Hospital Dallas-Fort Worth-Arlington, TX

Baylor Medical Center at Trophy Club

Listed in its price file as “Trophy Club Medical Center LP”.

Baylor Medical Center at Trophy Club in Trophy Club, TX publishes cash prices for 402 common procedures listed here, from its own machine-readable price file updated Apr 14, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Texas median for 282 of 401 procedures and above it for 118. By typical cash price it ranks #91 of 305 Texas hospitals and #8 of 82 hospitals in the Dallas, TX area, cheapest first. Click a procedure to compare it with other hospitals nearby.

2850 TX-114, Trophy Club, TX 76262 Collected Sep 27, 2026 Source price file (817) 837-4600

Acute care hospital Emergency department CCN 450883 · CMS hospital register NPI 1982609558

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Texas	Off list
Abdominal CT scan without and with contrast CPT 74170 BCE CT Abdomen w/o & w/contrast 74170	$1,779.00	$2,965.00	$1,393.55–$8,427.00	38% below	40%
Abdominal CT scan without and with contrast CPT 74170 CT Abdomen w/ + w/o Contrast 74170	$1,779.00	$2,965.00	$1,393.55–$8,427.00	38% below	40%
Abdominal CT scan without and with contrast inpatient CPT 74170 BCE CT Abdomen w/o & w/contrast 74170	$1,779.00	$2,965.00	$1,393.55–$8,427.00	—	40%
Abdominal CT scan without and with contrast inpatient CPT 74170 CT Abdomen w/ + w/o Contrast 74170	$1,779.00	$2,965.00	$1,393.55–$8,427.00	—	40%
Abdominal X-ray, 2 views CPT 74019 XR abdomen 2 views 74019	$209.40	$349.00	$164.03–$8,427.00	47% below	40%
Abdominal X-ray, 2 views CPT 74019 XR Abdomen 2 Views 74019	$209.40	$349.00	$164.03–$8,427.00	47% below	40%
Abdominal X-ray, 2 views CPT 74019 BCE Radiologic examination, abdomen; 2 views 74019	$209.40	$349.00	$164.03–$8,427.00	47% below	40%
Abdominal X-ray, 2 views inpatient CPT 74019 XR Abdomen 2 Views 74019	$209.40	$349.00	$164.03–$8,427.00	—	40%
Abdominal X-ray, 2 views inpatient CPT 74019 BCE Radiologic examination, abdomen; 2 views 74019	$209.40	$349.00	$164.03–$8,427.00	—	40%
Abdominal X-ray, 2 views inpatient CPT 74019 XR abdomen 2 views 74019	$209.40	$349.00	$164.03–$8,427.00	—	40%
Ankle X-ray, complete, 3 or more views both sides CPT 73610 XR Ankle Complete Bilateral 73610	$246.60	$411.00	$193.17–$8,427.00	—	40%
Ankle X-ray, complete, 3 or more views CPT 73610 BCE XR Ankle, complete min 3 views 73610	$246.60	$411.00	$193.17–$8,427.00	35% below	40%
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR Ankle Complete Right 73610	$246.60	$411.00	$193.17–$8,427.00	35% below	40%
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR Ankle Complete Left 73610	$246.60	$411.00	$193.17–$8,427.00	35% below	40%
Ankle X-ray, complete, 3 or more views inpatient both sides CPT 73610 XR Ankle Complete Bilateral 73610	$246.60	$411.00	$193.17–$8,427.00	—	40%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 BCE XR Ankle, complete min 3 views 73610	$246.60	$411.00	$193.17–$8,427.00	—	40%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR Ankle Complete Right 73610	$246.60	$411.00	$193.17–$8,427.00	—	40%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR Ankle Complete Left 73610	$246.60	$411.00	$193.17–$8,427.00	—	40%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 US Lmt bl physiologic of U/LE art 93922	$373.20	$622.00	$292.34–$8,427.00	39% below	40%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 BCE US Lmt bl physiologic of U/LE art 93922	$373.20	$622.00	$292.34–$8,427.00	39% below	40%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 BCE US Lmt bl physiologic of U/LE art 93922	$373.20	$622.00	$292.34–$8,427.00	—	40%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 US Lmt bl physiologic of U/LE art 93922	$373.20	$622.00	$292.34–$8,427.00	—	40%
Arm CT scan without contrast (shoulder to hand, any part) both sides CPT 73200 CT Forearm w/o Contrast Bilateral 73200	$1,579.80	$2,633.00	$1,237.51–$8,427.00	—	40%
Arm CT scan without contrast (shoulder to hand, any part) both sides CPT 73200 CT Elbow w/o Contrast Bilateral 73200	$1,579.80	$2,633.00	$1,237.51–$8,427.00	—	40%
Arm CT scan without contrast (shoulder to hand, any part) both sides CPT 73200 CT Hand w/o Contrast Bilateral 73200	$1,579.80	$2,633.00	$1,237.51–$8,427.00	—	40%
Arm CT scan without contrast (shoulder to hand, any part) both sides CPT 73200 CT Humerus w/o Contrast Bilateral 73200	$1,579.80	$2,633.00	$1,237.51–$8,427.00	—	40%
Arm CT scan without contrast (shoulder to hand, any part) both sides CPT 73200 CT Shoulder w/o Contrast Bilateral 73200	$1,579.80	$2,633.00	$1,237.51–$8,427.00	—	40%
Arm CT scan without contrast (shoulder to hand, any part) both sides CPT 73200 CT Wrist w/o Contrast Bilateral 73200	$1,579.80	$2,633.00	$1,237.51–$8,427.00	—	40%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Shoulder w/o Contrast Left 73200	$1,579.80	$2,633.00	$1,237.51–$8,427.00	14% below	40%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Elbow w/o Contrast Left 73200	$1,579.80	$2,633.00	$1,237.51–$8,427.00	14% below	40%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Elbow w/o Contrast Right 73200	$1,579.80	$2,633.00	$1,237.51–$8,427.00	14% below	40%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Forearm w/o Contrast Left 73200	$1,579.80	$2,633.00	$1,237.51–$8,427.00	14% below	40%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Forearm w/o Contrast Right 73200	$1,579.80	$2,633.00	$1,237.51–$8,427.00	14% below	40%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Hand w/o Contrast Left 73200	$1,579.80	$2,633.00	$1,237.51–$8,427.00	14% below	40%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Hand w/o Contrast Right 73200	$1,579.80	$2,633.00	$1,237.51–$8,427.00	14% below	40%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Humerus w/o Contrast Left 73200	$1,579.80	$2,633.00	$1,237.51–$8,427.00	14% below	40%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Humerus w/o Contrast Right 73200	$1,579.80	$2,633.00	$1,237.51–$8,427.00	14% below	40%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Shoulder w/o Contrast Right 73200	$1,579.80	$2,633.00	$1,237.51–$8,427.00	14% below	40%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Wrist w/o Contrast Left 73200	$1,579.80	$2,633.00	$1,237.51–$8,427.00	14% below	40%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Wrist w/o Contrast Right 73200	$1,579.80	$2,633.00	$1,237.51–$8,427.00	14% below	40%
Arm CT scan without contrast (shoulder to hand, any part) inpatient both sides CPT 73200 CT Wrist w/o Contrast Bilateral 73200	$1,579.80	$2,633.00	$1,237.51–$8,427.00	—	40%
Arm CT scan without contrast (shoulder to hand, any part) inpatient both sides CPT 73200 CT Humerus w/o Contrast Bilateral 73200	$1,579.80	$2,633.00	$1,237.51–$8,427.00	—	40%
Arm CT scan without contrast (shoulder to hand, any part) inpatient both sides CPT 73200 CT Forearm w/o Contrast Bilateral 73200	$1,579.80	$2,633.00	$1,237.51–$8,427.00	—	40%
Arm CT scan without contrast (shoulder to hand, any part) inpatient both sides CPT 73200 CT Elbow w/o Contrast Bilateral 73200	$1,579.80	$2,633.00	$1,237.51–$8,427.00	—	40%
Arm CT scan without contrast (shoulder to hand, any part) inpatient both sides CPT 73200 CT Shoulder w/o Contrast Bilateral 73200	$1,579.80	$2,633.00	$1,237.51–$8,427.00	—	40%
Arm CT scan without contrast (shoulder to hand, any part) inpatient both sides CPT 73200 CT Hand w/o Contrast Bilateral 73200	$1,579.80	$2,633.00	$1,237.51–$8,427.00	—	40%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Hand w/o Contrast Left 73200	$1,579.80	$2,633.00	$1,237.51–$8,427.00	—	40%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Hand w/o Contrast Right 73200	$1,579.80	$2,633.00	$1,237.51–$8,427.00	—	40%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Humerus w/o Contrast Left 73200	$1,579.80	$2,633.00	$1,237.51–$8,427.00	—	40%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Wrist w/o Contrast Right 73200	$1,579.80	$2,633.00	$1,237.51–$8,427.00	—	40%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Humerus w/o Contrast Right 73200	$1,579.80	$2,633.00	$1,237.51–$8,427.00	—	40%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Shoulder w/o Contrast Left 73200	$1,579.80	$2,633.00	$1,237.51–$8,427.00	—	40%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Forearm w/o Contrast Left 73200	$1,579.80	$2,633.00	$1,237.51–$8,427.00	—	40%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Wrist w/o Contrast Left 73200	$1,579.80	$2,633.00	$1,237.51–$8,427.00	—	40%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Forearm w/o Contrast Right 73200	$1,579.80	$2,633.00	$1,237.51–$8,427.00	—	40%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Elbow w/o Contrast Right 73200	$1,579.80	$2,633.00	$1,237.51–$8,427.00	—	40%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Shoulder w/o Contrast Right 73200	$1,579.80	$2,633.00	$1,237.51–$8,427.00	—	40%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Elbow w/o Contrast Left 73200	$1,579.80	$2,633.00	$1,237.51–$8,427.00	—	40%
Barium swallow (esophagus X-ray with contrast) CPT 74220 XR Esophagus 74220	$403.80	$673.00	$316.31–$8,427.00	19% below	40%
Barium swallow (esophagus X-ray with contrast) CPT 74220 BCE XR Esophagus 74220	$403.80	$673.00	$316.31–$8,427.00	19% below	40%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 XR Esophagus 74220	$403.80	$673.00	$316.31–$8,427.00	—	40%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 BCE XR Esophagus 74220	$403.80	$673.00	$316.31–$8,427.00	—	40%
Bone scan, whole body (nuclear medicine) CPT 78306 XR Bone and/or Joint Whole Body 78306	$1,134.00	$1,890.00	$888.30–$8,427.00	35% below	40%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 XR Bone and/or Joint Whole Body 78306	$1,134.00	$1,890.00	$888.30–$8,427.00	—	40%
Breast ultrasound, complete, one breast one side CPT 76641 BCE US Breast, Unilateral; Complete 76641	$153.00	$255.00	$119.85–$8,427.00	65% below	40%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 BCE US Breast, Unilateral; Complete 76641	$153.00	$255.00	$119.85–$8,427.00	—	40%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US Breast, unilateral; Limited 76642	$153.00	$255.00	$119.85–$8,427.00	59% below	40%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 BCE US Breast Unilateral; 76642	$153.00	$255.00	$119.85–$8,427.00	59% below	40%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US Breast, unilateral; Limited 76642	$153.00	$255.00	$119.85–$8,427.00	—	40%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 BCE US Breast Unilateral; 76642	$153.00	$255.00	$119.85–$8,427.00	—	40%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 BCE CTA Abdomen and Pelvis w/contrast 74174	$4,165.20	$6,942.00	$3,262.74–$8,427.00	5% below	40%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CTA Abdomen and Pelvis w/ + w/o contrast 74174	$4,165.20	$6,942.00	$3,262.74–$8,427.00	5% below	40%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 BCE CTA Abdomen and Pelvis w/contrast 74174	$4,165.20	$6,942.00	$3,262.74–$8,427.00	—	40%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CTA Abdomen and Pelvis w/ + w/o contrast 74174	$4,165.20	$6,942.00	$3,262.74–$8,427.00	—	40%
CT angiography (CTA) of the head CPT 70496 CTA Head w/ + w/o Contrast 70496	$1,976.40	$3,294.00	$1,548.18–$8,427.00	30% below	40%
CT angiography (CTA) of the head inpatient CPT 70496 CTA Head w/ + w/o Contrast 70496	$1,976.40	$3,294.00	$1,548.18–$8,427.00	—	40%
CT angiography (CTA) of the neck CPT 70498 CTA Neck w/ + w/o Contrast 70498	$1,977.60	$3,296.00	$1,549.12–$8,427.00	27% below	40%
CT angiography (CTA) of the neck inpatient CPT 70498 CTA Neck w/ + w/o Contrast 70498	$1,977.60	$3,296.00	$1,549.12–$8,427.00	—	40%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA Chest w/ + w/o Contrast 71275	$1,713.60	$2,856.00	$1,342.32–$8,427.00	40% below	40%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 BCE CTA Chest w/ + w/o Contrast 71275	$1,713.60	$2,856.00	$1,342.32–$8,427.00	40% below	40%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 BCE CTA Chest w/ + w/o Contrast 71275	$1,713.60	$2,856.00	$1,342.32–$8,427.00	—	40%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA Chest w/ + w/o Contrast 71275	$1,713.60	$2,856.00	$1,342.32–$8,427.00	—	40%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 BCE CT Heart w/o Contrast 75571	$82.80	$138.00	$64.86–$8,427.00	56% below	40%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT Heart w/o Contrast 75571	$82.80	$138.00	$64.86–$8,427.00	56% below	40%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 BCE CT Heart w/o Contrast 75571	$82.80	$138.00	$64.86–$8,427.00	—	40%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT Heart w/o Contrast 75571	$82.80	$138.00	$64.86–$8,427.00	—	40%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Abd and Pelvis w/o Contrast 74176	$2,735.40	$4,559.00	$2,142.73–$8,427.00	18% below	40%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 BCE CT Abd & Pelvis, w/o contrast 74176	$2,735.40	$4,559.00	$2,142.73–$8,427.00	18% below	40%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Renal Stone Protocol 74176	$2,735.40	$4,559.00	$2,142.73–$8,427.00	18% below	40%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT Renal Stone Protocol 74176	$2,735.40	$4,559.00	$2,142.73–$8,427.00	—	40%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 BCE CT Abd & Pelvis, w/o contrast 74176	$2,735.40	$4,559.00	$2,142.73–$8,427.00	—	40%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT Abd and Pelvis w/o Contrast 74176	$2,735.40	$4,559.00	$2,142.73–$8,427.00	—	40%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 BCE CT Abd & Pelvis, w/contrast 74177	$3,394.20	$5,657.00	$2,658.79–$8,427.00	13% below	40%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abdomen and Pelvis w/ Contrast 74177	$3,394.20	$5,657.00	$2,658.79–$8,427.00	13% below	40%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abdomen and Pelvis w/ Contrast 74177	$3,394.20	$5,657.00	$2,658.79–$8,427.00	—	40%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 BCE CT Abd & Pelvis, w/contrast 74177	$3,394.20	$5,657.00	$2,658.79–$8,427.00	—	40%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT Abd and Pelvis w/ + w/o Con 74178	$3,568.20	$5,947.00	$2,795.09–$8,427.00	14% below	40%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 BCE CT Abd & Pelvis, w & w/o contrast 74178	$3,568.20	$5,947.00	$2,795.09–$8,427.00	14% below	40%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 BCE CT Abd & Pelvis, w & w/o contrast 74178	$3,568.20	$5,947.00	$2,795.09–$8,427.00	—	40%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT Abd and Pelvis w/ + w/o Con 74178	$3,568.20	$5,947.00	$2,795.09–$8,427.00	—	40%
CT scan of the abdomen with contrast CPT 74160 BCE CT Abdomen w/ Contrast 74160	$1,747.80	$2,913.00	$1,369.11–$8,427.00	33% below	40%
CT scan of the abdomen with contrast CPT 74160 CT Abdomen w/ Contrast 74160	$1,747.80	$2,913.00	$1,369.11–$8,427.00	33% below	40%
CT scan of the abdomen with contrast inpatient CPT 74160 CT Abdomen w/ Contrast 74160	$1,747.80	$2,913.00	$1,369.11–$8,427.00	—	40%
CT scan of the abdomen with contrast inpatient CPT 74160 BCE CT Abdomen w/ Contrast 74160	$1,747.80	$2,913.00	$1,369.11–$8,427.00	—	40%
CT scan of the abdomen without contrast CPT 74150 BCE CT Abdomen, w/o contrast 74150	$1,385.40	$2,309.00	$1,085.23–$8,427.00	32% below	40%
CT scan of the abdomen without contrast CPT 74150 CT Abdomen w/o Contrast 74150	$1,385.40	$2,309.00	$1,085.23–$8,427.00	32% below	40%
CT scan of the abdomen without contrast inpatient CPT 74150 CT Abdomen w/o Contrast 74150	$1,385.40	$2,309.00	$1,085.23–$8,427.00	—	40%
CT scan of the abdomen without contrast inpatient CPT 74150 BCE CT Abdomen, w/o contrast 74150	$1,385.40	$2,309.00	$1,085.23–$8,427.00	—	40%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT Sinus w/o Contrast 70486	$1,130.40	$1,884.00	$885.48–$8,427.00	32% below	40%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT Sinus w/o Contrast 70486	$1,130.40	$1,884.00	$885.48–$8,427.00	32% below	40%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT Maxillofacial w/o Contrast 70486	$1,130.40	$1,884.00	$885.48–$8,427.00	32% below	40%
CT scan of the face and sinuses, no contrast dye CPT 70486 BCE CT Maxillofacial area w/o contrast 70486	$1,130.40	$1,884.00	$885.48–$8,427.00	32% below	40%
CT scan of the face and sinuses, no contrast dye CPT 70486 zzCT Sinus w/o Contrast 70486	$1,130.40	$1,884.00	$885.48–$8,427.00	32% below	40%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT Sinus w/o Contrast 70486	$1,130.40	$1,884.00	$885.48–$8,427.00	—	40%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 BCE CT Maxillofacial area w/o contrast 70486	$1,130.40	$1,884.00	$885.48–$8,427.00	—	40%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 zzCT Sinus w/o Contrast 70486	$1,130.40	$1,884.00	$885.48–$8,427.00	—	40%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT Sinus w/o Contrast 70486	$1,130.40	$1,884.00	$885.48–$8,427.00	—	40%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT Maxillofacial w/o Contrast 70486	$1,130.40	$1,884.00	$885.48–$8,427.00	—	40%
CT scan of the head or brain, no contrast dye CPT 70450 BCE CT, Head or brain; w/o contrast 70450	$1,330.80	$2,218.00	$1,042.46–$8,427.00	30% below	40%
CT scan of the head or brain, no contrast dye CPT 70450 CT Head or Brain w/o Contrast 70450	$1,330.80	$2,218.00	$1,042.46–$8,427.00	30% below	40%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Head or Brain w/o Contrast 70450	$1,330.80	$2,218.00	$1,042.46–$8,427.00	—	40%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 BCE CT, Head or brain; w/o contrast 70450	$1,330.80	$2,218.00	$1,042.46–$8,427.00	—	40%
CT scan of the head with contrast CPT 70460 CT Head or Brain w/ Contrast 70460	$1,466.40	$2,444.00	$1,148.68–$8,427.00	17% below	40%
CT scan of the head with contrast inpatient CPT 70460 CT Head or Brain w/ Contrast 70460	$1,466.40	$2,444.00	$1,148.68–$8,427.00	—	40%
CT scan of the head without and with contrast CPT 70470 CT Head or Brain w/ + w/o Contrast 70470	$1,780.80	$2,968.00	$1,394.96–$8,427.00	23% below	40%
CT scan of the head without and with contrast CPT 70470 BCE CT Head or Brain w/ + w/o Contrast 70470	$1,780.80	$2,968.00	$1,394.96–$8,427.00	23% below	40%
CT scan of the head without and with contrast inpatient CPT 70470 BCE CT Head or Brain w/ + w/o Contrast 70470	$1,780.80	$2,968.00	$1,394.96–$8,427.00	—	40%
CT scan of the head without and with contrast inpatient CPT 70470 CT Head or Brain w/ + w/o Contrast 70470	$1,780.80	$2,968.00	$1,394.96–$8,427.00	—	40%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 BCE CT Lumbar Spine w/o contrast 72131	$1,524.60	$2,541.00	$1,194.27–$8,427.00	26% below	40%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT Spine Lumbar w/o Contrast 72131	$1,524.60	$2,541.00	$1,194.27–$8,427.00	26% below	40%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT Spine Lumbar w/o Contrast 72131	$1,524.60	$2,541.00	$1,194.27–$8,427.00	—	40%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 BCE CT Lumbar Spine w/o contrast 72131	$1,524.60	$2,541.00	$1,194.27–$8,427.00	—	40%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 BCE CT Spine Cervical w/o Contrast 72125	$1,358.40	$2,264.00	$1,064.08–$8,427.00	36% below	40%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT Spine Cervical w/o Contrast 72125	$1,358.40	$2,264.00	$1,064.08–$8,427.00	36% below	40%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 BCE CT Spine Cervical w/o Contrast 72125	$1,358.40	$2,264.00	$1,064.08–$8,427.00	—	40%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT Spine Cervical w/o Contrast 72125	$1,358.40	$2,264.00	$1,064.08–$8,427.00	—	40%
CT scan of the pelvis, with contrast dye CPT 72193 CT Pelvis w/ Contrast 72193	$1,646.40	$2,744.00	$1,289.68–$8,427.00	25% below	40%
CT scan of the pelvis, with contrast dye CPT 72193 BCE CT Pelvis s/contrast 72193	$1,646.40	$2,744.00	$1,289.68–$8,427.00	25% below	40%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 BCE CT Pelvis s/contrast 72193	$1,646.40	$2,744.00	$1,289.68–$8,427.00	—	40%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Pelvis w/ Contrast 72193	$1,646.40	$2,744.00	$1,289.68–$8,427.00	—	40%
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 US Duplex Carotid 93880	$477.00	$795.00	$373.65–$8,427.00	65% below	40%
Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 US Duplex Carotid 93880	$477.00	$795.00	$373.65–$8,427.00	—	40%
Chest CT scan without and with contrast CPT 71270 CT Thorax w/ + w/o Contrast 71270	$1,939.80	$3,233.00	$1,519.51–$8,427.00	29% below	40%
Chest CT scan without and with contrast CPT 71270 BCE CT Thorax w/ + w/o Contrast 71270	$1,939.80	$3,233.00	$1,519.51–$8,427.00	29% below	40%
Chest CT scan without and with contrast inpatient CPT 71270 BCE CT Thorax w/ + w/o Contrast 71270	$1,939.80	$3,233.00	$1,519.51–$8,427.00	—	40%
Chest CT scan without and with contrast inpatient CPT 71270 CT Thorax w/ + w/o Contrast 71270	$1,939.80	$3,233.00	$1,519.51–$8,427.00	—	40%
Chest X-ray, 2 views CPT 71046 BCE Radiologic examination, chest; 2 views 71046	$171.00	$285.00	$133.95–$8,427.00	57% below	40%
Chest X-ray, 2 views CPT 71046 XR Chest 2 Views 71046	$171.00	$285.00	$133.95–$8,427.00	57% below	40%
Chest X-ray, 2 views CPT 71046 XR Chest 2 Views	$171.00	$285.00	$133.95–$8,427.00	57% below	40%
Chest X-ray, 2 views CPT 71046 XR Chest 2 View (Frontal & Lat) 71046	$171.00	$285.00	$133.95–$8,427.00	57% below	40%
Chest X-ray, 2 views inpatient CPT 71046 XR Chest 2 Views 71046	$171.00	$285.00	$133.95–$8,427.00	—	40%
Chest X-ray, 2 views inpatient CPT 71046 BCE Radiologic examination, chest; 2 views 71046	$171.00	$285.00	$133.95–$8,427.00	—	40%
Chest X-ray, 2 views inpatient CPT 71046 XR Chest 2 View (Frontal & Lat) 71046	$171.00	$285.00	$133.95–$8,427.00	—	40%
Chest X-ray, 2 views inpatient CPT 71046 XR Chest 2 Views	$171.00	$285.00	$133.95–$8,427.00	—	40%
Chest X-ray, single view CPT 71045 BCE Radiologic examination, chest; single view 71045	$127.20	$212.00	$99.64–$8,427.00	61% below	40%
Chest X-ray, single view CPT 71045 XR Chest 1 View Frontal 71045	$127.20	$212.00	$99.64–$8,427.00	61% below	40%
Chest X-ray, single view inpatient CPT 71045 BCE Radiologic examination, chest; single view 71045	$127.20	$212.00	$99.64–$8,427.00	—	40%
Chest X-ray, single view inpatient CPT 71045 XR Chest 1 View Frontal 71045	$127.20	$212.00	$99.64–$8,427.00	—	40%
Collarbone (clavicle) X-ray, complete both sides CPT 73000 XR Clavicle Bilateral 73000	$196.20	$327.00	$153.69–$8,427.00	—	40%
Collarbone (clavicle) X-ray, complete one side CPT 73000 XR Clavicle Right 73000	$196.20	$327.00	$153.69–$8,427.00	43% below	40%
Collarbone (clavicle) X-ray, complete one side CPT 73000 XR Clavicle Left 73000	$196.20	$327.00	$153.69–$8,427.00	43% below	40%
Collarbone (clavicle) X-ray, complete inpatient both sides CPT 73000 XR Clavicle Bilateral 73000	$196.20	$327.00	$153.69–$8,427.00	—	40%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 XR Clavicle Right 73000	$196.20	$327.00	$153.69–$8,427.00	—	40%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 XR Clavicle Left 73000	$196.20	$327.00	$153.69–$8,427.00	—	40%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US Aorta Renal 76770	$421.20	$702.00	$329.94–$8,427.00	43% below	40%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US Retroperitoneal Complete 76770	$421.20	$702.00	$329.94–$8,427.00	43% below	40%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US Retroperitoneal Complete 76770	$421.20	$702.00	$329.94–$8,427.00	—	40%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US Aorta Renal 76770	$421.20	$702.00	$329.94–$8,427.00	—	40%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 BCE US Pregnancy Complete w/ Detail 76811	$398.40	$664.00	$312.08–$8,427.00	42% below	40%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 BCE US Pregnancy Complete w/ Detail 76811	$398.40	$664.00	$312.08–$8,427.00	—	40%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Thorax w/o Contrast 71250	$1,437.00	$2,395.00	$1,125.65–$8,427.00	14% below	40%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 BCE CT Thorax, w/o contrast 71250	$1,437.00	$2,395.00	$1,125.65–$8,427.00	14% below	40%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Chest High Resolution 71250	$1,437.00	$2,395.00	$1,125.65–$8,427.00	14% below	40%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Chest High Resolution 71250	$1,437.00	$2,395.00	$1,125.65–$8,427.00	—	40%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Thorax w/o Contrast 71250	$1,437.00	$2,395.00	$1,125.65–$8,427.00	—	40%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 BCE CT Thorax, w/o contrast 71250	$1,437.00	$2,395.00	$1,125.65–$8,427.00	—	40%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 BCE CT Thorax w/contrast 71260	$1,713.60	$2,856.00	$1,342.32–$8,427.00	21% below	40%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Thorax w/ Contrast 71260	$1,713.60	$2,856.00	$1,342.32–$8,427.00	21% below	40%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 BCE CT Thorax w/contrast 71260	$1,713.60	$2,856.00	$1,342.32–$8,427.00	—	40%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Thorax w/ Contrast 71260	$1,713.60	$2,856.00	$1,342.32–$8,427.00	—	40%
Duplex ultrasound of the leg arteries, both legs CPT 93925 US Duplex Arterial LE Bl 93925	$677.40	$1,129.00	$530.63–$8,427.00	63% below	40%
