26	64% above	20%
Amylase blood test CPT 82150 AMYLASE-82150	$144.00	$180.00	$4.46–$168.26	76% above	20%
Amylase blood test CPT 82150 BF Amylase SBL	$144.00	$180.00	$4.46–$168.26	76% above	20%
Amylase blood test inpatient CPT 82150 Amylase, Synovial SBL	$134.40	$168.00	$4.46–$168.26	—	20%
Amylase blood test inpatient CPT 82150 AMYLASE-82150	$144.00	$180.00	$4.46–$168.26	—	20%
Amylase blood test inpatient CPT 82150 BF Amylase SBL	$144.00	$180.00	$4.46–$168.26	—	20%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP Antibodies IgG/IgA LC	$106.40	$133.00	$10.45–$113.05	27% above	20%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CCP Antibodies IgG/IgA LC	$106.40	$133.00	$10.45–$113.05	—	20%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Antinuclear Antibodies, IFA LC	$58.40	$73.00	$20.91–$63.51	35% below	20%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA IFA Reflex Titer LC	$84.00	$105.00	$10.45–$94.35	7% below	20%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA w/Reflex if Positive LC	$88.80	$111.00	$10.45–$94.35	1% below	20%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Antinuclear Antibodies, IFA LC	$58.40	$73.00	$20.91–$63.51	—	20%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA IFA Reflex Titer LC	$84.00	$105.00	$10.45–$94.35	—	20%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA w/Reflex if Positive LC	$88.80	$111.00	$10.45–$94.35	—	20%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 BNP 2	$198.40	$248.00	$51.15–$231.28	5% above	20%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NT-PRO BNP	$208.80	$261.00	$51.15–$231.28	11% above	20%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 BNP 2	$198.40	$248.00	$51.15–$231.28	—	20%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NT-PRO BNP	$208.80	$261.00	$51.15–$231.28	—	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Tissue Culture SBL	$96.00	$120.00	$104.40	7% above	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 THROAT CULTURE	$146.40	$183.00	$19.14–$254.91	63% above	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 NASAL CULTURE	$147.20	$184.00	$19.14–$254.91	64% above	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 ROUTINE CULTURE(NON- URINE), 1ST SITE	$234.40	$293.00	$19.14–$254.91	160% above	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Tissue Culture SBL	$96.00	$120.00	$104.40	—	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 THROAT CULTURE	$146.40	$183.00	$19.14–$254.91	—	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 NASAL CULTURE	$147.20	$184.00	$19.14–$254.91	—	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 ROUTINE CULTURE(NON- URINE), 1ST SITE	$234.40	$293.00	$19.14–$254.91	—	20%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC	$144.80	$181.00	$16.41–$157.47	13% above	20%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC	$144.80	$181.00	$16.41–$157.47	—	20%
Bilirubin blood test, total CPT 82247 BILIRUBIN TOTAL	$116.00	$145.00	$8.92–$127.02	89% above	20%
Bilirubin blood test, total CPT 82247 Bili Neo Total	$116.00	$145.00	$4.46	89% above	20%
Bilirubin blood test, total CPT 82247 BILIRUBIN-NEO TOTAL	$116.00	$145.00	$8.92–$127.02	89% above	20%
Bilirubin blood test, total inpatient CPT 82247 Bili Neo Total	$116.00	$145.00	$4.46	—	20%
Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN TOTAL	$116.00	$145.00	$8.92–$127.02	—	20%
Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN-NEO TOTAL	$116.00	$145.00	$8.92–$127.02	—	20%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 GROSS AND MICRO LEVEL IV	$223.20	$279.00	$36.11–$265.00	7% below	20%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 GROSS AND MICRO LEVEL IV	$223.20	$279.00	$36.11–$265.00	—	20%
Blood culture for bacteria CPT 87040 BLOOD CULTURE #1 87040	$193.60	$242.00	$4.78–$225.40	26% above	20%
Blood culture for bacteria CPT 87040 Blood Cultures x2	$193.60	$242.00	$4.78–$225.40	26% above	20%
Blood culture for bacteria inpatient CPT 87040 BLOOD CULTURE #1 87040	$193.60	$242.00	$4.78–$225.40	—	20%
Blood culture for bacteria inpatient CPT 87040 Blood Cultures x2	$193.60	$242.00	$4.78–$225.40	—	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE DRAWING FEE	$32.80	$41.00	$6.11–$41.00	40% above	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE DRAWING FEE	$32.80	$41.00	$6.11–$41.00	—	20%
Blood glucose (sugar) test CPT 82947 GLUCOSE (SUGAR DEXTROSE) - 82947	$126.40	$158.00	$9.80–$137.46	178% above	20%
Blood glucose (sugar) test CPT 82947 Glucose Level	$126.40	$158.00	$9.80–$137.46	178% above	20%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE (SUGAR DEXTROSE) - 82947	$126.40	$158.00	$9.80–$137.46	—	20%
Blood glucose (sugar) test inpatient CPT 82947 Glucose Level	$126.40	$158.00	$9.80–$137.46	—	20%
Blood lead test CPT 83655 LEAD, BLOOD ADULTS	$128.80	$161.00	$11.18–$159.21	130% above	20%
Blood lead test CPT 83655 Lead, Blood (Adult) LC	$146.40	$183.00	$11.18–$159.21	161% above	20%
Blood lead test CPT 83655 Lead (Pediatric) LC	$146.40	$183.00	$11.18–$159.21	161% above	20%
Blood lead test inpatient CPT 83655 LEAD, BLOOD ADULTS	$128.80	$161.00	$11.18–$159.21	—	20%
Blood lead test inpatient CPT 83655 Lead (Pediatric) LC	$146.40	$183.00	$11.18–$159.21	—	20%
Blood lead test inpatient CPT 83655 Lead, Blood (Adult) LC	$146.40	$183.00	$11.18–$159.21	—	20%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 PREGNANCY TEST/SERUM HCG 84703	$169.60	$212.00	$9.80–$184.44	86% above	20%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 PREGNANCY TEST/SERUM HCG 84703	$169.60	$212.00	$9.80–$184.44	—	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Bill Ref ABO type	$36.00	$45.00	$4.02–$322.00	57% below	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Cord ABO/Rh	$271.20	$339.00	$4.02–$322.00	222% above	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO/Rh	$271.20	$339.00	$4.02–$322.00	222% above	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 DAT IgG Gel	$362.40	$453.00	$4.02–$322.00	330% above	20%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Bill Ref ABO type	$36.00	$45.00	$4.02–$322.00	—	20%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO/Rh	$271.20	$339.00	$4.02–$322.00	—	20%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Cord ABO/Rh	$271.20	$339.00	$4.02–$322.00	—	20%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 DAT IgG Gel	$362.40	$453.00	$4.02–$322.00	—	20%
Blood urea nitrogen (BUN) test CPT 84520 BUN - BLOOD UREA NITROGEN 84520	$104.00	$130.00	$4.91–$48.42	100% above	20%
Blood urea nitrogen (BUN) test inpatient CPT 84520 BUN - BLOOD UREA NITROGEN 84520	$104.00	$130.00	$4.91–$48.42	—	20%
C-peptide blood test CPT 84681 C-Peptide LC	$116.80	$146.00	$40.87	13% above	20%
C-peptide blood test inpatient CPT 84681 C-Peptide LC	$116.80	$146.00	$40.87	—	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C REACTIVE PROTEIN/CRP	$146.40	$183.00	$20.91–$172.26	99% above	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C REACTIVE PROTEIN/CRP	$146.40	$183.00	$20.91–$172.26	—	20%
C. difficile toxin gene test (stool PCR) CPT 87493 C. DIFF XPERT	$229.60	$287.00	$77.59–$249.69	25% above	20%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C. DIFF XPERT	$229.60	$287.00	$77.59–$249.69	—	20%
CA 19-9 blood test (tumor marker) CPT 86301 CA 19-9 LC	$137.60	$172.00	$20.91–$48.88	24% above	20%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA 19-9 LC	$137.60	$172.00	$20.91–$48.88	—	20%
CA-125 blood test (ovarian cancer marker) CPT 86304 Cancer Antigen (CA) 125 LC	$228.80	$286.00	$20.91–$81.28	42% above	20%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 Cancer Antigen (CA) 125 LC	$228.80	$286.00	$20.91–$81.28	—	20%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 2019 Novel Coronavirus (CoVID-19), NAA LC	$158.40	$198.00	$53.43–$184.24	37% above	20%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-CoV-2 (COVID-19) PCR (GeneXpert)	$158.40	$198.00	$53.43–$184.24	37% above	20%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID-19 Lab Test	$158.40	$198.00	$53.43–$184.24	37% above	20%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 2019 Novel Coronavirus (CoVID-19), NAA LC	$158.40	$198.00	$53.43–$184.24	—	20%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-CoV-2 (COVID-19) PCR (GeneXpert)	$158.40	$198.00	$53.43–$184.24	—	20%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COVID-19 Lab Test	$158.40	$198.00	$53.43–$184.24	—	20%
Calcium blood test, total CPT 82310 Ca+PTH Intact LC	$103.20	$129.00	$9.81–$265.32	127% above	20%
Calcium blood test, total CPT 82310 CALCIUM SERUM-82310	$117.60	$147.00	$9.80–$41.78	159% above	20%
Calcium blood test, total inpatient CPT 82310 Ca+PTH Intact LC	$103.20	$129.00	$9.81–$265.32	—	20%
Calcium blood test, total inpatient CPT 82310 CALCIUM SERUM-82310	$117.60	$147.00	$9.80–$41.78	—	20%
Carcinoembryonic antigen (CEA) test CPT 82378 CEA LC	$201.60	$252.00	$18.58–$208.80	43% above	20%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CEA LC	$201.60	$252.00	$18.58–$208.80	—	20%
Chickenpox (varicella) immunity blood test CPT 86787 Varicella-Zoster V Ab, IgG LC	$43.20	$54.00	$19.01–$45.90	42% below	20%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 Varicella-Zoster V Ab, IgG LC	$43.20	$54.00	$19.01–$45.90	—	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia trachomatis NAA (GeneXpert)	$67.20	$84.00	$24.92–$157.47	46% below	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 87491- PapIG,CtNgTv,rfx Aptima HPV LC	$144.80	$181.00	$24.92–$157.47	17% above	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 87491 Component	$144.80	$181.00	$38.92–$153.85	17% above	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia NAA	$144.80	$181.00	$24.92–$157.47	17% above	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia trachomatis, NAA LC	$144.80	$181.00	$24.92–$157.47	17% above	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 chlamydia NAA	$144.80	$181.00	$24.92–$157.47	17% above	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 IGP,CtNgTv,Apt HPV,rfx16/18,45 LC	$144.80	$181.00	$22.78–$159.21	17% above	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia trachomatis NAA (GeneXpert)	$67.20	$84.00	$24.92–$157.47	—	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 IGP,CtNgTv,Apt HPV,rfx16/18,45 LC	$144.80	$181.00	$22.78–$159.21	—	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia trachomatis, NAA LC	$144.80	$181.00	$24.92–$157.47	—	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 87491 Component	$144.80	$181.00	$38.92–$153.85	—	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia NAA	$144.80	$181.00	$24.92–$157.47	—	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 chlamydia NAA	$144.80	$181.00	$24.92–$157.47	—	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 87491- PapIG,CtNgTv,rfx Aptima HPV LC	$144.80	$181.00	$24.92–$157.47	—	20%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL	$172.80	$216.00	$8.20–$216.00	34% above	20%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PROFILE	$172.80	$216.00	$8.20–$216.00	34% above	20%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL	$172.80	$216.00	$8.20–$216.00	—	20%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PROFILE	$172.80	$216.00	$8.20–$216.00	—	20%
Complete blood count (CBC) with differential CPT 85025 COMPL. BLD COUNT w DIFF	$100.00	$125.00	$10.78–$116.62	28% above	20%
Complete blood count (CBC) with differential inpatient CPT 85025 COMPL. BLD COUNT w DIFF	$100.00	$125.00	$10.78–$116.62	—	20%
Complete blood count (CBC), no differential CPT 85027 CBC - NO DIFF (HEMOGRAM)	$66.40	$83.00	$10.78–$72.21	2% above	20%
Complete blood count (CBC), no differential inpatient CPT 85027 CBC - NO DIFF (HEMOGRAM)	$66.40	$83.00	$10.78–$72.21	—	20%
Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL	$222.40	$278.00	$16.41–$258.72	39% above	20%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL	$222.40	$278.00	$16.41–$258.72	—	20%
