Hospital Lewiston-Auburn, ME

St Mary's Regional Medical Center

St Mary's Regional Medical Center in Lewiston, ME publishes cash prices for 401 common procedures listed here, from its own machine-readable price file updated Apr 1, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Maine median for 225 of 395 procedures and above it for 146. By typical cash price it ranks #11 of 28 Maine hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.

93 Campus Avenue - Po Box 291, Lewiston, ME 04243 Collected Sep 22, 2026 Source price file Check a bill from this hospital (207) 777-8100

Acute care hospital Nonprofit hospital Emergency department CMS star rating 4 of 5 CCN 200034 · CMS hospital register NPI 1447226584

Financial assistance

Nonprofit hospital: it must offer free or discounted care to patients who qualify. How to apply

St Mary's Regional Medical Center is a nonprofit hospital in the CMS register. Under section 501(r) of the federal tax code it must have a written Financial Assistance Policy with a free application, publish both on its website, and charge patients who qualify no more than the amounts generally billed to insured patients for emergency and other medically necessary care. Who qualifies depends on household income; the policy states the limits.

You can apply up to 240 days after the first bill. Before collection actions such as credit reporting or a lawsuit, the hospital must tell you about the policy and wait at least 120 days after that bill. Ask the billing office for the policy and the application before you pay, or search the hospital's website for “financial assistance”. Letters you can copy.

Source: IRS, section 501(r) requirements for nonprofit hospitals.

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Maine	Off list
Abdominal CT scan without and with contrast CPT 74170 HC CT ABD W&W/O CONT	$1,159.38	$3,051.00	—	17% below	62%
Abdominal CT scan without and with contrast inpatient CPT 74170 HC CT ABD W&W/O CONT	$1,159.38	$3,051.00	—	—	62%
Abdominal X-ray, 2 views CPT 74019 HC X-RAY EXAM ABDOMEN 2 VIEWS	$231.80	$610.00	—	5% below	62%
Abdominal X-ray, 2 views inpatient CPT 74019 HC X-RAY EXAM ABDOMEN 2 VIEWS	$231.80	$610.00	—	—	62%
Ankle X-ray, complete, 3 or more views CPT 73610 HC X-RAY ANKLE ROUT 3 VIEWS	$184.30	$485.00	—	13% below	62%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 HC X-RAY ANKLE ROUT 3 VIEWS	$184.30	$485.00	—	—	62%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 HC TCP02/ABI 1-2 LEVELS	$242.44	$638.00	—	66% above	62%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 HC TCP02/ABI 1-2 LEVELS	$242.44	$638.00	—	—	62%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 HC CT UPPER EXTREMITY W/O CONTRAST	$603.82	$1,589.00	—	47% below	62%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 HC CT UPPER EXTREMITY W/O CONTRAST	$603.82	$1,589.00	—	—	62%
Barium swallow (esophagus X-ray with contrast) CPT 74220 HC FLURO ESOPHAGRAM	$338.58	$891.00	—	4% below	62%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 HC FLURO ESOPHAGRAM	$338.58	$891.00	—	—	62%
Bone scan, whole body (nuclear medicine) CPT 78306 HC NM BONE SCAN WHOLE BODY	$787.74	$2,073.00	—	33% below	62%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 HC NM BONE SCAN WHOLE BODY	$787.74	$2,073.00	—	—	62%
Breast ultrasound, limited (one breast or one area) CPT 76642 HC US BREAST LTD	$249.28	$656.00	—	6% above	62%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 HC US BREAST LTD	$249.28	$656.00	—	—	62%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 HC CTA ABD & PELVIS W & W/O CONT	$832.58	$2,191.00	—	46% below	62%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 HC CTA ABD & PELVIS W & W/O CONT	$832.58	$2,191.00	—	—	62%
CT angiography (CTA) of the head CPT 70496 HC CTA HEAD W & W/O CONT	$971.28	$2,556.00	—	37% below	62%
CT angiography (CTA) of the head inpatient CPT 70496 HC CTA HEAD W & W/O CONT	$971.28	$2,556.00	—	—	62%
CT angiography (CTA) of the neck CPT 70498 HC CTA NECK/CAROTID W & W/O CONT	$928.72	$2,444.00	—	41% below	62%
CT angiography (CTA) of the neck inpatient CPT 70498 HC CTA NECK/CAROTID W & W/O CONT	$928.72	$2,444.00	—	—	62%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HC CT ANGIO CHEST W & W/O CONT	$1,026.76	$2,702.00	—	44% below	62%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 HC CT ANGIO CHEST W & W/O CONT	$1,026.76	$2,702.00	—	—	62%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 HC CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM	$142.88	$376.00	—	9% above	62%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 HC CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM	$142.88	$376.00	—	—	62%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 HC CT ABD/PELVIS W/O CONTRAST	$1,387.38	$3,651.00	—	at median	62%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 HC CT ABD/PELVIS W/O CONTRAST	$1,387.38	$3,651.00	—	—	62%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT ABD/PEL W CONT	$1,758.26	$4,627.00	—	12% below	62%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT ABD/PEL W CONT	$1,758.26	$4,627.00	—	—	62%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC CT ABD/PELVIS W W/O CONTRAST	$2,198.68	$5,786.00	—	at median	62%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 HC CT ABD/PELVIS W W/O CONTRAST	$2,198.68	$5,786.00	—	—	62%
CT scan of the abdomen with contrast CPT 74160 HC CT ABDOMEN W/ CONT	$938.98	$2,471.00	—	16% below	62%
CT scan of the abdomen with contrast inpatient CPT 74160 HC CT ABDOMEN W/ CONT	$938.98	$2,471.00	—	—	62%
CT scan of the abdomen without contrast CPT 74150 HC CT ABDOMEN W/O CONT	$679.82	$1,789.00	—	19% below	62%
CT scan of the abdomen without contrast inpatient CPT 74150 HC CT ABDOMEN W/O CONT	$679.82	$1,789.00	—	—	62%
CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT FACIAL BONES W/O CONTRAST	$647.90	$1,705.00	—	26% below	62%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 HC CT FACIAL BONES W/O CONTRAST	$647.90	$1,705.00	—	—	62%
CT scan of the head or brain, no contrast dye CPT 70450 HC CT BRAIN W/O CONTRAST	$601.16	$1,582.00	—	39% below	62%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT BRAIN W/O CONTRAST	$601.16	$1,582.00	—	—	62%
CT scan of the head with contrast CPT 70460 HC CT BRAIN W/ CONTRAST	$714.78	$1,881.00	—	33% below	62%
CT scan of the head with contrast inpatient CPT 70460 HC CT BRAIN W/ CONTRAST	$714.78	$1,881.00	—	—	62%
CT scan of the head without and with contrast CPT 70470 HC CT BRAIN W/WO CONTRAST	$978.88	$2,576.00	—	33% below	62%
CT scan of the head without and with contrast inpatient CPT 70470 HC CT BRAIN W/WO CONTRAST	$978.88	$2,576.00	—	—	62%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 HC CT L-SPINE W/O CONTRAST	$796.48	$2,096.00	—	19% below	62%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 HC CT L-SPINE W/O CONTRAST	$796.48	$2,096.00	—	—	62%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 HC CT C-SPINE W/O CONTRAST	$783.56	$2,062.00	—	20% below	62%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 HC CT C-SPINE W/O CONTRAST	$783.56	$2,062.00	—	—	62%