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 US Duplex Arterial LE Bl 93925	$677.40	$1,129.00	$530.63–$8,427.00	—	40%
Duplex ultrasound of the leg veins, both legs CPT 93970 BCE US Venous Doppler Extremity Bl 93970	$546.00	$910.00	$427.70–$8,427.00	73% below	40%
Duplex ultrasound of the leg veins, both legs CPT 93970 BCE BCE US Venous Doppler Extremity Bl 93970	$567.60	$946.00	$444.62–$8,427.00	72% below	40%
Duplex ultrasound of the leg veins, both legs CPT 93970 US Venous Doppler Extremity Bl 93970	$584.40	$974.00	$457.78–$8,427.00	71% below	40%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 BCE US Venous Doppler Extremity Bl 93970	$546.00	$910.00	$427.70–$8,427.00	—	40%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 BCE BCE US Venous Doppler Extremity Bl 93970	$567.60	$946.00	$444.62–$8,427.00	—	40%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 US Venous Doppler Extremity Bl 93970	$584.40	$974.00	$457.78–$8,427.00	—	40%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 US Echocardiogram w/ Color flow 93306	$719.40	$1,199.00	$563.53–$8,427.00	69% below	40%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 BCE US Echocardiography w/Color Flow 93306	$719.40	$1,199.00	$563.53–$8,427.00	69% below	40%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 US Echocardiogram w/ Color flow 93306	$719.40	$1,199.00	$563.53–$8,427.00	—	40%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 BCE US Echocardiography w/Color Flow 93306	$719.40	$1,199.00	$563.53–$8,427.00	—	40%
Elbow X-ray, 2 views both sides CPT 73070 XR Elbow 2 Views Bilateral 73070	$254.40	$424.00	$199.28–$8,427.00	—	40%
Elbow X-ray, 2 views CPT 73070 BCE XR Elbow 2 Views 73070	$254.40	$424.00	$199.28–$8,427.00	21% below	40%
Elbow X-ray, 2 views one side CPT 73070 XR Elbow 2 Views Right 73070	$254.40	$424.00	$199.28–$8,427.00	21% below	40%
Elbow X-ray, 2 views one side CPT 73070 XR Elbow 2 Views Left 73070	$254.40	$424.00	$199.28–$8,427.00	21% below	40%
Elbow X-ray, 2 views inpatient both sides CPT 73070 XR Elbow 2 Views Bilateral 73070	$254.40	$424.00	$199.28–$8,427.00	—	40%
Elbow X-ray, 2 views inpatient CPT 73070 BCE XR Elbow 2 Views 73070	$254.40	$424.00	$199.28–$8,427.00	—	40%
Elbow X-ray, 2 views inpatient one side CPT 73070 XR Elbow 2 Views Right 73070	$254.40	$424.00	$199.28–$8,427.00	—	40%
Elbow X-ray, 2 views inpatient one side CPT 73070 XR Elbow 2 Views Left 73070	$254.40	$424.00	$199.28–$8,427.00	—	40%
Elbow X-ray, complete, 3 or more views both sides CPT 73080 XR Elbow Complete Bilateral 73080	$271.20	$452.00	$212.44–$8,427.00	—	40%
Elbow X-ray, complete, 3 or more views CPT 73080 BCE XR Elbow Complete, min 3 views 73080	$271.20	$452.00	$212.44–$8,427.00	29% below	40%
Elbow X-ray, complete, 3 or more views one side CPT 73080 XR Elbow Complete Left 73080	$271.20	$452.00	$212.44–$8,427.00	29% below	40%
Elbow X-ray, complete, 3 or more views one side CPT 73080 XR Elbow Complete Right 73080	$271.20	$452.00	$212.44–$8,427.00	29% below	40%
Elbow X-ray, complete, 3 or more views inpatient both sides CPT 73080 XR Elbow Complete Bilateral 73080	$271.20	$452.00	$212.44–$8,427.00	—	40%
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 BCE XR Elbow Complete, min 3 views 73080	$271.20	$452.00	$212.44–$8,427.00	—	40%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 XR Elbow Complete Right 73080	$271.20	$452.00	$212.44–$8,427.00	—	40%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 XR Elbow Complete Left 73080	$271.20	$452.00	$212.44–$8,427.00	—	40%
Eye socket (orbit) CT scan without contrast CPT 70480 CT Orbit Sella Ear w/o Contrast 70480	$1,435.80	$2,393.00	$1,124.71–$8,427.00	14% below	40%
Eye socket (orbit) CT scan without contrast CPT 70480 BCE CT orbit, sella, or posterior fossa or outer, middle, or inner ear; w/o contrast 70480	$1,980.00	$3,300.00	$1,285.28–$8,427.00	18% above	40%
Eye socket (orbit) CT scan without contrast CPT 70480 CT Mid Inner Ear w/o Contrast 70480	$1,980.00	$3,300.00	$1,285.28–$8,427.00	18% above	40%
Eye socket (orbit) CT scan without contrast CPT 70480 CT Temporal Bones (IAC's) 70480	$1,980.00	$3,300.00	$1,285.28–$8,427.00	18% above	40%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT Orbit Sella Ear w/o Contrast 70480	$1,435.80	$2,393.00	$1,124.71–$8,427.00	—	40%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 BCE CT orbit, sella, or posterior fossa or outer, middle, or inner ear; w/o contrast 70480	$1,980.00	$3,300.00	$1,285.28–$8,427.00	—	40%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT Temporal Bones (IAC's) 70480	$1,980.00	$3,300.00	$1,285.28–$8,427.00	—	40%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT Mid Inner Ear w/o Contrast 70480	$1,980.00	$3,300.00	$1,285.28–$8,427.00	—	40%
Facial bones X-ray, complete, 3 or more views CPT 70150 XR Facial Bones Minimum 3 Views 70150	$220.80	$368.00	$172.96–$8,427.00	48% below	40%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 XR Facial Bones Minimum 3 Views 70150	$220.80	$368.00	$172.96–$8,427.00	—	40%
Forearm X-ray (radius and ulna), 2 views both sides CPT 73090 XR Forearm 2 Views Bilateral 73090	$264.60	$441.00	$207.27–$8,427.00	—	40%
Forearm X-ray (radius and ulna), 2 views CPT 73090 BCE XR Forearm, 2 views 73090	$264.60	$441.00	$207.27–$8,427.00	30% below	40%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 XR Forearm 2 Views Left 73090	$264.60	$441.00	$207.27–$8,427.00	30% below	40%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 XR Forearm 2 Views Right 73090	$264.60	$441.00	$207.27–$8,427.00	30% below	40%
Forearm X-ray (radius and ulna), 2 views inpatient both sides CPT 73090 XR Forearm 2 Views Bilateral 73090	$264.60	$441.00	$207.27–$8,427.00	—	40%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 BCE XR Forearm, 2 views 73090	$264.60	$441.00	$207.27–$8,427.00	—	40%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 XR Forearm 2 Views Left 73090	$264.60	$441.00	$207.27–$8,427.00	—	40%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 XR Forearm 2 Views Right 73090	$264.60	$441.00	$207.27–$8,427.00	—	40%
Hand X-ray, 2 views both sides CPT 73120 XR Hand 2 Views Bilateral 73120	$277.80	$463.00	$217.61–$8,427.00	—	40%
Hand X-ray, 2 views CPT 73120 BCE XR Hand 2 Views 73120	$277.80	$463.00	$217.61–$8,427.00	16% below	40%
Hand X-ray, 2 views one side CPT 73120 XR Hand 2 Views Right 73120	$277.80	$463.00	$217.61–$8,427.00	16% below	40%
Hand X-ray, 2 views one side CPT 73120 XR Hand Right 2 views 73120	$277.80	$463.00	$217.61–$8,427.00	16% below	40%
Hand X-ray, 2 views one side CPT 73120 XR Hand 2 Views Left 73120	$277.80	$463.00	$217.61–$8,427.00	16% below	40%
Hand X-ray, 2 views one side CPT 73120 XR Hand Left 2 views 73120	$277.80	$463.00	$217.61–$8,427.00	16% below	40%
Hand X-ray, 2 views inpatient both sides CPT 73120 XR Hand 2 Views Bilateral 73120	$277.80	$463.00	$217.61–$8,427.00	—	40%
Hand X-ray, 2 views inpatient CPT 73120 BCE XR Hand 2 Views 73120	$277.80	$463.00	$217.61–$8,427.00	—	40%
Hand X-ray, 2 views inpatient one side CPT 73120 XR Hand Left 2 views 73120	$277.80	$463.00	$217.61–$8,427.00	—	40%
Hand X-ray, 2 views inpatient one side CPT 73120 XR Hand 2 Views Left 73120	$277.80	$463.00	$217.61–$8,427.00	—	40%
Hand X-ray, 2 views inpatient one side CPT 73120 XR Hand 2 Views Right 73120	$277.80	$463.00	$217.61–$8,427.00	—	40%
Hand X-ray, 2 views inpatient one side CPT 73120 XR Hand Right 2 views 73120	$277.80	$463.00	$217.61–$8,427.00	—	40%
Heel bone (calcaneus) X-ray, 2 or more views both sides CPT 73650 XR Calcaneous Bilateral 73650	$100.80	$168.00	$78.96–$8,427.00	—	40%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 XR Calcaneus Minimum 2 Views 73650	$100.80	$168.00	$78.96–$8,427.00	65% below	40%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 BCE XR Calcaneus, min 2 views 73650	$191.40	$319.00	$90.25–$8,427.00	34% below	40%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 XR Calcaneous Right 73650	$100.80	$168.00	$78.96–$8,427.00	65% below	40%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 XR Calcaneous Left 73650	$100.80	$168.00	$78.96–$8,427.00	65% below	40%
Heel bone (calcaneus) X-ray, 2 or more views inpatient both sides CPT 73650 XR Calcaneous Bilateral 73650	$100.80	$168.00	$78.96–$8,427.00	—	40%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 XR Calcaneus Minimum 2 Views 73650	$100.80	$168.00	$78.96–$8,427.00	—	40%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 BCE XR Calcaneus, min 2 views 73650	$191.40	$319.00	$90.25–$8,427.00	—	40%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 XR Calcaneous Right 73650	$100.80	$168.00	$78.96–$8,427.00	—	40%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 XR Calcaneous Left 73650	$100.80	$168.00	$78.96–$8,427.00	—	40%
Knee X-ray, 3 views both sides CPT 73562 XR Knee 3 Views Bilateral 73562	$265.80	$443.00	$208.21–$8,427.00	—	40%
Knee X-ray, 3 views CPT 73562 BCE XR Knee 3 Views 73562	$265.80	$443.00	$208.21–$8,427.00	34% below	40%
Knee X-ray, 3 views one side CPT 73562 XR Knee 3 Views Right 73562	$265.80	$443.00	$208.21–$8,427.00	34% below	40%
Knee X-ray, 3 views one side CPT 73562 XR Knee 3 Views Left 73562	$265.80	$443.00	$208.21–$8,427.00	34% below	40%
Knee X-ray, 3 views inpatient both sides CPT 73562 XR Knee 3 Views Bilateral 73562	$265.80	$443.00	$208.21–$8,427.00	—	40%
Knee X-ray, 3 views inpatient CPT 73562 BCE XR Knee 3 Views 73562	$265.80	$443.00	$208.21–$8,427.00	—	40%
Knee X-ray, 3 views inpatient one side CPT 73562 XR Knee 3 Views Left 73562	$265.80	$443.00	$208.21–$8,427.00	—	40%
Knee X-ray, 3 views inpatient one side CPT 73562 XR Knee 3 Views Right 73562	$265.80	$443.00	$208.21–$8,427.00	—	40%
Knee X-ray, complete, 4 or more views CPT 73564 XR Knee Comp 4/more Views Bl 73564	$311.40	$519.00	$243.93–$8,427.00	27% below	40%
Knee X-ray, complete, 4 or more views CPT 73564 BCE XR Knee, complete, 4 or more views 73564	$311.40	$519.00	$243.93–$8,427.00	27% below	40%
Knee X-ray, complete, 4 or more views one side CPT 73564 XR Knee Complete 4/more Views Left 73564	$311.40	$519.00	$243.93–$8,427.00	27% below	40%
Knee X-ray, complete, 4 or more views one side CPT 73564 XR Knee Complete 4/more Views Rt 73564	$311.40	$519.00	$243.93–$8,427.00	27% below	40%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 XR Knee Comp 4/more Views Bl 73564	$311.40	$519.00	$243.93–$8,427.00	—	40%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 BCE XR Knee, complete, 4 or more views 73564	$311.40	$519.00	$243.93–$8,427.00	—	40%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 XR Knee Complete 4/more Views Rt 73564	$311.40	$519.00	$243.93–$8,427.00	—	40%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 XR Knee Complete 4/more Views Left 73564	$311.40	$519.00	$243.93–$8,427.00	—	40%
Leg CT scan without contrast (hip to foot, any part) both sides CPT 73700 CT Ankle w/o Contrast Bilateral 73700	$1,496.40	$2,494.00	$1,172.18–$8,427.00	—	40%
Leg CT scan without contrast (hip to foot, any part) both sides CPT 73700 CT Femur w/o Contrast Bilateral 73700	$1,496.40	$2,494.00	$1,172.18–$8,427.00	—	40%
Leg CT scan without contrast (hip to foot, any part) both sides CPT 73700 CT Knee w/o Contrast Bilateral 73700	$1,496.40	$2,494.00	$1,172.18–$8,427.00	—	40%
Leg CT scan without contrast (hip to foot, any part) both sides CPT 73700 CT Hip w/o Contrast Bilateral 73700	$1,496.40	$2,494.00	$1,172.18–$8,427.00	—	40%
Leg CT scan without contrast (hip to foot, any part) both sides CPT 73700 CT Foot w/o Contrast Bilateral 73700	$1,496.40	$2,494.00	$1,172.18–$8,427.00	—	40%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT Tibia/Fibula w/o Contrast Bl 73700	$1,496.40	$2,494.00	$1,172.18–$8,427.00	15% below	40%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 BCE CT LE w/o contrast 73700	$1,496.40	$2,494.00	$1,172.18–$8,427.00	15% below	40%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Tibia/Fibula w/o Contrast Left 73700	$1,496.40	$2,494.00	$1,172.18–$8,427.00	15% below	40%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Hip w/o Contrast Right 73700	$1,496.40	$2,494.00	$1,172.18–$8,427.00	15% below	40%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Femur w/o Contrast Left 73700	$1,496.40	$2,494.00	$1,172.18–$8,427.00	15% below	40%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Knee w/o Contrast Left 73700	$1,496.40	$2,494.00	$1,172.18–$8,427.00	15% below	40%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Femur w/o Contrast Right 73700	$1,496.40	$2,494.00	$1,172.18–$8,427.00	15% below	40%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Knee w/o Contrast Right 73700	$1,496.40	$2,494.00	$1,172.18–$8,427.00	15% below	40%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Ankle w/o Contrast Left 73700	$1,496.40	$2,494.00	$1,172.18–$8,427.00	15% below	40%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Hip w/o Contrast Left 73700	$1,496.40	$2,494.00	$1,172.18–$8,427.00	15% below	40%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Ankle w/o Contrast Right 73700	$1,496.40	$2,494.00	$1,172.18–$8,427.00	15% below	40%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Tibia/Fibula w/o Contrast Right 73700	$1,496.40	$2,494.00	$1,172.18–$8,427.00	15% below	40%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Foot w/o Contrast Left 73700	$1,496.40	$2,494.00	$1,172.18–$8,427.00	15% below	40%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Foot w/o Contrast Right 73700	$1,496.40	$2,494.00	$1,172.18–$8,427.00	15% below	40%
Leg CT scan without contrast (hip to foot, any part) inpatient both sides CPT 73700 CT Ankle w/o Contrast Bilateral 73700	$1,496.40	$2,494.00	$1,172.18–$8,427.00	—	40%
Leg CT scan without contrast (hip to foot, any part) inpatient both sides CPT 73700 CT Knee w/o Contrast Bilateral 73700	$1,496.40	$2,494.00	$1,172.18–$8,427.00	—	40%
Leg CT scan without contrast (hip to foot, any part) inpatient both sides CPT 73700 CT Hip w/o Contrast Bilateral 73700	$1,496.40	$2,494.00	$1,172.18–$8,427.00	—	40%
Leg CT scan without contrast (hip to foot, any part) inpatient both sides CPT 73700 CT Foot w/o Contrast Bilateral 73700	$1,496.40	$2,494.00	$1,172.18–$8,427.00	—	40%
Leg CT scan without contrast (hip to foot, any part) inpatient both sides CPT 73700 CT Femur w/o Contrast Bilateral 73700	$1,496.40	$2,494.00	$1,172.18–$8,427.00	—	40%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 BCE CT LE w/o contrast 73700	$1,496.40	$2,494.00	$1,172.18–$8,427.00	—	40%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 CT Tibia/Fibula w/o Contrast Bl 73700	$1,496.40	$2,494.00	$1,172.18–$8,427.00	—	40%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Knee w/o Contrast Right 73700	$1,496.40	$2,494.00	$1,172.18–$8,427.00	—	40%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Ankle w/o Contrast Left 73700	$1,496.40	$2,494.00	$1,172.18–$8,427.00	—	40%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Tibia/Fibula w/o Contrast Right 73700	$1,496.40	$2,494.00	$1,172.18–$8,427.00	—	40%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Foot w/o Contrast Left 73700	$1,496.40	$2,494.00	$1,172.18–$8,427.00	—	40%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Foot w/o Contrast Right 73700	$1,496.40	$2,494.00	$1,172.18–$8,427.00	—	40%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Femur w/o Contrast Right 73700	$1,496.40	$2,494.00	$1,172.18–$8,427.00	—	40%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Knee w/o Contrast Left 73700	$1,496.40	$2,494.00	$1,172.18–$8,427.00	—	40%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Femur w/o Contrast Left 73700	$1,496.40	$2,494.00	$1,172.18–$8,427.00	—	40%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Hip w/o Contrast Right 73700	$1,496.40	$2,494.00	$1,172.18–$8,427.00	—	40%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Hip w/o Contrast Left 73700	$1,496.40	$2,494.00	$1,172.18–$8,427.00	—	40%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Ankle w/o Contrast Right 73700	$1,496.40	$2,494.00	$1,172.18–$8,427.00	—	40%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Tibia/Fibula w/o Contrast Left 73700	$1,496.40	$2,494.00	$1,172.18–$8,427.00	—	40%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 BCE US Abdominal, limited 76705	$445.80	$743.00	$349.21–$8,427.00	29% below	40%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Abdomen Limited 76705	$445.80	$743.00	$349.21–$8,427.00	29% below	40%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Abdomen Limited 76705	$445.80	$743.00	$349.21–$8,427.00	—	40%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 BCE US Abdominal, limited 76705	$445.80	$743.00	$349.21–$8,427.00	—	40%
Limited ultrasound of an arm or leg (non-vascular) both sides CPT 76882 US Extremity, Nonvascular, Limited, Bilateral	$278.40	$464.00	$180.36–$8,427.00	—	40%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 BCE US Extremity, non-vascular; limited 76882	$278.40	$464.00	$180.36–$8,427.00	41% below	40%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US UE Nonvascular Limited Bl 76882	$278.40	$464.00	$180.36–$8,427.00	41% below	40%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US LE Nonvascular Limited Bl 76882	$278.40	$464.00	$180.36–$8,427.00	41% below	40%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US UE Nonvascular Limited Right 76882	$278.40	$464.00	$180.36–$8,427.00	41% below	40%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US UE Nonvascular Limited Left 76882	$278.40	$464.00	$180.36–$8,427.00	41% below	40%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US LE Nonvascular Limited Rt 76882	$278.40	$464.00	$180.36–$8,427.00	41% below	40%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US LE Nonvascular Limited Left 76882	$278.40	$464.00	$180.36–$8,427.00	41% below	40%
Limited ultrasound of an arm or leg (non-vascular) inpatient both sides CPT 76882 US Extremity, Nonvascular, Limited, Bilateral	$278.40	$464.00	$180.36–$8,427.00	—	40%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 BCE US Extremity, non-vascular; limited 76882	$278.40	$464.00	$180.36–$8,427.00	—	40%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US UE Nonvascular Limited Bl 76882	$278.40	$464.00	$180.36–$8,427.00	—	40%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US LE Nonvascular Limited Bl 76882	$278.40	$464.00	$180.36–$8,427.00	—	40%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US LE Nonvascular Limited Left 76882	$278.40	$464.00	$180.36–$8,427.00	—	40%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US LE Nonvascular Limited Rt 76882	$278.40	$464.00	$180.36–$8,427.00	—	40%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US UE Nonvascular Limited Left 76882	$278.40	$464.00	$180.36–$8,427.00	—	40%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US UE Nonvascular Limited Right 76882	$278.40	$464.00	$180.36–$8,427.00	—	40%
Lower leg X-ray (tibia and fibula), 2 views both sides CPT 73590 XR Tibia/Fibula 2 Views Bilateral 73590	$255.00	$425.00	$199.75–$8,427.00	—	40%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 BCE XR Tibia/Fibula 2 Views 73590	$255.00	$425.00	$199.75–$8,427.00	26% below	40%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 XR Tibia/Fibula 2 Views Left 73590	$255.00	$425.00	$199.75–$8,427.00	26% below	40%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 XR Tibia/Fibula 2 Views Right 73590	$255.00	$425.00	$199.75–$8,427.00	26% below	40%
Lower leg X-ray (tibia and fibula), 2 views inpatient both sides CPT 73590 XR Tibia/Fibula 2 Views Bilateral 73590	$255.00	$425.00	$199.75–$8,427.00	—	40%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 BCE XR Tibia/Fibula 2 Views 73590	$255.00	$425.00	$199.75–$8,427.00	—	40%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 XR Tibia/Fibula 2 Views Left 73590	$255.00	$425.00	$199.75–$8,427.00	—	40%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 XR Tibia/Fibula 2 Views Right 73590	$255.00	$425.00	$199.75–$8,427.00	—	40%
MR angiography (MRA) of the head without contrast CPT 70544 MRA Head w/o Contrast 70544	$1,272.60	$2,121.00	$996.87–$8,427.00	40% below	40%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRA Head w/o Contrast 70544	$1,272.60	$2,121.00	$996.87–$8,427.00	—	40%
MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 MRI Ankle w/o Contrast Bilateral 73721	$2,043.00	$3,405.00	$1,600.35–$8,427.00	—	40%
MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 MRI Knee w/o Contrast Bilateral 73721	$2,043.00	$3,405.00	$1,600.35–$8,427.00	—	40%
MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 MRI Hip w/o Contrast Bilateral 73721	$2,043.00	$3,405.00	$1,600.35–$8,427.00	—	40%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 BCE MRI w/o contrast lower extremity 73721	$2,043.00	$3,405.00	$1,600.35–$8,427.00	9% below	40%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Ankle w/o Contrast Left 73721	$2,043.00	$3,405.00	$1,600.35–$8,427.00	9% below	40%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Hip w/o Contrast Left 73721	$2,043.00	$3,405.00	$1,600.35–$8,427.00	9% below	40%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Hip w/o Contrast Right 73721	$2,043.00	$3,405.00	$1,600.35–$8,427.00	9% below	40%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Knee w/o Contrast Left 73721	$2,043.00	$3,405.00	$1,600.35–$8,427.00	9% below	40%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Knee w/o Contrast Right	$2,043.00	$3,405.00	$1,600.35–$8,427.00	9% below	40%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Ankle w/o Contrast Right 73721	$2,043.00	$3,405.00	$1,600.35–$8,427.00	9% below	40%
MRI of knee or other lower-limb joint, no contrast dye inpatient both sides CPT 73721 MRI Ankle w/o Contrast Bilateral 73721	$2,043.00	$3,405.00	$1,600.35–$8,427.00	—	40%
MRI of knee or other lower-limb joint, no contrast dye inpatient both sides CPT 73721 MRI Knee w/o Contrast Bilateral 73721	$2,043.00	$3,405.00	$1,600.35–$8,427.00	—	40%
MRI of knee or other lower-limb joint, no contrast dye inpatient both sides CPT 73721 MRI Hip w/o Contrast Bilateral 73721	$2,043.00	$3,405.00	$1,600.35–$8,427.00	—	40%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 BCE MRI w/o contrast lower extremity 73721	$2,043.00	$3,405.00	$1,600.35–$8,427.00	—	40%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Hip w/o Contrast Left 73721	$2,043.00	$3,405.00	$1,600.35–$8,427.00	—	40%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Knee w/o Contrast Right	$2,043.00	$3,405.00	$1,600.35–$8,427.00	—	40%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Knee w/o Contrast Left 73721	$2,043.00	$3,405.00	$1,600.35–$8,427.00	—	40%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Hip w/o Contrast Right 73721	$2,043.00	$3,405.00	$1,600.35–$8,427.00	—	40%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Ankle w/o Contrast Right 73721	$2,043.00	$3,405.00	$1,600.35–$8,427.00	—	40%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Ankle w/o Contrast Left 73721	$2,043.00	$3,405.00	$1,600.35–$8,427.00	—	40%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI Hip w/ + w/o Contrast Bl 73723	$1,904.40	$3,174.00	$1,491.78–$8,427.00	40% below	40%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI Ankle w/ + w/o Contrast Bl 73723	$1,904.40	$3,174.00	$1,491.78–$8,427.00	40% below	40%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI Knee w/ + w/o Contrast Bl 73723	$1,904.40	$3,174.00	$1,491.78–$8,427.00	40% below	40%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Hip w/ + w/o Contrast Left 73723	$1,904.40	$3,174.00	$1,491.78–$8,427.00	40% below	40%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Hip w/ + w/o Contrast Right 73723	$1,904.40	$3,174.00	$1,491.78–$8,427.00	40% below	40%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Ankle w/ + w/o Contrast Left 73723	$1,904.40	$3,174.00	$1,491.78–$8,427.00	40% below	40%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Knee w/ + w/o Contrast Right 73723	$1,904.40	$3,174.00	$1,491.78–$8,427.00	40% below	40%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Knee w/ + w/o Contrast Left 73723	$1,904.40	$3,174.00	$1,491.78–$8,427.00	40% below	40%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Ankle w/ + w/o Contrast Right 73723	$1,904.40	$3,174.00	$1,491.78–$8,427.00	40% below	40%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI Ankle w/ + w/o Contrast Bl 73723	$1,904.40	$3,174.00	$1,491.78–$8,427.00	—	40%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI Hip w/ + w/o Contrast Bl 73723	$1,904.40	$3,174.00	$1,491.78–$8,427.00	—	40%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI Knee w/ + w/o Contrast Bl 73723	$1,904.40	$3,174.00	$1,491.78–$8,427.00	—	40%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Knee w/ + w/o Contrast Right 73723	$1,904.40	$3,174.00	$1,491.78–$8,427.00	—	40%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Knee w/ + w/o Contrast Left 73723	$1,904.40	$3,174.00	$1,491.78–$8,427.00	—	40%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Hip w/ + w/o Contrast Right 73723	$1,904.40	$3,174.00	$1,491.78–$8,427.00	—	40%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Ankle w/ + w/o Contrast Left 73723	$1,904.40	$3,174.00	$1,491.78–$8,427.00	—	40%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Hip w/ + w/o Contrast Left 73723	$1,904.40	$3,174.00	$1,491.78–$8,427.00	—	40%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Ankle w/ + w/o Contrast Right 73723	$1,904.40	$3,174.00	$1,491.78–$8,427.00	—	40%
MRI of the abdomen without contrast CPT 74181 MRI Abdomen w/o Contrast 74181	$1,737.60	$2,896.00	$1,361.12–$8,427.00	21% below	40%