Cortisol blood test, total CPT 82533 CORTISOL AM	$137.60	$172.00	$11.97–$146.20	25% above	20%
Cortisol blood test, total CPT 82533 CORTISOL	$137.60	$172.00	$11.97–$146.20	25% above	20%
Cortisol blood test, total CPT 82533 CORTISOL PM	$137.60	$172.00	$11.97–$146.20	25% above	20%
Cortisol blood test, total CPT 82533 CORTISOL 60 MINUTES	$137.60	$172.00	$11.97–$146.20	25% above	20%
Cortisol blood test, total CPT 82533 CORTISOL 30 MINUTES	$137.60	$172.00	$11.97–$146.20	25% above	20%
Cortisol blood test, total inpatient CPT 82533 CORTISOL 30 MINUTES	$137.60	$172.00	$11.97–$146.20	—	20%
Cortisol blood test, total inpatient CPT 82533 CORTISOL 60 MINUTES	$137.60	$172.00	$11.97–$146.20	—	20%
Cortisol blood test, total inpatient CPT 82533 CORTISOL	$137.60	$172.00	$11.97–$146.20	—	20%
Cortisol blood test, total inpatient CPT 82533 CORTISOL AM	$137.60	$172.00	$11.97–$146.20	—	20%
Cortisol blood test, total inpatient CPT 82533 CORTISOL PM	$137.60	$172.00	$11.97–$146.20	—	20%
Creatine kinase (CK) blood test, total CPT 82550 CK Total	$104.00	$130.00	$4.91–$120.54	69% above	20%
Creatine kinase (CK) blood test, total CPT 82550 CK TOTAL	$104.00	$130.00	$4.91–$120.54	69% above	20%
Creatine kinase (CK) blood test, total inpatient CPT 82550 CK TOTAL	$104.00	$130.00	$4.91–$120.54	—	20%
Creatine kinase (CK) blood test, total inpatient CPT 82550 CK Total	$104.00	$130.00	$4.91–$120.54	—	20%
Creatinine blood test CPT 82565 CREATININE-82565	$108.00	$135.00	$4.91–$114.75	116% above	20%
Creatinine blood test inpatient CPT 82565 CREATININE-82565	$108.00	$135.00	$4.91–$114.75	—	20%
Cytomegalovirus (CMV) antibody test CPT 86644 Cytomegalovirus Ab, IgG LC	$198.40	$248.00	$10.44–$19.01	133% above	20%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 Cytomegalovirus Ab, IgG LC	$198.40	$248.00	$10.44–$19.01	—	20%
DHEA sulfate (DHEA-S) blood test CPT 82627 PCOS Diagnostic Profile 82627	$111.20	$139.00	$11.97–$192.10	3% above	20%
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA-Sulfate LC	$180.80	$226.00	$182.75–$192.10	68% above	20%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 PCOS Diagnostic Profile 82627	$111.20	$139.00	$11.97–$192.10	—	20%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA-Sulfate LC	$180.80	$226.00	$182.75–$192.10	—	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Meconium 5 Panel LC	$172.80	$216.00	$23.96–$175.60	77% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Synthetic Cannabinoids, Scr, Ur LC	$172.80	$216.00	$7.90–$175.60	77% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drugs of Abuse Screen, Oral Fl LC	$172.80	$216.00	$66.22–$175.60	77% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Expanded Drug Scr + BUP,UC LC	$172.80	$216.00	$66.22–$175.60	77% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Nicotine Metabolite, Urine LC	$172.80	$216.00	$66.22–$175.60	77% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Compliance Drug Analysis, Ur LC	$196.00	$245.00	$10.45–$228.34	101% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen 11 w/Conf, Serum LC	$280.80	$351.00	$126.74–$295.80	188% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Cord (Umbilical) Drug Screen LC	$299.20	$374.00	$66.22–$175.60	207% above	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Nicotine Metabolite, Urine LC	$172.80	$216.00	$66.22–$175.60	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drugs of Abuse Screen, Oral Fl LC	$172.80	$216.00	$66.22–$175.60	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Expanded Drug Scr + BUP,UC LC	$172.80	$216.00	$66.22–$175.60	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Meconium 5 Panel LC	$172.80	$216.00	$23.96–$175.60	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Synthetic Cannabinoids, Scr, Ur LC	$172.80	$216.00	$7.90–$175.60	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Compliance Drug Analysis, Ur LC	$196.00	$245.00	$10.45–$228.34	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Screen 11 w/Conf, Serum LC	$280.80	$351.00	$126.74–$295.80	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Cord (Umbilical) Drug Screen LC	$299.20	$374.00	$66.22–$175.60	—	20%
Epstein-Barr virus (EBV) antibody test CPT 86665 Epstein-Barr Virus Capsid	$44.80	$56.00	$10.45–$48.72	59% below	20%
Epstein-Barr virus (EBV) antibody test CPT 86665 Epstein-Barr Virus Capsid add'l	$44.80	$56.00	$10.45–$48.72	59% below	20%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 Epstein-Barr Virus Capsid add'l	$44.80	$56.00	$10.45–$48.72	—	20%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 Epstein-Barr Virus Capsid	$44.80	$56.00	$10.45–$48.72	—	20%
Estradiol blood test CPT 82670 Estradiol, Sensitive LC	$80.00	$100.00	$85.00–$87.00	25% below	20%
Estradiol blood test CPT 82670 PCOS Diagnostic Profile 82670	$111.20	$139.00	$11.97–$192.10	5% above	20%
Estradiol blood test CPT 82670 Estradiol LC	$180.00	$225.00	$23.96–$195.75	70% above	20%
Estradiol blood test inpatient CPT 82670 Estradiol, Sensitive LC	$80.00	$100.00	$85.00–$87.00	—	20%
Estradiol blood test inpatient CPT 82670 PCOS Diagnostic Profile 82670	$111.20	$139.00	$11.97–$192.10	—	20%
Estradiol blood test inpatient CPT 82670 Estradiol LC	$180.00	$225.00	$23.96–$195.75	—	20%
FSH (follicle-stimulating hormone) test CPT 83001 FSH LC	$147.20	$184.00	$11.98–$160.08	24% above	20%
FSH (follicle-stimulating hormone) test CPT 83001 FSH	$147.20	$184.00	$11.98–$160.08	24% above	20%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH LC	$147.20	$184.00	$11.98–$160.08	—	20%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH	$147.20	$184.00	$11.98–$160.08	—	20%
Fecal calprotectin (stool inflammation test) CPT 83993 Calprotectin, Fecal LC	$540.80	$676.00	$10.86–$588.12	212% above	20%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 Calprotectin, Fecal LC	$540.80	$676.00	$10.86–$588.12	—	20%
Ferritin blood test (iron stores) CPT 82728 FERRITIN 82728	$299.20	$374.00	$21.71–$348.88	126% above	20%
Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN 82728	$299.20	$374.00	$21.71–$348.88	—	20%
Fibrinogen blood test CPT 85384 Fib SBL	$73.60	$92.00	$80.04	16% below	20%
Fibrinogen blood test inpatient CPT 85384 Fib SBL	$73.60	$92.00	$80.04	—	20%
Folate (folic acid) blood test CPT 82746 FOLATE	$130.40	$163.00	$21.71–$161.37	16% above	20%
Folate (folic acid) blood test CPT 82746 Folate Level	$130.40	$163.00	$21.71–$161.37	16% above	20%
Folate (folic acid) blood test inpatient CPT 82746 Folate Level	$130.40	$163.00	$21.71–$161.37	—	20%
Folate (folic acid) blood test inpatient CPT 82746 FOLATE	$130.40	$163.00	$21.71–$161.37	—	20%
Free T3 thyroid hormone test CPT 84481 .T3Free LC	$115.20	$144.00	$11.98–$125.28	4% below	20%
Free T3 thyroid hormone test CPT 84481 Triiodothyronine,Free LC	$115.20	$144.00	$11.98–$125.28	4% below	20%
Free T3 thyroid hormone test inpatient CPT 84481 Triiodothyronine,Free LC	$115.20	$144.00	$11.98–$125.28	—	20%
Free T3 thyroid hormone test inpatient CPT 84481 .T3Free LC	$115.20	$144.00	$11.98–$125.28	—	20%
Free T4 (free thyroxine) thyroid blood test CPT 84439 Thyroxine (T4) Free, Direct, LC	$128.80	$161.00	$11.98–$161.00	11% above	20%
Free T4 (free thyroxine) thyroid blood test CPT 84439 T4-FREE	$128.80	$161.00	$11.98–$161.00	11% above	20%
Free T4 (free thyroxine) thyroid blood test CPT 84439 .Thyroxine (T4) Free, Direct, S LC	$128.80	$161.00	$11.98–$161.00	11% above	20%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4-FREE	$128.80	$161.00	$11.98–$161.00	—	20%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 Thyroxine (T4) Free, Direct, LC	$128.80	$161.00	$11.98–$161.00	—	20%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 .Thyroxine (T4) Free, Direct, S LC	$128.80	$161.00	$11.98–$161.00	—	20%
Free testosterone test CPT 84402 Testosterone, Free, Direct LC	$146.40	$183.00	$11.98–$155.55	20% above	20%
Free testosterone test CPT 84402 84402 Component	$146.40	$183.00	$11.98–$155.55	20% above	20%
Free testosterone test inpatient CPT 84402 84402 Component	$146.40	$183.00	$11.98–$155.55	—	20%
Free testosterone test inpatient CPT 84402 Testosterone, Free, Direct LC	$146.40	$183.00	$11.98–$155.55	—	20%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 Gamma Glutamyl Transferase LC	$80.00	$100.00	$9.81	37% above	20%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 GGT	$80.80	$101.00	$4.91–$28.43	38% above	20%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 Gamma Glutamyl Transferase LC	$80.00	$100.00	$9.81	—	20%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 GGT	$80.80	$101.00	$4.91–$28.43	—	20%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 GENERAL HEALTH PANEL-80050	$473.60	$592.00	$16.41–$515.04	43% above	20%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 GENERAL HEALTH PANEL-80050	$473.60	$592.00	$16.41–$515.04	—	20%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE 1HR POSTPRANDIAL	$146.40	$183.00	$9.80–$159.21	158% above	20%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose 1 HR PP	$146.40	$183.00	$9.80–$159.21	158% above	20%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Glucose 1 HR PP	$146.40	$183.00	$9.80–$159.21	—	20%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE 1HR POSTPRANDIAL	$146.40	$183.00	$9.80–$159.21	—	20%
Glucose tolerance test, 3 samples CPT 82951 Lactose Tolerance Test LC	$43.20	$54.00	$21.71–$433.26	68% below	20%
Glucose tolerance test, 3 samples CPT 82951 GTT 2 HOUR 75 GRAM	$228.00	$285.00	$21.71–$433.26	69% above	20%
Glucose tolerance test, 3 samples CPT 82951 .GTT-2 Hr	$228.00	$285.00	$21.71–$433.26	69% above	20%
Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE 2 HOUR	$228.00	$285.00	$21.71–$433.26	69% above	20%
Glucose tolerance test, 3 samples CPT 82951 GTT 3 specimens	$398.40	$498.00	$21.71–$433.26	195% above	20%
Glucose tolerance test, 3 samples inpatient CPT 82951 Lactose Tolerance Test LC	$43.20	$54.00	$21.71–$433.26	—	20%
Glucose tolerance test, 3 samples inpatient CPT 82951 .GTT-2 Hr	$228.00	$285.00	$21.71–$433.26	—	20%
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOLERANCE 2 HOUR	$228.00	$285.00	$21.71–$433.26	—	20%
Glucose tolerance test, 3 samples inpatient CPT 82951 GTT 2 HOUR 75 GRAM	$228.00	$285.00	$21.71–$433.26	—	20%
Glucose tolerance test, 3 samples inpatient CPT 82951 GTT 3 specimens	$398.40	$498.00	$21.71–$433.26	—	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Neisseria gonorrhoeae NAA (GeneXpert)	$67.20	$84.00	$24.92–$157.47	45% below	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 87591 Component LC	$144.80	$181.00	$38.92	17% above	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 87591 Component	$144.80	$181.00	$38.92–$153.85	17% above	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GONORRHEA NAA	$144.80	$181.00	$38.92	17% above	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 87591- PapIG,CtNgTv,rfx Aptima HPV LC	$144.80	$181.00	$24.92–$157.47	17% above	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Neisseria gonorrhoeae, NAA LC	$144.80	$181.00	$24.92–$157.47	17% above	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 87591-IGP,CtNgTv,Apt HPV,rfx16/18,45 LC	$144.80	$181.00	$22.78–$159.21	17% above	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Neiserria gonorrhea, NAA	$144.80	$181.00	$24.92–$157.47	17% above	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Neisseria gonorrhea NAA	$144.80	$181.00	$24.92–$157.47	17% above	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Neisseria gonorrhoeae NAA (GeneXpert)	$67.20	$84.00	$24.92–$157.47	—	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 87591- PapIG,CtNgTv,rfx Aptima HPV LC	$144.80	$181.00	$24.92–$157.47	—	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 87591 Component LC	$144.80	$181.00	$38.92	—	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 GONORRHEA NAA	$144.80	$181.00	$38.92	—	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 87591 Component	$144.80	$181.00	$38.92–$153.85	—	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Neisseria gonorrhea NAA	$144.80	$181.00	$24.92–$157.47	—	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Neisseria gonorrhoeae, NAA LC	$144.80	$181.00	$24.92–$157.47	—	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 87591-IGP,CtNgTv,Apt HPV,rfx16/18,45 LC	$144.80	$181.00	$22.78–$159.21	—	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Neiserria gonorrhea, NAA	$144.80	$181.00	$24.92–$157.47	—	20%