CT scan of the pelvis, with contrast dye CPT 72193 HC CT PELVIS W/ CONTRAST	$821.18	$2,161.00	—	18% below	62%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT PELVIS W/ CONTRAST	$821.18	$2,161.00	—	—	62%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 HC EXTRACRANIAL BILAT STUDY	$584.44	$1,538.00	—	—	62%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 HC EXTRACRANIAL BILAT STUDY	$584.44	$1,538.00	—	—	62%
Chest X-ray, 2 views CPT 71046 HC X-RAY EXAM CHEST 2 VIEWS	$184.68	$486.00	—	13% below	62%
Chest X-ray, 2 views inpatient CPT 71046 HC X-RAY EXAM CHEST 2 VIEWS	$184.68	$486.00	—	—	62%
Chest X-ray, single view CPT 71045 HC X-RAY EXAM CHEST 1 VIEW	$155.80	$410.00	—	23% below	62%
Chest X-ray, single view inpatient CPT 71045 HC X-RAY EXAM CHEST 1 VIEW	$155.80	$410.00	—	—	62%
Collarbone (clavicle) X-ray, complete CPT 73000 HC X-RAY CLAVICLE	$175.56	$462.00	—	20% below	62%
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 HC X-RAY CLAVICLE	$175.56	$462.00	—	—	62%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HC US RETROPERITONEAL COMPLETE	$405.08	$1,066.00	—	11% below	62%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 HC US RETROPERITONEAL COMPLETE	$405.08	$1,066.00	—	—	62%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 HC DEXA AXIAL SKELETON	$244.34	$643.00	—	3% below	62%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 HC DEXA AXIAL SKELETON	$244.34	$643.00	—	—	62%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 HC DEXA APPENDICULAR SKELETON	$72.20	$190.00	—	55% below	62%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 HC DEXA APPENDICULAR SKELETON	$72.20	$190.00	—	—	62%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 HC US FETAL ANATOMIC EVAL	$413.82	$1,089.00	—	at median	62%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 HC US FETAL ANATOMIC EVAL	$413.82	$1,089.00	—	—	62%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT CHEST W/O CONTRAST	$707.18	$1,861.00	—	25% below	62%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT CHEST W/O CONTRAST	$707.18	$1,861.00	—	—	62%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 HC CT CHEST W/ CONTRAST	$751.26	$1,977.00	—	42% below	62%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 HC CT CHEST W/ CONTRAST	$751.26	$1,977.00	—	—	62%
Diagnostic mammogram, both breasts both sides CPT 77066 HC MAMMO DGX BILATERAL INCL CAD IF PERF	$211.66	$557.00	—	—	62%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC MAMMO DGX BILATERAL INCL CAD IF PERF	$211.66	$557.00	—	—	62%
Diagnostic mammogram, one breast one side CPT 77065 HC MAMMO DGX UNILATERAL INCL CAD IF PERF	$152.76	$402.00	—	3% below	62%
Diagnostic mammogram, one breast inpatient one side CPT 77065 HC MAMMO DGX UNILATERAL INCL CAD IF PERF	$152.76	$402.00	—	—	62%
Duplex ultrasound of the leg arteries, both legs CPT 93925 HC BIL NIV ARTERIAL LOW EXT DUPLEX	$443.08	$1,166.00	—	19% above	62%
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 HC BIL NIV ARTERIAL LOW EXT DUPLEX	$443.08	$1,166.00	—	—	62%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HC NIV VENOUS DUPLEX BILAT STUDY	$513.76	$1,352.00	—	—	62%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 HC NIV VENOUS DUPLEX BILAT STUDY	$513.76	$1,352.00	—	—	62%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC 2D ECHO WITHOUT CONTRAST - WITH DOP/COLOR FLOW	$612.18	$1,611.00	—	44% below	62%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HC 2D ECHO WITHOUT CONTRAST - WITH DOP/COLOR FLOW	$612.18	$1,611.00	—	—	62%
Elbow X-ray, 2 views CPT 73070 HC ELBOW 2 VIEWS	$176.70	$465.00	—	19% below	62%
Elbow X-ray, 2 views inpatient CPT 73070 HC ELBOW 2 VIEWS	$176.70	$465.00	—	—	62%
Elbow X-ray, complete, 3 or more views CPT 73080 HC ELBOW MIN 3 VIEWS	$191.90	$505.00	—	13% below	62%
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 HC ELBOW MIN 3 VIEWS	$191.90	$505.00	—	—	62%
Eye socket (orbit) CT scan without contrast CPT 70480 HC CT ORBIT/EAR/FOSSA W/O CONTRAST	$693.88	$1,826.00	—	29% below	62%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 HC CT ORBIT/EAR/FOSSA W/O CONTRAST	$693.88	$1,826.00	—	—	62%
Facial bones X-ray, complete, 3 or more views CPT 70150 HC FACIAL BONES MIN 3 VIEWS	$254.98	$671.00	—	12% above	62%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 HC FACIAL BONES MIN 3 VIEWS	$254.98	$671.00	—	—	62%
Forearm X-ray (radius and ulna), 2 views CPT 73090 HC FOREARM 2 VIEWS	$176.70	$465.00	—	16% below	62%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 HC FOREARM 2 VIEWS	$176.70	$465.00	—	—	62%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HC NM HEPATOBILIARY IMAGING WO PHARM	$668.80	$1,760.00	—	33% below	62%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HC NM HEPATOBILIARY IMAGING WO PHARM	$668.80	$1,760.00	—	—	62%
Hand X-ray, 2 views CPT 73120 HC HAND 2 VIEWS	$193.42	$509.00	—	9% below	62%
Hand X-ray, 2 views inpatient CPT 73120 HC HAND 2 VIEWS	$193.42	$509.00	—	—	62%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 HC X-RAY OS CALCIS MIN 2 VIEWS	$186.20	$490.00	—	11% below	62%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 HC X-RAY OS CALCIS MIN 2 VIEWS	$186.20	$490.00	—	—	62%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 HC SLEEP STUDY UNATT & RESP EFFT	$446.50	$1,175.00	—	61% above	62%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 HC SLEEP STUDY UNATT & RESP EFFT	$446.50	$1,175.00	—	—	62%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 HC POLYSOM 6/>YRS CPAP 4/> PARM	$475.76	$1,252.00	—	73% below	62%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 HC ADULT CPAP TITRATION STUDY	$1,678.08	$4,416.00	—	4% below	62%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 HC POLYSOM 6/>YRS CPAP 4/> PARM	$475.76	$1,252.00	—	—	62%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 HC ADULT CPAP TITRATION STUDY	$1,678.08	$4,416.00	—	—	62%
Knee X-ray, 3 views CPT 73562 HC X-RAY KNEE 3 VIEWS	$207.10	$545.00	—	9% below	62%
Knee X-ray, 3 views inpatient CPT 73562 HC X-RAY KNEE 3 VIEWS	$207.10	$545.00	—	—	62%
Knee X-ray, complete, 4 or more views CPT 73564 HC X-RAY KNEE ROUT INC TUN PAT MIN 4 VIEW	$252.70	$665.00	—	at median	62%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 HC X-RAY KNEE ROUT INC TUN PAT MIN 4 VIEW	$252.70	$665.00	—	—	62%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 HC CT LOWER EXT W/O CONT	$672.98	$1,771.00	—	36% below	62%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 HC CT LOWER EXT W/O CONT	$672.98	$1,771.00	—	—	62%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US ABDOMINAL LIMITED	$349.22	$919.00	—	43% above	62%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC US ABDOMINAL LIMITED	$349.22	$919.00	—	—	62%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 HC US EXTREM LIMITED NONVASC	$141.36	$372.00	—	15% below	62%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 HC US EXTREM LIMITED NONVASC	$141.36	$372.00	—	—	62%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 HC CT CHEST SCREENING LOW DOSE WOUT CONT	$264.10	$695.00	—	17% above	62%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 HC CT CHEST SCREENING LOW DOSE WOUT CONT	$264.10	$695.00	—	—	62%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 HC X-RAY TIBIA/FIBULA 2 VIEWS	$196.46	$517.00	—	8% below	62%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 HC X-RAY TIBIA/FIBULA 2 VIEWS	$196.46	$517.00	—	—	62%