MRI of the abdomen without contrast inpatient CPT 74181 MRI Abdomen w/o Contrast 74181	$1,737.60	$2,896.00	$1,361.12–$8,427.00	—	40%
MRI of the abdomen, without and then with contrast dye CPT 74183 BCE MRI, abdomen; w/o contrast & w/contrast 74183	$2,400.00	$4,000.00	$1,880.00–$8,427.00	25% below	40%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI Abdomen w/ + w/o Contrast 74183	$2,400.00	$4,000.00	$1,880.00–$8,427.00	25% below	40%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 BCE MRI, abdomen; w/o contrast & w/contrast 74183	$2,400.00	$4,000.00	$1,880.00–$8,427.00	—	40%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI Abdomen w/ + w/o Contrast 74183	$2,400.00	$4,000.00	$1,880.00–$8,427.00	—	40%
MRI of the brain, no contrast dye CPT 70551 MRI Brain w/o Contrast 70551	$1,816.80	$3,028.00	$1,423.16–$8,427.00	17% below	40%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI Brain w/o Contrast 70551	$1,816.80	$3,028.00	$1,423.16–$8,427.00	—	40%
MRI of the brain, with and without contrast dye CPT 70553 MRI Brain w/ + w/o Contrast 70553	$2,571.00	$4,285.00	$2,013.95–$8,427.00	15% below	40%
MRI of the brain, with and without contrast dye CPT 70553 BCE MRI Brain, w/o & w/contrast 70553	$2,571.00	$4,285.00	$2,013.95–$8,427.00	15% below	40%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI Brain w/ + w/o Contrast 70553	$2,571.00	$4,285.00	$2,013.95–$8,427.00	—	40%
MRI of the brain, with and without contrast dye inpatient CPT 70553 BCE MRI Brain, w/o & w/contrast 70553	$2,571.00	$4,285.00	$2,013.95–$8,427.00	—	40%
MRI of the lower back, no contrast dye CPT 72148 MRI Spine Lumbar w/o Contrast 72148	$1,788.00	$2,980.00	$1,400.60–$8,427.00	22% below	40%
MRI of the lower back, no contrast dye CPT 72148 BCE MRI Spine Lumbar w/o contrast 72148	$1,788.00	$2,980.00	$1,400.60–$8,427.00	22% below	40%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI Spine Lumbar w/o Contrast 72148	$1,788.00	$2,980.00	$1,400.60–$8,427.00	—	40%
MRI of the lower back, no contrast dye inpatient CPT 72148 BCE MRI Spine Lumbar w/o contrast 72148	$1,788.00	$2,980.00	$1,400.60–$8,427.00	—	40%
MRI of the lower back, without and then with contrast dye CPT 72158 BCE MRI Spine Lumbar w/ & w/o contrast 72158	$2,608.80	$4,348.00	$2,043.56–$8,427.00	18% below	40%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI Spine Lumbar w/ + w/o Contrast 72158	$2,608.80	$4,348.00	$2,043.56–$8,427.00	18% below	40%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI Spine Lumbar w/ + w/o Contrast 72158	$2,608.80	$4,348.00	$2,043.56–$8,427.00	—	40%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 BCE MRI Spine Lumbar w/ & w/o contrast 72158	$2,608.80	$4,348.00	$2,043.56–$8,427.00	—	40%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 BCE MRI Spine Thoracic w/o Contrast 72146	$1,660.20	$2,767.00	$1,300.49–$8,427.00	23% below	40%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI Spine Thoracic w/o Contrast 72146	$1,660.20	$2,767.00	$1,300.49–$8,427.00	23% below	40%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 BCE MRI Spine Thoracic w/o Contrast 72146	$1,660.20	$2,767.00	$1,300.49–$8,427.00	—	40%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI Spine Thoracic w/o Contrast 72146	$1,660.20	$2,767.00	$1,300.49–$8,427.00	—	40%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI Spine Cervical w/ + w/o Cont 72156	$2,533.80	$4,223.00	$1,984.81–$8,427.00	22% below	40%
MRI of the neck (cervical spine) without and with contrast CPT 72156 BCE MRI Spinal canal w/o & w/contrast, cervical 72156	$2,533.80	$4,223.00	$1,984.81–$8,427.00	22% below	40%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI Spine Cervical w/ + w/o Cont 72156	$2,533.80	$4,223.00	$1,984.81–$8,427.00	—	40%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 BCE MRI Spinal canal w/o & w/contrast, cervical 72156	$2,533.80	$4,223.00	$1,984.81–$8,427.00	—	40%
MRI of the neck (cervical spine), no contrast dye CPT 72141 BCE MRI Spine Cervical 72141	$1,849.80	$3,083.00	$1,449.01–$8,427.00	20% below	40%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI Spine Cervical w/o Contrast 72141	$1,849.80	$3,083.00	$1,449.01–$8,427.00	20% below	40%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI Spine Cervical w/o Contrast 72141	$1,849.80	$3,083.00	$1,449.01–$8,427.00	—	40%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 BCE MRI Spine Cervical 72141	$1,849.80	$3,083.00	$1,449.01–$8,427.00	—	40%
MRI of the pelvis without and with contrast CPT 72197 MRI Pelvis w/ + w/o Contrast 72197	$2,047.80	$3,413.00	$1,604.11–$8,427.00	39% below	40%
MRI of the pelvis without and with contrast CPT 72197 BCE MRI Pelvis w/o Contrast + w Contrast 72197	$2,047.80	$3,413.00	$1,604.11–$8,427.00	39% below	40%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI Pelvis w/ + w/o Contrast 72197	$2,047.80	$3,413.00	$1,604.11–$8,427.00	—	40%
MRI of the pelvis without and with contrast inpatient CPT 72197 BCE MRI Pelvis w/o Contrast + w Contrast 72197	$2,047.80	$3,413.00	$1,604.11–$8,427.00	—	40%
MRI of the pelvis, no contrast dye CPT 72195 MRI Pelvis w/o Contrast 72195	$1,518.00	$2,530.00	$1,189.10–$8,427.00	38% below	40%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI Pelvis w/o Contrast 72195	$1,518.00	$2,530.00	$1,189.10–$8,427.00	—	40%
MRI of the shoulder, elbow or wrist joint, no contrast dye both sides CPT 73221 MRI Elbow w/o Contrast Bilateral 73221	$1,985.40	$3,309.00	$1,555.23–$8,427.00	—	40%
MRI of the shoulder, elbow or wrist joint, no contrast dye both sides CPT 73221 MRI Wrist w/o Contrast Bilateral 73221	$1,985.40	$3,309.00	$1,555.23–$8,427.00	—	40%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 BCE MRI UE Joint 73221	$1,985.40	$3,309.00	$1,555.23–$8,427.00	12% below	40%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI Shoulder w/o Contrast Bl 73221	$1,985.40	$3,309.00	$1,555.23–$8,427.00	12% below	40%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Shoulder w/o Contrast Left 73221	$1,985.40	$3,309.00	$1,555.23–$8,427.00	12% below	40%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Elbow w/o Contrast Right 73221	$1,985.40	$3,309.00	$1,555.23–$8,427.00	12% below	40%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Wrist w/o Contrast Right 73221	$1,985.40	$3,309.00	$1,555.23–$8,427.00	12% below	40%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Elbow w/o Contrast Left 73221	$1,985.40	$3,309.00	$1,555.23–$8,427.00	12% below	40%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Shoulder w/o Contrast Right 73221	$1,985.40	$3,309.00	$1,555.23–$8,427.00	12% below	40%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Wrist w/o Contrast Left 73221	$1,985.40	$3,309.00	$1,555.23–$8,427.00	12% below	40%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient both sides CPT 73221 MRI Wrist w/o Contrast Bilateral 73221	$1,985.40	$3,309.00	$1,555.23–$8,427.00	—	40%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient both sides CPT 73221 MRI Elbow w/o Contrast Bilateral 73221	$1,985.40	$3,309.00	$1,555.23–$8,427.00	—	40%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MRI Shoulder w/o Contrast Bl 73221	$1,985.40	$3,309.00	$1,555.23–$8,427.00	—	40%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 BCE MRI UE Joint 73221	$1,985.40	$3,309.00	$1,555.23–$8,427.00	—	40%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Shoulder w/o Contrast Left 73221	$1,985.40	$3,309.00	$1,555.23–$8,427.00	—	40%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Elbow w/o Contrast Right 73221	$1,985.40	$3,309.00	$1,555.23–$8,427.00	—	40%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Elbow w/o Contrast Left 73221	$1,985.40	$3,309.00	$1,555.23–$8,427.00	—	40%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Shoulder w/o Contrast Right 73221	$1,985.40	$3,309.00	$1,555.23–$8,427.00	—	40%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Wrist w/o Contrast Left 73221	$1,985.40	$3,309.00	$1,555.23–$8,427.00	—	40%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Wrist w/o Contrast Right 73221	$1,985.40	$3,309.00	$1,555.23–$8,427.00	—	40%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 BCE XR Spine, cervical 4 or 5 views 72050	$342.00	$570.00	$267.90–$8,427.00	37% below	40%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 XR Spine Cervical Minimum 4 Views 72050	$342.00	$570.00	$267.90–$8,427.00	37% below	40%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 BCE XR Spine, cervical 4 or 5 views 72050	$342.00	$570.00	$267.90–$8,427.00	—	40%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 XR Spine Cervical Minimum 4 Views 72050	$342.00	$570.00	$267.90–$8,427.00	—	40%
Neck soft tissue CT scan with contrast CPT 70491 CT Parotid w/ Contrast 70491	$1,484.40	$2,474.00	$1,162.78–$8,427.00	28% below	40%
Neck soft tissue CT scan with contrast CPT 70491 BCE CT Soft Tissue Neck w/ Contrast 70491	$1,484.40	$2,474.00	$1,162.78–$8,427.00	28% below	40%
Neck soft tissue CT scan with contrast CPT 70491 CT Soft Tissue Neck w/ Contrast 70491	$1,484.40	$2,474.00	$1,162.78–$8,427.00	28% below	40%
Neck soft tissue CT scan with contrast inpatient CPT 70491 CT Soft Tissue Neck w/ Contrast 70491	$1,484.40	$2,474.00	$1,162.78–$8,427.00	—	40%
Neck soft tissue CT scan with contrast inpatient CPT 70491 CT Parotid w/ Contrast 70491	$1,484.40	$2,474.00	$1,162.78–$8,427.00	—	40%
Neck soft tissue CT scan with contrast inpatient CPT 70491 BCE CT Soft Tissue Neck w/ Contrast 70491	$1,484.40	$2,474.00	$1,162.78–$8,427.00	—	40%
Neck soft tissue CT scan without contrast CPT 70490 BCE CT Soft tissue neck, w/o contrast 70490	$1,257.00	$2,095.00	$984.65–$8,427.00	28% below	40%
Neck soft tissue CT scan without contrast CPT 70490 CT Soft Tissue Neck w/o Contrast 70490	$1,257.00	$2,095.00	$984.65–$8,427.00	28% below	40%
Neck soft tissue CT scan without contrast inpatient CPT 70490 BCE CT Soft tissue neck, w/o contrast 70490	$1,257.00	$2,095.00	$984.65–$8,427.00	—	40%
Neck soft tissue CT scan without contrast inpatient CPT 70490 CT Soft Tissue Neck w/o Contrast 70490	$1,257.00	$2,095.00	$984.65–$8,427.00	—	40%
Neck soft tissue X-ray CPT 70360 BCE XR Neck Soft Tissue 70360	$130.80	$218.00	$102.46–$8,427.00	46% below	40%
Neck soft tissue X-ray CPT 70360 XR Neck Soft Tissue 70360	$130.80	$218.00	$102.46–$8,427.00	46% below	40%
Neck soft tissue X-ray inpatient CPT 70360 XR Neck Soft Tissue 70360	$130.80	$218.00	$102.46–$8,427.00	—	40%
Neck soft tissue X-ray inpatient CPT 70360 BCE XR Neck Soft Tissue 70360	$130.80	$218.00	$102.46–$8,427.00	—	40%
Pelvic CT scan without contrast CPT 72192 CT Pelvis w/o Contrast 72192	$1,350.60	$2,251.00	$1,057.97–$8,427.00	19% below	40%
Pelvic CT scan without contrast CPT 72192 BCE CT Pelvis w/o Contrast 72192	$1,350.60	$2,251.00	$1,057.97–$8,427.00	19% below	40%
Pelvic CT scan without contrast inpatient CPT 72192 BCE CT Pelvis w/o Contrast 72192	$1,350.60	$2,251.00	$1,057.97–$8,427.00	—	40%
Pelvic CT scan without contrast inpatient CPT 72192 CT Pelvis w/o Contrast 72192	$1,350.60	$2,251.00	$1,057.97–$8,427.00	—	40%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 BCE US Pelvis Non-OB Limited 76857	$412.80	$688.00	$323.36–$8,427.00	15% below	40%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US Pelvis Non-OB Limited 76857	$412.80	$688.00	$323.36–$8,427.00	15% below	40%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 BCE US Pelvis Non-OB Limited 76857	$412.80	$688.00	$323.36–$8,427.00	—	40%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US Pelvis Non-OB Limited 76857	$412.80	$688.00	$323.36–$8,427.00	—	40%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 76856 CPT Price	$427.20	$712.00	$334.64–$8,427.00	50% below	40%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US Pelvic/Trans (Non-OB) 76856/76830	$487.24	$812.06	$381.66–$8,427.00	43% below	40%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US Pelvis Non-OB Complete 76856	$527.40	$879.00	$397.64–$8,427.00	39% below	40%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 76856 CPT Price	$427.20	$712.00	$334.64–$8,427.00	—	40%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US Pelvic/Trans (Non-OB) 76856/76830	$487.24	$812.06	$381.66–$8,427.00	—	40%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US Pelvis Non-OB Complete 76856	$527.40	$879.00	$397.64–$8,427.00	—	40%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US Pregnancy After 1st Trimester 76805	$289.80	$483.00	$227.01–$8,427.00	56% below	40%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US Pregnancy After 1st Trimester 76805	$289.80	$483.00	$227.01–$8,427.00	—	40%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US Pregnancy 1st Trimester 76801	$364.80	$608.00	$285.76–$8,427.00	41% below	40%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US Pregnancy 1st Trimester 76801	$364.80	$608.00	$285.76–$8,427.00	—	40%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US Pregnancy Limited 76815	$125.40	$209.00	$98.23–$8,427.00	73% below	40%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US Pregnancy Limited 76815	$125.40	$209.00	$98.23–$8,427.00	—	40%
Rib X-ray, one side, 2 views one side CPT 71100 XR Ribs Unilateral 2 View Left 71100	$229.20	$382.00	$179.54–$8,427.00	36% below	40%
Rib X-ray, one side, 2 views one side CPT 71100 BCE XR Ribs, unilateral; 2 views 71100	$229.20	$382.00	$179.54–$8,427.00	36% below	40%
Rib X-ray, one side, 2 views one side CPT 71100 XR Ribs Unilateral 2 View Right 71100	$229.20	$382.00	$179.54–$8,427.00	36% below	40%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 BCE XR Ribs, unilateral; 2 views 71100	$229.20	$382.00	$179.54–$8,427.00	—	40%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 XR Ribs Unilateral 2 View Right 71100	$229.20	$382.00	$179.54–$8,427.00	—	40%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 XR Ribs Unilateral 2 View Left 71100	$229.20	$382.00	$179.54–$8,427.00	—	40%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 XR Ribs Unilat incl PA Chest Lt 71101	$352.80	$588.00	$276.36–$8,427.00	11% below	40%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 BCE XR Ribs, unilateral, min 3 views 71101	$352.80	$588.00	$276.36–$8,427.00	11% below	40%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 XR Ribs Unilat incl PA Chest Rt 71101	$352.80	$588.00	$276.36–$8,427.00	11% below	40%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 BCE XR Ribs, unilateral, min 3 views 71101	$352.80	$588.00	$276.36–$8,427.00	—	40%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 XR Ribs Unilat incl PA Chest Rt 71101	$352.80	$588.00	$276.36–$8,427.00	—	40%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 XR Ribs Unilat incl PA Chest Lt 71101	$352.80	$588.00	$276.36–$8,427.00	—	40%
Shoulder X-ray, complete, 2 or more views both sides CPT 73030 XR Shoulder Complete Bilateral 73030	$255.00	$425.00	$199.75–$8,427.00	—	40%
Shoulder X-ray, complete, 2 or more views CPT 73030 BCE XR Shoulder Complete 73030	$255.00	$425.00	$199.75–$8,427.00	26% below	40%
Shoulder X-ray, complete, 2 or more views CPT 73030 XR Shoulder Comp Min 2 View BL 73030	$255.00	$425.00	$199.75–$8,427.00	26% below	40%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR Shoulder Comp Min 2 View Right 73030	$255.00	$425.00	$199.75–$8,427.00	26% below	40%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR Shoulder Comp Min 2 View Left 73030	$255.00	$425.00	$199.75–$8,427.00	26% below	40%
Shoulder X-ray, complete, 2 or more views inpatient both sides CPT 73030 XR Shoulder Complete Bilateral 73030	$255.00	$425.00	$199.75–$8,427.00	—	40%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 BCE XR Shoulder Complete 73030	$255.00	$425.00	$199.75–$8,427.00	—	40%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 XR Shoulder Comp Min 2 View BL 73030	$255.00	$425.00	$199.75–$8,427.00	—	40%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR Shoulder Comp Min 2 View Right 73030	$255.00	$425.00	$199.75–$8,427.00	—	40%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR Shoulder Comp Min 2 View Left 73030	$255.00	$425.00	$199.75–$8,427.00	—	40%
Sinus X-ray, complete, 3 or more views CPT 70220 XR Sinus Paranasal Comp Min 3 V 70220	$246.00	$410.00	$192.70–$8,427.00	42% below	40%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 XR Sinus Paranasal Comp Min 3 V 70220	$246.00	$410.00	$192.70–$8,427.00	—	40%
Skull X-ray, fewer than 4 views CPT 70250 XR Skull Less Than 4 Views 70250	$207.00	$345.00	$162.15–$8,427.00	41% below	40%
Skull X-ray, fewer than 4 views inpatient CPT 70250 XR Skull Less Than 4 Views 70250	$207.00	$345.00	$162.15–$8,427.00	—	40%
Swallow study (modified barium swallow, video X-ray) CPT 74230 XR Swallowing Function w/ Video 74230	$440.40	$734.00	$344.98–$8,427.00	27% below	40%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 XR Swallowing Function w/ Video 74230	$440.40	$734.00	$344.98–$8,427.00	—	40%
Thigh bone (femur) X-ray, 2 or more views both sides CPT 73552 XR Femur Complete Bilateral 73552	$194.40	$324.00	$152.28–$8,427.00	—	40%
Thigh bone (femur) X-ray, 2 or more views both sides CPT 73552 XR Femur Min 2v Bilateral 73552	$194.40	$324.00	$152.28–$8,427.00	—	40%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 BCE XR Femur, minimum 2 Views 73552	$194.40	$324.00	$152.28–$8,427.00	45% below	40%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 XR Femur Min 2v Left 73552	$194.40	$324.00	$152.28–$8,427.00	45% below	40%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 XR Femur Complete Left 73552	$194.40	$324.00	$152.28–$8,427.00	45% below	40%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 XR Femur Complete Right 73552	$194.40	$324.00	$152.28–$8,427.00	45% below	40%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 XR Femur Min 2v Right 73552	$194.40	$324.00	$152.28–$8,427.00	45% below	40%
Thigh bone (femur) X-ray, 2 or more views inpatient both sides CPT 73552 XR Femur Min 2v Bilateral 73552	$194.40	$324.00	$152.28–$8,427.00	—	40%
Thigh bone (femur) X-ray, 2 or more views inpatient both sides CPT 73552 XR Femur Complete Bilateral 73552	$194.40	$324.00	$152.28–$8,427.00	—	40%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 BCE XR Femur, minimum 2 Views 73552	$194.40	$324.00	$152.28–$8,427.00	—	40%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 XR Femur Complete Right 73552	$194.40	$324.00	$152.28–$8,427.00	—	40%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 XR Femur Min 2v Left 73552	$194.40	$324.00	$152.28–$8,427.00	—	40%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 XR Femur Complete Left 73552	$194.40	$324.00	$152.28–$8,427.00	—	40%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 XR Femur Min 2v Right 73552	$194.40	$324.00	$152.28–$8,427.00	—	40%
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT Spine Thoracic w/o Contrast 72128	$1,574.40	$2,624.00	$1,233.28–$8,427.00	20% below	40%
Thoracic spine (mid back) CT scan without contrast CPT 72128 BCE CT Spine Thoracic w/o contrast 72128	$1,574.40	$2,624.00	$1,233.28–$8,427.00	20% below	40%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT Spine Thoracic w/o Contrast 72128	$1,574.40	$2,624.00	$1,233.28–$8,427.00	—	40%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 BCE CT Spine Thoracic w/o contrast 72128	$1,574.40	$2,624.00	$1,233.28–$8,427.00	—	40%
Toe X-ray, 2 or more views CPT 73660 BCE XRToes, min 2 views 73660	$159.60	$266.00	$125.02–$8,427.00	46% below	40%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes 3rd Digit Left 73660	$159.60	$266.00	$125.02–$8,427.00	46% below	40%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes Great Right 73660	$159.60	$266.00	$125.02–$8,427.00	46% below	40%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes 5th Digit Right 73660	$159.60	$266.00	$125.02–$8,427.00	46% below	40%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes 2nd Digit Right 73660	$159.60	$266.00	$125.02–$8,427.00	46% below	40%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes 5th Digit Left 73660	$159.60	$266.00	$125.02–$8,427.00	46% below	40%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes Great Left 73660	$159.60	$266.00	$125.02–$8,427.00	46% below	40%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes 4th Digit Right 73660	$159.60	$266.00	$125.02–$8,427.00	46% below	40%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes 4th Digit Left 73660	$159.60	$266.00	$125.02–$8,427.00	46% below	40%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes 2nd Digit Left 73660	$159.60	$266.00	$125.02–$8,427.00	46% below	40%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes 3rd Digit Right 73660	$159.60	$266.00	$125.02–$8,427.00	46% below	40%
Toe X-ray, 2 or more views inpatient CPT 73660 BCE XRToes, min 2 views 73660	$159.60	$266.00	$125.02–$8,427.00	—	40%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toes 2nd Digit Right 73660	$159.60	$266.00	$125.02–$8,427.00	—	40%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toes Great Left 73660	$159.60	$266.00	$125.02–$8,427.00	—	40%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toes 5th Digit Right 73660	$159.60	$266.00	$125.02–$8,427.00	—	40%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toes 5th Digit Left 73660	$159.60	$266.00	$125.02–$8,427.00	—	40%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toes 4th Digit Right 73660	$159.60	$266.00	$125.02–$8,427.00	—	40%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toes 4th Digit Left 73660	$159.60	$266.00	$125.02–$8,427.00	—	40%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toes 3rd Digit Right 73660	$159.60	$266.00	$125.02–$8,427.00	—	40%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toes 3rd Digit Left 73660	$159.60	$266.00	$125.02–$8,427.00	—	40%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toes Great Right 73660	$159.60	$266.00	$125.02–$8,427.00	—	40%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toes 2nd Digit Left 73660	$159.60	$266.00	$125.02–$8,427.00	—	40%
Transvaginal pelvic ultrasound CPT 76830 BCE US Transvaginal 76830	$427.20	$712.00	$334.64–$8,427.00	34% below	40%
Transvaginal pelvic ultrasound CPT 76830 US Transvaginal Non-OB	$427.20	$712.00	$334.64–$8,427.00	34% below	40%
Transvaginal pelvic ultrasound CPT 76830 US Transvaginal 76830	$427.20	$712.00	$334.64–$8,427.00	34% below	40%
Transvaginal pelvic ultrasound inpatient CPT 76830 US Transvaginal 76830	$427.20	$712.00	$334.64–$8,427.00	—	40%
Transvaginal pelvic ultrasound inpatient CPT 76830 BCE US Transvaginal 76830	$427.20	$712.00	$334.64–$8,427.00	—	40%
Transvaginal pelvic ultrasound inpatient CPT 76830 US Transvaginal Non-OB	$427.20	$712.00	$334.64–$8,427.00	—	40%
Transvaginal ultrasound during pregnancy CPT 76817 BCE US Pregnancy Transvaginal 76817	$206.40	$344.00	$161.68–$8,427.00	60% below	40%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 BCE US Pregnancy Transvaginal 76817	$206.40	$344.00	$161.68–$8,427.00	—	40%
Ultrasound of the abdomen, complete CPT 76700 US Abdomen Complete 76700	$619.20	$1,032.00	$397.64–$8,427.00	28% below	40%
Ultrasound of the abdomen, complete CPT 76700 BCE US Abdomen Complete 76700	$619.20	$1,032.00	$397.64–$8,427.00	28% below	40%
Ultrasound of the abdomen, complete inpatient CPT 76700 BCE US Abdomen Complete 76700	$619.20	$1,032.00	$397.64–$8,427.00	—	40%
Ultrasound of the abdomen, complete inpatient CPT 76700 US Abdomen Complete 76700	$619.20	$1,032.00	$397.64–$8,427.00	—	40%
Ultrasound of the scrotum and testicles CPT 76870 76870 CPT Add On	$391.80	$653.00	$306.91–$8,427.00	36% below	40%
Ultrasound of the scrotum and testicles CPT 76870 US Scrotum (Contents) 76870	$398.40	$664.00	$312.08–$8,427.00	35% below	40%
Ultrasound of the scrotum and testicles CPT 76870 BCE US, Scrotum and contents 76870	$398.40	$664.00	$312.08–$8,427.00	35% below	40%
Ultrasound of the scrotum and testicles inpatient CPT 76870 76870 CPT Add On	$391.80	$653.00	$306.91–$8,427.00	—	40%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US Scrotum (Contents) 76870	$398.40	$664.00	$312.08–$8,427.00	—	40%
Ultrasound of the scrotum and testicles inpatient CPT 76870 BCE US, Scrotum and contents 76870	$398.40	$664.00	$312.08–$8,427.00	—	40%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Soft Tissue of Head and Neck 76536	$420.60	$701.00	$329.47–$8,427.00	33% below	40%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 BCE US Soft Tissue of head & neck 76536	$420.60	$701.00	$329.47–$8,427.00	33% below	40%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 BCE US Soft Tissue of head & neck 76536	$420.60	$701.00	$329.47–$8,427.00	—	40%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US Soft Tissue of Head and Neck 76536	$420.60	$701.00	$329.47–$8,427.00	—	40%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 XR Upper GI without KUB 74240	$462.60	$771.00	$362.37–$8,427.00	37% below	40%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 BCE XR Upper GI Without KUB 74240	$462.60	$771.00	$362.37–$8,427.00	37% below	40%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 BCE XR Upper GI Without KUB 74240	$462.60	$771.00	$362.37–$8,427.00	—	40%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 XR Upper GI without KUB 74240	$462.60	$771.00	$362.37–$8,427.00	—	40%
Upper arm X-ray (humerus), 2 views CPT 73060 XR Humerus Minimum 2 Views Bl 73060	$258.00	$430.00	$202.10–$8,427.00	26% below	40%
Upper arm X-ray (humerus), 2 views CPT 73060 BCE XR Humerus, min of 2 views 73060	$258.00	$430.00	$202.10–$8,427.00	26% below	40%