H. pylori stool antigen test CPT 87338 H pylori Stool Ag EIA MB LC	$103.20	$129.00	$19.14	11% below	20%
H. pylori stool antigen test CPT 87338 H. pylori Stool Ag, EIA LC	$108.80	$136.00	$19.14–$112.23	6% below	20%
H. pylori stool antigen test inpatient CPT 87338 H pylori Stool Ag EIA MB LC	$103.20	$129.00	$19.14	—	20%
H. pylori stool antigen test inpatient CPT 87338 H. pylori Stool Ag, EIA LC	$108.80	$136.00	$19.14–$112.23	—	20%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV 1/2 Ag/AB RAPID	$148.00	$185.00	$19.12–$50.02	32% above	20%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 RAPID HIV 1/2	$156.00	$195.00	$19.12–$50.02	39% above	20%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV Ag/Ab with Reflex LC	$270.40	$338.00	$19.14–$294.06	140% above	20%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV 1/2 Ag/AB RAPID	$148.00	$185.00	$19.12–$50.02	—	20%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 RAPID HIV 1/2	$156.00	$195.00	$19.12–$50.02	—	20%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV Ag/Ab with Reflex LC	$270.40	$338.00	$19.14–$294.06	—	20%
HPV test for high-risk types, one combined (pooled) result CPT 87624 87624 HPV Aptima	$60.00	$75.00	$27.93–$70.70	59% below	20%
HPV test for high-risk types, one combined (pooled) result CPT 87624 IGP, Aptima HPV, rfx 16,18/45 on HR pos (chart) LC	$60.00	$75.00	$27.93–$159.21	59% below	20%
HPV test for high-risk types, one combined (pooled) result CPT 87624 87624-IGP,CtNgTv,Apt HPV,rfx16/18,45 LC	$60.00	$75.00	$22.78–$159.21	59% below	20%
HPV test for high-risk types, one combined (pooled) result CPT 87624 .HPV Aptima LC	$60.00	$75.00	$27.93–$70.70	59% below	20%
HPV test for high-risk types, one combined (pooled) result CPT 87624 IGP, Apt HPV,rfx 16/18,45 (Chart) LC	$60.00	$75.00	$27.93–$159.21	59% below	20%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV	$60.00	$75.00	$27.93–$70.70	59% below	20%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV Aptima	$60.00	$75.00	$27.93–$70.70	59% below	20%
HPV test for high-risk types, one combined (pooled) result CPT 87624 .HPV, high-risk LC	$144.80	$181.00	$27.93–$70.70	1% below	20%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 IGP, Apt HPV,rfx 16/18,45 (Chart) LC	$60.00	$75.00	$27.93–$159.21	—	20%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 IGP, Aptima HPV, rfx 16,18/45 on HR pos (chart) LC	$60.00	$75.00	$27.93–$159.21	—	20%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV Aptima	$60.00	$75.00	$27.93–$70.70	—	20%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 .HPV Aptima LC	$60.00	$75.00	$27.93–$70.70	—	20%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 87624 HPV Aptima	$60.00	$75.00	$27.93–$70.70	—	20%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 87624-IGP,CtNgTv,Apt HPV,rfx16/18,45 LC	$60.00	$75.00	$22.78–$159.21	—	20%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV	$60.00	$75.00	$27.93–$70.70	—	20%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 .HPV, high-risk LC	$144.80	$181.00	$27.93–$70.70	—	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1c w/ Avg. Glucose	$108.00	$135.00	$9.81–$117.45	21% above	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN A1C	$108.00	$135.00	$9.81–$117.45	21% above	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hgb A1c SBL	$108.00	$135.00	$9.81–$117.45	21% above	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hemoglobin A1c w/ Avg. Glucose	$108.00	$135.00	$9.81–$117.45	—	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hgb A1c SBL	$108.00	$135.00	$9.81–$117.45	—	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HEMOGLOBIN A1C	$108.00	$135.00	$9.81–$117.45	—	20%
Hemoglobin blood test CPT 85018 HEMOGLOBIN-85018	$47.20	$59.00	$10.77–$59.00	50% above	20%
Hemoglobin blood test CPT 85018 Hemoglobin	$47.20	$59.00	$10.77–$59.00	50% above	20%
Hemoglobin blood test inpatient CPT 85018 HEMOGLOBIN-85018	$47.20	$59.00	$10.77–$59.00	—	20%
Hemoglobin blood test inpatient CPT 85018 Hemoglobin	$47.20	$59.00	$10.77–$59.00	—	20%
Hepatitis B core antibody test (total) CPT 86704 Hepatitis B Core Ab LC	$49.60	$62.00	$17.92–$20.89	36% below	20%
Hepatitis B core antibody test (total) inpatient CPT 86704 Hepatitis B Core Ab LC	$49.60	$62.00	$17.92–$20.89	—	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hep B Surface Ab Qual LC	$248.80	$311.00	$20.91–$89.92	165% above	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hep B Surface Ab Qual LC	$248.80	$311.00	$20.91–$89.92	—	20%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HBsAg Screen LC	$229.60	$287.00	$9.57–$249.69	159% above	20%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HBsAg Screen LC	$229.60	$287.00	$9.57–$249.69	—	20%
Hepatitis C antibody blood test (screening) CPT 86803 HCV Antibody Cascade(PCR/Geno) LC	$171.20	$214.00	$20.91–$203.00	53% above	20%
Hepatitis C antibody blood test (screening) CPT 86803 HCV Antibody LC	$171.20	$214.00	$20.91–$186.18	53% above	20%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HCV Antibody Cascade(PCR/Geno) LC	$171.20	$214.00	$20.91–$203.00	—	20%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HCV Antibody LC	$171.20	$214.00	$20.91–$186.18	—	20%
Hepatitis C viral load (HCV RNA) test CPT 87522 HCV RNA Diagnosis, NAA LC	$117.60	$147.00	$39.79–$93.09	56% below	20%
Hepatitis C viral load (HCV RNA) test one side CPT 87522 .HCV RT-PCR, Quantitative (Non-Graph) LC	$90.40	$113.00	$39.79–$93.09	66% below	20%
Hepatitis C viral load (HCV RNA) test one side CPT 87522 HCV RT-PCR, Quant (Non-Graph) LC	$405.60	$507.00	$70.77–$430.95	53% above	20%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HCV RNA Diagnosis, NAA LC	$117.60	$147.00	$39.79–$93.09	—	20%
Hepatitis C viral load (HCV RNA) test inpatient one side CPT 87522 .HCV RT-PCR, Quantitative (Non-Graph) LC	$90.40	$113.00	$39.79–$93.09	—	20%
Hepatitis C viral load (HCV RNA) test inpatient one side CPT 87522 HCV RT-PCR, Quant (Non-Graph) LC	$405.60	$507.00	$70.77–$430.95	—	20%
Herpes blood test, HSV-1 antibody CPT 86695 HSV 1 IgG, Type Spec LC	$44.80	$56.00	$10.44–$45.05	31% below	20%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HSV 1 IgG, Type Spec LC	$44.80	$56.00	$10.44–$45.05	—	20%
Herpes blood test, HSV-2 antibody CPT 86696 HSV 2 IgG, Type Spec LC	$44.80	$56.00	$10.44–$45.05	44% below	20%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HSV 2 IgG, Type Spec LC	$44.80	$56.00	$10.44–$45.05	—	20%
High-sensitivity CRP (hs-CRP) test CPT 86141 C-Reactive Protein, Cardiac LC	$115.20	$144.00	$10.45–$116.45	25% above	20%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-Reactive Protein, Cardiac LC	$115.20	$144.00	$10.45–$116.45	—	20%
Insulin blood test CPT 83525 Insulin LC	$28.00	$35.00	$11.98–$30.45	62% below	20%
Insulin blood test inpatient CPT 83525 Insulin LC	$28.00	$35.00	$11.98–$30.45	—	20%
Iron blood test (serum iron) CPT 83540 Iron, serum	$82.40	$103.00	$4.91–$100.94	4% above	20%
Iron blood test (serum iron) CPT 83540 IRON 83540	$87.20	$109.00	$4.91–$100.94	10% above	20%
Iron blood test (serum iron) CPT 83540 Iron Level	$87.20	$109.00	$4.91–$100.94	10% above	20%
Iron blood test (serum iron) inpatient CPT 83540 Iron, serum	$82.40	$103.00	$4.91–$100.94	—	20%
Iron blood test (serum iron) inpatient CPT 83540 IRON 83540	$87.20	$109.00	$4.91–$100.94	—	20%
Iron blood test (serum iron) inpatient CPT 83540 Iron Level	$87.20	$109.00	$4.91–$100.94	—	20%
Iron-binding capacity (TIBC) test CPT 83550 TIBC	$64.80	$81.00	$4.91–$75.46	14% below	20%
Iron-binding capacity (TIBC) test inpatient CPT 83550 TIBC	$64.80	$81.00	$4.91–$75.46	—	20%
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL	$313.60	$392.00	$14.91–$317.05	111% above	20%
Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL	$313.60	$392.00	$14.91–$317.05	—	20%
LH (luteinizing hormone) test CPT 83002 Luteinizing Hormone(LH) LC	$147.20	$184.00	$10.45–$160.08	28% above	20%
LH (luteinizing hormone) test CPT 83002 LH	$147.20	$184.00	$11.98–$160.08	28% above	20%
LH (luteinizing hormone) test inpatient CPT 83002 LH	$147.20	$184.00	$11.98–$160.08	—	20%
LH (luteinizing hormone) test inpatient CPT 83002 Luteinizing Hormone(LH) LC	$147.20	$184.00	$10.45–$160.08	—	20%
Lactate (lactic acid) blood test CPT 83605 LACTIC ACID	$132.80	$166.00	$10.86–$154.84	48% above	20%
Lactate (lactic acid) blood test CPT 83605 LACTIC ACID SCREEN	$132.80	$166.00	$10.86–$154.84	48% above	20%
Lactate (lactic acid) blood test inpatient CPT 83605 LACTIC ACID SCREEN	$132.80	$166.00	$10.86–$154.84	—	20%
Lactate (lactic acid) blood test inpatient CPT 83605 LACTIC ACID	$132.80	$166.00	$10.86–$154.84	—	20%
Lactate dehydrogenase (LDH) blood test CPT 83615 BF LDH SBL	$121.60	$152.00	$40.92–$140.25	111% above	20%
Lactate dehydrogenase (LDH) blood test CPT 83615 LDH, Synovial SBL	$121.60	$152.00	$40.92	111% above	20%
Lactate dehydrogenase (LDH) blood test CPT 83615 LDH-83615	$123.20	$154.00	$4.91–$141.70	114% above	20%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 BF LDH SBL	$121.60	$152.00	$40.92–$140.25	—	20%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH, Synovial SBL	$121.60	$152.00	$40.92	—	20%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH-83615	$123.20	$154.00	$4.91–$141.70	—	20%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE SERUM-83690	$158.40	$198.00	$9.81–$184.24	70% above	20%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE SERUM-83690	$158.40	$198.00	$9.81–$184.24	—	20%
Liver function blood test panel CPT 80076 HEPATIC FUNCTION	$208.00	$260.00	$14.90–$221.00	51% above	20%
Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION	$208.00	$260.00	$14.90–$221.00	—	20%
Lyme disease antibody test CPT 86618 Lyme Disease Serology w/Reflex LC	$184.00	$230.00	$20.89–$195.50	154% above	20%
Lyme disease antibody test inpatient CPT 86618 Lyme Disease Serology w/Reflex LC	$184.00	$230.00	$20.89–$195.50	—	20%
Magnesium blood test CPT 83735 KIDNEY STONE, MAGNESIUM	$14.40	$18.00	$4.91–$37.24	79% below	20%
Magnesium blood test CPT 83735 83735 LC	$18.40	$23.00	$2.73–$37.24	74% below	20%
Magnesium blood test CPT 83735 Magnesium, Urine, LC	$21.60	$27.00	$4.91–$37.24	69% below	20%
Magnesium blood test CPT 83735 Magnesium, RBC LC	$44.80	$56.00	$4.91–$37.24	36% below	20%
Magnesium blood test CPT 83735 MAGNESIUM-83735	$136.80	$171.00	$4.91–$162.00	95% above	20%
Magnesium blood test inpatient CPT 83735 KIDNEY STONE, MAGNESIUM	$14.40	$18.00	$4.91–$37.24	—	20%
Magnesium blood test inpatient CPT 83735 83735 LC	$18.40	$23.00	$2.73–$37.24	—	20%
Magnesium blood test inpatient CPT 83735 Magnesium, Urine, LC	$21.60	$27.00	$4.91–$37.24	—	20%
Magnesium blood test inpatient CPT 83735 Magnesium, RBC LC	$44.80	$56.00	$4.91–$37.24	—	20%
Magnesium blood test inpatient CPT 83735 MAGNESIUM-83735	$136.80	$171.00	$4.91–$162.00	—	20%
Measles (rubeola) antibody test CPT 86765 RUBEOLA AB, IgG IMMUNITY	$28.80	$36.00	$10.45–$31.32	60% below	20%
Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA AB, IgG IMMUNITY	$28.80	$36.00	$10.45–$31.32	—	20%
Mono test (heterophile antibody, Monospot) CPT 86308 MONO SCREEN	$132.00	$165.00	$20.89–$140.25	63% above	20%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONO SCREEN	$132.00	$165.00	$20.89–$140.25	—	20%