MR angiography (MRA) of the head without contrast CPT 70544 HC MRI-ANGIO HEAD WO CONTRAST	$1,124.42	$2,959.00	—	36% below	62%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 HC MRI-ANGIO HEAD WO CONTRAST	$1,124.42	$2,959.00	—	—	62%
MRI of both breasts, without and then with contrast dye both sides CPT 77049 HC MRI BREAST W CONT BILATERAL	$2,014.38	$5,301.00	—	—	62%
MRI of both breasts, without and then with contrast dye inpatient both sides CPT 77049 HC MRI BREAST W CONT BILATERAL	$2,014.38	$5,301.00	—	—	62%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI LOWER EXT JNT W/O CONT	$1,124.42	$2,959.00	—	25% below	62%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MRI LOWER EXT JNT W/O CONT	$1,124.42	$2,959.00	—	—	62%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI LOWER EXT JNT W&W/O CONT	$1,684.92	$4,434.00	—	35% below	62%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HC MRI LOWER EXT JNT W&W/O CONT	$1,684.92	$4,434.00	—	—	62%
MRI of the abdomen without contrast CPT 74181 HC MRI-ABDOMEN WO CONTRAST	$1,124.42	$2,959.00	—	35% below	62%
MRI of the abdomen without contrast inpatient CPT 74181 HC MRI-ABDOMEN WO CONTRAST	$1,124.42	$2,959.00	—	—	62%
MRI of the abdomen, without and then with contrast dye CPT 74183 HC MRI-ABDOMEN W & WO CONTRAST	$2,034.52	$5,354.00	—	7% below	62%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 HC MRI-ABDOMEN W & WO CONTRAST	$2,034.52	$5,354.00	—	—	62%
MRI of the brain, no contrast dye CPT 70551 HC MRI BRAIN WO CTRST	$1,124.42	$2,959.00	—	22% below	62%
MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI BRAIN WO CTRST	$1,124.42	$2,959.00	—	—	62%
MRI of the brain, with and without contrast dye CPT 70553 HC MRI-BRAIN WO & W CONTRAST	$1,684.92	$4,434.00	—	24% below	62%
MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI-BRAIN WO & W CONTRAST	$1,684.92	$4,434.00	—	—	62%
MRI of the lower back, no contrast dye CPT 72148 HC MRI-SPINE LUMBAR WO CONTRAST	$1,124.42	$2,959.00	—	21% below	62%
MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI-SPINE LUMBAR WO CONTRAST	$1,124.42	$2,959.00	—	—	62%
MRI of the lower back, without and then with contrast dye CPT 72158 HC MRI-SPINE LUMBAR WO & W CONT	$1,600.94	$4,213.00	—	31% below	62%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 HC MRI-SPINE LUMBAR WO & W CONT	$1,600.94	$4,213.00	—	—	62%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 HC MRI-SPINE THORACIC WO CONTRAST	$1,124.42	$2,959.00	—	21% below	62%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 HC MRI-SPINE THORACIC WO CONTRAST	$1,124.42	$2,959.00	—	—	62%
MRI of the neck (cervical spine) without and with contrast CPT 72156 HC MRI-SPINE CERVICAL W & WO CONT	$1,600.94	$4,213.00	—	22% below	62%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 HC MRI-SPINE CERVICAL W & WO CONT	$1,600.94	$4,213.00	—	—	62%
MRI of the neck (cervical spine), no contrast dye CPT 72141 HC MRI-SPINE CERVICAL WO CONTRAST	$1,124.42	$2,959.00	—	21% below	62%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 HC MRI-SPINE CERVICAL WO CONTRAST	$1,124.42	$2,959.00	—	—	62%
MRI of the pelvis without and with contrast CPT 72197 HC MRI-PELVIS WO & W CONTRAST	$2,142.82	$5,639.00	—	8% below	62%
MRI of the pelvis without and with contrast inpatient CPT 72197 HC MRI-PELVIS WO & W CONTRAST	$2,142.82	$5,639.00	—	—	62%
MRI of the pelvis, no contrast dye CPT 72195 HC MRI-PELVIS WO CONTRAST	$1,124.42	$2,959.00	—	28% below	62%
MRI of the pelvis, no contrast dye inpatient CPT 72195 HC MRI-PELVIS WO CONTRAST	$1,124.42	$2,959.00	—	—	62%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 HC MRI-UPPER EXT JNT WO CONT	$1,176.10	$3,095.00	—	22% below	62%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 HC MRI-UPPER EXT JNT WO CONT	$1,176.10	$3,095.00	—	—	62%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 HC C-SPINE MIN 4 VIEWS	$289.56	$762.00	—	2% below	62%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 HC C-SPINE MIN 4 VIEWS	$289.56	$762.00	—	—	62%
Neck soft tissue CT scan with contrast CPT 70491 HC CT SOFT TISSUE NECK W/ CONTRAST	$876.28	$2,306.00	—	32% below	62%
Neck soft tissue CT scan with contrast inpatient CPT 70491 HC CT SOFT TISSUE NECK W/ CONTRAST	$876.28	$2,306.00	—	—	62%
Neck soft tissue CT scan without contrast CPT 70490 HC CT SOFT TISSUE NECK W/O CONTRAST	$513.76	$1,352.00	—	49% below	62%
Neck soft tissue CT scan without contrast inpatient CPT 70490 HC CT SOFT TISSUE NECK W/O CONTRAST	$513.76	$1,352.00	—	—	62%
Neck soft tissue X-ray CPT 70360 HC SOFT TISSUE LAT NECK	$193.80	$510.00	—	8% below	62%
Neck soft tissue X-ray inpatient CPT 70360 HC SOFT TISSUE LAT NECK	$193.80	$510.00	—	—	62%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC NM SEST. REST STRESS MULT	$1,947.12	$5,124.00	—	5% below	62%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HC NM SEST. REST STRESS MULT	$1,947.12	$5,124.00	—	—	62%
Pelvic CT scan without contrast CPT 72192 HC CT PELVIS W/O CONTRAST	$709.46	$1,867.00	—	25% below	62%
Pelvic CT scan without contrast inpatient CPT 72192 HC CT PELVIS W/O CONTRAST	$709.46	$1,867.00	—	—	62%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC US PELVIS LIMITED	$110.58	$291.00	—	37% below	62%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC US PELVIS LIMITED	$110.58	$291.00	—	—	62%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HC US PELVIS COMPLETE	$377.72	$994.00	—	4% below	62%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 HC US PELVIS COMPLETE	$377.72	$994.00	—	—	62%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC FETAL EVAL 2-3 TRIM SGL GEST	$440.80	$1,160.00	—	at median	62%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC FETAL EVAL 2-3 TRIM SGL GEST	$440.80	$1,160.00	—	—	62%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 HC FETAL EVAL 1ST TRI SGL GEST	$310.84	$818.00	—	at median	62%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 HC FETAL EVAL 1ST TRI SGL GEST	$310.84	$818.00	—	—	62%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC US FETAL EVALUATION-LIMITED	$191.52	$504.00	—	1% below	62%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC US FETAL EVALUATION-LIMITED	$191.52	$504.00	—	—	62%
Rib X-ray, one side, 2 views one side CPT 71100 HC RIBS UNILATERAL 2 VIEWS	$178.22	$469.00	—	22% below	62%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 HC RIBS UNILATERAL 2 VIEWS	$178.22	$469.00	—	—	62%
Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 HC X-RAY RIBS PA CHEST 3	$254.60	$670.00	—	22% below	62%
Rib X-ray, one side, with a chest view, 3 or more views inpatient CPT 71101 HC X-RAY RIBS PA CHEST 3	$254.60	$670.00	—	—	62%
Screening mammogram, both breasts CPT 77067 HC MAMMO SCREENING INCL CAD IF PERF	$185.44	$488.00	—	10% above	62%
Screening mammogram, both breasts inpatient CPT 77067 HC MAMMO SCREENING INCL CAD IF PERF	$185.44	$488.00	—	—	62%
Shoulder X-ray, complete, 2 or more views CPT 73030 HC SHOULDER COMPLETE MIN 2 VIEWS	$194.56	$512.00	—	15% below	62%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 HC SHOULDER COMPLETE MIN 2 VIEWS	$194.56	$512.00	—	—	62%
Sinus X-ray, complete, 3 or more views CPT 70220 HC SINUSES MIN 3 VIEWS	$217.74	$573.00	—	4% below	62%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 HC SINUSES MIN 3 VIEWS	$217.74	$573.00	—	—	62%