Upper arm X-ray (humerus), 2 views one side CPT 73060 XR Humerus Minimum 2 views Left 73060	$258.00	$430.00	$202.10–$8,427.00	26% below	40%
Upper arm X-ray (humerus), 2 views one side CPT 73060 XR Humerus Minimum 2 views Right 73060	$258.00	$430.00	$202.10–$8,427.00	26% below	40%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 BCE XR Humerus, min of 2 views 73060	$258.00	$430.00	$202.10–$8,427.00	—	40%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 XR Humerus Minimum 2 Views Bl 73060	$258.00	$430.00	$202.10–$8,427.00	—	40%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 XR Humerus Minimum 2 views Left 73060	$258.00	$430.00	$202.10–$8,427.00	—	40%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 XR Humerus Minimum 2 views Right 73060	$258.00	$430.00	$202.10–$8,427.00	—	40%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 BCE US Venous Doppler Extremity Unilat 93971	$708.60	$1,181.00	$397.64–$8,427.00	12% below	40%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Venous Doppler Extremity Unilat 93971	$708.60	$1,181.00	$397.64–$8,427.00	12% below	40%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Duplex Scan Extremity Veins, Unilat 93971	$708.60	$1,181.00	$397.64–$8,427.00	12% below	40%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 ED US Duplex Scan Extremity Veins, Unilat 93971	$730.20	$1,217.00	$397.64–$8,427.00	9% below	40%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 BCE US Venous Doppler Extremity Unilat 93971	$708.60	$1,181.00	$397.64–$8,427.00	—	40%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Venous Doppler Extremity Unilat 93971	$708.60	$1,181.00	$397.64–$8,427.00	—	40%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Duplex Scan Extremity Veins, Unilat 93971	$708.60	$1,181.00	$397.64–$8,427.00	—	40%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 ED US Duplex Scan Extremity Veins, Unilat 93971	$730.20	$1,217.00	$397.64–$8,427.00	—	40%
Wrist X-ray, 2 views both sides CPT 73100 XR Wrist 2 Views Bilateral 73100	$254.40	$424.00	$199.28–$8,427.00	—	40%
Wrist X-ray, 2 views CPT 73100 BCE XR Wrist, 2 views 73100	$254.40	$424.00	$199.28–$8,427.00	20% below	40%
Wrist X-ray, 2 views one side CPT 73100 XR Wrist 2 Views Left 73100	$254.40	$424.00	$199.28–$8,427.00	20% below	40%
Wrist X-ray, 2 views one side CPT 73100 XR Wrist 2 Views Right 73100	$254.40	$424.00	$199.28–$8,427.00	20% below	40%
Wrist X-ray, 2 views inpatient both sides CPT 73100 XR Wrist 2 Views Bilateral 73100	$254.40	$424.00	$199.28–$8,427.00	—	40%
Wrist X-ray, 2 views inpatient CPT 73100 BCE XR Wrist, 2 views 73100	$254.40	$424.00	$199.28–$8,427.00	—	40%
Wrist X-ray, 2 views inpatient one side CPT 73100 XR Wrist 2 Views Left 73100	$254.40	$424.00	$199.28–$8,427.00	—	40%
Wrist X-ray, 2 views inpatient one side CPT 73100 XR Wrist 2 Views Right 73100	$254.40	$424.00	$199.28–$8,427.00	—	40%
Wrist X-ray, complete, 3 or more views both sides CPT 73110 XR Wrist Complete Bilateral 73110	$258.00	$430.00	$202.10–$8,427.00	—	40%
Wrist X-ray, complete, 3 or more views CPT 73110 BCE XR Wrist, complete min of 3 views 73110	$258.00	$430.00	$202.10–$8,427.00	33% below	40%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR Wrist Complete Left 73110	$258.00	$430.00	$202.10–$8,427.00	33% below	40%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR Wrist Complete Right 73110	$258.00	$430.00	$202.10–$8,427.00	33% below	40%
Wrist X-ray, complete, 3 or more views inpatient both sides CPT 73110 XR Wrist Complete Bilateral 73110	$258.00	$430.00	$202.10–$8,427.00	—	40%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 BCE XR Wrist, complete min of 3 views 73110	$258.00	$430.00	$202.10–$8,427.00	—	40%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR Wrist Complete Right 73110	$258.00	$430.00	$202.10–$8,427.00	—	40%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR Wrist Complete Left 73110	$258.00	$430.00	$202.10–$8,427.00	—	40%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip 2-3 Views w/ Pelvis Right 73502	$189.00	$315.00	$148.05–$8,427.00	53% below	40%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip 2-3 Views w/ Pelvis Left 73502	$189.00	$315.00	$148.05–$8,427.00	53% below	40%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip 2-3 Views Left 73502	$189.00	$315.00	$148.05–$8,427.00	53% below	40%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 BCE XR Hip, Unilateral, w Pelvis 2-3 Views 73502	$189.00	$315.00	$148.05–$8,427.00	53% below	40%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip 2-3 Views Right 73502	$189.00	$315.00	$148.05–$8,427.00	53% below	40%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR Hip 2-3 Views w/ Pelvis Left 73502	$189.00	$315.00	$148.05–$8,427.00	—	40%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR Hip 2-3 Views Left 73502	$189.00	$315.00	$148.05–$8,427.00	—	40%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR Hip 2-3 Views Right 73502	$189.00	$315.00	$148.05–$8,427.00	—	40%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR Hip 2-3 Views w/ Pelvis Right 73502	$189.00	$315.00	$148.05–$8,427.00	—	40%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 BCE XR Hip, Unilateral, w Pelvis 2-3 Views 73502	$189.00	$315.00	$148.05–$8,427.00	—	40%
X-ray of the abdomen, 1 view CPT 74018 XR abdomen 1 view 74018	$160.20	$267.00	$125.49–$8,427.00	53% below	40%
X-ray of the abdomen, 1 view CPT 74018 XR Abdomen 1 View 74018	$160.20	$267.00	$125.49–$8,427.00	53% below	40%
X-ray of the abdomen, 1 view CPT 74018 BCE Radiologic examination, abdomen; 1 view 74018	$160.20	$267.00	$125.49–$8,427.00	53% below	40%
X-ray of the abdomen, 1 view inpatient CPT 74018 BCE Radiologic examination, abdomen; 1 view 74018	$160.20	$267.00	$125.49–$8,427.00	—	40%
X-ray of the abdomen, 1 view inpatient CPT 74018 XR abdomen 1 view 74018	$160.20	$267.00	$125.49–$8,427.00	—	40%
X-ray of the abdomen, 1 view inpatient CPT 74018 XR Abdomen 1 View 74018	$160.20	$267.00	$125.49–$8,427.00	—	40%
X-ray of the ankle, 2 views both sides CPT 73600 XR Ankle 2 Views Bilateral 73600	$181.20	$302.00	$141.94–$8,427.00	—	40%
X-ray of the ankle, 2 views CPT 73600 BCE XR Ankle 2 Views 73600	$181.20	$302.00	$141.94–$8,427.00	40% below	40%
X-ray of the ankle, 2 views one side CPT 73600 XR Ankle 2 Views Right 73600	$181.20	$302.00	$141.94–$8,427.00	40% below	40%
X-ray of the ankle, 2 views one side CPT 73600 XR Ankle 2 Views Left 73600	$181.20	$302.00	$141.94–$8,427.00	40% below	40%
X-ray of the ankle, 2 views inpatient both sides CPT 73600 XR Ankle 2 Views Bilateral 73600	$181.20	$302.00	$141.94–$8,427.00	—	40%
X-ray of the ankle, 2 views inpatient CPT 73600 BCE XR Ankle 2 Views 73600	$181.20	$302.00	$141.94–$8,427.00	—	40%
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR Ankle 2 Views Left 73600	$181.20	$302.00	$141.94–$8,427.00	—	40%
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR Ankle 2 Views Right 73600	$181.20	$302.00	$141.94–$8,427.00	—	40%
X-ray of the finger(s), 2 or more views CPT 73140 BCE XR Finger, min 2 views 73140	$180.60	$301.00	$141.47–$8,427.00	32% below	40%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger 5th Digit Left 73140	$180.60	$301.00	$141.47–$8,427.00	32% below	40%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger 5th Digit Right 73140	$180.60	$301.00	$141.47–$8,427.00	32% below	40%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger 2nd Digit Left 73140	$180.60	$301.00	$141.47–$8,427.00	32% below	40%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger 2nd Digit Right 73140	$180.60	$301.00	$141.47–$8,427.00	32% below	40%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger 3rd Digit Left 73140	$180.60	$301.00	$141.47–$8,427.00	32% below	40%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger 3rd Digit Right 73140	$180.60	$301.00	$141.47–$8,427.00	32% below	40%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger 4th Digit Left 73140	$180.60	$301.00	$141.47–$8,427.00	32% below	40%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger 4th Digit Right 73140	$180.60	$301.00	$141.47–$8,427.00	32% below	40%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger Thumb Right 73140	$180.60	$301.00	$141.47–$8,427.00	32% below	40%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger Thumb Left 73140	$180.60	$301.00	$141.47–$8,427.00	32% below	40%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 BCE XR Finger, min 2 views 73140	$180.60	$301.00	$141.47–$8,427.00	—	40%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger Thumb Right 73140	$180.60	$301.00	$141.47–$8,427.00	—	40%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger 4th Digit Left 73140	$180.60	$301.00	$141.47–$8,427.00	—	40%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger 3rd Digit Right 73140	$180.60	$301.00	$141.47–$8,427.00	—	40%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger 3rd Digit Left 73140	$180.60	$301.00	$141.47–$8,427.00	—	40%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger 2nd Digit Right 73140	$180.60	$301.00	$141.47–$8,427.00	—	40%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger 2nd Digit Left 73140	$180.60	$301.00	$141.47–$8,427.00	—	40%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger Thumb Left 73140	$180.60	$301.00	$141.47–$8,427.00	—	40%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger 5th Digit Right 73140	$180.60	$301.00	$141.47–$8,427.00	—	40%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger 4th Digit Right 73140	$180.60	$301.00	$141.47–$8,427.00	—	40%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger 5th Digit Left 73140	$180.60	$301.00	$141.47–$8,427.00	—	40%
X-ray of the foot, 2 views both sides CPT 73620 XR Foot 2 Views Bilateral 73620	$250.80	$418.00	$196.46–$8,427.00	—	40%
X-ray of the foot, 2 views CPT 73620 BCE XR Foot Complete 73620	$250.80	$418.00	$196.46–$8,427.00	25% below	40%
X-ray of the foot, 2 views one side CPT 73620 XR Foot 2 Views Right 73620	$250.80	$418.00	$196.46–$8,427.00	25% below	40%
X-ray of the foot, 2 views one side CPT 73620 XR Foot 2 Views Left 73620	$250.80	$418.00	$196.46–$8,427.00	25% below	40%
X-ray of the foot, 2 views inpatient both sides CPT 73620 XR Foot 2 Views Bilateral 73620	$250.80	$418.00	$196.46–$8,427.00	—	40%
X-ray of the foot, 2 views inpatient CPT 73620 BCE XR Foot Complete 73620	$250.80	$418.00	$196.46–$8,427.00	—	40%
X-ray of the foot, 2 views inpatient one side CPT 73620 XR Foot 2 Views Right 73620	$250.80	$418.00	$196.46–$8,427.00	—	40%
X-ray of the foot, 2 views inpatient one side CPT 73620 XR Foot 2 Views Left 73620	$250.80	$418.00	$196.46–$8,427.00	—	40%
X-ray of the foot, complete, 3 or more views both sides CPT 73630 XR Foot Complete Bilateral 73630	$318.60	$531.00	$249.57–$8,427.00	—	40%
X-ray of the foot, complete, 3 or more views CPT 73630 BCE XR Foot, complete, min 3 views 73630	$318.60	$531.00	$249.57–$8,427.00	14% below	40%
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR Foot Complete Left 73630	$318.60	$531.00	$249.57–$8,427.00	14% below	40%
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR Foot Complete min 3 views Rt 73630	$318.60	$531.00	$249.57–$8,427.00	14% below	40%
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR Foot Complete min 3 views Left 73630	$318.60	$531.00	$249.57–$8,427.00	14% below	40%
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR Foot Complete Right 73630	$318.60	$531.00	$249.57–$8,427.00	14% below	40%
X-ray of the foot, complete, 3 or more views inpatient both sides CPT 73630 XR Foot Complete Bilateral 73630	$318.60	$531.00	$249.57–$8,427.00	—	40%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 BCE XR Foot, complete, min 3 views 73630	$318.60	$531.00	$249.57–$8,427.00	—	40%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR Foot Complete Left 73630	$318.60	$531.00	$249.57–$8,427.00	—	40%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR Foot Complete min 3 views Rt 73630	$318.60	$531.00	$249.57–$8,427.00	—	40%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR Foot Complete min 3 views Left 73630	$318.60	$531.00	$249.57–$8,427.00	—	40%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR Foot Complete Right 73630	$318.60	$531.00	$249.57–$8,427.00	—	40%
X-ray of the hand, 3 or more views both sides CPT 73130 XR Hand Complete Bilateral 73130	$277.20	$462.00	$217.14–$8,427.00	—	40%
X-ray of the hand, 3 or more views CPT 73130 BCE XR Hand, min 3 views 73130	$277.20	$462.00	$217.14–$8,427.00	29% below	40%
X-ray of the hand, 3 or more views one side CPT 73130 XR Hand Complete Left 73130	$277.20	$462.00	$217.14–$8,427.00	29% below	40%
X-ray of the hand, 3 or more views one side CPT 73130 XR Hand Complete Right 73130	$277.20	$462.00	$217.14–$8,427.00	29% below	40%
X-ray of the hand, 3 or more views inpatient both sides CPT 73130 XR Hand Complete Bilateral 73130	$277.20	$462.00	$217.14–$8,427.00	—	40%
X-ray of the hand, 3 or more views inpatient CPT 73130 BCE XR Hand, min 3 views 73130	$277.20	$462.00	$217.14–$8,427.00	—	40%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 XR Hand Complete Right 73130	$277.20	$462.00	$217.14–$8,427.00	—	40%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 XR Hand Complete Left 73130	$277.20	$462.00	$217.14–$8,427.00	—	40%
X-ray of the knee, 1 or 2 views both sides CPT 73560 XR Knee 1 or 2 Views Bilateral 73560	$228.00	$380.00	$178.60–$8,427.00	—	40%
X-ray of the knee, 1 or 2 views CPT 73560 BCE XR Knee, 1 or 2 views 73560	$228.00	$380.00	$178.60–$8,427.00	23% below	40%
X-ray of the knee, 1 or 2 views one side CPT 73560 XR Knee 1 or 2 Views Left 73560	$228.00	$380.00	$178.60–$8,427.00	23% below	40%
X-ray of the knee, 1 or 2 views one side CPT 73560 XR Knee 1 or 2 Views Right 73560	$228.00	$380.00	$178.60–$8,427.00	23% below	40%
X-ray of the knee, 1 or 2 views inpatient both sides CPT 73560 XR Knee 1 or 2 Views Bilateral 73560	$228.00	$380.00	$178.60–$8,427.00	—	40%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 BCE XR Knee, 1 or 2 views 73560	$228.00	$380.00	$178.60–$8,427.00	—	40%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR Knee 1 or 2 Views Left 73560	$228.00	$380.00	$178.60–$8,427.00	—	40%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR Knee 1 or 2 Views Right 73560	$228.00	$380.00	$178.60–$8,427.00	—	40%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XR Spine Lumbosacral 2 or 3 Views 72100	$265.20	$442.00	$207.74–$8,427.00	43% below	40%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 BCE XR Spine, lumbosacral, 2 or 3 views 72100	$265.20	$442.00	$207.74–$8,427.00	43% below	40%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 XR Spine Lumbosacral 2 or 3 Views 72100	$265.20	$442.00	$207.74–$8,427.00	—	40%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 BCE XR Spine, lumbosacral, 2 or 3 views 72100	$265.20	$442.00	$207.74–$8,427.00	—	40%
X-ray of the lower back, 4 or more views CPT 72110 XR Spine Lumbosacral Minimum 4 V 72110	$355.80	$593.00	$278.71–$8,427.00	43% below	40%
X-ray of the lower back, 4 or more views CPT 72110 BCE XR Spine Lumbosacral Min 4 views 72110	$355.80	$593.00	$278.71–$8,427.00	43% below	40%
X-ray of the lower back, 4 or more views inpatient CPT 72110 XR Spine Lumbosacral Minimum 4 V 72110	$355.80	$593.00	$278.71–$8,427.00	—	40%
X-ray of the lower back, 4 or more views inpatient CPT 72110 BCE XR Spine Lumbosacral Min 4 views 72110	$355.80	$593.00	$278.71–$8,427.00	—	40%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 BCE XR Spine Thoracic 2 Views 72070	$234.00	$390.00	$183.30–$8,427.00	42% below	40%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 XR Spine Thoracic 2 Views 72070	$234.00	$390.00	$183.30–$8,427.00	42% below	40%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 XR Spine Thoracic 2 Views 72070	$234.00	$390.00	$183.30–$8,427.00	—	40%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 BCE XR Spine Thoracic 2 Views 72070	$234.00	$390.00	$183.30–$8,427.00	—	40%
X-ray of the nasal bones, 3 or more views CPT 70160 XR Nasal Bones Minimum 3 Views 70160	$184.80	$308.00	$144.76–$8,427.00	37% below	40%
X-ray of the nasal bones, 3 or more views CPT 70160 BCE XR nasal bones, complete, minimum of 3 views 70160	$184.80	$308.00	$144.76–$8,427.00	37% below	40%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 BCE XR nasal bones, complete, minimum of 3 views 70160	$184.80	$308.00	$144.76–$8,427.00	—	40%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 XR Nasal Bones Minimum 3 Views 70160	$184.80	$308.00	$144.76–$8,427.00	—	40%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XR Spine Cervical 2 or 3 Views 72040	$254.40	$424.00	$199.28–$8,427.00	32% below	40%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 BCE XR Spine, cervical; 2 or 3 views 72040	$254.40	$424.00	$199.28–$8,427.00	32% below	40%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 XR Spine Cervical 2 or 3 Views 72040	$254.40	$424.00	$199.28–$8,427.00	—	40%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 BCE XR Spine, cervical; 2 or 3 views 72040	$254.40	$424.00	$199.28–$8,427.00	—	40%
X-ray of the pelvis, 1 or 2 views CPT 72170 BCE XR Pelvis, 1 or 2 views 72170	$223.80	$373.00	$175.31–$8,427.00	40% below	40%
X-ray of the pelvis, 1 or 2 views CPT 72170 XR Pelvis 1 or 2 Views 72170	$223.80	$373.00	$175.31–$8,427.00	40% below	40%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 BCE XR Pelvis, 1 or 2 views 72170	$223.80	$373.00	$175.31–$8,427.00	—	40%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 XR Pelvis 1 or 2 Views 72170	$223.80	$373.00	$175.31–$8,427.00	—	40%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XR Sacrum/Coccyx Minimum 2 Views 72220	$227.40	$379.00	$178.13–$8,427.00	31% below	40%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 BCE XR sacrum/coccyx, minimum of 2 views 72220	$227.40	$379.00	$178.13–$8,427.00	31% below	40%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 XR Sacrum/Coccyx Minimum 2 Views 72220	$227.40	$379.00	$178.13–$8,427.00	—	40%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 BCE XR sacrum/coccyx, minimum of 2 views 72220	$227.40	$379.00	$178.13–$8,427.00	—	40%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Texas	Off list
ACTH blood test CPT 82024 Adrenocorticotropic hormone (ACTH) 82024	$121.20	$202.00	$0.47–$8,427.00	49% below	40%
ACTH blood test inpatient CPT 82024 Adrenocorticotropic hormone (ACTH) 82024	$121.20	$202.00	$0.47–$8,427.00	—	40%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 Alanine Aminotransferase	$99.00	$165.00	$0.47–$8,427.00	68% above	40%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 Alanine Aminotransferase	$99.00	$165.00	$0.47–$8,427.00	—	40%
AST (aspartate aminotransferase) enzyme test CPT 84450 AST	$99.00	$165.00	$0.47–$8,427.00	71% above	40%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 AST	$99.00	$165.00	$0.47–$8,427.00	—	40%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HEP ACUTE PROF	$316.20	$527.00	$0.47–$8,427.00	18% below	40%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HEP ACUTE PROF	$316.20	$527.00	$0.47–$8,427.00	—	40%
Albumin blood test CPT 82040 Albumin Level	$55.80	$93.00	$0.47–$8,427.00	50% above	40%
Albumin blood test inpatient CPT 82040 Albumin Level	$55.80	$93.00	$0.47–$8,427.00	—	40%
Aldosterone blood test CPT 82088 Serum Aldosterone	$107.40	$179.00	$0.47–$8,427.00	26% below	40%
Aldosterone blood test CPT 82088 Aldosterone Urine	$198.60	$331.00	$0.47–$8,427.00	38% above	40%
Aldosterone blood test inpatient CPT 82088 Serum Aldosterone	$107.40	$179.00	$0.47–$8,427.00	—	40%
Aldosterone blood test inpatient CPT 82088 Aldosterone Urine	$198.60	$331.00	$0.47–$8,427.00	—	40%
Alkaline phosphatase (ALP) blood test CPT 84075 Alkaline Phosphatase	$55.80	$93.00	$0.47–$8,427.00	5% below	40%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 Alkaline Phosphatase	$55.80	$93.00	$0.47–$8,427.00	—	40%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLG SPEC IGE CRUDE XTRC	$127.20	$212.00	$0.47–$8,427.00	359% above	40%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen specific IgE; quantitative or semiquantitative, eac	$152.40	$254.00	$0.47–$8,427.00	450% above	40%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLG SPEC IGE CRUDE XTRC	$127.20	$212.00	$0.47–$8,427.00	—	40%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen specific IgE; quantitative or semiquantitative, eac	$152.40	$254.00	$0.47–$8,427.00	—	40%
Alpha-fetoprotein (AFP) blood test CPT 82105 Alpha Fetoprotein Tumor Marker	$174.00	$290.00	$0.47–$8,427.00	42% above	40%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 Alpha Fetoprotein Tumor Marker	$174.00	$290.00	$0.47–$8,427.00	—	40%
Ammonia blood test CPT 82140 Ammonia Level	$121.20	$202.00	$0.47–$8,427.00	17% below	40%
Ammonia blood test inpatient CPT 82140 Ammonia Level	$121.20	$202.00	$0.47–$8,427.00	—	40%
Amylase blood test CPT 82150 Serum Amylase	$152.40	$254.00	$0.47–$8,427.00	55% above	40%
Amylase blood test inpatient CPT 82150 Serum Amylase	$152.40	$254.00	$0.47–$8,427.00	—	40%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Cyclic Citrullinated Peptide	$115.80	$193.00	$0.47–$8,427.00	88% above	40%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 Cyclic Citrullinated Peptide	$115.80	$193.00	$0.47–$8,427.00	—	40%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Antinuclear Antibody Screen	$24.60	$41.00	$0.47–$8,427.00	72% below	40%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Antinuclear Antibody Screen	$24.60	$41.00	$0.47–$8,427.00	—	40%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 Brain Natriuretic Peptide	$448.20	$747.00	$0.47–$8,427.00	141% above	40%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 Brain Natriuretic Peptide	$448.20	$747.00	$0.47–$8,427.00	—	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Cerebrospinal Fluid Culture	$121.20	$202.00	$0.47–$8,427.00	74% above	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CSF Culture	$121.20	$202.00	$0.47–$8,427.00	74% above	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture, bacterial; w/isolation presumptive ID of isolates 87070	$142.20	$237.00	$0.47–$8,427.00	105% above	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Genital Culture.	$142.20	$237.00	$0.47–$8,427.00	105% above	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture, Nasopharyngeal/Nasal 87070	$142.20	$237.00	$0.47–$8,427.00	105% above	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Throat Culture	$142.20	$237.00	$0.47–$8,427.00	105% above	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Aerobic Culture.	$174.00	$290.00	$0.47–$8,427.00	150% above	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Wound Culture	$174.00	$290.00	$0.47–$8,427.00	150% above	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Aerobic Culture	$174.00	$290.00	$0.47–$8,427.00	150% above	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CSF Culture	$121.20	$202.00	$0.47–$8,427.00	—	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Cerebrospinal Fluid Culture	$121.20	$202.00	$0.47–$8,427.00	—	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Genital Culture.	$142.20	$237.00	$0.47–$8,427.00	—	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Throat Culture	$142.20	$237.00	$0.47–$8,427.00	—	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture, bacterial; w/isolation presumptive ID of isolates 87070	$142.20	$237.00	$0.47–$8,427.00	—	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture, Nasopharyngeal/Nasal 87070	$142.20	$237.00	$0.47–$8,427.00	—	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Wound Culture	$174.00	$290.00	$0.47–$8,427.00	—	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Aerobic Culture.	$174.00	$290.00	$0.47–$8,427.00	—	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Aerobic Culture	$174.00	$290.00	$0.47–$8,427.00	—	40%
Basic metabolic panel (blood test) CPT 80048 Basic Metabolic Panel	$121.20	$202.00	$0.47–$8,427.00	50% below	40%
Basic metabolic panel (blood test) inpatient CPT 80048 Basic Metabolic Panel	$121.20	$202.00	$0.47–$8,427.00	—	40%
Bilirubin blood test, total CPT 82247 Bilirubin Total	$55.80	$93.00	$0.47–$8,427.00	17% below	40%
Bilirubin blood test, total CPT 82247 Bilirubin Body Fluid	$215.40	$359.00	$0.47–$8,427.00	221% above	40%
Bilirubin blood test, total inpatient CPT 82247 Bilirubin Total	$55.80	$93.00	$0.47–$8,427.00	—	40%
Bilirubin blood test, total inpatient CPT 82247 Bilirubin Body Fluid	$215.40	$359.00	$0.47–$8,427.00	—	40%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Surgical Pathology Level IV 88305	$276.00	$460.00	$0.47–$8,427.00	7% below	40%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 Surgical Pathology Level IV 88305	$276.00	$460.00	$0.47–$8,427.00	—	40%
Blood culture for bacteria CPT 87040 Blood Culture	$142.20	$237.00	$0.47–$8,427.00	40% below	40%
Blood culture for bacteria CPT 87040 Blood Culture.	$142.20	$237.00	$0.47–$8,427.00	40% below	40%
Blood culture for bacteria inpatient CPT 87040 Blood Culture	$142.20	$237.00	$0.47–$8,427.00	—	40%