Mumps immunity blood test CPT 86735 MUMPS AB, IgG IMMUNITY	$27.20	$34.00	$10.45–$29.58	62% below	20%
Mumps immunity blood test CPT 86735 Mumps Antibodies, IgM LC	$294.40	$368.00	$10.45–$29.58	306% above	20%
Mumps immunity blood test inpatient CPT 86735 MUMPS AB, IgG IMMUNITY	$27.20	$34.00	$10.45–$29.58	—	20%
Mumps immunity blood test inpatient CPT 86735 Mumps Antibodies, IgM LC	$294.40	$368.00	$10.45–$29.58	—	20%
PSA (prostate-specific antigen) blood test, free CPT 84154 .%fPSA Reflex LC	$16.00	$20.00	$5.41	83% below	20%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA-FREE ONLY	$75.20	$94.00	$10.86–$27.64	19% below	20%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 .%fPSA Reflex LC	$16.00	$20.00	$5.41	—	20%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA-FREE ONLY	$75.20	$94.00	$10.86–$27.64	—	20%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA (Ultrasensitive) LC	$156.00	$195.00	$52.68–$165.75	38% above	20%
PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate Health Index (phi) LC	$156.00	$195.00	$52.68–$165.75	38% above	20%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Total (Reflex To Free) LC	$156.00	$195.00	$52.68–$165.75	38% above	20%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA	$159.20	$199.00	$21.69–$173.13	40% above	20%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Prostate Health Index (phi) LC	$156.00	$195.00	$52.68–$165.75	—	20%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA Total (Reflex To Free) LC	$156.00	$195.00	$52.68–$165.75	—	20%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA (Ultrasensitive) LC	$156.00	$195.00	$52.68–$165.75	—	20%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA	$159.20	$199.00	$21.69–$173.13	—	20%
Pap test (liquid-based, automated screening with review) CPT 88175 88175 ComponentA LC	$104.00	$130.00	$37.15–$159.21	24% below	20%
Pap test (liquid-based, automated screening with review) CPT 88175 IGP, rfx Aptima HPV ASCU (Chart) LC	$139.20	$174.00	$37.12–$159.21	2% above	20%
Pap test (liquid-based, automated screening with review) CPT 88175 88175-IGP,CtNgTv,Apt HPV,rfx16/18,45 LC	$146.40	$183.00	$22.78–$159.21	7% above	20%
Pap test (liquid-based, automated screening with review) CPT 88175 IGP, Apt HPV,rfx 16/18,45 (Chart) LC	$146.40	$183.00	$27.93–$159.21	7% above	20%
Pap test (liquid-based, automated screening with review) CPT 88175 Pap image guided	$146.40	$183.00	$37.15–$159.21	7% above	20%
Pap test (liquid-based, automated screening with review) CPT 88175 PAP - THIN PREP	$146.40	$183.00	$37.15–$159.21	7% above	20%
Pap test (liquid-based, automated screening with review) CPT 88175 PAP THIN PREP	$146.40	$183.00	$37.15–$159.21	7% above	20%
Pap test (liquid-based, automated screening with review) CPT 88175 88175 Component LC	$146.40	$183.00	$37.15–$159.21	7% above	20%
Pap test (liquid-based, automated screening with review) CPT 88175 PAP, Ig, Rflx HPV ASCU or LSIL LC	$146.40	$183.00	$37.15–$159.21	7% above	20%
Pap test (liquid-based, automated screening with review) CPT 88175 IGP, Aptima HPV, rfx 16/18,45 (Chart) LC	$146.40	$183.00	$37.12–$159.21	7% above	20%
Pap test (liquid-based, automated screening with review) CPT 88175 PapIG,CtNgTv,rfx Aptima HPV LC	$146.40	$183.00	$37.15–$159.21	7% above	20%
Pap test (liquid-based, automated screening with review) CPT 88175 Pap IG, rfx HPV ASCU,16/18 (Chart) LC	$146.40	$183.00	$37.15–$159.21	7% above	20%
Pap test (liquid-based, automated screening with review) CPT 88175 88175 Component	$146.40	$183.00	$37.15–$159.21	7% above	20%
Pap test (liquid-based, automated screening with review) CPT 88175 PAP - THIN PREP,RFLX,HPV,ASCUS	$146.40	$183.00	$37.15–$159.21	7% above	20%
Pap test (liquid-based, automated screening with review) CPT 88175 Pap IG, rfx HPV ASCU, 16/18(Aptima) LC	$146.40	$183.00	$37.15–$159.21	7% above	20%
Pap test (liquid-based, automated screening with review) CPT 88175 IGP, Aptima HPV, rfx 16/18,45 LC	$146.40	$183.00	$37.12–$159.21	7% above	20%
Pap test (liquid-based, automated screening with review) CPT 88175 Pap Ig, rfx HPV ASCU, 16/18 (Aptima) (Chart) LC	$146.40	$183.00	$37.15–$159.21	7% above	20%
Pap test (liquid-based, automated screening with review) CPT 88175 Pap IG (Image Guided) (Chart) LC	$146.40	$183.00	$37.12–$159.21	7% above	20%
Pap test (liquid-based, automated screening with review) CPT 88175 IGP, Aptima HPV, rfx 16,18/45 on HR pos (chart) LC	$146.40	$183.00	$27.93–$159.21	7% above	20%
Pap test (liquid-based, automated screening with review) CPT 88175 Pap IG (Image Guided) LC	$146.40	$183.00	$37.15–$159.21	7% above	20%
Pap test (liquid-based, automated screening with review) CPT 88175 PapIG, HPV, rfx 16/18 (Chart) LC	$223.20	$279.00	$37.15–$159.21	63% above	20%
Pap test (liquid-based, automated screening with review) CPT 88175 PapIG, CtNgTv, HPV, rfx 16/18 LC	$556.80	$696.00	$37.15–$159.21	307% above	20%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 88175 ComponentA LC	$104.00	$130.00	$37.15–$159.21	—	20%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 IGP, rfx Aptima HPV ASCU (Chart) LC	$139.20	$174.00	$37.12–$159.21	—	20%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 PapIG,CtNgTv,rfx Aptima HPV LC	$146.40	$183.00	$37.15–$159.21	—	20%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 PAP - THIN PREP	$146.40	$183.00	$37.15–$159.21	—	20%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 IGP, Aptima HPV, rfx 16/18,45 LC	$146.40	$183.00	$37.12–$159.21	—	20%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 IGP, Aptima HPV, rfx 16/18,45 (Chart) LC	$146.40	$183.00	$37.12–$159.21	—	20%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 IGP, Apt HPV,rfx 16/18,45 (Chart) LC	$146.40	$183.00	$27.93–$159.21	—	20%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 88175 Component LC	$146.40	$183.00	$37.15–$159.21	—	20%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 Pap IG (Image Guided) (Chart) LC	$146.40	$183.00	$37.12–$159.21	—	20%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 Pap image guided	$146.40	$183.00	$37.15–$159.21	—	20%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 PAP THIN PREP	$146.40	$183.00	$37.15–$159.21	—	20%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 PAP, Ig, Rflx HPV ASCU or LSIL LC	$146.40	$183.00	$37.15–$159.21	—	20%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 PAP - THIN PREP,RFLX,HPV,ASCUS	$146.40	$183.00	$37.15–$159.21	—	20%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 88175 Component	$146.40	$183.00	$37.15–$159.21	—	20%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 Pap IG, rfx HPV ASCU, 16/18(Aptima) LC	$146.40	$183.00	$37.15–$159.21	—	20%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 Pap Ig, rfx HPV ASCU, 16/18 (Aptima) (Chart) LC	$146.40	$183.00	$37.15–$159.21	—	20%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 88175-IGP,CtNgTv,Apt HPV,rfx16/18,45 LC	$146.40	$183.00	$22.78–$159.21	—	20%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 Pap IG, rfx HPV ASCU,16/18 (Chart) LC	$146.40	$183.00	$37.15–$159.21	—	20%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 IGP, Aptima HPV, rfx 16,18/45 on HR pos (chart) LC	$146.40	$183.00	$27.93–$159.21	—	20%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 Pap IG (Image Guided) LC	$146.40	$183.00	$37.15–$159.21	—	20%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 PapIG, HPV, rfx 16/18 (Chart) LC	$223.20	$279.00	$37.15–$159.21	—	20%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 PapIG, CtNgTv, HPV, rfx 16/18 LC	$556.80	$696.00	$37.15–$159.21	—	20%
Parathyroid hormone (PTH) blood test CPT 83970 83970 Parathormone (parathyroid hormone)	$103.20	$129.00	$9.81–$265.32	53% below	20%
Parathyroid hormone (PTH) blood test CPT 83970 PTH, Intact LC	$214.40	$268.00	$63.53–$265.32	1% below	20%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 83970 Parathormone (parathyroid hormone)	$103.20	$129.00	$9.81–$265.32	—	20%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH, Intact LC	$214.40	$268.00	$63.53–$265.32	—	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT SBL	$136.80	$171.00	$8.04–$158.76	96% above	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT ( heparin therapy)	$136.80	$171.00	$8.04–$158.76	96% above	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 PARTIAL THOMBOPLASTIN TIME-PTT-85730	$136.80	$171.00	$8.04–$158.76	96% above	20%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT ( heparin therapy)	$136.80	$171.00	$8.04–$158.76	—	20%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PARTIAL THOMBOPLASTIN TIME-PTT-85730	$136.80	$171.00	$8.04–$158.76	—	20%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT SBL	$136.80	$171.00	$8.04–$158.76	—	20%
Phosphorus (phosphate) blood test CPT 84100 PHOSPHORUS	$121.60	$152.00	$4.91–$141.12	95% above	20%
Phosphorus (phosphate) blood test inpatient CPT 84100 PHOSPHORUS	$121.60	$152.00	$4.91–$141.12	—	20%
Potassium blood test CPT 84132 POTASSIUM-K-SERUM-84132	$87.20	$109.00	$9.81–$92.65	95% above	20%
Potassium blood test inpatient CPT 84132 POTASSIUM-K-SERUM-84132	$87.20	$109.00	$9.81–$92.65	—	20%
Progesterone blood test CPT 84144 Progesterone LC	$170.40	$213.00	$11.98–$213.00	26% above	20%
Progesterone blood test inpatient CPT 84144 Progesterone LC	$170.40	$213.00	$11.98–$213.00	—	20%
Prolactin blood test CPT 84146 Prolactin LC	$170.40	$213.00	$11.98–$175.74	34% above	20%
Prolactin blood test inpatient CPT 84146 Prolactin LC	$170.40	$213.00	$11.98–$175.74	—	20%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME-85610	$73.60	$92.00	$4.02–$80.04	91% above	20%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME-85610	$73.60	$92.00	$4.02–$80.04	—	20%
Renin blood test CPT 84244 84244 Component LC	$75.20	$94.00	$23.94–$103.70	33% below	20%
Renin blood test CPT 84244 Renin Activity, Plasma LC	$97.60	$122.00	$23.94–$103.70	13% below	20%
Renin blood test inpatient CPT 84244 84244 Component LC	$75.20	$94.00	$23.94–$103.70	—	20%
Renin blood test inpatient CPT 84244 Renin Activity, Plasma LC	$97.60	$122.00	$23.94–$103.70	—	20%
Rh blood typing CPT 86901 Bill Ref RH type	$36.00	$45.00	$11.94–$12.79	47% below	20%
Rh blood typing CPT 86901 RH TYPING	$271.20	$339.00	$4.02–$280.14	297% above	20%
Rh blood typing CPT 86901 Rh Typing	$271.20	$339.00	$4.02–$280.14	297% above	20%
Rh blood typing inpatient CPT 86901 Bill Ref RH type	$36.00	$45.00	$11.94–$12.79	—	20%
Rh blood typing inpatient CPT 86901 Rh Typing	$271.20	$339.00	$4.02–$280.14	—	20%
Rh blood typing inpatient CPT 86901 RH TYPING	$271.20	$339.00	$4.02–$280.14	—	20%
Rheumatoid factor (RF) test CPT 86431 Rheumatoid Arthritis Factor LC	$100.00	$125.00	$10.44–$108.75	58% above	20%
Rheumatoid factor (RF) test inpatient CPT 86431 Rheumatoid Arthritis Factor LC	$100.00	$125.00	$10.44–$108.75	—	20%
Rubella antibody test (immunity check) CPT 86762 Rubella Abs, IgG LC	$204.00	$255.00	$10.45–$221.85	167% above	20%
Rubella antibody test (immunity check) CPT 86762 RUBELLA AB, IgG IMMUNITY	$204.00	$255.00	$10.45–$221.85	167% above	20%
Rubella antibody test (immunity check) inpatient CPT 86762 Rubella Abs, IgG LC	$204.00	$255.00	$10.45–$221.85	—	20%
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA AB, IgG IMMUNITY	$204.00	$255.00	$10.45–$221.85	—	20%
Sodium blood test CPT 84295 SODIUM-NA-84295	$104.00	$130.00	$36.95–$38.22	112% above	20%
Sodium blood test inpatient CPT 84295 SODIUM-NA-84295	$104.00	$130.00	$36.95–$38.22	—	20%
Stool ova and parasites exam CPT 87177 Ova + Parasite Direct Smear MB LC	$156.00	$195.00	$9.57–$169.65	108% above	20%
Stool ova and parasites exam CPT 87177 OP CONCENTRATION, ID	$156.00	$195.00	$9.57–$169.65	108% above	20%
Stool ova and parasites exam inpatient CPT 87177 Ova + Parasite Direct Smear MB LC	$156.00	$195.00	$9.57–$169.65	—	20%