Skull X-ray, fewer than 4 views CPT 70250 HC SKULL LESS THAN 4 VIEWS	$216.60	$570.00	—	at median	62%
Skull X-ray, fewer than 4 views inpatient CPT 70250 HC SKULL LESS THAN 4 VIEWS	$216.60	$570.00	—	—	62%
Sleep study in a lab (polysomnography) CPT 95810 HC POLYSOM 6/> YRS 4/> PARAM	$1,629.82	$4,289.00	—	at median	62%
Sleep study in a lab (polysomnography) CPT 95810 HC ADULT SLEEP STUDY (POLYSOMNOGRAM)	$1,629.82	$4,289.00	—	at median	62%
Sleep study in a lab (polysomnography) inpatient CPT 95810 HC POLYSOM 6/> YRS 4/> PARAM	$1,629.82	$4,289.00	—	—	62%
Sleep study in a lab (polysomnography) inpatient CPT 95810 HC ADULT SLEEP STUDY (POLYSOMNOGRAM)	$1,629.82	$4,289.00	—	—	62%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 HC 2D ECHO STRESS TST REST&CARDIO	$1,125.18	$2,961.00	—	at median	62%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 HC 2D ECHO STRESS TST REST&CARDIO	$1,125.18	$2,961.00	—	—	62%
Swallow study (modified barium swallow, video X-ray) CPT 74230 HC DYSPHAGIA/SWALLOWING STUDY	$467.02	$1,229.00	—	5% above	62%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 HC DYSPHAGIA/SWALLOWING STUDY	$467.02	$1,229.00	—	—	62%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 HC X-RAY EXAM OF FEMUR MIN 2 VIEWS	$211.66	$557.00	—	at median	62%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 HC X-RAY EXAM OF FEMUR MIN 2 VIEWS	$211.66	$557.00	—	—	62%
Thoracic spine (mid back) CT scan without contrast CPT 72128 HC CT T-SPINE W/O CONTRAST	$641.44	$1,688.00	—	39% below	62%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 HC CT T-SPINE W/O CONTRAST	$641.44	$1,688.00	—	—	62%
Toe X-ray, 2 or more views CPT 73660 HC X-RAY TOES MIN 2 VIEWS	$162.64	$428.00	—	10% below	62%
Toe X-ray, 2 or more views inpatient CPT 73660 HC X-RAY TOES MIN 2 VIEWS	$162.64	$428.00	—	—	62%
Transvaginal pelvic ultrasound CPT 76830 HC US TRANSVAGINAL NON OB	$327.94	$863.00	—	13% below	62%
Transvaginal pelvic ultrasound inpatient CPT 76830 HC US TRANSVAGINAL NON OB	$327.94	$863.00	—	—	62%
Transvaginal ultrasound during pregnancy CPT 76817 HC US TRANSVAGINAL OBSETRICAL	$310.08	$816.00	—	at median	62%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 HC US TRANSVAGINAL OBSETRICAL	$310.08	$816.00	—	—	62%
Ultrasound of the abdomen, complete CPT 76700 HC US ABDOMEN COMPLETE	$413.06	$1,087.00	—	12% below	62%
Ultrasound of the abdomen, complete inpatient CPT 76700 HC US ABDOMEN COMPLETE	$413.06	$1,087.00	—	—	62%
Ultrasound of the scrotum and testicles CPT 76870 HC US SCROTUM & CONTENTS	$185.44	$488.00	—	60% below	62%
Ultrasound of the scrotum and testicles inpatient CPT 76870 HC US SCROTUM & CONTENTS	$185.44	$488.00	—	—	62%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC SOFT TISSUE NECK US	$308.56	$812.00	—	24% below	62%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HC SOFT TISSUE NECK US	$308.56	$812.00	—	—	62%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 HC RAD EXAM UPR GI TRACT SINGLE CONTRAST STUDY	$472.72	$1,244.00	—	8% above	62%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 HC RAD EXAM UPR GI TRACT SINGLE CONTRAST STUDY	$472.72	$1,244.00	—	—	62%
Upper arm X-ray (humerus), 2 views CPT 73060 HC HUMERUS MIN 2 VIEW	$167.20	$440.00	—	19% below	62%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 HC HUMERUS MIN 2 VIEW	$167.20	$440.00	—	—	62%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 HC NIV VENOUS DUPLEX UNI/LTD STUDY	$246.24	$648.00	—	50% below	62%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 HC NIV VENOUS DUPLEX UNI/LTD STUDY	$246.24	$648.00	—	—	62%
Wrist X-ray, 2 views CPT 73100 HC XR WRIST 2 VIEWS	$170.62	$449.00	—	25% below	62%
Wrist X-ray, 2 views inpatient CPT 73100 HC XR WRIST 2 VIEWS	$170.62	$449.00	—	—	62%
Wrist X-ray, complete, 3 or more views CPT 73110 HC WRIST MIN 3 VIEWS	$182.02	$479.00	—	17% below	62%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 HC WRIST MIN 3 VIEWS	$182.02	$479.00	—	—	62%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 HC X-RAY EXAM HIP UNI 2-3 VIEWS	$183.16	$482.00	—	10% below	62%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 HC X-RAY EXAM HIP UNI 2-3 VIEWS	$183.16	$482.00	—	—	62%
X-ray of the abdomen, 1 view CPT 74018 HC X-RAY EXAM ABDOMEN 1 VIEW	$177.46	$467.00	—	16% below	62%
X-ray of the abdomen, 1 view inpatient CPT 74018 HC X-RAY EXAM ABDOMEN 1 VIEW	$177.46	$467.00	—	—	62%
X-ray of the ankle, 2 views CPT 73600 HC X-RAY ANKLE 2 VIEWS	$174.04	$458.00	—	16% below	62%
X-ray of the ankle, 2 views inpatient CPT 73600 HC X-RAY ANKLE 2 VIEWS	$174.04	$458.00	—	—	62%
X-ray of the finger(s), 2 or more views CPT 73140 HC FINGERS MIN 2 VIEWS	$165.68	$436.00	—	16% below	62%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 HC FINGERS MIN 2 VIEWS	$165.68	$436.00	—	—	62%
X-ray of the foot, 2 views CPT 73620 HC X-RAY FOOT 2 VIEWS	$178.22	$469.00	—	12% below	62%
X-ray of the foot, 2 views inpatient CPT 73620 HC X-RAY FOOT 2 VIEWS	$178.22	$469.00	—	—	62%
X-ray of the foot, complete, 3 or more views CPT 73630 HC X-RAY FOOT MIN 3 VIEWS COMPLETE	$185.06	$487.00	—	13% below	62%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 HC X-RAY FOOT MIN 3 VIEWS COMPLETE	$185.06	$487.00	—	—	62%
X-ray of the hand, 3 or more views CPT 73130 HC HAND ROUTINE MIN 3 VIEWS	$200.64	$528.00	—	9% below	62%
X-ray of the hand, 3 or more views inpatient CPT 73130 HC HAND ROUTINE MIN 3 VIEWS	$200.64	$528.00	—	—	62%
X-ray of the knee, 1 or 2 views CPT 73560 HC X-RAY KNEE 1-2 VIEWS	$183.92	$484.00	—	16% below	62%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 HC X-RAY KNEE 1-2 VIEWS	$183.92	$484.00	—	—	62%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HC L-SPINE 2-3 VIEWS	$258.78	$681.00	—	5% above	62%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 HC L-SPINE 2-3 VIEWS	$258.78	$681.00	—	—	62%
X-ray of the lower back, 4 or more views CPT 72110 HC L-SPINE MIN 4 VIEWS	$329.84	$868.00	—	2% above	62%
X-ray of the lower back, 4 or more views inpatient CPT 72110 HC L-SPINE MIN 4 VIEWS	$329.84	$868.00	—	—	62%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 HC T-SPINE 2 VIEWS	$224.58	$591.00	—	1% below	62%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 HC T-SPINE 2 VIEWS	$224.58	$591.00	—	—	62%
X-ray of the nasal bones, 3 or more views CPT 70160 HC NASAL BONES MIN 3 VIEWS	$201.40	$530.00	—	11% below	62%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 HC NASAL BONES MIN 3 VIEWS	$201.40	$530.00	—	—	62%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 HC C-SPINE 2-3 VIEWS	$194.56	$512.00	—	8% below	62%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 HC C-SPINE 2-3 VIEWS	$194.56	$512.00	—	—	62%
X-ray of the pelvis, 1 or 2 views CPT 72170 HC PELVIS AP ONLY	$175.94	$463.00	—	17% below	62%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 HC PELVIS AP ONLY	$175.94	$463.00	—	—	62%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 HC SACRUM AND COCCYX MIN 2 VIEWS	$228.76	$602.00	—	1% above	62%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 HC SACRUM AND COCCYX MIN 2 VIEWS	$228.76	$602.00	—	—	62%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Maine	Off list
ACTH blood test CPT 82024 HC SO ACTH	$168.34	$443.00	—	5% above	62%