Blood culture for bacteria inpatient CPT 87040 Blood Culture.	$142.20	$237.00	$0.47–$8,427.00	—	40%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLLECTION: Venous Draw Charge	$24.60	$41.00	$13.23–$8,427.00	24% above	40%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Venipuncture	$24.60	$41.00	$13.23–$8,427.00	24% above	40%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 ED COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE 36415	$24.60	$41.00	$13.23–$8,427.00	24% above	40%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLLECTION: Venous Draw	$24.60	$41.00	$13.23–$8,427.00	24% above	40%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE 36415	$24.60	$41.00	$13.23–$8,427.00	24% above	40%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE 36415	$24.60	$41.00	$13.23–$8,427.00	—	40%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 ED COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE 36415	$24.60	$41.00	$13.23–$8,427.00	—	40%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 COLLECTION: Venous Draw Charge	$24.60	$41.00	$13.23–$8,427.00	—	40%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Venipuncture	$24.60	$41.00	$13.23–$8,427.00	—	40%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 COLLECTION: Venous Draw	$24.60	$41.00	$13.23–$8,427.00	—	40%
Blood glucose (sugar) test CPT 82947 Glucose Random	$24.60	$41.00	$0.47–$8,427.00	45% below	40%
Blood glucose (sugar) test CPT 82947 Blood Glucose, Capillary	$49.80	$83.00	$0.47–$8,427.00	12% above	40%
Blood glucose (sugar) test inpatient CPT 82947 Glucose Random	$24.60	$41.00	$0.47–$8,427.00	—	40%
Blood glucose (sugar) test inpatient CPT 82947 Blood Glucose, Capillary	$49.80	$83.00	$0.47–$8,427.00	—	40%
Blood lead test CPT 83655 Lead Level	$73.80	$123.00	$0.47–$8,427.00	39% above	40%
Blood lead test inpatient CPT 83655 Lead Level	$73.80	$123.00	$0.47–$8,427.00	—	40%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Beta Human Chorionic Gonadotropin Qualitative	$121.20	$202.00	$0.47–$8,427.00	12% below	40%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 Beta Human Chorionic Gonadotropin Qualitative	$121.20	$202.00	$0.47–$8,427.00	—	40%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO Group by Blood Center 86900	$169.80	$283.00	$0.47–$8,427.00	92% above	40%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO Group by Blood Center 86900	$169.80	$283.00	$0.47–$8,427.00	—	40%
Blood urea nitrogen (BUN) test CPT 84520 BUN	$77.40	$129.00	$0.47–$8,427.00	32% above	40%
Blood urea nitrogen (BUN) test inpatient CPT 84520 BUN	$77.40	$129.00	$0.47–$8,427.00	—	40%
C-peptide blood test CPT 84681 Glucagon Level	$99.00	$165.00	$0.47–$8,427.00	22% above	40%
C-peptide blood test inpatient CPT 84681 Glucagon Level	$99.00	$165.00	$0.47–$8,427.00	—	40%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-Reactive Protein	$87.00	$145.00	$0.47–$8,427.00	49% above	40%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-Reactive Protein	$87.00	$145.00	$0.47–$8,427.00	—	40%
C. difficile toxin gene test (stool PCR) CPT 87493 Infectious agent detection by nucleic acid; Clostridium difficile, toxin gene(s) 87493	$276.00	$460.00	$0.47–$8,427.00	55% above	40%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 Infectious agent detection by nucleic acid; Clostridium difficile, toxin gene(s) 87493	$276.00	$460.00	$0.47–$8,427.00	—	40%
CA 19-9 blood test (tumor marker) CPT 86301 Immunoassay for tumor antigen, quantitative; CA 19-9 86301	$152.40	$254.00	$0.47–$8,427.00	12% above	40%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 Immunoassay for tumor antigen, quantitative; CA 19-9 86301	$152.40	$254.00	$0.47–$8,427.00	—	40%
CA-125 blood test (ovarian cancer marker) CPT 86304 Cancer Antigen 125	$177.00	$295.00	$0.47–$8,427.00	10% above	40%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 Cancer Antigen 125	$177.00	$295.00	$0.47–$8,427.00	—	40%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID-19 PCR	$74.40	$124.00	$0.47–$8,427.00	16% below	40%
COVID-19 PCR test (SARS-CoV-2 lab test) one side CPT 87635 COVID-19 Ql RT-PCR	$74.40	$124.00	$0.47–$8,427.00	16% below	40%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COVID-19 PCR	$74.40	$124.00	$0.47–$8,427.00	—	40%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient one side CPT 87635 COVID-19 Ql RT-PCR	$74.40	$124.00	$0.47–$8,427.00	—	40%
Calcium blood test, total CPT 82310 Calcium	$55.80	$93.00	$0.47–$8,427.00	11% below	40%
Calcium blood test, total inpatient CPT 82310 Calcium	$55.80	$93.00	$0.47–$8,427.00	—	40%
Carcinoembryonic antigen (CEA) test CPT 82378 Carcinoembryonic Antigen	$165.00	$275.00	$0.47–$8,427.00	3% above	40%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 Carcinoembryonic Antigen	$165.00	$275.00	$0.47–$8,427.00	—	40%
Chickenpox (varicella) immunity blood test CPT 86787 Varicella Zoster Antibody	$127.80	$213.00	$0.47–$8,427.00	103% above	40%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 Varicella Zoster Antibody	$127.80	$213.00	$0.47–$8,427.00	—	40%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia Trachomatis Rapid DNA	$279.00	$465.00	$0.47–$8,427.00	121% above	40%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Wet Prep	$283.80	$473.00	$0.47–$8,427.00	125% above	40%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia Trachomatis Rapid DNA	$279.00	$465.00	$0.47–$8,427.00	—	40%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Wet Prep	$283.80	$473.00	$0.47–$8,427.00	—	40%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel	$196.80	$328.00	$0.47–$8,427.00	1% above	40%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel	$196.80	$328.00	$0.47–$8,427.00	—	40%
Complete blood count (CBC) with differential CPT 85025 CBC w/ Auto Diff	$99.00	$165.00	$0.47–$8,427.00	8% above	40%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC w/ Auto Diff	$99.00	$165.00	$0.47–$8,427.00	—	40%
Complete blood count (CBC), no differential CPT 85027 CBC Auto No Diff	$66.00	$110.00	$0.47–$8,427.00	31% below	40%
Complete blood count (CBC), no differential inpatient CPT 85027 CBC Auto No Diff	$66.00	$110.00	$0.47–$8,427.00	—	40%
Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive Metabolic Panel	$152.40	$254.00	$0.47–$8,427.00	49% below	40%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 Comprehensive Metabolic Panel	$152.40	$254.00	$0.47–$8,427.00	—	40%
Cortisol blood test, total CPT 82533 Cortisol Level	$109.80	$183.00	$0.47–$8,427.00	20% above	40%
Cortisol blood test, total inpatient CPT 82533 Cortisol Level	$109.80	$183.00	$0.47–$8,427.00	—	40%
Creatine kinase (CK) blood test, total CPT 82550 Creatine Kinase	$109.80	$183.00	$0.47–$8,427.00	54% above	40%
Creatine kinase (CK) blood test, total inpatient CPT 82550 Creatine Kinase	$109.80	$183.00	$0.47–$8,427.00	—	40%
Creatinine blood test CPT 82565 Creatinine POCT	$91.46	$152.44	$0.47–$8,427.00	51% above	40%
Creatinine blood test CPT 82565 Creatinine	$99.00	$165.00	$0.47–$8,427.00	64% above	40%
Creatinine blood test inpatient CPT 82565 Creatinine POCT	$91.46	$152.44	$0.47–$8,427.00	—	40%
Creatinine blood test inpatient CPT 82565 Creatinine	$99.00	$165.00	$0.47–$8,427.00	—	40%
Cytomegalovirus (CMV) antibody test CPT 86644 Cytomegalovirus Antibody	$96.60	$161.00	$0.47–$8,427.00	25% above	40%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 Cytomegalovirus Antibody	$96.60	$161.00	$0.47–$8,427.00	—	40%
D-dimer blood test (blood clot marker) CPT 85379 D-Dimer	$174.00	$290.00	$0.47–$8,427.00	1% below	40%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-Dimer	$174.00	$290.00	$0.47–$8,427.00	—	40%
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA-Sulfate	$63.60	$106.00	$0.47–$8,427.00	59% below	40%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA-Sulfate	$63.60	$106.00	$0.47–$8,427.00	—	40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Urine Drug Screen G0479	$232.80	$388.00	$0.47–$8,427.00	223% above	40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug test any number of drug classes instrumented chemistry analyzers immunoassay 80307	$232.80	$388.00	$0.47–$8,427.00	223% above	40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Toxicology Drug Screen Urine	$298.80	$498.00	$0.47–$8,427.00	315% above	40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen Urine TC	$298.80	$498.00	$0.47–$8,427.00	315% above	40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Barbiturate Screen Urine	$424.80	$708.00	$0.47–$8,427.00	490% above	40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Urine Drug Screen G0479	$232.80	$388.00	$0.47–$8,427.00	—	40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug test any number of drug classes instrumented chemistry analyzers immunoassay 80307	$232.80	$388.00	$0.47–$8,427.00	—	40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Screen Urine TC	$298.80	$498.00	$0.47–$8,427.00	—	40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Toxicology Drug Screen Urine	$298.80	$498.00	$0.47–$8,427.00	—	40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Barbiturate Screen Urine	$424.80	$708.00	$0.47–$8,427.00	—	40%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 Electrolyte Panel	$87.00	$145.00	$0.47–$8,427.00	55% below	40%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 Electrolyte Panel	$87.00	$145.00	$0.47–$8,427.00	—	40%
Epstein-Barr virus (EBV) antibody test CPT 86665 Antibody; Epstein-Barr virus (VCA) 86665	$123.00	$205.00	$0.47–$8,427.00	28% above	40%
Epstein-Barr virus (EBV) antibody test CPT 86665 Epstein Barr Virus Antibody Panel	$126.00	$210.00	$0.47–$8,427.00	31% above	40%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 Antibody; Epstein-Barr virus (VCA) 86665	$123.00	$205.00	$0.47–$8,427.00	—	40%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 Epstein Barr Virus Antibody Panel	$126.00	$210.00	$0.47–$8,427.00	—	40%
Estradiol blood test CPT 82670 Estradiol	$177.60	$296.00	$0.47–$8,427.00	22% above	40%
Estradiol blood test inpatient CPT 82670 Estradiol	$177.60	$296.00	$0.47–$8,427.00	—	40%
FSH (follicle-stimulating hormone) test CPT 83001 Follicle Stimulating Hormone	$152.40	$254.00	$0.47–$8,427.00	5% below	40%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 Follicle Stimulating Hormone	$152.40	$254.00	$0.47–$8,427.00	—	40%
Fecal calprotectin (stool inflammation test) CPT 83993 Calprotectin	$214.20	$357.00	$0.47–$8,427.00	at median	40%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 Calprotectin	$214.20	$357.00	$0.47–$8,427.00	—	40%
Ferritin blood test (iron stores) CPT 82728 Ferritin	$109.80	$183.00	$0.47–$8,427.00	6% above	40%
Ferritin blood test (iron stores) inpatient CPT 82728 Ferritin	$109.80	$183.00	$0.47–$8,427.00	—	40%
Fibrinogen blood test CPT 85384 Fibrinogen	$130.80	$218.00	$0.47–$8,427.00	43% above	40%
Fibrinogen blood test inpatient CPT 85384 Fibrinogen	$130.80	$218.00	$0.47–$8,427.00	—	40%
Folate (folic acid) blood test CPT 82746 Folate Level	$109.80	$183.00	$0.47–$8,427.00	16% above	40%
Folate (folic acid) blood test inpatient CPT 82746 Folate Level	$109.80	$183.00	$0.47–$8,427.00	—	40%
Free T3 thyroid hormone test CPT 84481 T3 Free	$87.00	$145.00	$0.47–$8,427.00	38% below	40%
Free T3 thyroid hormone test inpatient CPT 84481 T3 Free	$87.00	$145.00	$0.47–$8,427.00	—	40%
Free T4 (free thyroxine) thyroid blood test CPT 84439 Throxine Free	$87.00	$145.00	$0.47–$8,427.00	1% below	40%
Free T4 (free thyroxine) thyroid blood test CPT 84439 Thyroxine Free	$87.00	$145.00	$0.47–$8,427.00	1% below	40%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 Thyroxine Free	$87.00	$145.00	$0.47–$8,427.00	—	40%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 Throxine Free	$87.00	$145.00	$0.47–$8,427.00	—	40%
Free testosterone test CPT 84402 Testosterone Free	$142.20	$237.00	$0.47–$8,427.00	29% above	40%
Free testosterone test inpatient CPT 84402 Testosterone Free	$142.20	$237.00	$0.47–$8,427.00	—	40%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 Gamma Glutamyl Transferase	$55.80	$93.00	$0.47–$8,427.00	13% below	40%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 Gamma Glutamyl Transferase	$55.80	$93.00	$0.47–$8,427.00	—	40%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 GENERAL HEALTH PANEL 80050	$189.43	$315.72	$0.47–$8,427.00	58% below	40%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 GENERAL HEALTH PANEL 80050	$189.43	$315.72	$0.47–$8,427.00	—	40%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae 87591	$283.80	$473.00	$0.47–$8,427.00	101% above	40%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae 87591	$283.80	$473.00	$0.47–$8,427.00	—	40%
H. pylori antibody blood test CPT 86677 Helicobacter Pylori Antibody	$109.80	$183.00	$0.47–$8,427.00	16% below	40%
H. pylori antibody blood test inpatient CPT 86677 Helicobacter Pylori Antibody	$109.80	$183.00	$0.47–$8,427.00	—	40%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV Viral Load	$49.80	$83.00	$0.47–$8,427.00	85% below	40%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV Viral Load	$49.80	$83.00	$0.47–$8,427.00	—	40%
HIV-1 and HIV-2 antibody test CPT 86703 Antibody; HIV-1 and HIV-2, single result 86703	$165.60	$276.00	$0.47–$8,427.00	58% above	40%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 Antibody; HIV-1 and HIV-2, single result 86703	$165.60	$276.00	$0.47–$8,427.00	—	40%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV-1 and HIV-2 87389	$49.80	$83.00	$0.47–$8,427.00	65% below	40%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV-1 and HIV-2 87389	$49.80	$83.00	$0.47–$8,427.00	—	40%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1c	$130.80	$218.00	$0.47–$8,427.00	42% above	40%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hemoglobin A1c	$130.80	$218.00	$0.47–$8,427.00	—	40%
Hemoglobin blood test CPT 85018 zzH&H iSTAT	$22.20	$37.00	$0.47–$8,427.00	53% below	40%
Hemoglobin blood test CPT 85018 Hematocrit w/Hgb Calc POCT	$22.25	$37.08	$0.47–$8,427.00	53% below	40%
Hemoglobin blood test CPT 85018 Hemoglobin	$24.60	$41.00	$0.47–$8,427.00	48% below	40%
Hemoglobin blood test inpatient CPT 85018 zzH&H iSTAT	$22.20	$37.00	$0.47–$8,427.00	—	40%
Hemoglobin blood test inpatient CPT 85018 Hematocrit w/Hgb Calc POCT	$22.25	$37.08	$0.47–$8,427.00	—	40%
Hemoglobin blood test inpatient CPT 85018 Hemoglobin	$24.60	$41.00	$0.47–$8,427.00	—	40%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B Surface Antibody	$99.00	$165.00	$0.47–$8,427.00	50% above	40%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hepatitis B Surface Antibody	$99.00	$165.00	$0.47–$8,427.00	—	40%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hepatitis B Surface Antigen	$99.00	$165.00	$0.47–$8,427.00	27% above	40%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hepatitis B Surface Antigen	$99.00	$165.00	$0.47–$8,427.00	—	40%
Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C Antibody IgM + IgG	$77.40	$129.00	$0.47–$8,427.00	11% below	40%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 Hepatitis C Antibody IgM + IgG	$77.40	$129.00	$0.47–$8,427.00	—	40%
Hepatitis C viral load (HCV RNA) test CPT 87522 Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C 87522	$177.00	$295.00	$0.47–$8,427.00	40% below	40%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C 87522	$177.00	$295.00	$0.47–$8,427.00	—	40%
Herpes blood test, HSV-1 antibody CPT 86695 Antibody; herpes simplex, type 1 86695	$108.60	$181.00	$0.47–$8,427.00	38% above	40%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 Antibody; herpes simplex, type 1 86695	$108.60	$181.00	$0.47–$8,427.00	—	40%
Herpes blood test, HSV-2 antibody CPT 86696 Herpes Simplex Type 2 Antibody	$106.20	$177.00	$0.47–$8,427.00	18% above	40%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 Herpes Simplex Type 2 Antibody	$106.20	$177.00	$0.47–$8,427.00	—	40%
High-sensitivity CRP (hs-CRP) test CPT 86141 C-reactive protein; high sensitivity (hsCRP) 86141	$90.60	$151.00	$0.47–$8,427.00	14% above	40%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-reactive protein; high sensitivity (hsCRP) 86141	$90.60	$151.00	$0.47–$8,427.00	—	40%
Homocysteine blood test CPT 83090 Homocystine Total	$130.80	$218.00	$0.47–$8,427.00	13% below	40%
Homocysteine blood test inpatient CPT 83090 Homocystine Total	$130.80	$218.00	$0.47–$8,427.00	—	40%
Insulin blood test CPT 83525 Insulin Level Total	$43.80	$73.00	$0.47–$8,427.00	48% below	40%
Insulin blood test inpatient CPT 83525 Insulin Level Total	$43.80	$73.00	$0.47–$8,427.00	—	40%
Iron blood test (serum iron) CPT 83540 Total Iron	$108.60	$181.00	$0.47–$8,427.00	25% above	40%
Iron blood test (serum iron) CPT 83540 Iron Level	$108.60	$181.00	$0.47–$8,427.00	25% above	40%
Iron blood test (serum iron) inpatient CPT 83540 Total Iron	$108.60	$181.00	$0.47–$8,427.00	—	40%
Iron blood test (serum iron) inpatient CPT 83540 Iron Level	$108.60	$181.00	$0.47–$8,427.00	—	40%
Iron-binding capacity (TIBC) test CPT 83550 Iron Binding Capacity Total	$66.00	$110.00	$0.47–$8,427.00	33% below	40%
Iron-binding capacity (TIBC) test inpatient CPT 83550 Iron Binding Capacity Total	$66.00	$110.00	$0.47–$8,427.00	—	40%
Kidney function blood test panel CPT 80069 Renal Function Panel	$152.40	$254.00	$0.47–$8,427.00	14% below	40%
Kidney function blood test panel inpatient CPT 80069 Renal Function Panel	$152.40	$254.00	$0.47–$8,427.00	—	40%
LH (luteinizing hormone) test CPT 83002 Luteinizing Hormone	$109.80	$183.00	$0.47–$8,427.00	27% below	40%
LH (luteinizing hormone) test inpatient CPT 83002 Luteinizing Hormone	$109.80	$183.00	$0.47–$8,427.00	—	40%
Lactate (lactic acid) blood test CPT 83605 Lactic Acid POCT	$51.29	$85.49	$0.47–$8,427.00	48% below	40%
Lactate (lactic acid) blood test inpatient CPT 83605 Lactic Acid POCT	$51.29	$85.49	$0.47–$8,427.00	—	40%
Lactate dehydrogenase (LDH) blood test CPT 83615 Lactate Dehydrogenase	$55.80	$93.00	$0.47–$8,427.00	19% above	40%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Lactate Dehydrogenase	$55.80	$93.00	$0.47–$8,427.00	—	40%
Lipase blood test (pancreas enzyme) CPT 83690 Lipase Level	$152.40	$254.00	$0.47–$8,427.00	61% above	40%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase Level	$152.40	$254.00	$0.47–$8,427.00	—	40%
Liver function blood test panel CPT 80076 LIVER	$121.20	$202.00	$0.47–$8,427.00	44% below	40%
Liver function blood test panel CPT 80076 Hepatic Function Panel	$121.20	$202.00	$0.47–$8,427.00	44% below	40%
Liver function blood test panel inpatient CPT 80076 Hepatic Function Panel	$121.20	$202.00	$0.47–$8,427.00	—	40%
Liver function blood test panel inpatient CPT 80076 LIVER	$121.20	$202.00	$0.47–$8,427.00	—	40%
Lyme disease antibody test CPT 86618 LYMES	$142.80	$238.00	$0.47–$8,427.00	73% above	40%
Lyme disease antibody test inpatient CPT 86618 LYMES	$142.80	$238.00	$0.47–$8,427.00	—	40%
Magnesium blood test CPT 83735 Serum Magnesium	$66.00	$110.00	$0.47–$8,427.00	33% above	40%
Magnesium blood test CPT 83735 U Magnesium	$69.60	$116.00	$0.47–$8,427.00	40% above	40%
Magnesium blood test CPT 83735 Magnesium, RBC	$69.60	$116.00	$0.47–$8,427.00	40% above	40%
Magnesium blood test inpatient CPT 83735 Serum Magnesium	$66.00	$110.00	$0.47–$8,427.00	—	40%
Magnesium blood test inpatient CPT 83735 U Magnesium	$69.60	$116.00	$0.47–$8,427.00	—	40%
Magnesium blood test inpatient CPT 83735 Magnesium, RBC	$69.60	$116.00	$0.47–$8,427.00	—	40%
Measles (rubeola) antibody test CPT 86765 Antiboy; rubeola 86765	$54.00	$90.00	$0.47–$8,427.00	47% above	40%
Measles (rubeola) antibody test inpatient CPT 86765 Antiboy; rubeola 86765	$54.00	$90.00	$0.47–$8,427.00	—	40%
Mono test (heterophile antibody, Monospot) CPT 86308 Heterophile antibodies; screening 86308	$109.80	$183.00	$0.47–$8,427.00	29% above	40%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 Heterophile antibodies; screening 86308	$109.80	$183.00	$0.47–$8,427.00	—	40%
Mumps immunity blood test CPT 86735 Antibody; mumps 86735	$75.00	$125.00	$0.47–$8,427.00	22% above	40%
Mumps immunity blood test inpatient CPT 86735 Antibody; mumps 86735	$75.00	$125.00	$0.47–$8,427.00	—	40%
PSA (prostate-specific antigen) blood test, free CPT 84154 Prostate specific antigen (PSA); free 84154	$109.20	$182.00	$0.47–$8,427.00	3% below	40%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 Prostate specific antigen (PSA); free 84154	$109.20	$182.00	$0.47–$8,427.00	—	40%
PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate Specific Antigen	$121.20	$202.00	$0.47–$8,427.00	36% above	40%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Prostate Specific Antigen	$121.20	$202.00	$0.47–$8,427.00	—	40%
Parathyroid hormone (PTH) blood test CPT 83970 iPTH	$196.80	$328.00	$0.47–$8,427.00	9% below	40%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 iPTH	$196.80	$328.00	$0.47–$8,427.00	—	40%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT	$130.80	$218.00	$0.47–$8,427.00	142% above	40%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT	$130.80	$218.00	$0.47–$8,427.00	—	40%
Phosphorus (phosphate) blood test CPT 84100 Phosphorus Level	$55.80	$93.00	$0.47–$8,427.00	11% below	40%
Phosphorus (phosphate) blood test inpatient CPT 84100 Phosphorus Level	$55.80	$93.00	$0.47–$8,427.00	—	40%
Potassium blood test CPT 84132 Potassium Level	$87.00	$145.00	$0.47–$8,427.00	33% above	40%
Potassium blood test inpatient CPT 84132 Potassium Level	$87.00	$145.00	$0.47–$8,427.00	—	40%
Progesterone blood test CPT 84144 Progesterone 84144	$121.20	$202.00	$0.47–$8,427.00	5% above	40%
Progesterone blood test inpatient CPT 84144 Progesterone 84144	$121.20	$202.00	$0.47–$8,427.00	—	40%
Prolactin blood test CPT 84146 Prolactin Level	$152.40	$254.00	$0.47–$8,427.00	31% above	40%
Prolactin blood test inpatient CPT 84146 Prolactin Level	$152.40	$254.00	$0.47–$8,427.00	—	40%
Prothrombin time (PT/INR) clotting test CPT 85610 PT	$77.40	$129.00	$0.47–$8,427.00	64% above	40%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT	$77.40	$129.00	$0.47–$8,427.00	—	40%
Rapid flu test (influenza antigen) CPT 87804 Flu	$55.80	$93.00	$0.47–$8,427.00	41% below	40%
Rapid flu test (influenza antigen) inpatient CPT 87804 Flu	$55.80	$93.00	$0.47–$8,427.00	—	40%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Rapid Strep Test	$31.80	$53.00	$0.47–$8,427.00	68% below	40%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 Rapid Strep Test	$31.80	$53.00	$0.47–$8,427.00	—	40%
Renin blood test CPT 84244 Plasma Renin Act, LC/MS/MS 84244	$97.80	$163.00	$0.47–$8,427.00	5% below	40%
Renin blood test CPT 84244 Plasma Renin Act, LC/MS/MS	$97.80	$163.00	$0.47–$8,427.00	5% below	40%
Renin blood test inpatient CPT 84244 Plasma Renin Act, LC/MS/MS 84244	$97.80	$163.00	$0.47–$8,427.00	—	40%
Renin blood test inpatient CPT 84244 Plasma Renin Act, LC/MS/MS	$97.80	$163.00	$0.47–$8,427.00	—	40%
Rh blood typing CPT 86901 RH Type by Blood Center 86901	$169.80	$283.00	$0.47–$8,427.00	164% above	40%
Rh blood typing inpatient CPT 86901 RH Type by Blood Center 86901	$169.80	$283.00	$0.47–$8,427.00	—	40%
Rheumatoid factor (RF) test CPT 86431 Rheumatoid Factor	$55.80	$93.00	$0.47–$8,427.00	1% above	40%
Rheumatoid factor (RF) test inpatient CPT 86431 Rheumatoid Factor	$55.80	$93.00	$0.47–$8,427.00	—	40%
Rubella antibody test (immunity check) CPT 86762 MMR Titer	$24.60	$41.00	$0.47–$8,427.00	49% below	40%
Rubella antibody test (immunity check) inpatient CPT 86762 MMR Titer	$24.60	$41.00	$0.47–$8,427.00	—	40%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 ESR	$55.80	$93.00	$0.47–$8,427.00	at median	40%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 ESR	$55.80	$93.00	$0.47–$8,427.00	—	40%
Sodium blood test CPT 84295 Sodium Level	$55.80	$93.00	$0.47–$8,427.00	10% below	40%
Sodium blood test inpatient CPT 84295 Sodium Level	$55.80	$93.00	$0.47–$8,427.00	—	40%
Stool ova and parasites exam CPT 87177 Ova and Parasites Exam	$145.80	$243.00	$0.47–$8,427.00	64% above	40%
Stool ova and parasites exam inpatient CPT 87177 Ova and Parasites Exam	$145.80	$243.00	$0.47–$8,427.00	—	40%
Stool test for hidden blood (guaiac FOBT) CPT 82270 Stool for Occult Blood POC	$29.40	$49.00	$0.47–$8,427.00	23% below	40%
Stool test for hidden blood (guaiac FOBT) CPT 82270 Occult Blood Stool	$45.60	$76.00	$0.47–$8,427.00	19% above	40%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Stool for Occult Blood POC	$29.40	$49.00	$0.47–$8,427.00	—	40%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Occult Blood Stool	$45.60	$76.00	$0.47–$8,427.00	—	40%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Rapid Plasma Reagin Test	$109.80	$183.00	$0.47–$8,427.00	109% above	40%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Rapid Plasma Reagin Test	$109.80	$183.00	$0.47–$8,427.00	—	40%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Quantiferon-TB Gold	$216.60	$361.00	$0.47–$8,427.00	6% above	40%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 Quantiferon-TB Gold	$216.60	$361.00	$0.47–$8,427.00	—	40%
Testosterone blood test, total (not free testosterone) CPT 84403 Testost Total	$142.20	$237.00	$0.47–$8,427.00	40% above	40%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testost Total	$142.20	$237.00	$0.47–$8,427.00	—	40%
Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroid Peroxidase Antibodies (TPO)	$108.60	$181.00	$0.47–$8,427.00	21% above	40%
Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroid Anti-Microsomal Antibody	$207.00	$345.00	$0.47–$8,427.00	131% above	40%
Thyroid peroxidase (TPO) antibody test CPT 86376 Microsomal antibodies (eg, thyroid or liver-kidney), each 8	$207.00	$345.00	$0.47–$8,427.00	131% above	40%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Thyroid Peroxidase Antibodies (TPO)	$108.60	$181.00	$0.47–$8,427.00	—	40%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Thyroid Anti-Microsomal Antibody	$207.00	$345.00	$0.47–$8,427.00	—	40%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Microsomal antibodies (eg, thyroid or liver-kidney), each 8	$207.00	$345.00	$0.47–$8,427.00	—	40%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH w/ Rflx Free T4	$196.80	$328.00	$0.47–$8,427.00	60% above	40%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Stimulating Hormone	$196.80	$328.00	$0.47–$8,427.00	60% above	40%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 zzTSH/FT4	$196.80	$328.00	$0.47–$8,427.00	60% above	40%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Stimulating Hormone	$196.80	$328.00	$0.47–$8,427.00	—	40%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH w/ Rflx Free T4	$196.80	$328.00	$0.47–$8,427.00	—	40%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 zzTSH/FT4	$196.80	$328.00	$0.47–$8,427.00	—	40%