Stool ova and parasites exam inpatient CPT 87177 OP CONCENTRATION, ID	$156.00	$195.00	$9.57–$169.65	—	20%
Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLOOD SCREENING	$33.60	$42.00	$8.92–$11.76	17% above	20%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 OCCULT BLOOD SCREENING	$33.60	$42.00	$8.92–$11.76	—	20%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 OCCULT BLOOD, IMMUNO(iFOBT)	$46.40	$58.00	$16.48–$46.75	36% below	20%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 OCCULT BLOOD, IMMUNO(iFOBT)	$46.40	$58.00	$16.48–$46.75	—	20%
Syphilis antibody test (Treponema pallidum) CPT 86780 Syphilis: Treponemal AB, TPPA LC	$54.40	$68.00	$9.50–$69.70	19% below	20%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 Syphilis: Treponemal AB, TPPA LC	$54.40	$68.00	$9.50–$69.70	—	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR LC	$100.00	$125.00	$10.45–$228.34	96% above	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR LC	$100.00	$125.00	$10.45–$228.34	—	20%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB QUANTIFERON GOLD PLUS 1 TUBE- SBL	$139.20	$174.00	$46.89–$140.25	37% below	20%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB Quantiferon Plus-TMF SBL	$139.20	$174.00	$46.89–$140.25	37% below	20%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QuantiFERON-TB Gold Plus (client Incubated) LC	$139.20	$174.00	$40.92–$140.25	37% below	20%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 TB Quantiferon Plus-TMF SBL	$139.20	$174.00	$46.89–$140.25	—	20%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 QuantiFERON-TB Gold Plus (client Incubated) LC	$139.20	$174.00	$40.92–$140.25	—	20%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 TB QUANTIFERON GOLD PLUS 1 TUBE- SBL	$139.20	$174.00	$46.89–$140.25	—	20%
Testosterone blood test, total (not free testosterone) CPT 84403 84403 Component	$156.00	$195.00	$10.89–$169.65	25% above	20%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone LC	$156.00	$195.00	$10.89–$169.65	25% above	20%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone LC	$156.00	$195.00	$10.89–$169.65	—	20%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 84403 Component	$156.00	$195.00	$10.89–$169.65	—	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroid Peroxidase Ab LC	$22.40	$28.00	$7.90–$24.36	72% below	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 Liver-Kidney Microsomal Ab LC	$46.40	$58.00	$10.86–$338.20	42% below	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 86376 Component LC	$180.80	$226.00	$7.90–$24.36	126% above	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 .Thyroid Peroxidase (TPO) Ab LC	$313.60	$392.00	$338.20	292% above	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 THYROID PEROXIDASE ANTIBODIES	$313.60	$392.00	$7.90–$175.60	292% above	20%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Thyroid Peroxidase Ab LC	$22.40	$28.00	$7.90–$24.36	—	20%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Liver-Kidney Microsomal Ab LC	$46.40	$58.00	$10.86–$338.20	—	20%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 86376 Component LC	$180.80	$226.00	$7.90–$24.36	—	20%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 .Thyroid Peroxidase (TPO) Ab LC	$313.60	$392.00	$338.20	—	20%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 THYROID PEROXIDASE ANTIBODIES	$313.60	$392.00	$7.90–$175.60	—	20%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 PCOS Diagnostic Profile 84443	$111.20	$139.00	$11.97–$192.10	13% below	20%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH 84443	$154.40	$193.00	$23.96–$193.00	21% above	20%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH RFLX TO FT4 IF ABNORMAL 84443	$154.40	$193.00	$23.96–$193.00	21% above	20%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH RFLX TO FT4 IF ABNORMAL	$154.40	$193.00	$23.96–$193.00	21% above	20%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Cascade Profile LC	$154.40	$193.00	$16.46–$55.99	21% above	20%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 84443 Thyroid stimulating hormone (TSH)	$154.40	$193.00	$16.46–$55.99	21% above	20%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 PCOS Diagnostic Profile 84443	$111.20	$139.00	$11.97–$192.10	—	20%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH RFLX TO FT4 IF ABNORMAL 84443	$154.40	$193.00	$23.96–$193.00	—	20%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Cascade Profile LC	$154.40	$193.00	$16.46–$55.99	—	20%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 84443 Thyroid stimulating hormone (TSH)	$154.40	$193.00	$16.46–$55.99	—	20%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH 84443	$154.40	$193.00	$23.96–$193.00	—	20%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH RFLX TO FT4 IF ABNORMAL	$154.40	$193.00	$23.96–$193.00	—	20%
Total IgE blood test CPT 82785 Immunoglobulin E, Total LC	$358.40	$448.00	$10.86–$21.71	322% above	20%
Total IgE blood test inpatient CPT 82785 Immunoglobulin E, Total LC	$358.40	$448.00	$10.86–$21.71	—	20%
Total cholesterol blood test CPT 82465 CHOLESTEROL-82465	$120.80	$151.00	$4.91	171% above	20%
Total cholesterol blood test inpatient CPT 82465 CHOLESTEROL-82465	$120.80	$151.00	$4.91	—	20%
Total thyroxine (T4) blood test CPT 84436 T3 Uptake (thyroid profile) LC	$40.00	$50.00	$14.21–$171.70	51% below	20%
Total thyroxine (T4) blood test CPT 84436 Thyroxine (T4) LC	$80.00	$100.00	$14.21–$171.70	2% below	20%
Total thyroxine (T4) blood test CPT 84436 Thyroxine	$170.40	$213.00	$14.21–$171.70	108% above	20%
Total thyroxine (T4) blood test CPT 84436 T4-84436	$170.40	$213.00	$14.21–$171.70	108% above	20%
Total thyroxine (T4) blood test inpatient CPT 84436 T3 Uptake (thyroid profile) LC	$40.00	$50.00	$14.21–$171.70	—	20%
Total thyroxine (T4) blood test inpatient CPT 84436 Thyroxine (T4) LC	$80.00	$100.00	$14.21–$171.70	—	20%
Total thyroxine (T4) blood test inpatient CPT 84436 T4-84436	$170.40	$213.00	$14.21–$171.70	—	20%
Total thyroxine (T4) blood test inpatient CPT 84436 Thyroxine	$170.40	$213.00	$14.21–$171.70	—	20%
Total triiodothyronine (T3) blood test CPT 84480 Triiodothyronine (T3) LC	$256.80	$321.00	$23.94–$279.27	162% above	20%
Total triiodothyronine (T3) blood test inpatient CPT 84480 Triiodothyronine (T3) LC	$256.80	$321.00	$23.94–$279.27	—	20%
Transferrin blood test CPT 84466 Transferrin LC	$179.20	$224.00	$10.85–$181.05	85% above	20%
Transferrin blood test inpatient CPT 84466 Transferrin LC	$179.20	$224.00	$10.85–$181.05	—	20%
Trichomonas test (NAAT) CPT 87661 87661 Component LC	$67.20	$84.00	$38.92–$69.60	46% below	20%
Trichomonas test (NAAT) CPT 87661 TRICHOMONAS NAA	$67.20	$84.00	$22.78–$84.00	46% below	20%
Trichomonas test (NAAT) CPT 87661 Trichomonas vaginalis NAA	$67.20	$84.00	$38.92–$69.60	46% below	20%
Trichomonas test (NAAT) CPT 87661 87661- PapIG,CtNgTv,rfx Aptima HPV LC	$67.20	$84.00	$38.92–$69.60	46% below	20%
Trichomonas test (NAAT) CPT 87661 Infectious agent detection by nucleic acid (DNA or RNA); Tri	$67.20	$84.00	$38.92–$69.60	46% below	20%
Trichomonas test (NAAT) CPT 87661 87661 Component	$70.40	$88.00	$22.78–$84.00	43% below	20%
Trichomonas test (NAAT) CPT 87661 Trich vag by NAA LC	$70.40	$88.00	$22.78–$84.00	43% below	20%
Trichomonas test (NAAT) CPT 87661 87661-IGP,CtNgTv,Apt HPV,rfx16/18,45 LC	$70.40	$88.00	$22.78–$159.21	43% below	20%
Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS NAA	$67.20	$84.00	$22.78–$84.00	—	20%
Trichomonas test (NAAT) inpatient CPT 87661 Infectious agent detection by nucleic acid (DNA or RNA); Tri	$67.20	$84.00	$38.92–$69.60	—	20%
Trichomonas test (NAAT) inpatient CPT 87661 Trichomonas vaginalis NAA	$67.20	$84.00	$38.92–$69.60	—	20%
Trichomonas test (NAAT) inpatient CPT 87661 87661- PapIG,CtNgTv,rfx Aptima HPV LC	$67.20	$84.00	$38.92–$69.60	—	20%
Trichomonas test (NAAT) inpatient CPT 87661 87661 Component LC	$67.20	$84.00	$38.92–$69.60	—	20%
Trichomonas test (NAAT) inpatient CPT 87661 87661 Component	$70.40	$88.00	$22.78–$84.00	—	20%
Trichomonas test (NAAT) inpatient CPT 87661 87661-IGP,CtNgTv,Apt HPV,rfx16/18,45 LC	$70.40	$88.00	$22.78–$159.21	—	20%
Trichomonas test (NAAT) inpatient CPT 87661 Trich vag by NAA LC	$70.40	$88.00	$22.78–$84.00	—	20%
Triglycerides blood test CPT 84478 TRIGLYCERIDES-84478	$170.40	$213.00	$8.91	265% above	20%
Triglycerides blood test inpatient CPT 84478 TRIGLYCERIDES-84478	$170.40	$213.00	$8.91	—	20%
Troponin test, quantitative CPT 84484 TROPONIN I	$216.80	$271.00	$10.86–$258.00	38% above	20%
Troponin test, quantitative CPT 84484 Troponin ISTAT	$216.80	$271.00	$79.67	38% above	20%
Troponin test, quantitative inpatient CPT 84484 Troponin ISTAT	$216.80	$271.00	$79.67	—	20%
Troponin test, quantitative inpatient CPT 84484 TROPONIN I	$216.80	$271.00	$10.86–$258.00	—	20%
Uric acid blood test CPT 84550 URIC ACID SERUM-84550	$117.60	$147.00	$4.91–$137.20	61% above	20%
Uric acid blood test inpatient CPT 84550 URIC ACID SERUM-84550	$117.60	$147.00	$4.91–$137.20	—	20%
Urinalysis with microscope exam, automated CPT 81001 Urinalysis with Microscopic 2	$73.60	$92.00	$5.47–$85.26	14% above	20%
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS W/MICRO, Rfx to ID and SENS	$73.60	$92.00	$5.47–$85.26	14% above	20%
Urinalysis with microscope exam, automated CPT 81001 UA Complete 2	$73.60	$92.00	$5.47–$85.26	14% above	20%
Urinalysis with microscope exam, automated CPT 81001 U/A with MICROSCOPY	$73.60	$92.00	$5.47–$85.26	14% above	20%
Urinalysis with microscope exam, automated CPT 81001 UA Complete w/ Reflex to CS if Indicated 4	$73.60	$92.00	$5.47–$85.26	14% above	20%
Urinalysis with microscope exam, automated CPT 81001 Urinalysis with Microscopic	$73.60	$92.00	$5.47–$85.26	14% above	20%
Urinalysis with microscope exam, automated CPT 81001 Urinalysis with Microscopic Standard	$73.60	$92.00	$5.47–$85.26	14% above	20%
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS W/MICRO, Rfx to ID and SENS	$73.60	$92.00	$5.47–$85.26	—	20%
Urinalysis with microscope exam, automated inpatient CPT 81001 U/A with MICROSCOPY	$73.60	$92.00	$5.47–$85.26	—	20%
Urinalysis with microscope exam, automated inpatient CPT 81001 UA Complete 2	$73.60	$92.00	$5.47–$85.26	—	20%
Urinalysis with microscope exam, automated inpatient CPT 81001 UA Complete w/ Reflex to CS if Indicated 4	$73.60	$92.00	$5.47–$85.26	—	20%
Urinalysis with microscope exam, automated inpatient CPT 81001 Urinalysis with Microscopic 2	$73.60	$92.00	$5.47–$85.26	—	20%
Urinalysis with microscope exam, automated inpatient CPT 81001 Urinalysis with Microscopic	$73.60	$92.00	$5.47–$85.26	—	20%
Urinalysis with microscope exam, automated inpatient CPT 81001 Urinalysis with Microscopic Standard	$73.60	$92.00	$5.47–$85.26	—	20%
Urinalysis without microscope exam, automated CPT 81003 Urine Protein Dipstick	$11.20	$14.00	$5.47–$61.74	55% below	20%
Urinalysis without microscope exam, automated CPT 81003 Urine Dipstick, POC	$50.40	$63.00	$5.47–$61.74	102% above	20%
Urinalysis without microscope exam, automated CPT 81003 URINE BY DIPSTICK	$50.40	$63.00	$5.47–$61.74	102% above	20%
Urinalysis without microscope exam, automated inpatient CPT 81003 Urine Protein Dipstick	$11.20	$14.00	$5.47–$61.74	—	20%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINE BY DIPSTICK	$50.40	$63.00	$5.47–$61.74	—	20%
Urinalysis without microscope exam, automated inpatient CPT 81003 Urine Dipstick, POC	$50.40	$63.00	$5.47–$61.74	—	20%
Urine culture for bacteria, with colony count CPT 87086 URINE CULTURE ( ID and Sens)	$152.80	$191.00	$9.57–$283.62	67% above	20%
Urine culture for bacteria, with colony count CPT 87086 Urine Culture	$152.80	$191.00	$9.57–$283.62	67% above	20%
Urine culture for bacteria, with colony count inpatient CPT 87086 URINE CULTURE ( ID and Sens)	$152.80	$191.00	$9.57–$283.62	—	20%
Urine culture for bacteria, with colony count inpatient CPT 87086 Urine Culture	$152.80	$191.00	$9.57–$283.62	—	20%