ACTH blood test inpatient CPT 82024 HC SO ACTH	$168.34	$443.00	—	—	62%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC SGPT (ALT)	$31.92	$84.00	—	5% below	62%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 HC SGPT (ALT)	$31.92	$84.00	—	—	62%
AST (aspartate aminotransferase) enzyme test CPT 84450 HC SGOT (AST)	$28.12	$74.00	—	9% below	62%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 HC SGOT (AST)	$28.12	$74.00	—	—	62%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HC SO HEPATITIS PANEL ACUTE	$175.94	$463.00	—	10% above	62%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HC HEPATITIS PANEL ACUTE	$175.94	$463.00	—	10% above	62%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HC SO HEPATITIS PANEL ACUTE	$175.94	$463.00	—	—	62%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HC HEPATITIS PANEL ACUTE	$175.94	$463.00	—	—	62%
Albumin blood test CPT 82040 HC SO ALBUMIN	$23.56	$62.00	—	3% above	62%
Albumin blood test CPT 82040 HC ALBUMIN	$23.56	$62.00	—	3% above	62%
Albumin blood test inpatient CPT 82040 HC ALBUMIN	$23.56	$62.00	—	—	62%
Albumin blood test inpatient CPT 82040 HC SO ALBUMIN	$23.56	$62.00	—	—	62%
Aldosterone blood test CPT 82088 HC SO ALDOSTERONE SERUM	$157.70	$415.00	—	1% above	62%
Aldosterone blood test inpatient CPT 82088 HC SO ALDOSTERONE SERUM	$157.70	$415.00	—	—	62%
Alkaline phosphatase (ALP) blood test CPT 84075 HC ALKALINE PHOSPHATASE	$26.60	$70.00	—	3% below	62%
Alkaline phosphatase (ALP) blood test CPT 84075 HC SO ALKALINE PHOSPHATASE	$26.60	$70.00	—	3% below	62%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 HC ALKALINE PHOSPHATASE	$26.60	$70.00	—	—	62%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 HC SO ALKALINE PHOSPHATASE	$26.60	$70.00	—	—	62%
Allergy blood test, specific IgE, per allergen CPT 86003 HC SO ALLERGEN SPECIFIC	$22.42	$59.00	—	2% below	62%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC SO ALLERGEN SPECIFIC	$22.42	$59.00	—	—	62%
Alpha-fetoprotein (AFP) blood test CPT 82105 HC SO ALPHA FETOPROTEIN	$77.90	$205.00	—	18% above	62%
Alpha-fetoprotein (AFP) blood test CPT 82105 HC SO1 ALPHA FETOPROTEIN	$77.90	$205.00	—	18% above	62%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 HC SO1 ALPHA FETOPROTEIN	$77.90	$205.00	—	—	62%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 HC SO ALPHA FETOPROTEIN	$77.90	$205.00	—	—	62%
Ammonia blood test CPT 82140 HC SO AMMONIA	$114.38	$301.00	—	25% above	62%
Ammonia blood test CPT 82140 HC AMMONIA	$114.38	$301.00	—	25% above	62%
Ammonia blood test inpatient CPT 82140 HC AMMONIA	$114.38	$301.00	—	—	62%
Ammonia blood test inpatient CPT 82140 HC SO AMMONIA	$114.38	$301.00	—	—	62%
Amylase blood test CPT 82150 HC AMYLASE	$40.28	$106.00	—	3% below	62%
Amylase blood test CPT 82150 HC SO AMYLASE	$40.28	$106.00	—	3% below	62%
Amylase blood test inpatient CPT 82150 HC SO AMYLASE	$40.28	$106.00	—	—	62%
Amylase blood test inpatient CPT 82150 HC AMYLASE	$40.28	$106.00	—	—	62%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 HC SO CYCLIC CITRULLINATED PEPTDAB	$297.92	$784.00	—	317% above	62%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 HC SO CYCLIC CITRULLINATED PEPTDAB	$297.92	$784.00	—	—	62%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC SO ANTI NUCLEAR ANTIBODY	$61.18	$161.00	—	11% above	62%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC SO ANTI NUCLEAR ANTIBODY	$61.18	$161.00	—	—	62%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HC NATRIURETIC PEPTIDE	$141.36	$372.00	—	10% below	62%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 HC NATRIURETIC PEPTIDE	$141.36	$372.00	—	—	62%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC SO BODY FLUID CULTURE	$28.12	$74.00	—	48% below	62%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE AEROBIC	$28.12	$74.00	—	48% below	62%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC CULTURE AEROBIC	$28.12	$74.00	—	—	62%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC SO BODY FLUID CULTURE	$28.12	$74.00	—	—	62%
Basic metabolic panel (blood test) CPT 80048 HC BASIC METABOLIC PANEL	$80.18	$211.00	—	3% above	62%
Basic metabolic panel (blood test) inpatient CPT 80048 HC BASIC METABOLIC PANEL	$80.18	$211.00	—	—	62%
Bilirubin blood test, total CPT 82247 HC SO BILIRUBIN TOTAL	$50.16	$132.00	—	62% above	62%
Bilirubin blood test, total CPT 82247 HC BILIRUBIN TOTAL	$50.16	$132.00	—	62% above	62%
Bilirubin blood test, total inpatient CPT 82247 HC BILIRUBIN TOTAL	$50.16	$132.00	—	—	62%
Bilirubin blood test, total inpatient CPT 82247 HC SO BILIRUBIN TOTAL	$50.16	$132.00	—	—	62%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC TISSUE LEVEL IV	$123.88	$326.00	—	11% below	62%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC SO TISSUE LEVEL IV	$123.88	$326.00	—	11% below	62%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC TISSUE LEVEL IV	$123.88	$326.00	—	—	62%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC SO TISSUE LEVEL IV	$123.88	$326.00	—	—	62%
Blood culture for bacteria CPT 87040 HC CULTURE BLOOD	$82.46	$217.00	—	3% below	62%
Blood culture for bacteria inpatient CPT 87040 HC CULTURE BLOOD	$82.46	$217.00	—	—	62%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC VENIPUNCTURE	$16.72	$44.00	—	19% above	62%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC VENIPUNCTURE	$16.72	$44.00	—	—	62%
Blood glucose (sugar) test CPT 82947 HC GLUCOSE FASTING	$3.04	$8.00	—	87% below	62%
Blood glucose (sugar) test inpatient CPT 82947 HC GLUCOSE FASTING	$3.04	$8.00	—	—	62%
Blood lead test CPT 83655 HC SO LEAD	$58.14	$153.00	—	29% above	62%
Blood lead test CPT 83655 HC ASSAY OF LEAD	$58.14	$153.00	—	29% above	62%
Blood lead test inpatient CPT 83655 HC ASSAY OF LEAD	$58.14	$153.00	—	—	62%
Blood lead test inpatient CPT 83655 HC SO LEAD	$58.14	$153.00	—	—	62%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HC GONADOTROPIN CHORIONIC (HCG) QUALITATIVE	$41.04	$108.00	—	5% below	62%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HC GONADOTROPIN CHORIONIC (HCG) QUALITATIVE	$41.04	$108.00	—	—	62%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HC SO BLOOD TYPING ABO	$173.66	$457.00	—	252% above	62%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HC BLOOD TYPING ABO	$173.66	$457.00	—	252% above	62%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HC SO ABO	$173.66	$457.00	—	252% above	62%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HC SO ABO	$173.66	$457.00	—	—	62%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HC BLOOD TYPING ABO	$173.66	$457.00	—	—	62%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HC SO BLOOD TYPING ABO	$173.66	$457.00	—	—	62%
Blood urea nitrogen (BUN) test CPT 84520 HC BUN	$28.12	$74.00	—	12% above	62%
Blood urea nitrogen (BUN) test inpatient CPT 84520 HC BUN	$28.12	$74.00	—	—	62%
C-peptide blood test CPT 84681 HC SO PEPTIDEC	$94.24	$248.00	—	34% above	62%
C-peptide blood test inpatient CPT 84681 HC SO PEPTIDEC	$94.24	$248.00	—	—	62%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC CRP	$41.80	$110.00	—	13% above	62%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC SO CRP	$41.80	$110.00	—	13% above	62%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 HC CRP	$41.80	$110.00	—	—	62%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 HC SO CRP	$41.80	$110.00	—	—	62%