Total cholesterol blood test CPT 82465 Cholesterol Total	$55.80	$93.00	$0.47–$8,427.00	17% below	40%
Total cholesterol blood test inpatient CPT 82465 Cholesterol Total	$55.80	$93.00	$0.47–$8,427.00	—	40%
Total thyroxine (T4) blood test CPT 84436 Thyroxine	$84.00	$140.00	$0.47–$8,427.00	4% above	40%
Total thyroxine (T4) blood test CPT 84436 Thyroid Panel Quest	$84.00	$140.00	$0.47–$8,427.00	4% above	40%
Total thyroxine (T4) blood test CPT 84436 Thyroid Panel	$84.00	$140.00	$0.47–$8,427.00	4% above	40%
Total thyroxine (T4) blood test CPT 84436 TOTAL T4	$84.00	$140.00	$0.47–$8,427.00	4% above	40%
Total thyroxine (T4) blood test CPT 84436 Free Thyroxine Index	$87.00	$145.00	$0.47–$8,427.00	8% above	40%
Total thyroxine (T4) blood test inpatient CPT 84436 Thyroid Panel Quest	$84.00	$140.00	$0.47–$8,427.00	—	40%
Total thyroxine (T4) blood test inpatient CPT 84436 TOTAL T4	$84.00	$140.00	$0.47–$8,427.00	—	40%
Total thyroxine (T4) blood test inpatient CPT 84436 Thyroid Panel	$84.00	$140.00	$0.47–$8,427.00	—	40%
Total thyroxine (T4) blood test inpatient CPT 84436 Thyroxine	$84.00	$140.00	$0.47–$8,427.00	—	40%
Total thyroxine (T4) blood test inpatient CPT 84436 Free Thyroxine Index	$87.00	$145.00	$0.47–$8,427.00	—	40%
Total triiodothyronine (T3) blood test CPT 84480 Triiodothyronine Total	$77.40	$129.00	$0.47–$8,427.00	39% below	40%
Total triiodothyronine (T3) blood test CPT 84480 Triiodothyronine	$77.40	$129.00	$0.47–$8,427.00	39% below	40%
Total triiodothyronine (T3) blood test inpatient CPT 84480 Triiodothyronine Total	$77.40	$129.00	$0.47–$8,427.00	—	40%
Total triiodothyronine (T3) blood test inpatient CPT 84480 Triiodothyronine	$77.40	$129.00	$0.47–$8,427.00	—	40%
Trichomonas test (NAAT) CPT 87661 Infectious agent detection by nucleic acid; Trich vaginalis, amplified probe tech 87661	$251.40	$419.00	$0.47–$8,427.00	187% above	40%
Trichomonas test (NAAT) inpatient CPT 87661 Infectious agent detection by nucleic acid; Trich vaginalis, amplified probe tech 87661	$251.40	$419.00	$0.47–$8,427.00	—	40%
Triglycerides blood test CPT 84478 Triglycerides	$45.60	$76.00	$0.47–$8,427.00	48% below	40%
Triglycerides blood test inpatient CPT 84478 Triglycerides	$45.60	$76.00	$0.47–$8,427.00	—	40%
Troponin test, quantitative CPT 84484 Troponin	$196.80	$328.00	$0.47–$8,427.00	45% above	40%
Troponin test, quantitative CPT 84484 Troponin-I	$196.80	$328.00	$0.47–$8,427.00	45% above	40%
Troponin test, quantitative inpatient CPT 84484 Troponin	$196.80	$328.00	$0.47–$8,427.00	—	40%
Troponin test, quantitative inpatient CPT 84484 Troponin-I	$196.80	$328.00	$0.47–$8,427.00	—	40%
Uric acid blood test CPT 84550 Uric Acid	$77.40	$129.00	$0.47–$8,427.00	15% below	40%
Uric acid blood test inpatient CPT 84550 Uric Acid	$77.40	$129.00	$0.47–$8,427.00	—	40%
Urinalysis with microscope exam, automated CPT 81001 Urinalysis With Microscopy	$77.40	$129.00	$0.47–$8,427.00	28% below	40%
Urinalysis with microscope exam, automated inpatient CPT 81001 Urinalysis With Microscopy	$77.40	$129.00	$0.47–$8,427.00	—	40%
Urinalysis without microscope exam, automated CPT 81003 Urine Dipstick POC	$7.80	$13.00	$0.47–$8,427.00	84% below	40%
Urinalysis without microscope exam, automated CPT 81003 Urine Dipstick	$9.60	$16.00	$0.47–$8,427.00	81% below	40%
Urinalysis without microscope exam, automated CPT 81003 Urinalysis	$77.40	$129.00	$0.47–$8,427.00	54% above	40%
Urinalysis without microscope exam, automated inpatient CPT 81003 Urine Dipstick POC	$7.80	$13.00	$0.47–$8,427.00	—	40%
Urinalysis without microscope exam, automated inpatient CPT 81003 Urine Dipstick	$9.60	$16.00	$0.47–$8,427.00	—	40%
Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis	$77.40	$129.00	$0.47–$8,427.00	—	40%
Urinalysis without microscope exam, manual CPT 81002 Urinalysis Macroscopic	$31.80	$53.00	$0.47–$8,427.00	11% below	40%
Urinalysis without microscope exam, manual inpatient CPT 81002 Urinalysis Macroscopic	$31.80	$53.00	$0.47–$8,427.00	—	40%
Urine culture for bacteria, with colony count CPT 87086 Urine Culture	$109.80	$183.00	$0.47–$8,427.00	21% below	40%
Urine culture for bacteria, with colony count CPT 87086 Urine Culture.	$109.80	$183.00	$0.47–$8,427.00	21% below	40%
Urine culture for bacteria, with colony count CPT 87086 Culture, bacterial; quantitative colony count, urine 87086	$109.80	$183.00	$0.47–$8,427.00	21% below	40%
Urine culture for bacteria, with colony count inpatient CPT 87086 Culture, bacterial; quantitative colony count, urine 87086	$109.80	$183.00	$0.47–$8,427.00	—	40%
Urine culture for bacteria, with colony count inpatient CPT 87086 Urine Culture	$109.80	$183.00	$0.47–$8,427.00	—	40%
Urine culture for bacteria, with colony count inpatient CPT 87086 Urine Culture.	$109.80	$183.00	$0.47–$8,427.00	—	40%
Urine microalbumin (albumin) test CPT 82043 Albumin Level 24 Hour Urine	$55.80	$93.00	$0.47–$8,427.00	9% above	40%
Urine microalbumin (albumin) test inpatient CPT 82043 Albumin Level 24 Hour Urine	$55.80	$93.00	$0.47–$8,427.00	—	40%
Urine pregnancy test, read by color change CPT 81025 Urine Pregnancy Test POC	$58.80	$98.00	$0.47–$8,427.00	31% below	40%
Urine pregnancy test, read by color change CPT 81025 Urine Pregnancy Test- Point Of Care	$83.40	$139.00	$0.47–$8,427.00	2% below	40%
Urine pregnancy test, read by color change CPT 81025 Beta Human Chorionic Gonadotropin Qualitative Urine	$87.00	$145.00	$0.47–$8,427.00	2% above	40%
Urine pregnancy test, read by color change inpatient CPT 81025 Urine Pregnancy Test POC	$58.80	$98.00	$0.47–$8,427.00	—	40%
Urine pregnancy test, read by color change inpatient CPT 81025 Urine Pregnancy Test- Point Of Care	$83.40	$139.00	$0.47–$8,427.00	—	40%
Urine pregnancy test, read by color change inpatient CPT 81025 Beta Human Chorionic Gonadotropin Qualitative Urine	$87.00	$145.00	$0.47–$8,427.00	—	40%
Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B12 Level	$77.40	$129.00	$0.47–$8,427.00	15% below	40%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Vitamin B12 Level	$77.40	$129.00	$0.47–$8,427.00	—	40%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D 25 Hydroxy Level	$234.60	$391.00	$0.47–$8,427.00	90% above	40%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VIT D HYDROXY	$234.60	$391.00	$0.47–$8,427.00	90% above	40%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D 25 Hydroxy Level	$234.60	$391.00	$0.47–$8,427.00	—	40%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VIT D HYDROXY	$234.60	$391.00	$0.47–$8,427.00	—	40%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 VIT D 1,25	$270.00	$450.00	$0.47–$8,427.00	62% above	40%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 VIT D 1,25	$270.00	$450.00	$0.47–$8,427.00	—	40%
Zinc blood test CPT 84630 Zinc 84630	$87.00	$145.00	$0.47–$8,427.00	26% above	40%
Zinc blood test inpatient CPT 84630 Zinc 84630	$87.00	$145.00	$0.47–$8,427.00	—	40%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Beta Human Chorionic Gonadotropin Quantitative	$174.00	$290.00	$0.47–$8,427.00	55% above	40%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Beta Human Chorionic Gonadotropin Quantitative	$174.00	$290.00	$0.47–$8,427.00	—	40%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Texas	Off list
Adenoid removal (adenoidectomy), child under 12 CPT 42830 ADENOIDECTOMY UNDER AGE 12 42830	$1,612.20	$2,687.00	$1,477.85–$8,427.00	57% below	40%
Adenoid removal (adenoidectomy), child under 12 inpatient CPT 42830 ADENOIDECTOMY UNDER AGE 12 42830	$1,612.20	$2,687.00	$1,477.85–$8,427.00	—	40%
Anterior cervical discectomy and fusion (ACDF), one level CPT 22551 ARTHRODESIS ANTERIOR INTERBODY CERVICAL BELOW C2 22551	$3,411.00	$5,685.00	$3,126.75–$14,483.00	51% below	40%
Anterior cervical discectomy and fusion (ACDF), one level inpatient CPT 22551 ARTHRODESIS ANTERIOR INTERBODY CERVICAL BELOW C2 22551	$3,411.00	$5,685.00	$3,126.75–$14,483.00	—	40%
Appendectomy for a ruptured appendix with abscess or peritonitis CPT 44960 APPENDECTOMY FOR RUPTURED APPENDIX 44960	$2,017.80	$3,363.00	$1,483.00–$18,989.00	39% below	40%
Appendectomy for a ruptured appendix with abscess or peritonitis inpatient CPT 44960 APPENDECTOMY FOR RUPTURED APPENDIX 44960	$2,017.80	$3,363.00	$1,483.00–$18,989.00	—	40%
Appendectomy, open surgery CPT 44950 APPENDECTOMY INCIDENTAL DURING INTRA-ABDOMINAL SURGERY 44950	$3,411.00	$5,685.00	$3,094.00–$8,427.00	41% below	40%
Appendectomy, open surgery inpatient CPT 44950 APPENDECTOMY INCIDENTAL DURING INTRA-ABDOMINAL SURGERY 44950	$3,411.00	$5,685.00	$3,094.00–$8,427.00	—	40%
Arthroscopic ACL reconstruction or repair of the knee CPT 29888 ARTHROSCOPICALLY AIDED KNEE ANTERIOR CRUCIATE LIGAMENT REPAIR/RECONSTRUCTION 29888	$3,411.00	$5,685.00	$3,126.75–$14,275.00	53% below	40%
Arthroscopic ACL reconstruction or repair of the knee inpatient CPT 29888 ARTHROSCOPICALLY AIDED KNEE ANTERIOR CRUCIATE LIGAMENT REPAIR/RECONSTRUCTION 29888	$3,411.00	$5,685.00	$3,126.75–$14,275.00	—	40%
Arthroscopic rotator cuff repair of the shoulder CPT 29827 ARTHROSCOPY SHOULDER ROTATOR CUFF REPAIR 29827	$3,411.00	$5,685.00	$3,126.75–$14,275.00	41% below	40%
Arthroscopic rotator cuff repair of the shoulder inpatient CPT 29827 ARTHROSCOPY SHOULDER ROTATOR CUFF REPAIR 29827	$3,411.00	$5,685.00	$3,126.75–$14,275.00	—	40%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 ED CLOSED TREATMENT DISTAL FIBULA W/O MANIPULATION	$576.00	$960.00	$528.00–$8,427.00	24% above	40%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 CLOSED TREATMENT DISTAL FIBULA W/O MANIPULATION 27786	$611.40	$1,019.00	$560.45–$8,427.00	31% above	40%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 ED CLOSED TREATMENT DISTAL FIBULA W/O MANIPULATION	$576.00	$960.00	$528.00–$8,427.00	—	40%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 CLOSED TREATMENT DISTAL FIBULA W/O MANIPULATION 27786	$611.40	$1,019.00	$560.45–$8,427.00	—	40%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 ED CLSD TRMT OF METATARSAL FRACTURE; W/O MANIPULATION, EACH	$576.00	$960.00	$109.00–$8,427.00	106% above	40%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 CLOSED TREATMENT OF METATARSAL FRACTURE WITHOUT MANIPULATION 28470	$612.00	$1,020.00	$109.00–$8,427.00	119% above	40%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 ED CLSD TRMT OF METATARSAL FRACTURE; W/O MANIPULATION, EACH	$576.00	$960.00	$109.00–$8,427.00	—	40%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 CLOSED TREATMENT OF METATARSAL FRACTURE WITHOUT MANIPULATION 28470	$612.00	$1,020.00	$109.00–$8,427.00	—	40%
Bunion correction with a bone cut near the head of the first metatarsal CPT 28296 BUNIONECTOMY; W/SESAMOIDECTOMY; W/DISTAL METATARSAL OSTEOTOMY 28296	$2,017.80	$3,363.00	$1,849.65–$8,427.00	52% below	40%
Bunion correction with a bone cut near the head of the first metatarsal inpatient CPT 28296 BUNIONECTOMY; W/SESAMOIDECTOMY; W/DISTAL METATARSAL OSTEOTOMY 28296	$2,017.80	$3,363.00	$1,849.65–$8,427.00	—	40%
Bunion correction with removal of part of the big toe joint CPT 28292 BUNIONECTOMY; W/SESAMOIDECTOMY; W/RESEC. PROXIMAL PHALANX BASE 28292	$2,017.80	$3,363.00	$1,849.65–$8,427.00	51% below	40%
Bunion correction with removal of part of the big toe joint inpatient CPT 28292 BUNIONECTOMY; W/SESAMOIDECTOMY; W/RESEC. PROXIMAL PHALANX BASE 28292	$2,017.80	$3,363.00	$1,849.65–$8,427.00	—	40%
Cardioversion, elective (restoring heart rhythm) CPT 92960 ED Cardioversion, elective, electrical conversion of arrhythmia; external 92960	$646.80	$1,078.00	$1,659.00–$10,356.00	55% below	40%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 ED Cardioversion, elective, electrical conversion of arrhythmia; external 92960	$646.80	$1,078.00	$1,659.00–$10,356.00	—	40%
Carpal tunnel release, open surgery CPT 64721 NEUROPLASTY AND/OR TRANSPOSITION;MEDIAN NERVE AT CARPAL TUNNEL 64721	$2,658.00	$4,430.00	$2,436.50–$8,427.00	21% below	40%
Carpal tunnel release, open surgery inpatient CPT 64721 NEUROPLASTY AND/OR TRANSPOSITION;MEDIAN NERVE AT CARPAL TUNNEL 64721	$2,658.00	$4,430.00	$2,436.50–$8,427.00	—	40%
Cataract surgery with lens implant CPT 66984 EXTRACAPSULAR CATARACT REMOVAL W/INSERTION OF INTRAOCULAR LENS PROSTHESIS REG. 66984	$1,612.20	$2,687.00	$1,477.85–$9,391.00	61% below	40%
Cataract surgery with lens implant inpatient CPT 66984 EXTRACAPSULAR CATARACT REMOVAL W/INSERTION OF INTRAOCULAR LENS PROSTHESIS REG. 66984	$1,612.20	$2,687.00	$1,477.85–$9,391.00	—	40%
Cervical biopsy CPT 57500 BIOPSY OF CERVIX 57500	$1,208.40	$2,014.00	$1,107.70–$8,427.00	at median	40%
Cervical biopsy inpatient CPT 57500 BIOPSY OF CERVIX 57500	$1,208.40	$2,014.00	$1,107.70–$8,427.00	—	40%
Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 CIRCUMCISION-SURGICAL EXCISION-OLDER THAN 28 DAYS 54161	$1,612.20	$2,687.00	$1,477.85–$8,427.00	51% below	40%
Circumcision by surgical excision, older than 28 days (children and adults) inpatient CPT 54161 CIRCUMCISION-SURGICAL EXCISION-OLDER THAN 28 DAYS 54161	$1,612.20	$2,687.00	$1,477.85–$8,427.00	—	40%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION USING CLAMP OR RING BLOCK 54150	$1,612.20	$2,687.00	$1,477.85–$8,427.00	31% above	40%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 CIRCUMCISION USING CLAMP OR RING BLOCK 54150	$1,612.20	$2,687.00	$1,477.85–$8,427.00	—	40%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 ED CLOSED REDUCTION OF DISTAL RADIUS FRACTURE W/O MANIPULATION	$576.00	$960.00	$109.00–$8,427.00	12% above	40%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 CLOSED REDUCTION OF DISTAL RADIUS FRACTURE W/O MANIPULATION 25600	$611.40	$1,019.00	$109.00–$8,427.00	19% above	40%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 ED CLOSED REDUCTION OF DISTAL RADIUS FRACTURE W/O MANIPULATION	$576.00	$960.00	$109.00–$8,427.00	—	40%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 CLOSED REDUCTION OF DISTAL RADIUS FRACTURE W/O MANIPULATION 25600	$611.40	$1,019.00	$109.00–$8,427.00	—	40%
Colonoscopy with polyp removal CPT 45385 COLONOSCOPY FLEXIBLE; WITH REMOVAL OF TUMOR/POLYP/LESION BY SNARE TECHNIQUE 45385	$1,208.40	$2,014.00	$1,107.70–$8,427.00	1% above	40%
Colonoscopy with polyp removal inpatient CPT 45385 COLONOSCOPY FLEXIBLE; WITH REMOVAL OF TUMOR/POLYP/LESION BY SNARE TECHNIQUE 45385	$1,208.40	$2,014.00	$1,107.70–$8,427.00	—	40%
Colonoscopy with tissue sample CPT 45380 COLONOSCOPY FLEXIBLE; WITH BIOPSY; SINGLE OR MULTIPLE 45380	$807.60	$1,346.00	$740.30–$8,427.00	39% below	40%
Colonoscopy with tissue sample inpatient CPT 45380 COLONOSCOPY FLEXIBLE; WITH BIOPSY; SINGLE OR MULTIPLE 45380	$807.60	$1,346.00	$740.30–$8,427.00	—	40%
Colonoscopy, diagnostic CPT 45378 COLONOSCOPY FLEXIBLE; DIAGNOSTIC; INCL. COLLECTION OF SPECIMENS 45378	$807.60	$1,346.00	$740.30–$8,427.00	48% below	40%
Colonoscopy, diagnostic inpatient CPT 45378 COLONOSCOPY FLEXIBLE; DIAGNOSTIC; INCL. COLLECTION OF SPECIMENS 45378	$807.60	$1,346.00	$740.30–$8,427.00	—	40%
Cystoscopy with ureteral stent placement CPT 52332 CYSTOURETHROSCOPY URETERAL STENT INSERTION 52332	$1,612.20	$2,687.00	$1,477.85–$14,275.00	63% below	40%
Cystoscopy with ureteral stent placement inpatient CPT 52332 CYSTOURETHROSCOPY URETERAL STENT INSERTION 52332	$1,612.20	$2,687.00	$1,477.85–$14,275.00	—	40%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOURETHROSCOPY 52000	$1,612.20	$2,687.00	$1,477.85–$8,427.00	40% above	40%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 CYSTOURETHROSCOPY 52000	$1,612.20	$2,687.00	$1,477.85–$8,427.00	—	40%
D&C (dilation and curettage), not related to pregnancy CPT 58120 DILATION AND CURETTAGE; NON-OBSTETRICAL 58120	$807.60	$1,346.00	$740.30–$8,427.00	81% below	40%
D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 DILATION AND CURETTAGE; NON-OBSTETRICAL 58120	$807.60	$1,346.00	$740.30–$8,427.00	—	40%
Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 TYMPANOSTOMY-GENERAL ANESTHESIA 69436	$2,017.80	$3,363.00	$1,659.00–$8,427.00	41% below	40%
Ear tube placement (tympanostomy) under general anesthesia, one ear inpatient CPT 69436 TYMPANOSTOMY-GENERAL ANESTHESIA 69436	$2,017.80	$3,363.00	$1,659.00–$8,427.00	—	40%
Earwax removal by irrigation (rinsing), one ear CPT 69209 ED Removal Impacted Cerumen Using Irrigation/lavage 69209	$784.20	$1,307.00	$109.00–$8,427.00	543% above	40%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE; UNILATERAL 69209	$783.60	$1,306.00	$109.00–$8,427.00	542% above	40%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 ED Removal Impacted Cerumen Using Irrigation/lavage 69209	$784.20	$1,307.00	$109.00–$8,427.00	—	40%
Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE; UNILATERAL 69209	$783.60	$1,306.00	$109.00–$8,427.00	—	40%
Earwax removal with instruments, one ear CPT 69210 ED REMOVAL IMPACTED CERUMEN (SEPARATE PROCEDURE), ONE OR BOTH EARS	$760.20	$1,267.00	$109.00–$8,427.00	376% above	40%
Earwax removal with instruments, one ear one side CPT 69210 REMOVAL IMPACTED CERUMEN W/INST. UNILATERAL 69210	$807.60	$1,346.00	$109.00–$8,427.00	406% above	40%
Earwax removal with instruments, one ear inpatient CPT 69210 ED REMOVAL IMPACTED CERUMEN (SEPARATE PROCEDURE), ONE OR BOTH EARS	$760.20	$1,267.00	$109.00–$8,427.00	—	40%
Earwax removal with instruments, one ear inpatient one side CPT 69210 REMOVAL IMPACTED CERUMEN W/INST. UNILATERAL 69210	$807.60	$1,346.00	$109.00–$8,427.00	—	40%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 ENDOMETRIAL BIOPSY 58100	$1,208.40	$2,014.00	$109.00–$8,427.00	228% above	40%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 ENDOMETRIAL BIOPSY 58100	$1,208.40	$2,014.00	$109.00–$8,427.00	—	40%
Endoscopic sinus surgery: full ethmoid sinus opening CPT 31255 ENDOSCOPY NASAL ETHMOIDECTOMY TOTAL 31255	$2,658.00	$4,430.00	$2,436.50–$9,519.00	48% below	40%
Endoscopic sinus surgery: full ethmoid sinus opening inpatient CPT 31255 ENDOSCOPY NASAL ETHMOIDECTOMY TOTAL 31255	$2,658.00	$4,430.00	$2,436.50–$9,519.00	—	40%
Endoscopic sinus surgery: opening the frontal sinus CPT 31276 NASAL/SINUS ENDOSCOPY W/FRONTAL SINUS EXPLORATION 31276	$2,017.80	$3,363.00	$1,849.65–$14,275.00	60% below	40%
Endoscopic sinus surgery: opening the frontal sinus inpatient CPT 31276 NASAL/SINUS ENDOSCOPY W/FRONTAL SINUS EXPLORATION 31276	$2,017.80	$3,363.00	$1,849.65–$14,275.00	—	40%
Endoscopic sinus surgery: opening the maxillary (cheek) sinus CPT 31256 NASAL/SINUS ENDOSCOPY W/MAXILLARY ANTROSTOMY 31256	$2,017.80	$3,363.00	$1,849.65–$10,356.00	41% below	40%
Endoscopic sinus surgery: opening the maxillary (cheek) sinus inpatient CPT 31256 NASAL/SINUS ENDOSCOPY W/MAXILLARY ANTROSTOMY 31256	$2,017.80	$3,363.00	$1,849.65–$10,356.00	—	40%
Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue CPT 31267 NASAL ENDOSCOPY W/MAXILLARY ANTROSTOMY W/REM.OF TISSUE MAXILLARY SINUS 31267	$2,017.80	$3,363.00	$1,849.65–$14,275.00	59% below	40%
Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue inpatient CPT 31267 NASAL ENDOSCOPY W/MAXILLARY ANTROSTOMY W/REM.OF TISSUE MAXILLARY SINUS 31267	$2,017.80	$3,363.00	$1,849.65–$14,275.00	—	40%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 INJECTION DIAG./THER. SUB. W/NEEDLE OR CATH. CERVICAL/THORACIC W/IMAGE 62321	$1,208.40	$2,014.00	$1,107.70–$8,427.00	16% below	40%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 INJECTION DIAG./THER. SUB. W/NEEDLE OR CATH. CERVICAL/THORACIC W/IMAGE 62321	$1,208.40	$2,014.00	$1,107.70–$8,427.00	—	40%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 INJ DIAGNOSTIC/THERAPEUTIC AGENT PARAVERTEBRAL FACET JOINT W/ IMAGE GUIDANCE LUMBAR/SACRAL 64493	$2,073.60	$3,456.00	$1,659.00–$8,427.00	17% above	40%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 INJ DIAGNOSTIC/THERAPEUTIC AGENT PARAVERTEBRAL FACET JOINT W/ IMAGE GUIDANCE LUMBAR/SACRAL 64493	$2,073.60	$3,456.00	$1,659.00–$8,427.00	—	40%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 REPAIR ANT. ABD. HERNIA INITIAL INC. IMPLANT MESH; 3 CM TO 10 CM 49593	$2,464.80	$4,108.00	$2,259.40–$10,356.00	69% below	40%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm inpatient CPT 49593 REPAIR ANT. ABD. HERNIA INITIAL INC. IMPLANT MESH; 3 CM TO 10 CM 49593	$2,464.80	$4,108.00	$2,259.40–$10,356.00	—	40%
First repair of a front abdominal hernia larger than 10 cm CPT 49595 REPAIR ANT. ABD. HERNIA INITIAL INC. IMPLANT MESH GREATER THAN 10 CM 49595	$2,658.00	$4,430.00	$2,436.50–$8,427.00	71% below	40%
First repair of a front abdominal hernia larger than 10 cm inpatient CPT 49595 REPAIR ANT. ABD. HERNIA INITIAL INC. IMPLANT MESH GREATER THAN 10 CM 49595	$2,658.00	$4,430.00	$2,436.50–$8,427.00	—	40%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 REPAIR ANT. ABD. HERNIA INITIAL INC. IMPLANT MESH LESS THAN 3 CM 49591	$1,612.20	$2,687.00	$1,477.85–$9,519.00	75% below	40%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm inpatient CPT 49591 REPAIR ANT. ABD. HERNIA INITIAL INC. IMPLANT MESH LESS THAN 3 CM 49591	$1,612.20	$2,687.00	$1,477.85–$9,519.00	—	40%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 SIGMOIDOSCOPY FLEXIBLE DIAGNOSTIC W/COLLECTION OF SPECIMENS 45330	$807.60	$1,346.00	$740.30–$8,427.00	12% below	40%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 SIGMOIDOSCOPY FLEXIBLE DIAGNOSTIC W/COLLECTION OF SPECIMENS 45330	$807.60	$1,346.00	$740.30–$8,427.00	—	40%
Gallbladder removal, laparoscopic CPT 47562 CHOLECYSTECTOMY LAPAROSCOPIC 47562	$1,612.20	$2,687.00	$1,477.85–$14,275.00	80% below	40%
Gallbladder removal, laparoscopic inpatient CPT 47562 CHOLECYSTECTOMY LAPAROSCOPIC 47562	$1,612.20	$2,687.00	$1,477.85–$14,275.00	—	40%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 CHOLECYSTECTOMY CHOLANGIOGRAM LAPRASCOPIC 47563	$2,017.80	$3,363.00	$1,849.65–$14,275.00	76% below	40%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery inpatient CPT 47563 CHOLECYSTECTOMY CHOLANGIOGRAM LAPRASCOPIC 47563	$2,017.80	$3,363.00	$1,849.65–$14,275.00	—	40%
Gallbladder removal, open surgery through a larger incision CPT 47600 CHOLECYSTECTOMY 47600	$2,017.80	$3,363.00	$1,483.00–$14,275.00	39% below	40%
Gallbladder removal, open surgery through a larger incision inpatient CPT 47600 CHOLECYSTECTOMY 47600	$2,017.80	$3,363.00	$1,483.00–$14,275.00	—	40%
Hammertoe correction surgery CPT 28285 CORRECTION HAMMER TOE 28285	$1,612.20	$2,687.00	$1,477.85–$8,427.00	54% below	40%
Hammertoe correction surgery inpatient CPT 28285 CORRECTION HAMMER TOE 28285	$1,612.20	$2,687.00	$1,477.85–$8,427.00	—	40%
Hemorrhoid banding (rubber band ligation) CPT 46221 HEMORRHOIDECTOMY INTERNAL BY BANDING 46221	$1,208.40	$2,014.00	$1,107.70–$8,427.00	36% above	40%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 HEMORRHOIDECTOMY INTERNAL BY BANDING 46221	$1,208.40	$2,014.00	$1,107.70–$8,427.00	—	40%
Hemorrhoidectomy (internal and external), one area CPT 46255 HEMORRHOIDECTOMY INTERNAL AND EXTERNAL-SINGLE COLUMN 46255	$2,017.80	$3,363.00	$1,849.65–$8,427.00	45% below	40%
Hemorrhoidectomy (internal and external), one area inpatient CPT 46255 HEMORRHOIDECTOMY INTERNAL AND EXTERNAL-SINGLE COLUMN 46255	$2,017.80	$3,363.00	$1,849.65–$8,427.00	—	40%
Hip replacement after an earlier hip surgery (conversion to total hip) CPT 27132 CONVERSION OF PREVIOUS HIP SURGERY TO TOTAL HIP ARTHROPLASTY W/ OR W/O GRAFT 27132	$2,017.80	$3,363.00	$1,849.65–$18,989.00	44% below	40%
Hip replacement after an earlier hip surgery (conversion to total hip) inpatient CPT 27132 CONVERSION OF PREVIOUS HIP SURGERY TO TOTAL HIP ARTHROPLASTY W/ OR W/O GRAFT 27132	$2,017.80	$3,363.00	$1,849.65–$18,989.00	—	40%
Hysterectomy through an abdominal incision (total) CPT 58150 TOTAL ABDOMINAL HYSTERECTOMY W/ OR W/O REML OF TUBE(S) OR OVARY(S) 58150	$2,658.00	$4,430.00	$1,483.00–$14,275.00	37% below	40%
Hysterectomy through an abdominal incision (total) inpatient CPT 58150 TOTAL ABDOMINAL HYSTERECTOMY W/ OR W/O REML OF TUBE(S) OR OVARY(S) 58150	$2,658.00	$4,430.00	$1,483.00–$14,275.00	—	40%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HYSTEROSALPINGOGRAPHY	$611.40	$1,019.00	$560.45–$8,427.00	63% above	40%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 HYSTEROSALPINGOGRAPHY	$611.40	$1,019.00	$560.45–$8,427.00	—	40%
Hysteroscopy with endometrial ablation CPT 58563 HYSTEROSCOPY WITH ENDOMETRIAL ABLATION 58563	$2,658.00	$4,430.00	$2,436.50–$10,356.00	55% below	40%
Hysteroscopy with endometrial ablation inpatient CPT 58563 HYSTEROSCOPY WITH ENDOMETRIAL ABLATION 58563	$2,658.00	$4,430.00	$2,436.50–$10,356.00	—	40%
Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 HYSTEROSCOPY WITH BIOPSY 58558	$2,017.80	$3,363.00	$1,849.65–$8,427.00	58% below	40%
Hysteroscopy with uterine lining sampling and/or polyp removal inpatient CPT 58558 HYSTEROSCOPY WITH BIOPSY 58558	$2,017.80	$3,363.00	$1,849.65–$8,427.00	—	40%
Incision and drainage of a simple or single skin abscess CPT 10060 ED INCISION AND DRAINAGE SIMPLE 10060	$1,140.00	$1,900.00	$109.00–$8,427.00	144% above	40%