Urine microalbumin (albumin) test CPT 82043 Microalbumin Level Urine	$83.20	$104.00	$5.47–$99.00	29% above	20%
Urine microalbumin (albumin) test CPT 82043 MICRO ALBUMIN - ASSOC 60065	$83.20	$104.00	$5.47–$99.00	29% above	20%
Urine microalbumin (albumin) test inpatient CPT 82043 Microalbumin Level Urine	$83.20	$104.00	$5.47–$99.00	—	20%
Urine microalbumin (albumin) test inpatient CPT 82043 MICRO ALBUMIN - ASSOC 60065	$83.20	$104.00	$5.47–$99.00	—	20%
Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY TEST VISUAL COMPAR METH	$44.80	$56.00	$5.47–$64.38	40% below	20%
Urine pregnancy test, read by color change CPT 81025 Urine Preg Test POC	$62.40	$78.00	$5.47–$64.38	16% below	20%
Urine pregnancy test, read by color change CPT 81025 PREGNANCY TEST/URINE HCG - QUALITATIVE	$65.60	$82.00	$2.73–$71.34	12% below	20%
Urine pregnancy test, read by color change CPT 81025 Pregnancy POC	$65.60	$82.00	$5.47–$64.38	12% below	20%
Urine pregnancy test, read by color change inpatient CPT 81025 URINE PREGNANCY TEST VISUAL COMPAR METH	$44.80	$56.00	$5.47–$64.38	—	20%
Urine pregnancy test, read by color change inpatient CPT 81025 Urine Preg Test POC	$62.40	$78.00	$5.47–$64.38	—	20%
Urine pregnancy test, read by color change inpatient CPT 81025 Pregnancy POC	$65.60	$82.00	$5.47–$64.38	—	20%
Urine pregnancy test, read by color change inpatient CPT 81025 PREGNANCY TEST/URINE HCG - QUALITATIVE	$65.60	$82.00	$2.73–$71.34	—	20%
Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B12 Level	$190.40	$238.00	$23.96–$207.06	47% above	20%
Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B12	$190.40	$238.00	$23.96–$207.06	47% above	20%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Vitamin B12 Level	$190.40	$238.00	$23.96–$207.06	—	20%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B12	$190.40	$238.00	$23.96–$207.06	—	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D, 25-Hydroxy LC	$222.40	$278.00	$10.85–$241.86	22% above	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D 25-Hydroxy, D2 + D3 LC	$222.40	$278.00	$42.91–$241.86	22% above	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D, 25-Hydroxy LC	$222.40	$278.00	$10.85–$241.86	—	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D 25-Hydroxy, D2 + D3 LC	$222.40	$278.00	$42.91–$241.86	—	20%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 Calcitriol LC	$222.40	$278.00	$98.32	15% above	20%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 Calcitriol LC	$222.40	$278.00	$98.32	—	20%
Zinc blood test CPT 84630 Zinc LC	$155.20	$194.00	$22.36	121% above	20%
Zinc blood test CPT 84630 Zinc, RBC LC	$155.20	$194.00	$22.36	121% above	20%
Zinc blood test inpatient CPT 84630 Zinc, RBC LC	$155.20	$194.00	$22.36	—	20%
Zinc blood test inpatient CPT 84630 Zinc LC	$155.20	$194.00	$22.36	—	20%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 QUANTITATIVE hCG	$222.40	$278.00	$23.96–$241.86	112% above	20%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 84702 Quant. HCG	$222.40	$278.00	$23.96–$241.86	112% above	20%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 QUANTITATIVE hCG	$222.40	$278.00	$23.96–$241.86	—	20%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 84702 Quant. HCG	$222.40	$278.00	$23.96–$241.86	—	20%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Illinois	Off list
Botox injections for chronic migraine CPT 64615 64615 BOTOX PROTOCOL FOR CHRONIC DAILY MIGRAINE (CDM) INJ	$600.00	$750.00	$216.15	60% above	20%
Botox injections for chronic migraine CPT 64615 64615 Chemodenervation of muscle(s)	$620.00	$775.00	$216.15	65% above	20%
Botox injections for chronic migraine inpatient CPT 64615 64615 BOTOX PROTOCOL FOR CHRONIC DAILY MIGRAINE (CDM) INJ	$600.00	$750.00	$216.15	—	20%
Botox injections for chronic migraine inpatient CPT 64615 64615 Chemodenervation of muscle(s)	$620.00	$775.00	$216.15	—	20%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 CLSD TREAT DISTAL FIBULAR FX WO MANIPULA	$735.20	$919.00	$198.65–$919.00	66% above	20%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 CLSD TREAT DISTAL FIBULAR FX WO MANIPULA	$735.20	$919.00	$198.65–$919.00	—	20%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 CLSD TREAT METATARSAL FX WO MANIPULATION	$348.00	$435.00	$95.33	46% below	20%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 CLSD TREAT METATARSAL FX WO MANIPULATION	$348.00	$435.00	$95.33	—	20%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 CLSD TREAT DIST RADIAL FX WO MANIPULATIO	$788.80	$986.00	$289.02–$839.32	51% above	20%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 CLSD TREAT DIST RADIAL FX WO MANIPULATIO	$788.80	$986.00	$289.02–$839.32	—	20%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 52000 CYSTOURETHROSCOPY	$1,656.00	$2,070.00	$568.04–$2,070.00	36% above	20%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 52000 CYSTOURETHROSCOPY	$1,656.00	$2,070.00	$568.04–$2,070.00	—	20%
Hammertoe correction surgery CPT 28285 28285 REPAIR OF HAMMERTOE	$5,192.00	$6,490.00	$3,740.84	49% above	20%
Hammertoe correction surgery inpatient CPT 28285 28285 REPAIR OF HAMMERTOE	$5,192.00	$6,490.00	$3,740.84	—	20%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 20550 PF INJECTION THERAPY	$636.80	$796.00	$217.30–$655.98	67% above	20%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 20550 PF INJECTION THERAPY	$636.80	$796.00	$217.30–$655.98	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHROCNTSS ASPIRATN AND/OR JNT INJ MAJR	$633.60	$792.00	$155.05–$711.63	41% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Pain PF 20610 Anthrocentesis/Asp/Inj Major Joint	$636.80	$796.00	$155.05–$711.63	42% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ARTHROCNTSS ASPIRATN AND/OR JNT INJ MAJR	$633.60	$792.00	$155.05–$711.63	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Pain PF 20610 Anthrocentesis/Asp/Inj Major Joint	$636.80	$796.00	$155.05–$711.63	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 20605 ASP/INJ INTERMEDIATE JOINT	$636.80	$796.00	$243.82–$653.65	64% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 20605 Podiatry Asp / Inject intermed joint or bursa	$711.20	$889.00	$243.82–$653.65	83% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 ARTHROCNTSS ASPIRATION AND/OR JNT INJ IM RT	$615.20	$769.00	$243.82–$653.65	59% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 20605 ASP/INJ INTERMEDIATE JOINT	$636.80	$796.00	$243.82–$653.65	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 20605 Podiatry Asp / Inject intermed joint or bursa	$711.20	$889.00	$243.82–$653.65	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 ARTHROCNTSS ASPIRATION AND/OR JNT INJ IM RT	$615.20	$769.00	$243.82–$653.65	—	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 20600 ARTHROCENTESIS ASPIR/INJ SMALL JT/BURSA W/O US TechFe	$636.80	$796.00	$108.46–$228.25	112% above	20%
Joint injection or drainage, small joint (fingers, toes) one side CPT 20600 ARTHROCNTSS ASPIRATION AND/OR JNT INJ SM RT	$633.60	$792.00	$108.46–$228.25	111% above	20%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 20600 ARTHROCENTESIS ASPIR/INJ SMALL JT/BURSA W/O US TechFe	$636.80	$796.00	$108.46–$228.25	—	20%
Joint injection or drainage, small joint (fingers, toes) inpatient one side CPT 20600 ARTHROCNTSS ASPIRATION AND/OR JNT INJ SM RT	$633.60	$792.00	$108.46–$228.25	—	20%
Lower-back epidural injection, without imaging guidance CPT 62322 62322 Lumbar or sacral Inj(s), of diag or therap substance(s	$1,768.80	$2,211.00	$928.79	21% above	20%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 62322 Lumbar or sacral Inj(s), of diag or therap substance(s	$1,768.80	$2,211.00	$928.79	—	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXCISE BENIGN LES TRUNK/ARMS .5CM OR LES	$217.60	$272.00	$220.15	69% below	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXCISE BENIGN LES TRUNK/ARMS .5CM OR LES	$217.60	$272.00	$220.15	—	20%
Nail removal (partial or complete), one nail CPT 11730 Avulsion of Nail Plate, Partial or Complete, Simple; Single	$144.80	$181.00	$148.78–$463.71	49% below	20%
Nail removal (partial or complete), one nail CPT 11730 11730 Podiatry Avul Nail Part of Compl Single Charge	$426.40	$533.00	$148.78–$463.71	51% above	20%
Nail removal (partial or complete), one nail CPT 11730 11730 Removal of Nail Plate	$426.40	$533.00	$148.78–$463.71	51% above	20%
Nail removal (partial or complete), one nail inpatient CPT 11730 Avulsion of Nail Plate, Partial or Complete, Simple; Single	$144.80	$181.00	$148.78–$463.71	—	20%
Nail removal (partial or complete), one nail inpatient CPT 11730 11730 Removal of Nail Plate	$426.40	$533.00	$148.78–$463.71	—	20%
Nail removal (partial or complete), one nail inpatient CPT 11730 11730 Podiatry Avul Nail Part of Compl Single Charge	$426.40	$533.00	$148.78–$463.71	—	20%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Excise of Nail & matrix, Part. or Complete, for Permanent Removal Charge	$684.80	$856.00	$285.32–$941.71	9% above	20%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISE INGROWN TOENAIL	$832.00	$1,040.00	$285.32–$941.71	33% above	20%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Excise of Nail & matrix, Part. or Complete, for Permanent Removal Charge	$684.80	$856.00	$285.32–$941.71	—	20%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXCISE INGROWN TOENAIL	$832.00	$1,040.00	$285.32–$941.71	—	20%
Short arm cast (elbow to hand) CPT 29075 APPLICATION, CAST ELBOW TO FINGER	$213.60	$267.00	$38.61–$402.36	31% below	20%
Short arm cast (elbow to hand) inpatient CPT 29075 APPLICATION, CAST ELBOW TO FINGER	$213.60	$267.00	$38.61–$402.36	—	20%
Skin biopsy, punch, one lesion CPT 11104 11104 Punch biopsy of single skin lesion	$180.00	$225.00	$203.15–$693.00	53% below	20%
Skin biopsy, punch, one lesion CPT 11104 11104 Punch biopsy of skin (including simple closure, when p	$554.40	$693.00	$203.15–$693.00	44% above	20%
Skin biopsy, punch, one lesion inpatient CPT 11104 11104 Punch biopsy of single skin lesion	$180.00	$225.00	$203.15–$693.00	—	20%
Skin biopsy, punch, one lesion inpatient CPT 11104 11104 Punch biopsy of skin (including simple closure, when p	$554.40	$693.00	$203.15–$693.00	—	20%
Skin tag removal, up to 15 tags CPT 11200 Removal of Skin Tags, Mult Fibrocutaneous Tags, Any Area; Up to & w/15 Lesions Charge	$360.00	$450.00	$216.00–$775.66	42% above	20%
Skin tag removal, up to 15 tags inpatient CPT 11200 Removal of Skin Tags, Mult Fibrocutaneous Tags, Any Area; Up to & w/15 Lesions Charge	$360.00	$450.00	$216.00–$775.66	—	20%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ;SING OR MULT TRIGGER PTS;1 OR 2 MUSC	$633.60	$792.00	$229.41–$610.30	29% above	20%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ;SING OR MULT TRIGGER PTS;1 OR 2 MUSC	$633.60	$792.00	$229.41–$610.30	—	20%
Vasectomy, one or both sides, including follow-up semen testing both sides CPT 55250 55250 Vasectomy, unilateral or bilateral (separate procedure	$882.40	$1,103.00	$913.50	—	20%
Vasectomy, one or both sides, including follow-up semen testing both sides CPT 55250 VASECTOMY UNILATERAL OR BILATERAL	$956.80	$1,196.00	$913.50	—	20%
Vasectomy, one or both sides, including follow-up semen testing inpatient both sides CPT 55250 55250 Vasectomy, unilateral or bilateral (separate procedure	$882.40	$1,103.00	$913.50	—	20%
Vasectomy, one or both sides, including follow-up semen testing inpatient both sides CPT 55250 VASECTOMY UNILATERAL OR BILATERAL	$956.80	$1,196.00	$913.50	—	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 11042 DEB SUBQ TISSUE 20 SQ CM/<	$684.80	$856.00	$123.88–$855.01	3% above	20%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 11042 DEB SUBQ TISSUE 20 SQ CM/<	$684.80	$856.00	$123.88–$855.01	—	20%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Illinois	Off list