C. difficile toxin gene test (stool PCR) CPT 87493 HC CLOST DIFFTOXIN GENEAMP PRBE	$95.00	$250.00	—	7% below	62%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 HC CLOST DIFFTOXIN GENEAMP PRBE	$95.00	$250.00	—	—	62%
CA 19-9 blood test (tumor marker) CPT 86301 HC SO CARBOHYDRATE ANTIGEN 19-9	$79.04	$208.00	—	22% above	62%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 HC SO CARBOHYDRATE ANTIGEN 19-9	$79.04	$208.00	—	—	62%
CA-125 blood test (ovarian cancer marker) CPT 86304 HC SO CA 125	$85.88	$226.00	—	at median	62%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 HC SO CA 125	$85.88	$226.00	—	—	62%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC IADNA SARS-COV-2-19 AMP PROBE TQ	$169.48	$446.00	—	93% above	62%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC SO IADNA SARS-COV-2-19 AMP PROBE TQ	$169.48	$446.00	—	93% above	62%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HC SO IADNA SARS-COV-2-19 AMP PROBE TQ	$169.48	$446.00	—	—	62%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HC IADNA SARS-COV-2-19 AMP PROBE TQ	$169.48	$446.00	—	—	62%
Calcium blood test, total CPT 82310 HC CALCIUMSERUM	$25.84	$68.00	—	8% below	62%
Calcium blood test, total CPT 82310 HC SO CALCIUM,SERUM	$25.84	$68.00	—	8% below	62%
Calcium blood test, total inpatient CPT 82310 HC CALCIUMSERUM	$25.84	$68.00	—	—	62%
Calcium blood test, total inpatient CPT 82310 HC SO CALCIUM,SERUM	$25.84	$68.00	—	—	62%
Carcinoembryonic antigen (CEA) test CPT 82378 HC CEA	$105.26	$277.00	—	20% above	62%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 HC CEA	$105.26	$277.00	—	—	62%
Chickenpox (varicella) immunity blood test CPT 86787 HC VARICELLA IGG IGM	$60.42	$159.00	—	24% above	62%
Chickenpox (varicella) immunity blood test CPT 86787 HC SO VARICELLA IGG IGM	$60.42	$159.00	—	24% above	62%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 HC SO VARICELLA IGG IGM	$60.42	$159.00	—	—	62%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 HC VARICELLA IGG IGM	$60.42	$159.00	—	—	62%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC SO CHYLMD TRACH DNA AMP PROBE	$85.50	$225.00	—	18% above	62%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC SO1 CHYLMD TRACH DNA AMP PROBE	$85.50	$225.00	—	18% above	62%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC CHLAMYDIA AMP PROBE TECH 1	$85.50	$225.00	—	18% above	62%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HC SO CHYLMD TRACH DNA AMP PROBE	$85.50	$225.00	—	—	62%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HC CHLAMYDIA AMP PROBE TECH 1	$85.50	$225.00	—	—	62%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HC SO1 CHYLMD TRACH DNA AMP PROBE	$85.50	$225.00	—	—	62%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PANEL	$82.08	$216.00	—	11% above	62%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC SO LIPID PANEL	$82.08	$216.00	—	11% above	62%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC LIPID PANEL	$82.08	$216.00	—	—	62%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC SO LIPID PANEL	$82.08	$216.00	—	—	62%
Complete blood count (CBC) with differential CPT 85025 HC CBC	$39.14	$103.00	—	17% below	62%
Complete blood count (CBC) with differential inpatient CPT 85025 HC CBC	$39.14	$103.00	—	—	62%
Complete blood count (CBC), no differential CPT 85027 HC CBC (HEMOGRAM)	$34.58	$91.00	—	12% above	62%
Complete blood count (CBC), no differential inpatient CPT 85027 HC CBC (HEMOGRAM)	$34.58	$91.00	—	—	62%
Comprehensive metabolic panel (blood test) CPT 80053 HC COMPREHENSIVE METABOLIC PANEL	$82.08	$216.00	—	22% below	62%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC COMPREHENSIVE METABOLIC PANEL	$82.08	$216.00	—	—	62%
Cortisol blood test, total CPT 82533 HC SO CORTISOLSERUM	$76.38	$201.00	—	9% above	62%
Cortisol blood test, total CPT 82533 HC CORTISOLSERUM	$76.38	$201.00	—	9% above	62%
Cortisol blood test, total inpatient CPT 82533 HC CORTISOLSERUM	$76.38	$201.00	—	—	62%
Cortisol blood test, total inpatient CPT 82533 HC SO CORTISOLSERUM	$76.38	$201.00	—	—	62%
Creatine kinase (CK) blood test, total CPT 82550 HC CPK (CK)	$38.00	$100.00	—	16% below	62%
Creatine kinase (CK) blood test, total inpatient CPT 82550 HC CPK (CK)	$38.00	$100.00	—	—	62%
Creatinine blood test CPT 82565 HC CREATININESERUM	$19.00	$50.00	—	34% below	62%
Creatinine blood test inpatient CPT 82565 HC CREATININESERUM	$19.00	$50.00	—	—	62%
Cytomegalovirus (CMV) antibody test CPT 86644 HC SO CYTOMEGALOVIRUS IGG ANTIBODY	$62.32	$164.00	—	1% below	62%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 HC SO CYTOMEGALOVIRUS IGG ANTIBODY	$62.32	$164.00	—	—	62%
D-dimer blood test (blood clot marker) CPT 85379 HC D-DIMER QUANTITATIVE	$64.60	$170.00	—	11% below	62%
D-dimer blood test (blood clot marker) CPT 85379 HC SO D-DIMER QUANTITATIVE	$64.60	$170.00	—	11% below	62%
D-dimer blood test (blood clot marker) inpatient CPT 85379 HC SO D-DIMER QUANTITATIVE	$64.60	$170.00	—	—	62%
D-dimer blood test (blood clot marker) inpatient CPT 85379 HC D-DIMER QUANTITATIVE	$64.60	$170.00	—	—	62%
DHEA sulfate (DHEA-S) blood test CPT 82627 HC SO DHEA SULFATE	$116.28	$306.00	—	28% above	62%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 HC SO DHEA SULFATE	$116.28	$306.00	—	—	62%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR	$185.44	$488.00	—	91% above	62%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC SO2 DRG SCRN CLASS LIST A	$185.44	$488.00	—	91% above	62%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC SO1 DRG SCRN CLASS LIST A	$185.44	$488.00	—	91% above	62%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC SO DRG SCRN CLASS LIST A	$185.44	$488.00	—	91% above	62%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC SO1 DRG SCRN CLASS LIST A	$185.44	$488.00	—	—	62%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC SO2 DRG SCRN CLASS LIST A	$185.44	$488.00	—	—	62%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC SO DRG SCRN CLASS LIST A	$185.44	$488.00	—	—	62%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC DRUG TEST PRSMV CHEM ANLYZR	$185.44	$488.00	—	—	62%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 HC ELECTROLYTE PANEL	$41.04	$108.00	—	18% below	62%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 HC ELECTROLYTE PANEL	$41.04	$108.00	—	—	62%
Epstein-Barr virus (EBV) antibody test CPT 86665 HC SO EPSTEIN-BARR VIRUS VCA	$76.00	$200.00	—	25% above	62%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 HC SO EPSTEIN-BARR VIRUS VCA	$76.00	$200.00	—	—	62%
Estradiol blood test CPT 82670 HC SO ESTRADIOL	$120.46	$317.00	—	18% above	62%
Estradiol blood test inpatient CPT 82670 HC SO ESTRADIOL	$120.46	$317.00	—	—	62%
FSH (follicle-stimulating hormone) test CPT 83001 HC GONADOTROPIN FOLLICLE STIMULATING HORMONE	$110.20	$290.00	—	39% above	62%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 HC GONADOTROPIN FOLLICLE STIMULATING HORMONE	$110.20	$290.00	—	—	62%
Fecal calprotectin (stool inflammation test) CPT 83993 HC SO CALPROTECTIN FECAL	$152.38	$401.00	—	1% below	62%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 HC SO CALPROTECTIN FECAL	$152.38	$401.00	—	—	62%
Ferritin blood test (iron stores) CPT 82728 HC FERRITIN	$72.58	$191.00	—	3% below	62%
Ferritin blood test (iron stores) inpatient CPT 82728 HC FERRITIN	$72.58	$191.00	—	—	62%