Incision and drainage of a simple or single skin abscess CPT 10060 INCISION AND DRAINAGE SURGERY SIMPLE 10060	$1,208.40	$2,014.00	$109.00–$8,427.00	158% above	40%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 ED INCISION AND DRAINAGE SIMPLE 10060	$1,140.00	$1,900.00	$109.00–$8,427.00	—	40%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 INCISION AND DRAINAGE SURGERY SIMPLE 10060	$1,208.40	$2,014.00	$109.00–$8,427.00	—	40%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 REPAIR INITIAL HERNIA INGUINAL-AGE 5 YEARS OR OLDER-REDUCIBLE 49505	$2,017.80	$3,363.00	$1,849.65–$8,427.00	68% below	40%
Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 REPAIR INITIAL HERNIA INGUINAL-AGE 5 YEARS OR OLDER-REDUCIBLE 49505	$2,017.80	$3,363.00	$1,849.65–$8,427.00	—	40%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 ED TRIGGER POINT INJECTION	$760.20	$1,267.00	$696.85–$8,427.00	72% above	40%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJECTION RECTUS SHEATH 20550	$807.60	$1,346.00	$740.30–$8,427.00	83% above	40%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 ED TRIGGER POINT INJECTION	$760.20	$1,267.00	$696.85–$8,427.00	—	40%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJECTION RECTUS SHEATH 20550	$807.60	$1,346.00	$740.30–$8,427.00	—	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ED ARTHROCENTESIS, ASPIRATION AND/OR INJ, MAJOR JOINT OR BURSA	$760.20	$1,267.00	$696.85–$8,427.00	16% above	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ASPIRATION/INJECTION MAJOR JOINT/BURSA W/O ULTRASOUND GUIDANCE 20610	$807.60	$1,346.00	$740.30–$8,427.00	23% above	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 XR Steroid Injection Bursa 20610	$2,118.00	$3,530.00	$1,105.00–$8,427.00	222% above	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 BCE IR Asp &/or Inj Major Jt or Bursa 20610	$2,118.00	$3,530.00	$1,105.00–$8,427.00	222% above	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ED ARTHROCENTESIS, ASPIRATION AND/OR INJ, MAJOR JOINT OR BURSA	$760.20	$1,267.00	$696.85–$8,427.00	—	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ASPIRATION/INJECTION MAJOR JOINT/BURSA W/O ULTRASOUND GUIDANCE 20610	$807.60	$1,346.00	$740.30–$8,427.00	—	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 XR Steroid Injection Bursa 20610	$2,118.00	$3,530.00	$1,105.00–$8,427.00	—	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 BCE IR Asp &/or Inj Major Jt or Bursa 20610	$2,118.00	$3,530.00	$1,105.00–$8,427.00	—	40%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 INSERTION DRUG DELIVERY IMPLANT 11981	$593.40	$989.00	$109.00–$18,989.00	147% above	40%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 INSERTION DRUG DELIVERY IMPLANT 11981	$593.40	$989.00	$109.00–$18,989.00	—	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ED ASPIRATE/INJECT INTERMEDIATE JNT, BURSA/GANGLION	$576.00	$960.00	$528.00–$8,427.00	2% below	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ASPIRATION INTERMEDIATE JOINT/BURSA W/O ULTRASOUND GUIDANCE 20605	$611.40	$1,019.00	$560.45–$8,427.00	3% above	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ED ASPIRATE/INJECT INTERMEDIATE JNT, BURSA/GANGLION	$576.00	$960.00	$528.00–$8,427.00	—	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ASPIRATION INTERMEDIATE JOINT/BURSA W/O ULTRASOUND GUIDANCE 20605	$611.40	$1,019.00	$560.45–$8,427.00	—	40%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ED STEROID INJECTION JOINT	$576.00	$960.00	$528.00–$8,427.00	32% above	40%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS SMALL JOINT OR BURSA; W/O ULTRASOUND GUIDANCE 20600	$611.40	$1,019.00	$560.45–$8,427.00	40% above	40%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ED STEROID INJECTION JOINT	$576.00	$960.00	$528.00–$8,427.00	—	40%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCENTESIS SMALL JOINT OR BURSA; W/O ULTRASOUND GUIDANCE 20600	$611.40	$1,019.00	$560.45–$8,427.00	—	40%
Knee arthroscopy with meniscus repair (one side of the knee) CPT 29882 ARTHROSCOPY KNEE W/MEDIAL OR LATERAL MENISCAL REPAIR 29882	$2,658.00	$4,430.00	$2,436.50–$14,275.00	54% below	40%
Knee arthroscopy with meniscus repair (one side of the knee) inpatient CPT 29882 ARTHROSCOPY KNEE W/MEDIAL OR LATERAL MENISCAL REPAIR 29882	$2,658.00	$4,430.00	$2,436.50–$14,275.00	—	40%
Knee arthroscopy with meniscus trim CPT 29881 ARTHROSCOPY KNEE W/MEDIAL OR LATERAL MENISCECTOMY 29881	$2,658.00	$4,430.00	$2,436.50–$8,427.00	55% below	40%
Knee arthroscopy with meniscus trim inpatient CPT 29881 ARTHROSCOPY KNEE W/MEDIAL OR LATERAL MENISCECTOMY 29881	$2,658.00	$4,430.00	$2,436.50–$8,427.00	—	40%
Knee arthroscopy with removal of both torn meniscus parts CPT 29880 ARTHROSCOPY KNEE W/MEDIAL AND LATERAL MENISCECTOMY 29880	$2,658.00	$4,430.00	$2,436.50–$8,427.00	53% below	40%
Knee arthroscopy with removal of both torn meniscus parts inpatient CPT 29880 ARTHROSCOPY KNEE W/MEDIAL AND LATERAL MENISCECTOMY 29880	$2,658.00	$4,430.00	$2,436.50–$8,427.00	—	40%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 ARTHROSCOPY KNEE CHONDROPLASTY 29877	$2,658.00	$4,430.00	$2,436.50–$8,427.00	44% below	40%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) inpatient CPT 29877 ARTHROSCOPY KNEE CHONDROPLASTY 29877	$2,658.00	$4,430.00	$2,436.50–$8,427.00	—	40%
Laparoscopic Roux-en-Y gastric bypass, standard limb length CPT 43644 BYPASS GASTRIC LAPAROSCOPIC ROUX-EN-Y 43644	$4,216.20	$7,027.00	$3,864.85–$19,020.00	31% below	40%
Laparoscopic Roux-en-Y gastric bypass, standard limb length inpatient CPT 43644 BYPASS GASTRIC LAPAROSCOPIC ROUX-EN-Y 43644	$4,216.20	$7,027.00	$3,864.85–$19,020.00	—	40%
Laparoscopic adjustable gastric band placement (Lap-Band) CPT 43770 GASTRIC BANDING LAPAROSCOPIC 43770	$3,411.00	$5,685.00	$3,126.75–$19,020.00	53% below	40%
Laparoscopic adjustable gastric band placement (Lap-Band) inpatient CPT 43770 GASTRIC BANDING LAPAROSCOPIC 43770	$3,411.00	$5,685.00	$3,126.75–$19,020.00	—	40%
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 APPENDECTOMY LAPAROSCOPIC 44970	$2,017.80	$3,363.00	$1,849.65–$14,275.00	72% below	40%
Laparoscopic appendectomy (appendix removal through small cuts) inpatient CPT 44970 APPENDECTOMY LAPAROSCOPIC 44970	$2,017.80	$3,363.00	$1,849.65–$14,275.00	—	40%
Laparoscopic fundoplication (anti-reflux surgery) CPT 43280 FUNDOPLICATION LAPAROSCOPIC 43280	$3,411.00	$5,685.00	$3,126.75–$14,275.00	70% below	40%
Laparoscopic fundoplication (anti-reflux surgery) inpatient CPT 43280 FUNDOPLICATION LAPAROSCOPIC 43280	$3,411.00	$5,685.00	$3,126.75–$14,275.00	—	40%
Laparoscopic hysterectomy (uterus 250 g or less) CPT 58570 LAPAROSCOPIC TOTAL HYSTERECTOMY 250 G OR LESS 58570	$2,658.00	$4,430.00	$2,436.50–$14,275.00	68% below	40%
Laparoscopic hysterectomy (uterus 250 g or less) inpatient CPT 58570 LAPAROSCOPIC TOTAL HYSTERECTOMY 250 G OR LESS 58570	$2,658.00	$4,430.00	$2,436.50–$14,275.00	—	40%
Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries CPT 58571 LAP.TOTAL HYST.250 G OR LESS W/REMOVALTUBES/OVARY 58571	$2,972.40	$4,954.00	$2,724.70–$14,275.00	72% below	40%
Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries inpatient CPT 58571 LAP.TOTAL HYST.250 G OR LESS W/REMOVALTUBES/OVARY 58571	$2,972.40	$4,954.00	$2,724.70–$14,275.00	—	40%
Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 REPAIR HERNIA INGUINAL LAPAROSCOPIC-INITIAL 49650	$2,658.00	$4,430.00	$2,436.50–$14,275.00	79% below	40%
Laparoscopic inguinal (groin) hernia repair, first repair on that side inpatient CPT 49650 REPAIR HERNIA INGUINAL LAPAROSCOPIC-INITIAL 49650	$2,658.00	$4,430.00	$2,436.50–$14,275.00	—	40%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 REPAIR HERNIA INGUINAL LAPAROSCOPIC-RECURRENT 49651	$2,658.00	$4,430.00	$2,436.50–$14,275.00	67% below	40%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia inpatient CPT 49651 REPAIR HERNIA INGUINAL LAPAROSCOPIC-RECURRENT 49651	$2,658.00	$4,430.00	$2,436.50–$14,275.00	—	40%
Laparoscopic removal of an adjustable gastric band and its port CPT 43774 REMOVAL GASTRIC BAND LAPAROSCOPIC-COMPONENT AND PORT 43774	$2,658.00	$4,430.00	$2,436.50–$19,020.00	56% below	40%
Laparoscopic removal of an adjustable gastric band and its port inpatient CPT 43774 REMOVAL GASTRIC BAND LAPAROSCOPIC-COMPONENT AND PORT 43774	$2,658.00	$4,430.00	$2,436.50–$19,020.00	—	40%
Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 LAPARASCOPY WITH LYSIS OF ADHESIONS AND REMOVAL OF ADNEXAL STRUCTURES 58661	$2,658.00	$4,430.00	$2,436.50–$14,275.00	69% below	40%
Laparoscopic removal of fallopian tubes and/or ovaries inpatient CPT 58661 LAPARASCOPY WITH LYSIS OF ADHESIONS AND REMOVAL OF ADNEXAL STRUCTURES 58661	$2,658.00	$4,430.00	$2,436.50–$14,275.00	—	40%
Laparoscopic sleeve gastrectomy for weight loss CPT 43775 GASTRECTOMY LAPAROSCOPIC-LONGITUDINAL 43775	$3,411.00	$5,685.00	$3,126.75–$19,020.00	81% below	40%
Laparoscopic sleeve gastrectomy for weight loss inpatient CPT 43775 GASTRECTOMY LAPAROSCOPIC-LONGITUDINAL 43775	$3,411.00	$5,685.00	$3,126.75–$19,020.00	—	40%
Laser treatment of clouding after cataract surgery (YAG) CPT 66821 DISCISSION OF SECONDARY MEMBRANEOUS CATARACT;LASER SURGERY 66821	$2,017.80	$3,363.00	$1,659.00–$8,427.00	52% above	40%
Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 DISCISSION OF SECONDARY MEMBRANEOUS CATARACT;LASER SURGERY 66821	$2,017.80	$3,363.00	$1,659.00–$8,427.00	—	40%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 ED REPAIR WOUND 2.5 CM OR LESS SCALP/AXILLAE, TRUNK/EXTREMITIES EXCLUDING HAND/FOOT 12031	$1,140.00	$1,900.00	$109.00–$8,427.00	114% above	40%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 REPAIR WOUND 2.5 CM OR LESS SCALP/AXILLAE-TRUNK/EXTREMITIES EXCLUDING HAND/FOOT 12031	$1,208.40	$2,014.00	$109.00–$8,427.00	127% above	40%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 ED REPAIR WOUND 2.5 CM OR LESS SCALP/AXILLAE, TRUNK/EXTREMITIES EXCLUDING HAND/FOOT 12031	$1,140.00	$1,900.00	$109.00–$8,427.00	—	40%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 REPAIR WOUND 2.5 CM OR LESS SCALP/AXILLAE-TRUNK/EXTREMITIES EXCLUDING HAND/FOOT 12031	$1,208.40	$2,014.00	$109.00–$8,427.00	—	40%
Lower-back epidural injection, with imaging guidance CPT 62323 INJECTION DIAG./THER. SUB. W/NEEDLE OR CATH. LUMBAR/SACRAL W/IMAGE 62323	$1,208.40	$2,014.00	$1,107.70–$8,427.00	28% below	40%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 INJECTION DIAG./THER. SUB. W/NEEDLE OR CATH. LUMBAR/SACRAL W/IMAGE 62323	$1,208.40	$2,014.00	$1,107.70–$8,427.00	—	40%
Lower-back epidural injection, without imaging guidance CPT 62322 INJECTION DIAG./THER. SUB. W/NEEDLE OR CATH. LUMBAR/SACRAL W/O IMAGE 62322	$1,208.40	$2,014.00	$1,107.70–$8,427.00	4% below	40%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 INJECTION DIAG./THER. SUB. W/NEEDLE OR CATH. LUMBAR/SACRAL W/O IMAGE 62322	$1,208.40	$2,014.00	$1,107.70–$8,427.00	—	40%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJ.ANESTHETIC AGENT AND/OR STEROID; LUMBAR/SACRAL 64483	$1,208.40	$2,014.00	$1,107.70–$8,427.00	18% below	40%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 INJ.ANESTHETIC AGENT AND/OR STEROID; LUMBAR/SACRAL 64483	$1,208.40	$2,014.00	$1,107.70–$8,427.00	—	40%
Lumbar discectomy or laminotomy to free a nerve root, one level CPT 63030 LAMINOTOMY W/DECOMP.OF NERVE ROOTS W/EXCISION OF HERNIATED DISC/LUMBAR 63030	$3,411.00	$5,685.00	$3,126.75–$14,275.00	61% below	40%
Lumbar discectomy or laminotomy to free a nerve root, one level inpatient CPT 63030 LAMINOTOMY W/DECOMP.OF NERVE ROOTS W/EXCISION OF HERNIATED DISC/LUMBAR 63030	$3,411.00	$5,685.00	$3,126.75–$14,275.00	—	40%
Lumbar fusion with interbody cage and posterolateral graft (TLIF), one level CPT 22633 ARTHRODESIS COMB. POSTERIOR INTERBODY TECH . W/LAMI OR DISC SIN. LUM. 22633	$3,411.60	$5,686.00	$1,483.00–$23,180.00	71% below	40%
Lumbar fusion with interbody cage and posterolateral graft (TLIF), one level inpatient CPT 22633 ARTHRODESIS COMB. POSTERIOR INTERBODY TECH . W/LAMI OR DISC SIN. LUM. 22633	$3,411.60	$5,686.00	$1,483.00–$23,180.00	—	40%
Lumbar interbody fusion (PLIF or TLIF), one level CPT 22630 FUSION SPINE LUMBAR TRANSFORAMINAL INTERBODY 22630	$3,411.00	$5,685.00	$1,483.00–$16,185.00	58% below	40%
Lumbar interbody fusion (PLIF or TLIF), one level inpatient CPT 22630 FUSION SPINE LUMBAR TRANSFORAMINAL INTERBODY 22630	$3,411.00	$5,685.00	$1,483.00–$16,185.00	—	40%
Lumbar laminectomy (spinal decompression), one level CPT 63047 LAMINECTOMY FACETECTOMY AND FORAMINOTOMY SINGLE VERTEBRAL SEGMENT;LUMBAR 63047	$3,411.00	$5,685.00	$3,126.75–$14,275.00	62% below	40%
Lumbar laminectomy (spinal decompression), one level inpatient CPT 63047 LAMINECTOMY FACETECTOMY AND FORAMINOTOMY SINGLE VERTEBRAL SEGMENT;LUMBAR 63047	$3,411.00	$5,685.00	$3,126.75–$14,275.00	—	40%
Lumbar spinal fusion (posterior), one level CPT 22612 FUSION SPINE LUMBAR POSTERIOR 22612	$3,411.00	$5,685.00	$3,126.75–$14,483.00	68% below	40%
Lumbar spinal fusion (posterior), one level inpatient CPT 22612 FUSION SPINE LUMBAR POSTERIOR 22612	$3,411.00	$5,685.00	$3,126.75–$14,483.00	—	40%
Lumpectomy (partial mastectomy) CPT 19301 MASTECTOMY PARTIAL 19301	$2,017.80	$3,363.00	$1,849.65–$8,427.00	57% below	40%
Lumpectomy (partial mastectomy) inpatient CPT 19301 MASTECTOMY PARTIAL 19301	$2,017.80	$3,363.00	$1,849.65–$8,427.00	—	40%
Mastectomy (total removal of the breast) CPT 19303 MASTECTOMY SIMPLE 19303	$2,017.80	$3,363.00	$1,849.65–$14,275.00	67% below	40%
Mastectomy (total removal of the breast) inpatient CPT 19303 MASTECTOMY SIMPLE 19303	$2,017.80	$3,363.00	$1,849.65–$14,275.00	—	40%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXCISION BENIGN LESIONTRUNK 0.5CM OR LESS 11400	$1,208.40	$2,014.00	$1,107.70–$8,427.00	50% above	40%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXCISION BENIGN LESIONTRUNK 0.5CM OR LESS 11400	$1,208.40	$2,014.00	$1,107.70–$8,427.00	—	40%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 ED Excision Benign Lesion Facial 0.5cm or less 11440	$1,140.00	$1,900.00	$1,045.00–$8,427.00	28% above	40%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXCISION BENIGN LESION FACIAL 0.5CM OR LESS 11440	$1,208.40	$2,014.00	$1,107.70–$8,427.00	35% above	40%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 ED Excision Benign Lesion Facial 0.5cm or less 11440	$1,140.00	$1,900.00	$1,045.00–$8,427.00	—	40%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 EXCISION BENIGN LESION FACIAL 0.5CM OR LESS 11440	$1,208.40	$2,014.00	$1,107.70–$8,427.00	—	40%
Nail removal (partial or complete), one nail CPT 11730 ED AVULSION OF NAIL PLATE,PARTIAL OR COMPLETE,SIMPLE; SINGLE	$1,519.80	$2,533.00	$109.00–$8,427.00	397% above	40%
Nail removal (partial or complete), one nail CPT 11730 AVULSION NAIL PLATE PARTIAL OR COMPLETE SIMPLE SINGLE 11730	$1,612.20	$2,687.00	$109.00–$8,427.00	428% above	40%
Nail removal (partial or complete), one nail inpatient CPT 11730 ED AVULSION OF NAIL PLATE,PARTIAL OR COMPLETE,SIMPLE; SINGLE	$1,519.80	$2,533.00	$109.00–$8,427.00	—	40%
Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSION NAIL PLATE PARTIAL OR COMPLETE SIMPLE SINGLE 11730	$1,612.20	$2,687.00	$109.00–$8,427.00	—	40%
Occipital nerve block (injection for headaches) CPT 64405 INJECTION ANESTHETIC AGENT/STEROID;GREATER OCCIPITAL NERVE 64405	$1,208.40	$2,014.00	$1,107.70–$8,427.00	183% above	40%
Occipital nerve block (injection for headaches) inpatient CPT 64405 INJECTION ANESTHETIC AGENT/STEROID;GREATER OCCIPITAL NERVE 64405	$1,208.40	$2,014.00	$1,107.70–$8,427.00	—	40%
Open Roux-en-Y gastric bypass through an abdominal incision CPT 43846 BYPASS GASTRIC-ROUX-EN-Y 43846	$3,411.00	$5,685.00	$1,483.00–$19,020.00	1% above	40%
Open Roux-en-Y gastric bypass through an abdominal incision inpatient CPT 43846 BYPASS GASTRIC-ROUX-EN-Y 43846	$3,411.00	$5,685.00	$1,483.00–$19,020.00	—	40%
Paracentesis with imaging guidance CPT 49083 ABDOMINAL PARACENTESIS W/IMAGE GUIDANCE 49083	$1,612.20	$2,687.00	$1,477.85–$8,427.00	1% below	40%
Paracentesis with imaging guidance inpatient CPT 49083 ABDOMINAL PARACENTESIS W/IMAGE GUIDANCE 49083	$1,612.20	$2,687.00	$1,477.85–$8,427.00	—	40%
Partial knee replacement (one compartment) CPT 27446 ARTHROPLASTY KNEE CONDYLE AND PLATEA MEDIAL OR LATERAL COMPARTMENT 27446	$2,658.00	$4,430.00	$2,436.50–$18,989.00	79% below	40%
Partial knee replacement (one compartment) inpatient CPT 27446 ARTHROPLASTY KNEE CONDYLE AND PLATEA MEDIAL OR LATERAL COMPARTMENT 27446	$2,658.00	$4,430.00	$2,436.50–$18,989.00	—	40%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 ED EXCISION OF NAIL AND NAIL MATRIX, PARTIAL OR COMPLETE, (EG, INGROWN OR DEFORMED NAIL) FOR PERMANE	$1,519.80	$2,533.00	$1,393.15–$8,427.00	189% above	40%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION NAIL & MATRIX 11750	$1,612.20	$2,687.00	$1,477.85–$8,427.00	206% above	40%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 ED EXCISION OF NAIL AND NAIL MATRIX, PARTIAL OR COMPLETE, (EG, INGROWN OR DEFORMED NAIL) FOR PERMANE	$1,519.80	$2,533.00	$1,393.15–$8,427.00	—	40%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXCISION NAIL & MATRIX 11750	$1,612.20	$2,687.00	$1,477.85–$8,427.00	—	40%
Prostate biopsy CPT 55700 BIOPSY PROSTATE;NEEDLE OR PUNCTURE 55700	$1,612.20	$2,687.00	$1,477.85–$8,427.00	39% below	40%
Prostate biopsy inpatient CPT 55700 BIOPSY PROSTATE;NEEDLE OR PUNCTURE 55700	$1,612.20	$2,687.00	$1,477.85–$8,427.00	—	40%
Prostate removal (prostatectomy), laparoscopic CPT 55866 LAPARASCOPIC PROSTATECTOMY RETROPUBIC RADICAL 55866	$2,017.80	$3,363.00	$1,849.65–$16,185.00	82% below	40%
Prostate removal (prostatectomy), laparoscopic inpatient CPT 55866 LAPARASCOPIC PROSTATECTOMY RETROPUBIC RADICAL 55866	$2,017.80	$3,363.00	$1,849.65–$16,185.00	—	40%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 DESTRUCTION BY NEUROLYTIC AGT PARARVERT FACET JT W/IMAGE LUM/SAC SINGLE JT 64635	$1,208.40	$2,014.00	$1,107.70–$8,427.00	57% below	40%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 DESTRUCTION BY NEUROLYTIC AGT PARARVERT FACET JT W/IMAGE LUM/SAC SINGLE JT 64635	$1,208.40	$2,014.00	$1,107.70–$8,427.00	—	40%
Removal of a breast lump, open surgery CPT 19120 EXCISION LIPOMA BREAST 19120	$1,612.20	$2,687.00	$1,477.85–$8,427.00	67% below	40%
Removal of a breast lump, open surgery inpatient CPT 19120 EXCISION LIPOMA BREAST 19120	$1,612.20	$2,687.00	$1,477.85–$8,427.00	—	40%
Removal of a foreign object under the skin, simple CPT 10120 ED INCISION AND REMOVAL OF FOREIGN BODY	$936.00	$1,560.00	$109.00–$8,427.00	76% above	40%
Removal of a foreign object under the skin, simple CPT 10120 INCISION AND REMOVAL OF FOREIGN BODY 10120	$993.00	$1,655.00	$109.00–$8,427.00	87% above	40%
Removal of a foreign object under the skin, simple inpatient CPT 10120 ED INCISION AND REMOVAL OF FOREIGN BODY	$936.00	$1,560.00	$109.00–$8,427.00	—	40%
Removal of a foreign object under the skin, simple inpatient CPT 10120 INCISION AND REMOVAL OF FOREIGN BODY 10120	$993.00	$1,655.00	$109.00–$8,427.00	—	40%
Removal of one lobe of the thyroid (lobectomy) one side CPT 60220 TOTAL THYROID LOBECTOMY-UNILATERAL 60220	$2,017.80	$3,363.00	$1,849.65–$8,945.00	75% below	40%
Removal of one lobe of the thyroid (lobectomy) inpatient one side CPT 60220 TOTAL THYROID LOBECTOMY-UNILATERAL 60220	$2,017.80	$3,363.00	$1,849.65–$8,945.00	—	40%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 COLON CANCER SCREEN NOT HIGH RISK G0121	$672.60	$1,121.00	$616.55–$5,101.00	14% below	40%
Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 COLON CANCER SCREEN NOT HIGH RISK G0121	$672.60	$1,121.00	$616.55–$5,101.00	—	40%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 COLORECTAL CANCER SCREEN COLONOSCOPY IND. W/HIGH RISK G0105	$993.00	$1,655.00	$910.25–$5,101.00	1% below	40%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 COLORECTAL CANCER SCREEN COLONOSCOPY IND. W/HIGH RISK G0105	$993.00	$1,655.00	$910.25–$5,101.00	—	40%
Septoplasty to straighten the nasal septum CPT 30520 SEPTOPLASTY OR SUBMUCOUS RESECTION W/ OR W/O CARTILAGE SCORING-CONTOURING-OR GRAFT 30520	$1,612.20	$2,687.00	$1,477.85–$10,356.00	56% below	40%
Septoplasty to straighten the nasal septum inpatient CPT 30520 SEPTOPLASTY OR SUBMUCOUS RESECTION W/ OR W/O CARTILAGE SCORING-CONTOURING-OR GRAFT 30520	$1,612.20	$2,687.00	$1,477.85–$10,356.00	—	40%
Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 LITHOTRIPSY 50590	$6,940.80	$11,568.00	$3,986.00–$14,275.00	4% below	40%
Shock-wave lithotripsy to break up kidney stones (from outside the body) inpatient CPT 50590 LITHOTRIPSY 50590	$6,940.80	$11,568.00	$3,986.00–$14,275.00	—	40%
Short arm cast (elbow to hand) CPT 29075 ED, CAST ELBOW TO FINGER (SHORT ARM) 29075	$199.80	$333.00	$109.00–$10,356.00	28% below	40%
Short arm cast (elbow to hand) CPT 29075 APPLICATION CAST ELBOW TO FINGERS 29075	$212.40	$354.00	$109.00–$10,356.00	23% below	40%
Short arm cast (elbow to hand) inpatient CPT 29075 ED, CAST ELBOW TO FINGER (SHORT ARM) 29075	$199.80	$333.00	$109.00–$10,356.00	—	40%
Short arm cast (elbow to hand) inpatient CPT 29075 APPLICATION CAST ELBOW TO FINGERS 29075	$212.40	$354.00	$109.00–$10,356.00	—	40%
Short arm splint (forearm and hand) CPT 29125 ED APPLICATION SPLINT FOREARM TO HAND	$199.80	$333.00	$109.00–$14,275.00	16% below	40%
Short arm splint (forearm and hand) CPT 29125 APPLICATION SPLINT FOREARM TO HAND-STATIC 29125	$212.40	$354.00	$109.00–$14,275.00	10% below	40%
Short arm splint (forearm and hand) inpatient CPT 29125 ED APPLICATION SPLINT FOREARM TO HAND	$199.80	$333.00	$109.00–$14,275.00	—	40%
Short arm splint (forearm and hand) inpatient CPT 29125 APPLICATION SPLINT FOREARM TO HAND-STATIC 29125	$212.40	$354.00	$109.00–$14,275.00	—	40%
Short leg cast (below the knee) CPT 29405 APPLICATION OF SHORT LEG CAST-BELOW KNEE TO TOES 29405	$212.40	$354.00	$109.00–$8,427.00	37% below	40%
Short leg cast (below the knee) inpatient CPT 29405 APPLICATION OF SHORT LEG CAST-BELOW KNEE TO TOES 29405	$212.40	$354.00	$109.00–$8,427.00	—	40%
Short leg splint (calf to foot) CPT 29515 ED APPLICATION SHORT LEG SPLINT-CALF TO FOOT	$199.80	$333.00	$109.00–$14,275.00	23% below	40%
Short leg splint (calf to foot) CPT 29515 APPLICATION SHORT LEG SPLINT-CALF TO FOOT 29515	$212.40	$354.00	$109.00–$14,275.00	19% below	40%
Short leg splint (calf to foot) inpatient CPT 29515 ED APPLICATION SHORT LEG SPLINT-CALF TO FOOT	$199.80	$333.00	$109.00–$14,275.00	—	40%
Short leg splint (calf to foot) inpatient CPT 29515 APPLICATION SHORT LEG SPLINT-CALF TO FOOT 29515	$212.40	$354.00	$109.00–$14,275.00	—	40%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 ARTHROSCOPY SHOULDER FOR EXCISION OF DISTAL CLAVICLE 29824	$3,411.00	$5,685.00	$3,126.75–$14,275.00	20% below	40%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) inpatient CPT 29824 ARTHROSCOPY SHOULDER FOR EXCISION OF DISTAL CLAVICLE 29824	$3,411.00	$5,685.00	$3,126.75–$14,275.00	—	40%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 ARTHROSCOPY SHOULDER W/SUBACROMIAL DECOMPRESSION/ACROMIOPLASTY 29826	$3,411.00	$5,685.00	$1,105.00–$14,275.00	35% below	40%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 ARTHROSCOPY SHOULDER W/SUBACROMIAL DECOMPRESSION/ACROMIOPLASTY 29826	$3,411.00	$5,685.00	$1,105.00–$14,275.00	—	40%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 ED Simple repair, superficial; 2.5 cm or less 12001	$576.00	$960.00	$109.00–$8,427.00	59% above	40%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 SIMPLE REPAIR WOUNDS SCALP-NECK-AXILLAE-GEITALIA-TRUNK-EXT. 2.5CM OR LESS 12001	$611.40	$1,019.00	$109.00–$8,427.00	69% above	40%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 ED Simple repair, superficial; 2.5 cm or less 12001	$576.00	$960.00	$109.00–$8,427.00	—	40%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 SIMPLE REPAIR WOUNDS SCALP-NECK-AXILLAE-GEITALIA-TRUNK-EXT. 2.5CM OR LESS 12001	$611.40	$1,019.00	$109.00–$8,427.00	—	40%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BIOPSY OF SKIN SINGLE LESION 11104	$592.80	$988.00	$109.00–$8,427.00	30% above	40%
Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BIOPSY OF SKIN SINGLE LESION 11104	$592.80	$988.00	$109.00–$8,427.00	—	40%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 EXC MALIGNANT LESION INCLUDING MARGIN TRUNK/ARM/LEG 0.5CM OR LESS 11600	$1,208.40	$2,014.00	$1,107.70–$8,427.00	1% below	40%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 EXC MALIGNANT LESION INCLUDING MARGIN TRUNK/ARM/LEG 0.5CM OR LESS 11600	$1,208.40	$2,014.00	$1,107.70–$8,427.00	—	40%
Skin tag removal, up to 15 tags CPT 11200 ED REMOVAL SKIN TAGS,MULTIPLE FIBROCUTANEOUS TAGS,ANY AREA, TO 15 TAGS	$760.20	$1,267.00	$109.00–$8,427.00	139% above	40%
Skin tag removal, up to 15 tags CPT 11200 REMOVAL OF SKIN TAGS MULTIPLE FIBROCUTANEOUS ANY AREA UP TO 15 LESIONS 11200	$807.60	$1,346.00	$109.00–$8,427.00	153% above	40%
Skin tag removal, up to 15 tags inpatient CPT 11200 ED REMOVAL SKIN TAGS,MULTIPLE FIBROCUTANEOUS TAGS,ANY AREA, TO 15 TAGS	$760.20	$1,267.00	$109.00–$8,427.00	—	40%
Skin tag removal, up to 15 tags inpatient CPT 11200 REMOVAL OF SKIN TAGS MULTIPLE FIBROCUTANEOUS ANY AREA UP TO 15 LESIONS 11200	$807.60	$1,346.00	$109.00–$8,427.00	—	40%
Spinal tap (lumbar puncture), diagnostic CPT 62270 ED Spinal puncture, lumbar, diagnostic 62270	$936.00	$1,560.00	$858.00–$8,427.00	10% below	40%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL PUNCTURE LUMBAR DIAGNOSTIC 62270	$993.00	$1,655.00	$910.25–$8,427.00	5% below	40%
Spinal tap (lumbar puncture), diagnostic CPT 62270 BCE IR Lumbar Puncture 62270	$2,118.00	$3,530.00	$1,659.00–$8,427.00	103% above	40%