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION BLOOD/BLOOD COMP 1 UNIT	$1,058.40	$1,323.00	$363.13–$904.39	13% above	20%
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION BLOOD/BLOOD COMP-2 UNITS	$1,313.60	$1,642.00	$363.13–$904.39	40% above	20%
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION BLOOD/BLOOD COMP-3 UNITS	$1,565.60	$1,957.00	$363.13–$904.39	67% above	20%
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION BLOOD/BLOOD COMP-4 UNITS	$1,817.60	$2,272.00	$363.13–$904.39	94% above	20%
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION BLOOD/BLOOD COMP >4 UNITS	$2,071.20	$2,589.00	$363.13–$904.39	121% above	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSION BLOOD/BLOOD COMP 1 UNIT	$1,058.40	$1,323.00	$363.13–$904.39	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSION BLOOD/BLOOD COMP-2 UNITS	$1,313.60	$1,642.00	$363.13–$904.39	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSION BLOOD/BLOOD COMP-3 UNITS	$1,565.60	$1,957.00	$363.13–$904.39	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSION BLOOD/BLOOD COMP-4 UNITS	$1,817.60	$2,272.00	$363.13–$904.39	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSION BLOOD/BLOOD COMP >4 UNITS	$2,071.20	$2,589.00	$363.13–$904.39	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 INHALER-MDI	$113.60	$142.00	$38.91–$802.35	39% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 EZPAP SUBSEQUENT THERAPY	$113.60	$142.00	$38.91–$802.35	39% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HAND HELD NEBULIZER SUBSEQUENT THERAPY	$113.60	$142.00	$38.91–$802.35	39% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 SPUTUM INDUCTION	$113.60	$142.00	$38.91–$802.35	39% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 94640 Aerosol Treatment	$119.20	$149.00	$38.91–$802.35	36% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AERO/HAND HELD NEB INITIAL TREATMENT	$136.80	$171.00	$38.91–$802.35	27% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 EZPAP INITIAL	$166.40	$208.00	$38.91–$802.35	11% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HAND HELD NEBULIZER SUBSEQUENT THERAPY	$113.60	$142.00	$38.91–$802.35	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 EZPAP SUBSEQUENT THERAPY	$113.60	$142.00	$38.91–$802.35	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 SPUTUM INDUCTION	$113.60	$142.00	$38.91–$802.35	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 INHALER-MDI	$113.60	$142.00	$38.91–$802.35	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 94640 Aerosol Treatment	$119.20	$149.00	$38.91–$802.35	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AERO/HAND HELD NEB INITIAL TREATMENT	$136.80	$171.00	$38.91–$802.35	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 EZPAP INITIAL	$166.40	$208.00	$38.91–$802.35	—	20%
Chemotherapy IV infusion, first hour CPT 96413 CHEMOTHERAPY-MULTI IV INF/1ST HR	$764.80	$956.00	$145.31–$281.06	21% above	20%
Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMOTHERAPY-MULTI IV INF/1ST HR	$764.80	$956.00	$145.31–$281.06	—	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG (Lab)	$276.80	$346.00	$57.58–$329.00	19% above	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ECG 12-Lead Acquisition	$276.80	$346.00	$57.58–$329.00	19% above	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG (Lab)	$276.80	$346.00	$57.58–$329.00	—	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ECG 12-Lead Acquisition	$276.80	$346.00	$57.58–$329.00	—	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 E.R. BRIEF LEVEL 1	$337.60	$422.00	$122.38–$409.77	64% above	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 E.R. BRIEF LEVEL 1	$337.60	$422.00	$122.38–$409.77	—	20%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 E.R. BASIC LEVEL 2	$408.00	$510.00	$139.78–$492.15	5% above	20%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 E.R. BASIC LEVEL 2	$408.00	$510.00	$139.78–$492.15	—	20%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 E.R INTERMEDIATE LEVEL 3	$567.20	$709.00	$90.00–$689.20	18% below	20%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 E.R INTERMEDIATE LEVEL 3	$567.20	$709.00	$90.00–$689.20	—	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 E.R EXTENDED LEVEL 4	$939.20	$1,174.00	$90.00–$1,098.14	17% below	20%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 E.R EXTENDED LEVEL 4	$939.20	$1,174.00	$90.00–$1,098.14	—	20%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 E.R CRITICAL LEVEL 5	$1,345.60	$1,682.00	$90.00–$1,601.00	20% below	20%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 E.R CRITICAL LEVEL 5	$1,345.60	$1,682.00	$90.00–$1,601.00	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 INFUSION - HYDRATION 1ST HR	$425.60	$532.00	$145.83–$495.88	22% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 INFUSION - HYDRATION 31MIN TO 1 HOUR	$425.60	$532.00	$145.83–$452.20	22% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 INFUSION - HYDRATION 31MIN TO 1 HOUR	$425.60	$532.00	$145.83–$452.20	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 INFUSION - HYDRATION 1ST HR	$425.60	$532.00	$145.83–$495.88	—	20%
IV infusion of a medicine, first hour CPT 96365 INFUSION-THERAPY,PROPHYLAX OR DIAG,1STHR	$512.00	$640.00	$174.15–$640.00	22% above	20%
IV infusion of a medicine, first hour CPT 96365 2ND INF-THERAPY,PROPHYLAX OR DIAG,1STHR	$512.00	$640.00	$174.15–$640.00	22% above	20%
IV infusion of a medicine, first hour inpatient CPT 96365 2ND INF-THERAPY,PROPHYLAX OR DIAG,1STHR	$512.00	$640.00	$174.15–$640.00	—	20%
IV infusion of a medicine, first hour inpatient CPT 96365 INFUSION-THERAPY,PROPHYLAX OR DIAG,1STHR	$512.00	$640.00	$174.15–$640.00	—	20%
IV push of a medicine, first drug CPT 96374 96374 IV PUSH INITIAL CHARGE	$319.20	$399.00	$60.65–$114.99	48% above	20%
IV push of a medicine, first drug CPT 96374 IV INTRAVENOUS INJECTION-INITIAL	$541.60	$677.00	$60.65–$644.00	152% above	20%
IV push of a medicine, first drug inpatient CPT 96374 96374 IV PUSH INITIAL CHARGE	$319.20	$399.00	$60.65–$114.99	—	20%
IV push of a medicine, first drug inpatient CPT 96374 IV INTRAVENOUS INJECTION-INITIAL	$541.60	$677.00	$60.65–$644.00	—	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJ ADM SUBCUT IM	$167.20	$209.00	$56.90–$181.83	53% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJ ADM SUBCUT IM - ER	$167.20	$209.00	$34.58–$195.02	53% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 IM INJECTION CHARGE	$167.20	$209.00	$56.90–$181.83	53% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 2nd THER,PROPHYL,DIAG INJECTION;SQ OR IM	$167.20	$209.00	$56.90–$181.83	53% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 CLINIC INJ SUB/IM CHARGE	$172.00	$215.00	$59.98–$177.48	58% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Inj administation Therapeutic- prophylatic- or diagnostic su	$172.00	$215.00	$59.98–$177.48	58% above	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJ ADM SUBCUT IM	$167.20	$209.00	$56.90–$181.83	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 IM INJECTION CHARGE	$167.20	$209.00	$56.90–$181.83	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJ ADM SUBCUT IM - ER	$167.20	$209.00	$34.58–$195.02	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 2nd THER,PROPHYL,DIAG INJECTION;SQ OR IM	$167.20	$209.00	$56.90–$181.83	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 CLINIC INJ SUB/IM CHARGE	$172.00	$215.00	$59.98–$177.48	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Inj administation Therapeutic- prophylatic- or diagnostic su	$172.00	$215.00	$59.98–$177.48	—	20%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 EMG 7-8 TESTS (TC)	$2,773.60	$3,467.00	$296.91	282% above	20%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 EMG 7-8 TESTS (TC)	$2,773.60	$3,467.00	$296.91	—	20%
Neuromuscular re-education, 15 minutes CPT 97112 OT NEUROMUSCULAR RE-ED (15 MIN) 97530	$133.60	$167.00	$49.10	9% above	20%
Neuromuscular re-education, 15 minutes CPT 97112 PT Neuromuscular Reeducation Units	$133.60	$167.00	$40.37–$141.95	9% above	20%
Neuromuscular re-education, 15 minutes CPT 97112 Neuromuscular Reeducation Charges	$133.60	$167.00	$40.37–$141.95	9% above	20%
Neuromuscular re-education, 15 minutes CPT 97112 PT Neuromuscular Reeducation Rehab Units	$133.60	$167.00	$40.37–$141.95	9% above	20%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 OT NEUROMUSCULAR RE-ED (15 MIN) 97530	$133.60	$167.00	$49.10	—	20%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 PT Neuromuscular Reeducation Rehab Units	$133.60	$167.00	$40.37–$141.95	—	20%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 Neuromuscular Reeducation Charges	$133.60	$167.00	$40.37–$141.95	—	20%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 PT Neuromuscular Reeducation Units	$133.60	$167.00	$40.37–$141.95	—	20%
New patient office visit, about 30 minutes CPT 99203 99203 OP CLINIC VISIT LEVEL 3 - new	$393.60	$492.00	$60.23–$391.80	83% above	20%
New patient office visit, about 30 minutes inpatient CPT 99203 99203 OP CLINIC VISIT LEVEL 3 - new	$393.60	$492.00	$60.23–$391.80	—	20%
New patient office visit, about 45 minutes CPT 99204 99204 OP CLINIC VISIT LEVEL 4 - new	$402.40	$503.00	$187.32–$503.00	37% above	20%
New patient office visit, about 45 minutes inpatient CPT 99204 99204 OP CLINIC VISIT LEVEL 4 - new	$402.40	$503.00	$187.32–$503.00	—	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 99202 OP CLINIC VISIT LEVEL 2 - new	$379.20	$474.00	$68.55–$300.15	143% above	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 99202 OP CLINIC VISIT LEVEL 2 - new	$379.20	$474.00	$68.55–$300.15	—	20%
Occupational therapy evaluation, low complexity CPT 97165 OT INITIAL EVAL - LOW COMPLEXITY	$178.40	$223.00	$61.10–$212.00	31% below	20%
Occupational therapy evaluation, low complexity inpatient CPT 97165 OT INITIAL EVAL - LOW COMPLEXITY	$178.40	$223.00	$61.10–$212.00	—	20%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT High Complex Units	$355.20	$444.00	$3.03–$424.45	3% above	20%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT Evaluation High Complexity Units	$355.20	$444.00	$3.03–$424.45	3% above	20%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT Evaluation High Complexity Units	$355.20	$444.00	$3.03–$424.45	—	20%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT High Complex Units	$355.20	$444.00	$3.03–$424.45	—	20%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT Evaluation Low Complexity Units	$213.60	$267.00	$73.20–$254.00	5% below	20%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT Low Complex Units	$213.60	$267.00	$73.20–$254.00	5% below	20%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT Evaluation Low Complexity Units	$213.60	$267.00	$73.20–$254.00	—	20%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT Low Complex Units	$213.60	$267.00	$73.20–$254.00	—	20%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT Evaluation Moderate Complexity Units	$284.80	$356.00	$97.70–$339.00	7% below	20%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT Moderate Complex Units	$284.80	$356.00	$97.70–$339.00	7% below	20%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT Moderate Complex Units	$284.80	$356.00	$97.70–$339.00	—	20%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT Evaluation Moderate Complexity Units	$284.80	$356.00	$97.70–$339.00	—	20%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Manual Therapy Charge Units	$140.80	$176.00	$40.33–$153.12	at median	20%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 OT MANUAL THERAPY (15 MIN)	$140.80	$176.00	$40.33–$153.12	at median	20%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PT Manual Therapy Units	$140.80	$176.00	$40.37–$153.12	at median	20%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PT MANUAL THERAPY (15 MIN)	$140.80	$176.00	$40.37–$153.12	at median	