Fibrinogen blood test CPT 85384 HC FIBRINOGEN	$85.50	$225.00	—	42% above	62%
Fibrinogen blood test CPT 85384 HC SO FIBRINOGEN	$85.50	$225.00	—	42% above	62%
Fibrinogen blood test inpatient CPT 85384 HC SO FIBRINOGEN	$85.50	$225.00	—	—	62%
Fibrinogen blood test inpatient CPT 85384 HC FIBRINOGEN	$85.50	$225.00	—	—	62%
Folate (folic acid) blood test CPT 82746 HC FOLIC ACID SERUM	$83.98	$221.00	—	12% above	62%
Folate (folic acid) blood test inpatient CPT 82746 HC FOLIC ACID SERUM	$83.98	$221.00	—	—	62%
Free T3 thyroid hormone test CPT 84481 HC TRIIODOTHYRONINE T-3 FREE	$82.08	$216.00	—	5% below	62%
Free T3 thyroid hormone test inpatient CPT 84481 HC TRIIODOTHYRONINE T-3 FREE	$82.08	$216.00	—	—	62%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HC SO T4 FREE	$61.94	$163.00	—	4% above	62%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HC T-4FREE	$61.94	$163.00	—	4% above	62%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HC SO T4 FREE	$61.94	$163.00	—	—	62%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HC T-4FREE	$61.94	$163.00	—	—	62%
Free testosterone test CPT 84402 HC SO TESTOSTERONE FREE	$102.22	$269.00	—	at median	62%
Free testosterone test inpatient CPT 84402 HC SO TESTOSTERONE FREE	$102.22	$269.00	—	—	62%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 HC GGTP	$34.58	$91.00	—	22% below	62%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 HC GGTP	$34.58	$91.00	—	—	62%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 HC GENERAL HEALTH PROFILE	$135.66	$357.00	—	68% below	62%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 HC GENERAL HEALTH PROFILE	$135.66	$357.00	—	—	62%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC GLUCOSE POST PRANDIAL	$22.42	$59.00	—	40% below	62%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 HC GLUCOSE POST PRANDIAL	$22.42	$59.00	—	—	62%
Glucose tolerance test, 3 samples CPT 82951 HC GLUCOSE TOLERANCE TEST	$104.12	$274.00	—	63% above	62%
Glucose tolerance test, 3 samples inpatient CPT 82951 HC GLUCOSE TOLERANCE TEST	$104.12	$274.00	—	—	62%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC SO N GONORRHOEAE DNA AMP PROB	$80.18	$211.00	—	22% above	62%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC N.GONORRHEA DNA AMP PROBE	$80.18	$211.00	—	22% above	62%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC SO1 N.GONORRHEA DNA AMP PROBE	$80.18	$211.00	—	22% above	62%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC N.GONORRHEA DNA AMP PROBE	$80.18	$211.00	—	—	62%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC SO1 N.GONORRHEA DNA AMP PROBE	$80.18	$211.00	—	—	62%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC SO N GONORRHOEAE DNA AMP PROB	$80.18	$211.00	—	—	62%
H. pylori antibody blood test CPT 86677 HC H.PYLORI. SERUM	$76.76	$202.00	—	at median	62%
H. pylori antibody blood test CPT 86677 HC SO H.PYLORI. SERUM	$76.76	$202.00	—	at median	62%
H. pylori antibody blood test inpatient CPT 86677 HC SO H.PYLORI. SERUM	$76.76	$202.00	—	—	62%
H. pylori antibody blood test inpatient CPT 86677 HC H.PYLORI. SERUM	$76.76	$202.00	—	—	62%
H. pylori stool antigen test CPT 87338 HC H.PYLORI STOOL ANTIGEN	$61.94	$163.00	—	46% below	62%
H. pylori stool antigen test CPT 87338 HC SO H.PYLORI STOOL ANTIGEN	$61.94	$163.00	—	46% below	62%
H. pylori stool antigen test inpatient CPT 87338 HC SO H.PYLORI STOOL ANTIGEN	$61.94	$163.00	—	—	62%
H. pylori stool antigen test inpatient CPT 87338 HC H.PYLORI STOOL ANTIGEN	$61.94	$163.00	—	—	62%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HC SO HIV-1 QUANTIFICATION	$207.48	$546.00	—	9% below	62%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HC SO HIV-1 QUANTIFICATION	$207.48	$546.00	—	—	62%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HC HIV COMBO TESTING W/REFLX	$75.24	$198.00	—	59% above	62%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HC SO HIV-1 & HIV-2 AB	$75.24	$198.00	—	59% above	62%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HC HIV COMBO TESTING W/REFLX	$75.24	$198.00	—	—	62%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HC SO HIV-1 & HIV-2 AB	$75.24	$198.00	—	—	62%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HC SO HPV DNA AMP PROBE	$33.06	$87.00	—	54% below	62%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HC SO HPV DNA AMP PROBE	$33.06	$87.00	—	—	62%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC SO GLYCOHEMOGLOBIN	$50.16	$132.00	—	4% below	62%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC GLYCOHEMOGLOBIN	$50.16	$132.00	—	4% below	62%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HC GLYCOHEMOGLOBIN	$50.16	$132.00	—	—	62%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HC SO GLYCOHEMOGLOBIN	$50.16	$132.00	—	—	62%
Hemoglobin blood test CPT 85018 HC HEMOGLOBIN	$15.20	$40.00	—	at median	62%
Hemoglobin blood test inpatient CPT 85018 HC HEMOGLOBIN	$15.20	$40.00	—	—	62%
Hepatitis B core antibody test (total) CPT 86704 HC HEPATITIS B CORE ANTIBODY	$60.80	$160.00	—	at median	62%
Hepatitis B core antibody test (total) CPT 86704 HC SO HEPATITIS B CORE ANTIBODY	$60.80	$160.00	—	at median	62%
Hepatitis B core antibody test (total) inpatient CPT 86704 HC SO HEPATITIS B CORE ANTIBODY	$60.80	$160.00	—	—	62%
Hepatitis B core antibody test (total) inpatient CPT 86704 HC HEPATITIS B CORE ANTIBODY	$60.80	$160.00	—	—	62%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HC SO ANTI-HBS	$60.42	$159.00	—	20% above	62%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HC HEPATITIS B SURFACE ANTIBODY	$60.42	$159.00	—	20% above	62%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HC SO ANTI-HBS	$60.42	$159.00	—	—	62%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HC HEPATITIS B SURFACE ANTIBODY	$60.42	$159.00	—	—	62%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HC M94 HEPB SURFACE ANTIGEN HBSAG - BMT	$47.88	$126.00	—	2% below	62%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HC SO HEPATITIS B SURFACE AG	$47.88	$126.00	—	2% below	62%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HC SO HEPATITIS B SURFACE AG	$47.88	$126.00	—	—	62%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HC M94 HEPB SURFACE ANTIGEN HBSAG - BMT	$47.88	$126.00	—	—	62%
Hepatitis C antibody blood test (screening) CPT 86803 HC HEPATITIS C VIRUS ANTIBODY	$70.68	$186.00	—	4% below	62%
Hepatitis C antibody blood test (screening) CPT 86803 HC SO HEPATITIS C VIRUS ANTIBODY	$70.68	$186.00	—	4% below	62%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HC SO HEPATITIS C VIRUS ANTIBODY	$70.68	$186.00	—	—	62%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HC HEPATITIS C VIRUS ANTIBODY	$70.68	$186.00	—	—	62%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC SO HCV ULTRAQUANT	$172.52	$454.00	—	at median	62%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HC SO HCV ULTRAQUANT	$172.52	$454.00	—	—	62%
Herpes blood test, HSV-1 antibody CPT 86695 HC HERPES SIMPLEX TYPE 1	$53.96	$142.00	—	2% above	62%
Herpes blood test, HSV-1 antibody CPT 86695 HC SO HERPES SIMPLEX, TYPE 1	$53.96	$142.00	—	2% above	62%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HC SO HERPES SIMPLEX, TYPE 1	$53.96	$142.00	—	—	62%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HC HERPES SIMPLEX TYPE 1	$53.96	$142.00	—	—	62%