Spinal tap (lumbar puncture), diagnostic CPT 62270 IR Lumbar Puncture 62270	$2,118.00	$3,530.00	$1,659.00–$8,427.00	103% above	40%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 ED Spinal puncture, lumbar, diagnostic 62270	$936.00	$1,560.00	$858.00–$8,427.00	—	40%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL PUNCTURE LUMBAR DIAGNOSTIC 62270	$993.00	$1,655.00	$910.25–$8,427.00	—	40%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 IR Lumbar Puncture 62270	$2,118.00	$3,530.00	$1,659.00–$8,427.00	—	40%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 BCE IR Lumbar Puncture 62270	$2,118.00	$3,530.00	$1,659.00–$8,427.00	—	40%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 ED SIMPLE REPAIR WOUNDS SCALP,NECK,AXILLAE,GEITALIA,TRUNK,EXT. 2.6CM-7.5CM 12002	$576.00	$960.00	$109.00–$8,427.00	26% above	40%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 SIMPLE REPAIR WOUNDS SCALP-NECK-AXILLAE-GENITALIA-TRUNK-EXT. 2.6CM TO 7.5CM 12002	$611.40	$1,019.00	$109.00–$8,427.00	34% above	40%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 ED SIMPLE REPAIR WOUNDS SCALP,NECK,AXILLAE,GEITALIA,TRUNK,EXT. 2.6CM-7.5CM 12002	$576.00	$960.00	$109.00–$8,427.00	—	40%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 SIMPLE REPAIR WOUNDS SCALP-NECK-AXILLAE-GENITALIA-TRUNK-EXT. 2.6CM TO 7.5CM 12002	$611.40	$1,019.00	$109.00–$8,427.00	—	40%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 ED SIMPLE REPAIR OF WOUNDS-FACIAL, EARS, MUCOUS MEMBRANES 2.5CM OR LESS	$576.00	$960.00	$109.00–$8,427.00	47% above	40%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 SIMPLE REPAIR OF WOUNDS-FACIAL-EARS-MUCOUS MEMBRANES 2.5CM OR LESS 12011	$611.40	$1,019.00	$109.00–$8,427.00	57% above	40%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 ED SIMPLE REPAIR OF WOUNDS-FACIAL, EARS, MUCOUS MEMBRANES 2.5CM OR LESS	$576.00	$960.00	$109.00–$8,427.00	—	40%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 SIMPLE REPAIR OF WOUNDS-FACIAL-EARS-MUCOUS MEMBRANES 2.5CM OR LESS 12011	$611.40	$1,019.00	$109.00–$8,427.00	—	40%
TURP (transurethral resection of the prostate) CPT 52601 CYSTOURETHROSCOPY WITH TRANSURETHRAL PROSTATECTOMY 52601	$2,658.00	$4,430.00	$2,436.50–$8,427.00	62% below	40%
TURP (transurethral resection of the prostate) inpatient CPT 52601 CYSTOURETHROSCOPY WITH TRANSURETHRAL PROSTATECTOMY 52601	$2,658.00	$4,430.00	$2,436.50–$8,427.00	—	40%
Thoracentesis with imaging guidance CPT 32555 THORACENTESIS NEEDLE OR CATHETER ASPIRATION OF PLEURAL SPACE W/IMAGE 32555	$993.00	$1,655.00	$910.25–$8,427.00	30% below	40%
Thoracentesis with imaging guidance inpatient CPT 32555 THORACENTESIS NEEDLE OR CATHETER ASPIRATION OF PLEURAL SPACE W/IMAGE 32555	$993.00	$1,655.00	$910.25–$8,427.00	—	40%
Tonsil and adenoid removal, age 12 or older CPT 42821 TONSILLECTOMY AND ADENOIDECTOMY AGE 12 OR OVER 42821	$1,612.20	$2,687.00	$1,477.85–$8,427.00	57% below	40%
Tonsil and adenoid removal, age 12 or older inpatient CPT 42821 TONSILLECTOMY AND ADENOIDECTOMY AGE 12 OR OVER 42821	$1,612.20	$2,687.00	$1,477.85–$8,427.00	—	40%
Tonsil and adenoid removal, child under 12 CPT 42820 TONSILLECTOMY AND ADENOIDECTOMY UNDER AGE 12 42820	$1,612.20	$2,687.00	$1,477.85–$8,427.00	66% below	40%
Tonsil and adenoid removal, child under 12 inpatient CPT 42820 TONSILLECTOMY AND ADENOIDECTOMY UNDER AGE 12 42820	$1,612.20	$2,687.00	$1,477.85–$8,427.00	—	40%
Tonsil removal (tonsillectomy) only, age 12 or older CPT 42826 TONSILLECTOMY AGE 12 OR OVER 42826	$1,612.20	$2,687.00	$1,477.85–$8,427.00	64% below	40%
Tonsil removal (tonsillectomy) only, age 12 or older inpatient CPT 42826 TONSILLECTOMY AGE 12 OR OVER 42826	$1,612.20	$2,687.00	$1,477.85–$8,427.00	—	40%
Tonsil removal (tonsillectomy) only, child under 12 CPT 42825 TONSILLECTOMY UNDER AGE 12 42825	$1,612.20	$2,687.00	$1,477.85–$8,427.00	65% below	40%
Tonsil removal (tonsillectomy) only, child under 12 inpatient CPT 42825 TONSILLECTOMY UNDER AGE 12 42825	$1,612.20	$2,687.00	$1,477.85–$8,427.00	—	40%
Total hip replacement CPT 27130 ARTHROPLASTY ACETABULAR & PROXIMAL FEMORAL PROSTHETIC REPLACEMENT 27130	$4,216.20	$7,027.00	$3,864.85–$18,989.00	67% below	40%
Total hip replacement inpatient CPT 27130 ARTHROPLASTY ACETABULAR & PROXIMAL FEMORAL PROSTHETIC REPLACEMENT 27130	$4,216.20	$7,027.00	$3,864.85–$18,989.00	—	40%
Total knee replacement CPT 27447 ARTHROPLASTY KNEE CONDYLE & PLATEAU MEDIAL AND LATERAL 27447	$4,216.20	$7,027.00	$3,864.85–$18,989.00	67% below	40%
Total knee replacement inpatient CPT 27447 ARTHROPLASTY KNEE CONDYLE & PLATEAU MEDIAL AND LATERAL 27447	$4,216.20	$7,027.00	$3,864.85–$18,989.00	—	40%
Total shoulder replacement CPT 23472 TOTAL SHOULDER REPLACEMENT 23472	$4,216.20	$7,027.00	$3,864.85–$18,989.00	76% below	40%
Total shoulder replacement inpatient CPT 23472 TOTAL SHOULDER REPLACEMENT 23472	$4,216.20	$7,027.00	$3,864.85–$18,989.00	—	40%
Total thyroid removal (thyroidectomy) CPT 60240 THYROIDECTOMY TOTAL OR COMPLETE 60240	$2,017.80	$3,363.00	$1,849.65–$14,275.00	79% below	40%
Total thyroid removal (thyroidectomy) inpatient CPT 60240 THYROIDECTOMY TOTAL OR COMPLETE 60240	$2,017.80	$3,363.00	$1,849.65–$14,275.00	—	40%
Trigger finger release surgery CPT 26055 TENDON SHEATH INCISION (EG. FOR TRIGGER FINGER) 26055	$1,208.40	$2,014.00	$1,107.70–$8,427.00	64% below	40%
Trigger finger release surgery inpatient CPT 26055 TENDON SHEATH INCISION (EG. FOR TRIGGER FINGER) 26055	$1,208.40	$2,014.00	$1,107.70–$8,427.00	—	40%
Trigger point injections, 1 or 2 muscles CPT 20552 ED INJECTION; SINGLE OR MULTIPLE TRIGGER POINTS, ONE OR TWO MUSCLE GROUPS	$760.20	$1,267.00	$696.85–$8,427.00	32% above	40%
Trigger point injections, 1 or 2 muscles CPT 20552 INJECTION TRIGGER POINT SINGLE 20552	$807.60	$1,346.00	$740.30–$8,427.00	40% above	40%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 ED INJECTION; SINGLE OR MULTIPLE TRIGGER POINTS, ONE OR TWO MUSCLE GROUPS	$760.20	$1,267.00	$696.85–$8,427.00	—	40%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJECTION TRIGGER POINT SINGLE 20552	$807.60	$1,346.00	$740.30–$8,427.00	—	40%
Tubal ligation, laparoscopic (tubes sealed by cautery) CPT 58670 LAPARASCOPY WITH LYSIS OF ADHESIONS AND FULGURATION OF OVIDUCTS 58670	$2,658.00	$4,430.00	$2,436.50–$9,519.00	46% below	40%
Tubal ligation, laparoscopic (tubes sealed by cautery) inpatient CPT 58670 LAPARASCOPY WITH LYSIS OF ADHESIONS AND FULGURATION OF OVIDUCTS 58670	$2,658.00	$4,430.00	$2,436.50–$9,519.00	—	40%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 ESOPHAGOGASTRODUODENOSCOPY BALLOON DILATATION 43249	$993.00	$1,655.00	$910.25–$8,427.00	32% below	40%
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 ESOPHAGOGASTRODUODENOSCOPY BALLOON DILATATION 43249	$993.00	$1,655.00	$910.25–$8,427.00	—	40%
Upper endoscopy (EGD) with biopsy CPT 43239 ESOPHAGOGASTRODUODENOSCOPY W/BIOPSY 43239	$993.00	$1,655.00	$910.25–$8,427.00	32% below	40%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 ESOPHAGOGASTRODUODENOSCOPY W/BIOPSY 43239	$993.00	$1,655.00	$910.25–$8,427.00	—	40%
Upper endoscopy (EGD) with injection into the lining CPT 43236 ESOPHAGOGASTRODUODENOSCOPY; FLEXIBLE W/SUBMUCOSAL INJ. 43236	$993.00	$1,655.00	$910.25–$8,427.00	36% above	40%
Upper endoscopy (EGD) with injection into the lining inpatient CPT 43236 ESOPHAGOGASTRODUODENOSCOPY; FLEXIBLE W/SUBMUCOSAL INJ. 43236	$993.00	$1,655.00	$910.25–$8,427.00	—	40%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 ESOPHAGOGASTRODUODENOSCOPY; FLEXIBLE W/REMOVAL OF TUMORS/POLYPS/LESIONS BY SNARE 43251	$993.60	$1,656.00	$910.80–$8,427.00	13% below	40%
Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 ESOPHAGOGASTRODUODENOSCOPY; FLEXIBLE W/REMOVAL OF TUMORS/POLYPS/LESIONS BY SNARE 43251	$993.60	$1,656.00	$910.80–$8,427.00	—	40%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 ESOPHAGOGASTRODUODENOSCOPY W/GUIDE WIRE DILATATION 43248	$993.00	$1,655.00	$910.25–$8,427.00	36% above	40%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire inpatient CPT 43248 ESOPHAGOGASTRODUODENOSCOPY W/GUIDE WIRE DILATATION 43248	$993.00	$1,655.00	$910.25–$8,427.00	—	40%
Upper endoscopy (EGD), diagnostic CPT 43235 ESOPHAGOGASTRODUODENOSCOPY; FLEXIBLE DIAGNOSTIC 43235	$993.00	$1,655.00	$910.25–$8,427.00	32% below	40%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 ESOPHAGOGASTRODUODENOSCOPY; FLEXIBLE DIAGNOSTIC 43235	$993.00	$1,655.00	$910.25–$8,427.00	—	40%
Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 CYSTOURETHROSCOPY W/URETEROSCOPY AND/OR PYELOSCOPY W/LITHOTRIPSY 52353	$2,658.00	$4,430.00	$2,436.50–$14,275.00	64% below	40%
Ureteroscopy with laser stone breaking (lithotripsy) inpatient CPT 52353 CYSTOURETHROSCOPY W/URETEROSCOPY AND/OR PYELOSCOPY W/LITHOTRIPSY 52353	$2,658.00	$4,430.00	$2,436.50–$14,275.00	—	40%
Ureteroscopy with laser stone breaking and stent placement CPT 52356 CYSTOURETHROSCOPY W/URETEROSCOPY/PYELOSCOPY INC. LITHOTRIPSY AND STENT INSERTION 52356	$2,016.60	$3,361.00	$1,848.55–$10,329.00	62% below	40%
Ureteroscopy with laser stone breaking and stent placement inpatient CPT 52356 CYSTOURETHROSCOPY W/URETEROSCOPY/PYELOSCOPY INC. LITHOTRIPSY AND STENT INSERTION 52356	$2,016.60	$3,361.00	$1,848.55–$10,329.00	—	40%
Vasectomy, one or both sides, including follow-up semen testing both sides CPT 55250 VASECTOMY-UNILATERAL OR BILATERAL-INC. POST OP SEMEN EXAMINATION(S) 55250	$1,208.40	$2,014.00	$1,107.70–$8,427.00	—	40%
Vasectomy, one or both sides, including follow-up semen testing inpatient both sides CPT 55250 VASECTOMY-UNILATERAL OR BILATERAL-INC. POST OP SEMEN EXAMINATION(S) 55250	$1,208.40	$2,014.00	$1,107.70–$8,427.00	—	40%
Wart removal, up to 14 warts CPT 17110 DESTRUCTION OF BENIGN LESIONS UP TO 14 LESIONS 17110	$1,208.40	$2,014.00	$109.00–$8,427.00	504% above	40%
Wart removal, up to 14 warts inpatient CPT 17110 DESTRUCTION OF BENIGN LESIONS UP TO 14 LESIONS 17110	$1,208.40	$2,014.00	$109.00–$8,427.00	—	40%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 ED DEBRIDEMENT SKIN AND SUB-Q TISSUE	$1,140.00	$1,900.00	$1,045.00–$8,427.00	13% above	40%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDEMENT SUBCUTANEOUS TISSUE FIRST 20CM OR LESS 11042	$1,208.40	$2,014.00	$1,105.00–$8,427.00	19% above	40%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 ED DEBRIDEMENT SKIN AND SUB-Q TISSUE	$1,140.00	$1,900.00	$1,045.00–$8,427.00	—	40%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDEMENT SUBCUTANEOUS TISSUE FIRST 20CM OR LESS 11042	$1,208.40	$2,014.00	$1,105.00–$8,427.00	—	40%
Wrist fracture surgery (plate and screws), distal radius CPT 25607 OPEN REDUCTION INTERNAL FIXATION RADIUS EXTRA-ARTICULAR 25607	$2,658.00	$4,430.00	$2,436.50–$10,356.00	66% below	40%
Wrist fracture surgery (plate and screws), distal radius inpatient CPT 25607 OPEN REDUCTION INTERNAL FIXATION RADIUS EXTRA-ARTICULAR 25607	$2,658.00	$4,430.00	$2,436.50–$10,356.00	—	40%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Texas	Off list
Blood transfusion (giving blood or blood components) CPT 36430 Transfusion, blood or blood components 36430	$1,308.60	$2,181.00	$1,105.00–$8,427.00	49% above	40%
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION OF BLOOD OR BLOOD COMPONENTS 36430	$1,308.60	$2,181.00	$1,105.00–$8,427.00	49% above	40%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Transfusion, blood or blood components 36430	$1,308.60	$2,181.00	$1,105.00–$8,427.00	—	40%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSION OF BLOOD OR BLOOD COMPONENTS 36430	$1,308.60	$2,181.00	$1,105.00–$8,427.00	—	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT Charges SV -> IPPB subsequent	$97.80	$163.00	$3,986.00–$8,427.00	52% below	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT Charges SV -> IPPB initial	$97.80	$163.00	$3,986.00–$8,427.00	52% below	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 ED PRESSURIZED OR NONPRESSURIZED INHALATION TREATMENT FOR ACUTE AIRWAY OBSTRUCTION	$102.60	$171.00	$3,986.00–$8,427.00	50% below	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 BCE Pressurized or nonpressurized inhalation treatment for acute airway obstruction 94640	$106.20	$177.00	$3,986.00–$8,427.00	48% below	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 BCE SPUTUM INDICATION W/INHALATION TREATMENT 94640	$106.20	$177.00	$3,986.00–$8,427.00	48% below	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction one side CPT 94640 RT Charges - RT -> Each additional treatment (for this date of service) for pre	$81.00	$135.00	$3,986.00–$8,427.00	60% below	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction one side CPT 94640 RT Charges - RT -> Inhalation Treatment Initial	$97.80	$163.00	$3,986.00–$8,427.00	52% below	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction one side CPT 94640 RT Charges - RT -> Pressurized Non-Pressurized Inhalation Treatment	$978.00	$1,630.00	$3,986.00–$8,427.00	381% above	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RT Charges SV -> IPPB subsequent	$97.80	$163.00	$3,986.00–$8,427.00	—	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RT Charges SV -> IPPB initial	$97.80	$163.00	$3,986.00–$8,427.00	—	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 ED PRESSURIZED OR NONPRESSURIZED INHALATION TREATMENT FOR ACUTE AIRWAY OBSTRUCTION	$102.60	$171.00	$3,986.00–$8,427.00	—	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 BCE SPUTUM INDICATION W/INHALATION TREATMENT 94640	$106.20	$177.00	$3,986.00–$8,427.00	—	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 BCE Pressurized or nonpressurized inhalation treatment for acute airway obstruction 94640	$106.20	$177.00	$3,986.00–$8,427.00	—	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient one side CPT 94640 RT Charges - RT -> Each additional treatment (for this date of service) for pre	$81.00	$135.00	$3,986.00–$8,427.00	—	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient one side CPT 94640 RT Charges - RT -> Inhalation Treatment Initial	$97.80	$163.00	$3,986.00–$8,427.00	—	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient one side CPT 94640 RT Charges - RT -> Pressurized Non-Pressurized Inhalation Treatment	$978.00	$1,630.00	$3,986.00–$8,427.00	—	40%
Critical care, first 30 to 74 minutes CPT 99291 ED Critical Care, eval & mgmt of critically injured pt, 99291	$1,493.40	$2,489.00	$3,840.00–$8,427.00	42% below	40%
Critical care, first 30 to 74 minutes inpatient CPT 99291 ED Critical Care, eval & mgmt of critically injured pt, 99291	$1,493.40	$2,489.00	$3,840.00–$8,427.00	—	40%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 12 Lead EKG 93005	$117.60	$196.00	$92.12–$8,427.00	59% below	40%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 12 Lead EKG w/o interp 93005	$117.60	$196.00	$92.12–$8,427.00	59% below	40%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 BCE EKG, at least 12 leads, tracing only 93005	$120.00	$200.00	$94.00–$8,427.00	58% below	40%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge one side CPT 93005 RT Charges - RT -> EKG	$151.80	$253.00	$118.91–$8,427.00	47% below	40%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 12 Lead EKG 93005	$117.60	$196.00	$92.12–$8,427.00	—	40%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 12 Lead EKG w/o interp 93005	$117.60	$196.00	$92.12–$8,427.00	—	40%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 BCE EKG, at least 12 leads, tracing only 93005	$120.00	$200.00	$94.00–$8,427.00	—	40%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient one side CPT 93005 RT Charges - RT -> EKG	$151.80	$253.00	$118.91–$8,427.00	—	40%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ED Visit Level 1	$294.00	$490.00	$202.00–$8,427.00	12% above	40%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ED Visit Level 1	$294.00	$490.00	$202.00–$8,427.00	—	40%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ED Visit Level 2	$516.00	$860.00	$432.00–$8,427.00	10% above	40%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ED Visit Level 2	$516.00	$860.00	$432.00–$8,427.00	—	40%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ED Visit Level 3	$1,101.00	$1,835.00	$917.00–$8,427.00	34% above	40%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ED Visit Level 3	$1,101.00	$1,835.00	$917.00–$8,427.00	—	40%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ED Visit Level 4	$2,175.00	$3,625.00	$1,820.00–$8,427.00	66% above	40%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ED Visit Level 4	$2,175.00	$3,625.00	$1,820.00–$8,427.00	—	40%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ED Visit Level 5	$4,601.40	$7,669.00	$2,457.00–$8,427.00	129% above	40%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ED Visit Level 5	$4,601.40	$7,669.00	$2,457.00–$8,427.00	—	40%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Intravenous infusion, hydration; initial, 31 minutes to 1 hour 96360	$213.60	$356.00	$3,986.00–$8,427.00	52% below	40%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 ED IV INFUSION HYDRATION, INITIAL 31 MINUTES TO 1 HOUR	$215.40	$359.00	$3,986.00–$8,427.00	52% below	40%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 Intravenous infusion, hydration; initial, 31 minutes to 1 hour 96360	$213.60	$356.00	$3,986.00–$8,427.00	—	40%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 ED IV INFUSION HYDRATION, INITIAL 31 MINUTES TO 1 HOUR	$215.40	$359.00	$3,986.00–$8,427.00	—	40%
IV infusion of a medicine, first hour CPT 96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour 96365	$213.60	$356.00	$3,986.00–$8,427.00	54% below	40%
IV infusion of a medicine, first hour CPT 96365 ED IV INFUSION, FOR THERAPY, PROPHYLAXIS, OR DIAGNOSIS ; INITIAL, UP TO 1	$215.40	$359.00	$3,986.00–$8,427.00	54% below	40%
IV infusion of a medicine, first hour CPT 96365 INTRAVENOUS INFUSION FOR THERAPY PROPHYLAXIS OR DIAGNOSIS INITIAL UP TO 1 HOUR 96365	$228.60	$381.00	$3,986.00–$8,427.00	51% below	40%
IV infusion of a medicine, first hour inpatient CPT 96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour 96365	$213.60	$356.00	$3,986.00–$8,427.00	—	40%
IV infusion of a medicine, first hour inpatient CPT 96365 ED IV INFUSION, FOR THERAPY, PROPHYLAXIS, OR DIAGNOSIS ; INITIAL, UP TO 1	$215.40	$359.00	$3,986.00–$8,427.00	—	40%
IV infusion of a medicine, first hour inpatient CPT 96365 INTRAVENOUS INFUSION FOR THERAPY PROPHYLAXIS OR DIAGNOSIS INITIAL UP TO 1 HOUR 96365	$228.60	$381.00	$3,986.00–$8,427.00	—	40%
IV push of a medicine, first drug CPT 96374 THERAPEUTIC PROPHYLACTIC./DIAG. INJECTION I.V. PUSH SINGLE OR INITIAL SUB./DRUG 96374	$207.60	$346.00	$3,986.00–$8,427.00	10% below	40%
IV push of a medicine, first drug CPT 96374 ED THER/PROPH/DIAG INJ ; IV PUSH, SINGLE OR INITIAL SUBSTANCE/DRUG	$215.40	$359.00	$3,986.00–$8,427.00	7% below	40%
IV push of a medicine, first drug CPT 96374 THERAPEUTIC PROPHY./DIAG. INJECTION I.V. PUSH SINGLE OR INITIAL SUB./DRUG 96374	$229.20	$382.00	$3,986.00–$8,427.00	1% below	40%
IV push of a medicine, first drug inpatient CPT 96374 THERAPEUTIC PROPHYLACTIC./DIAG. INJECTION I.V. PUSH SINGLE OR INITIAL SUB./DRUG 96374	$207.60	$346.00	$3,986.00–$8,427.00	—	40%
IV push of a medicine, first drug inpatient CPT 96374 ED THER/PROPH/DIAG INJ ; IV PUSH, SINGLE OR INITIAL SUBSTANCE/DRUG	$215.40	$359.00	$3,986.00–$8,427.00	—	40%
IV push of a medicine, first drug inpatient CPT 96374 THERAPEUTIC PROPHY./DIAG. INJECTION I.V. PUSH SINGLE OR INITIAL SUB./DRUG 96374	$229.20	$382.00	$3,986.00–$8,427.00	—	40%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THERAPUETIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION SUBCUATANEOUS OR INTRAMSUCULAR 96372	$207.00	$345.00	$3,986.00–$8,427.00	36% above	40%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 ED THERAPUETIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION SUBCUATANEOUS OR INTRAMSUCULAR	$215.40	$359.00	$3,986.00–$8,427.00	42% above	40%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THERAPEUTIC PROPHYLACTIC OR DIAGNOSTIC INJ. SUCUTANEOUS OR INTRAMUSCULAR 96372	$228.60	$381.00	$3,986.00–$8,427.00	50% above	40%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THERAPUETIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION SUBCUATANEOUS OR INTRAMSUCULAR 96372	$207.00	$345.00	$3,986.00–$8,427.00	—	40%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 ED THERAPUETIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION SUBCUATANEOUS OR INTRAMSUCULAR	$215.40	$359.00	$3,986.00–$8,427.00	—	40%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THERAPEUTIC PROPHYLACTIC OR DIAGNOSTIC INJ. SUCUTANEOUS OR INTRAMUSCULAR 96372	$228.60	$381.00	$3,986.00–$8,427.00	—	40%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT Complexity -> High	$85.20	$142.00	$3,986.00–$8,427.00	72% below	40%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 BCE PT Eval, high complexity 97163	$115.20	$192.00	$3,986.00–$8,427.00	62% below	40%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT Complexity -> High	$85.20	$142.00	$3,986.00–$8,427.00	—	40%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 BCE PT Eval, high complexity 97163	$115.20	$192.00	$3,986.00–$8,427.00	—	40%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT Complexity -> Low	$85.20	$142.00	$3,986.00–$8,427.00	57% below	40%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 BCE PT Eval, low complexity 97161	$115.20	$192.00	$3,986.00–$8,427.00	43% below	40%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT Complexity -> Low	$85.20	$142.00	$3,986.00–$8,427.00	—	40%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 BCE PT Eval, low complexity 97161	$115.20	$192.00	$3,986.00–$8,427.00	—	40%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT Complexity -> Moderate	$85.20	$142.00	$3,986.00–$8,427.00	66% below	40%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 BCE PT Eval, moderate complexity 97162	$115.20	$192.00	$3,986.00–$8,427.00	54% below	40%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT Complexity -> Moderate	$85.20	$142.00	$3,986.00–$8,427.00	—	40%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 BCE PT Eval, moderate complexity 97162	$115.20	$192.00	$3,986.00–$8,427.00	—	40%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 BCE Manual therapy techniques 97140	$66.00	$110.00	$3,986.00–$8,427.00	41% below	40%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Manual Therapy Charges - PTA	$66.00	$110.00	$3,986.00–$8,427.00	41% below	40%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 Manual Therapy Charges - PTA	$66.00	$110.00	$3,986.00–$8,427.00	—	40%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 BCE Manual therapy techniques 97140	$66.00	$110.00	$3,986.00–$8,427.00	—	40%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exercise Charges	$66.00	$110.00	$3,986.00–$8,427.00	41% below	40%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exercise Charges - PTA	$66.00	$110.00	$3,986.00–$8,427.00	41% below	40%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic Exercise Charges	$66.00	$110.00	$3,986.00–$8,427.00	—	40%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic Exercise Charges - PTA	$66.00	$110.00	$3,986.00–$8,427.00	—	40%
Spirometry (breathing test) CPT 94010 Spirometry w/graphic record, total/timed vital capacity, expiratory flow rate measurement(s), w +w/o	$345.00	$575.00	$3,986.00–$8,427.00	3% below	40%
Spirometry (breathing test) inpatient CPT 94010 Spirometry w/graphic record, total/timed vital capacity, expiratory flow rate measurement(s), w +w/o	$345.00	$575.00	$3,986.00–$8,427.00	—	40%
Therapeutic activities (functional training), 15 minutes CPT 97530 Therapeutic Activities Charge	$66.00	$110.00	$3,986.00–$8,427.00	41% below	40%
Therapeutic activities (functional training), 15 minutes CPT 97530 Therapeutic Activities Charge - PTA	$66.00	$110.00	$3,986.00–$8,427.00	41% below	40%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Therapeutic Activities Charge	$66.00	$110.00	$3,986.00–$8,427.00	—	40%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Therapeutic Activities Charge - PTA	$66.00	$110.00	$3,986.00–$8,427.00	—	40%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Texas	Off list
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETATNUS & DIPHTHERIA TOXIDS, 7 YRS OR OLDER	$59.40	$99.00	$3,986.00–$8,427.00	52% below	40%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETATNUS & DIPHTHERIA TOXIDS, 7 YRS OR OLDER	$59.40	$99.00	$3,986.00–$8,427.00	—	40%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Tetanus/diphtheria/pertuss (Tdap), 7 years or older, intramuscular use 90715	$60.60	$101.00	$3,986.00–$8,427.00	60% below	40%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Tetanus/diphtheria/pertuss (Tdap), 7 years or older, intramuscular use 90715	$60.60	$101.00	$3,986.00–$8,427.00	—	40%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ED IMMUNIZATION ADMINISTRATION; ONE VACCINE (SINGLE OR COMBINATION VACCINE/TOXOID)	$82.20	$137.00	$3,986.00–$8,427.00	10% above	40%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ED IMMUNIZATION ADMINISTRATION; ONE VACCINE (SINGLE OR COMBINATION VACCINE/TOXOID)	$82.20	$137.00	$3,986.00–$8,427.00	—	40%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Immunization admin, each add'l vaccine 90472	$60.60	$101.00	$3,986.00–$8,427.00	13% above	40%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Immunization admin, each add'l vaccine 90472	$60.60	$101.00	$3,986.00–$8,427.00	—	40%

Source file: https://mrfs.hyvehealthcare.com/USPI/481260190_trophy-club-medical-center-lp_standardcharges.json