20%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 PT MANUAL THERAPY (15 MIN)	$140.80	$176.00	$40.37–$153.12	—	20%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 Manual Therapy Charge Units	$140.80	$176.00	$40.33–$153.12	—	20%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 OT MANUAL THERAPY (15 MIN)	$140.80	$176.00	$40.33–$153.12	—	20%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 PT Manual Therapy Units	$140.80	$176.00	$40.37–$153.12	—	20%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT THERAPEUTIC EXER. (15 MIN) 97110	$167.20	$209.00	$40.33–$195.02	39% above	20%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT THERAPEUTIC EXER. REHAB UNITS (15 MIN)	$167.20	$209.00	$40.33–$195.02	39% above	20%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT Therapeutic Exercise Units	$167.20	$209.00	$40.37–$363.66	39% above	20%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exercise Charges	$167.20	$209.00	$40.37–$363.66	39% above	20%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic Exercise Charges	$167.20	$209.00	$40.37–$363.66	—	20%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT THERAPEUTIC EXER. REHAB UNITS (15 MIN)	$167.20	$209.00	$40.33–$195.02	—	20%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT THERAPEUTIC EXER. (15 MIN) 97110	$167.20	$209.00	$40.33–$195.02	—	20%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT Therapeutic Exercise Units	$167.20	$209.00	$40.37–$363.66	—	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OV - ESTABLISHED PAT INTERMEDIATE	$176.00	$220.00	$99.43–$425.00	16% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 99213 OP CLINIC VISIT LEVEL 3 - EST	$357.60	$447.00	$99.43–$425.00	137% above	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OV - ESTABLISHED PAT INTERMEDIATE	$176.00	$220.00	$99.43–$425.00	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 99213 OP CLINIC VISIT LEVEL 3 - EST	$357.60	$447.00	$99.43–$425.00	—	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE VISIT LEVEL 4	$213.60	$267.00	$99.43–$457.00	20% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214 OP CLINIC VISIT LEVEL 4 - EST	$365.60	$457.00	$99.43–$457.00	106% above	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OFFICE VISIT LEVEL 4	$213.60	$267.00	$99.43–$457.00	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 99214 OP CLINIC VISIT LEVEL 4 - EST	$365.60	$457.00	$99.43–$457.00	—	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFC VISIT LEVEL 2	$139.20	$174.00	$52.44–$374.97	16% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OV - ESTABLISHED PAT LIMITED	$344.80	$431.00	$118.16–$410.00	187% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212 OP CLINIC VISIT LEVEL 2 - EST	$344.80	$431.00	$52.44–$374.97	187% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Surgical Facility Fee	$344.80	$431.00	$118.16–$410.00	187% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 NURSING CHARGES ROOM CHARGE 99212	$344.80	$431.00	$118.16–$410.00	187% above	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OFFC VISIT LEVEL 2	$139.20	$174.00	$52.44–$374.97	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OV - ESTABLISHED PAT LIMITED	$344.80	$431.00	$118.16–$410.00	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Surgical Facility Fee	$344.80	$431.00	$118.16–$410.00	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 NURSING CHARGES ROOM CHARGE 99212	$344.80	$431.00	$118.16–$410.00	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 99212 OP CLINIC VISIT LEVEL 2 - EST	$344.80	$431.00	$52.44–$374.97	—	20%
Speech and language evaluation CPT 92523 SLP Language Without Speech Minutes	$220.00	$275.00	$93.88–$321.00	44% below	20%
Speech and language evaluation CPT 92523 SLP Sound Prod w/ Lang Comp Eval Rehab Units	$256.80	$321.00	$93.88–$321.00	35% below	20%
Speech and language evaluation CPT 92523 92523 Speech Sound Prod w/ Language Charge	$256.80	$321.00	$93.88–$321.00	35% below	20%
Speech and language evaluation inpatient CPT 92523 SLP Language Without Speech Minutes	$220.00	$275.00	$93.88–$321.00	—	20%
Speech and language evaluation inpatient CPT 92523 92523 Speech Sound Prod w/ Language Charge	$256.80	$321.00	$93.88–$321.00	—	20%
Speech and language evaluation inpatient CPT 92523 SLP Sound Prod w/ Lang Comp Eval Rehab Units	$256.80	$321.00	$93.88–$321.00	—	20%
Speech therapy session, individual CPT 92507 Tx of Speech/Lang/Voice/Comm/Auditory Chg	$132.00	$165.00	$52.74–$183.00	29% below	20%
Speech therapy session, individual CPT 92507 SLP Auditory Processing Tx Rehab Units	$154.40	$193.00	$52.74–$183.00	17% below	20%
Speech therapy session, individual CPT 92507 92507 Tx of Speech/Lang/Voice/Comm/Auditory	$154.40	$193.00	$52.74–$183.00	17% below	20%
Speech therapy session, individual inpatient CPT 92507 Tx of Speech/Lang/Voice/Comm/Auditory Chg	$132.00	$165.00	$52.74–$183.00	—	20%
Speech therapy session, individual inpatient CPT 92507 SLP Auditory Processing Tx Rehab Units	$154.40	$193.00	$52.74–$183.00	—	20%
Speech therapy session, individual inpatient CPT 92507 92507 Tx of Speech/Lang/Voice/Comm/Auditory	$154.40	$193.00	$52.74–$183.00	—	20%
Spirometry (breathing test) CPT 94010 PFT - BASIC W/LUNG VOLUMES	$316.80	$396.00	$119.31–$128.99	4% above	20%
Spirometry (breathing test) CPT 94010 Incentive Spirometry Initial	$331.20	$414.00	$119.31–$128.99	9% above	20%
Spirometry (breathing test) inpatient CPT 94010 PFT - BASIC W/LUNG VOLUMES	$316.80	$396.00	$119.31–$128.99	—	20%
Spirometry (breathing test) inpatient CPT 94010 Incentive Spirometry Initial	$331.20	$414.00	$119.31–$128.99	—	20%
Spirometry before and after a bronchodilator CPT 94060 RT Pre Post Spiro Charge	$467.20	$584.00	$88.77–$508.08	11% below	20%
Spirometry before and after a bronchodilator CPT 94060 PFT PRE/POST W/LUNG VOLUMES	$514.40	$643.00	$88.77–$508.08	2% below	20%
Spirometry before and after a bronchodilator inpatient CPT 94060 RT Pre Post Spiro Charge	$467.20	$584.00	$88.77–$508.08	—	20%
Spirometry before and after a bronchodilator inpatient CPT 94060 PFT PRE/POST W/LUNG VOLUMES	$514.40	$643.00	$88.77–$508.08	—	20%
Therapeutic activities (functional training), 15 minutes CPT 97530 OT THERAPEUTIC ACTIVITIES (15 MIN)	$141.60	$177.00	$26.91–$153.99	11% above	20%
Therapeutic activities (functional training), 15 minutes CPT 97530 PT Therapeutic Activity Units	$141.60	$177.00	$40.37–$292.32	11% above	20%
Therapeutic activities (functional training), 15 minutes CPT 97530 Therapeutic Activities Charge	$141.60	$177.00	$40.37–$292.32	11% above	20%
Therapeutic activities (functional training), 15 minutes CPT 97530 PT THERPEUTIC ACTIVITIES (15 MIN)	$141.60	$177.00	$40.37–$292.32	11% above	20%
Therapeutic activities (functional training), 15 minutes CPT 97530 OT Therapeutic Activities Rehab Units	$141.60	$177.00	$26.91–$153.99	11% above	20%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 OT THERAPEUTIC ACTIVITIES (15 MIN)	$141.60	$177.00	$26.91–$153.99	—	20%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 PT Therapeutic Activity Units	$141.60	$177.00	$40.37–$292.32	—	20%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Therapeutic Activities Charge	$141.60	$177.00	$40.37–$292.32	—	20%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 OT Therapeutic Activities Rehab Units	$141.60	$177.00	$26.91–$153.99	—	20%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 PT THERPEUTIC ACTIVITIES (15 MIN)	$141.60	$177.00	$40.37–$292.32	—	20%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 THERAPEUTIC PHLEBOTOMY (CRAW)	$284.80	$356.00	$302.60	37% above	20%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 THERAPEUTIC PHLEBOTOMY (CRAW)	$284.80	$356.00	$302.60	—	20%
Treadmill or drug stress test with ECG, supervision and report CPT 93015 DOBUTAMINE STRESS TEST	$885.60	$1,107.00	$303.76–$1,048.54	105% above	20%
Treadmill or drug stress test with ECG, supervision and report CPT 93015 93015 C LEXISCAN STRESS TEST	$885.60	$1,107.00	$303.76–$1,048.54	105% above	20%
Treadmill or drug stress test with ECG, supervision and report CPT 93015 Adenosine Stress Test	$885.60	$1,107.00	$303.76–$1,048.54	105% above	20%
Treadmill or drug stress test with ECG, supervision and report CPT 93015 Exercise Stress Test	$885.60	$1,107.00	$303.76–$1,048.54	105% above	20%
Treadmill or drug stress test with ECG, supervision and report CPT 93015 Lexiscan Stress Test	$885.60	$1,107.00	$303.76–$1,048.54	105% above	20%
Treadmill or drug stress test with ECG, supervision and report inpatient CPT 93015 Adenosine Stress Test	$885.60	$1,107.00	$303.76–$1,048.54	—	20%
Treadmill or drug stress test with ECG, supervision and report inpatient CPT 93015 Lexiscan Stress Test	$885.60	$1,107.00	$303.76–$1,048.54	—	20%
Treadmill or drug stress test with ECG, supervision and report inpatient CPT 93015 Exercise Stress Test	$885.60	$1,107.00	$303.76–$1,048.54	—	20%
Treadmill or drug stress test with ECG, supervision and report inpatient CPT 93015 DOBUTAMINE STRESS TEST	$885.60	$1,107.00	$303.76–$1,048.54	—	20%
Treadmill or drug stress test with ECG, supervision and report inpatient CPT 93015 93015 C LEXISCAN STRESS TEST	$885.60	$1,107.00	$303.76–$1,048.54	—	20%
Visual field test, extended CPT 92083 VISION FIELD - EXTENDED	$261.60	$327.00	$89.63–$168.72	79% above	20%
Visual field test, extended inpatient CPT 92083 VISION FIELD - EXTENDED	$261.60	$327.00	$89.63–$168.72	—	20%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Illinois	Off list
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 influenza virus vaccine, inactivated preservative-free trivalent Sus [CRAW	$74.15	$92.69	$22.76–$50.00	115% above	20%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 influenza virus vaccine, inactivated preservative-free trivalent Sus [CRAW]	$94.50	$118.13	$22.76–$50.00	175% above	20%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 influenza virus vaccine, inactivated preservative-free trivalent Sus [CRAW	$74.15	$92.69	$22.76–$50.00	—	20%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 influenza virus vaccine, inactivated preservative-free trivalent Sus [CRAW]	$94.50	$118.13	$22.76–$50.00	—	20%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 pneumococcal 20-valent conjugate vaccine - Sus	$819.03	$1,023.79	$301.06–$306.64	84% above	20%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 pneumococcal 20-valent conjugate vaccine - Sus	$819.03	$1,023.79	$301.06–$306.64	—	20%
Rabies vaccine, one dose CPT 90675 rabies vaccine, purified chick embyro cell 2.5 intl units IM Inj [CRAW]	$1,092.00	$1,365.00	$252.03–$1,328.55	45% above	20%
Rabies vaccine, one dose inpatient CPT 90675 rabies vaccine, purified chick embyro cell 2.5 intl units IM Inj [CRAW]	$1,092.00	$1,365.00	$252.03–$1,328.55	—	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 tetanus-diphth toxoids (Td) adult/adol 5 units-2 units/0.5 mL preservative-free Sus UD [CRAW]	$158.19	$197.74	$58.21–$234.00	105% above	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 tetanus-diphth toxoids (Td) adult/adol 5 units-2 units/0.5 mL preservative-free Sus UD [CRAW]	$158.19	$197.74	$58.21–$234.00	—	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 tetanus/diphtheria/pertussis, acel (Tdap) 5 units-2 units-15.5 mcg/0.5 mL IM Susp 0.5 mL [CRAW]	$140.01	$175.01	$43.25–$234.03	39% above	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 tetanus/diphtheria/pertussis, acel (Tdap) 5 units-2 units-15.5 mcg/0.5 mL IM Susp 0.5 mL [CRAW]	$140.01	$175.01	$43.25–$234.03	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 VACCINE ADMINISTRATION	$133.60	$167.00	$45.82–$145.29	132% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 VACCINE ADMINISTRATION	$133.60	$167.00	$45.82–$145.29	—	20%

Source file: https://www.crawfordmh.org/clientuploads/CMS-4205-F/370793762_Crawford-Memorial-Hospital_standardcharges.csv