Herpes blood test, HSV-2 antibody CPT 86696 HC HERPES SIMPLEX TYPE 2	$67.26	$177.00	—	5% below	62%
Herpes blood test, HSV-2 antibody CPT 86696 HC SO HERPES SIMPLEX, TYPE 2	$67.26	$177.00	—	5% below	62%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HC SO HERPES SIMPLEX, TYPE 2	$67.26	$177.00	—	—	62%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HC HERPES SIMPLEX TYPE 2	$67.26	$177.00	—	—	62%
High-sensitivity CRP (hs-CRP) test CPT 86141 HC SO CRP HIGH SENSITIVITY	$56.24	$148.00	—	9% above	62%
High-sensitivity CRP (hs-CRP) test CPT 86141 HC C-REACTIVE PROTEIN CARDIAC	$56.24	$148.00	—	9% above	62%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 HC SO CRP HIGH SENSITIVITY	$56.24	$148.00	—	—	62%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 HC C-REACTIVE PROTEIN CARDIAC	$56.24	$148.00	—	—	62%
Homocysteine blood test CPT 83090 HC SO HOMOCYSTINE	$57.38	$151.00	—	21% below	62%
Homocysteine blood test inpatient CPT 83090 HC SO HOMOCYSTINE	$57.38	$151.00	—	—	62%
Insulin blood test CPT 83525 HC SO INSULIN	$66.50	$175.00	—	3% above	62%
Insulin blood test inpatient CPT 83525 HC SO INSULIN	$66.50	$175.00	—	—	62%
Iron blood test (serum iron) CPT 83540 HC SO IRON	$34.96	$92.00	—	7% below	62%
Iron blood test (serum iron) CPT 83540 HC IRON	$34.96	$92.00	—	7% below	62%
Iron blood test (serum iron) inpatient CPT 83540 HC SO IRON	$34.96	$92.00	—	—	62%
Iron blood test (serum iron) inpatient CPT 83540 HC IRON	$34.96	$92.00	—	—	62%
Iron-binding capacity (TIBC) test CPT 83550 HC IRON BINDING CAPACITY	$52.06	$137.00	—	29% above	62%
Iron-binding capacity (TIBC) test inpatient CPT 83550 HC IRON BINDING CAPACITY	$52.06	$137.00	—	—	62%
Kidney function blood test panel CPT 80069 HC RENAL FUNCTION PANEL	$68.78	$181.00	—	3% above	62%
Kidney function blood test panel inpatient CPT 80069 HC RENAL FUNCTION PANEL	$68.78	$181.00	—	—	62%
LH (luteinizing hormone) test CPT 83002 HC LUTEINIZING HORMONE	$96.52	$254.00	—	14% above	62%
LH (luteinizing hormone) test inpatient CPT 83002 HC LUTEINIZING HORMONE	$96.52	$254.00	—	—	62%
Lactate (lactic acid) blood test CPT 83605 HC LACTIC ACID	$46.36	$122.00	—	20% below	62%
Lactate (lactic acid) blood test inpatient CPT 83605 HC LACTIC ACID	$46.36	$122.00	—	—	62%
Lactate dehydrogenase (LDH) blood test CPT 83615 HC LDH	$27.36	$72.00	—	24% below	62%
Lactate dehydrogenase (LDH) blood test CPT 83615 HC SO LDH	$27.36	$72.00	—	24% below	62%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HC SO LDH	$27.36	$72.00	—	—	62%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HC LDH	$27.36	$72.00	—	—	62%
Lipase blood test (pancreas enzyme) CPT 83690 HC LIPASE	$37.24	$98.00	—	19% below	62%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 HC LIPASE	$37.24	$98.00	—	—	62%
Liver function blood test panel CPT 80076 HC LIVER PROFILE-HEPATIC PANEL	$63.46	$167.00	—	24% below	62%
Liver function blood test panel inpatient CPT 80076 HC LIVER PROFILE-HEPATIC PANEL	$63.46	$167.00	—	—	62%
Lyme disease antibody test CPT 86618 HC SO LYME DISEASE TOTAL ANITBODIES	$74.10	$195.00	—	4% below	62%
Lyme disease antibody test CPT 86618 HC LYME DISEASE TOTAL ANITBODIES	$74.10	$195.00	—	4% below	62%
Lyme disease antibody test inpatient CPT 86618 HC LYME DISEASE TOTAL ANITBODIES	$74.10	$195.00	—	—	62%
Lyme disease antibody test inpatient CPT 86618 HC SO LYME DISEASE TOTAL ANITBODIES	$74.10	$195.00	—	—	62%
Magnesium blood test CPT 83735 HC MAGNESIUM	$47.88	$126.00	—	19% above	62%
Magnesium blood test CPT 83735 HC SO MAGNESIUM	$47.88	$126.00	—	19% above	62%
Magnesium blood test inpatient CPT 83735 HC SO MAGNESIUM	$47.88	$126.00	—	—	62%
Magnesium blood test inpatient CPT 83735 HC MAGNESIUM	$47.88	$126.00	—	—	62%
Measles (rubeola) antibody test CPT 86765 HC SO RUBEOLA IGG / IGM	$49.02	$129.00	—	39% above	62%
Measles (rubeola) antibody test CPT 86765 HC RUBEOLA IGG / IGM	$49.02	$129.00	—	39% above	62%
Measles (rubeola) antibody test inpatient CPT 86765 HC RUBEOLA IGG / IGM	$49.02	$129.00	—	—	62%
Measles (rubeola) antibody test inpatient CPT 86765 HC SO RUBEOLA IGG / IGM	$49.02	$129.00	—	—	62%
Mono test (heterophile antibody, Monospot) CPT 86308 HC MONO SPOT TESTAGGLUTINATION	$35.34	$93.00	—	2% below	62%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HC MONO SPOT TESTAGGLUTINATION	$35.34	$93.00	—	—	62%
Mumps immunity blood test CPT 86735 HC ANTIBODY; MUMPS	$47.88	$126.00	—	29% above	62%
Mumps immunity blood test CPT 86735 HC SO ANTIBODY; MUMPS	$47.88	$126.00	—	29% above	62%
Mumps immunity blood test inpatient CPT 86735 HC SO ANTIBODY; MUMPS	$47.88	$126.00	—	—	62%
Mumps immunity blood test inpatient CPT 86735 HC ANTIBODY; MUMPS	$47.88	$126.00	—	—	62%
PSA (prostate-specific antigen) blood test, free CPT 84154 HC PROSTATE SPECIFIC ANTIGEN/FREE	$74.86	$197.00	—	20% below	62%
PSA (prostate-specific antigen) blood test, free CPT 84154 HC SO PROSTATE SPECIFIC ANTIGEN/FREE	$74.86	$197.00	—	20% below	62%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC SO PROSTATE SPECIFIC ANTIGEN/FREE	$74.86	$197.00	—	—	62%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC PROSTATE SPECIFIC ANTIGEN/FREE	$74.86	$197.00	—	—	62%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC SO ASSAY OF PSA TOTAL	$72.58	$191.00	—	1% above	62%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC ASSAY OF PSA TOTAL	$72.58	$191.00	—	1% above	62%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC ASSAY OF PSA TOTAL	$72.58	$191.00	—	—	62%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC SO ASSAY OF PSA TOTAL	$72.58	$191.00	—	—	62%
Pap test (liquid-based, automated screening with review) CPT 88175 HC SO CYTOPATH C/V AUTO FLUID REDO	$85.50	$225.00	—	33% above	62%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 HC SO CYTOPATH C/V AUTO FLUID REDO	$85.50	$225.00	—	—	62%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 HC CYTOPATH C/V THIN LAYER	$70.30	$185.00	—	at median	62%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 HC CYTOPATH C/V THIN LAYER	$70.30	$185.00	—	—	62%
Parathyroid hormone (PTH) blood test CPT 83970 HC PARATHYROID HORMONE	$183.92	$484.00	—	87% above	62%
Parathyroid hormone (PTH) blood test CPT 83970 HC SO PARATHYROID HORMONE	$183.92	$484.00	—	87% above	62%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 HC PARATHYROID HORMONE	$183.92	$484.00	—	—	62%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 HC SO PARATHYROID HORMONE	$183.92	$484.00	—	—	62%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC PTT	$68.02	$179.00	—	56% above	62%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC SO PTT	$68.02	$179.00	—	56% above	62%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC SO PTT	$68.02	$179.00	—	—	62%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC PTT	$68.02	$179.00	—	—	62%
Phosphorus (phosphate) blood test CPT 84100 HC PHOSPHORUS SERUM	$27.36	$72.00	—	1% below	62%
Phosphorus (phosphate) blood test CPT 84100 HC SO PHOSPHORUS INORGANIC	$27.36	$72.00	—	1% below	62%
Phosphorus (phosphate) blood test inpatient CPT 84100 HC PHOSPHORUS SERUM	$27.36	$72.00	—	—	62%
Phosphorus (phosphate) blood test inpatient CPT 84100 HC SO PHOSPHORUS INORGANIC	$27.36	$72.00	—	—	62%
Potassium blood test CPT 84132 HC POTASSIUM	$25.08	$66.00	—	3% above	62%
Potassium blood test inpatient CPT 84132 HC POTASSIUM	$25.08	$66.00	—	—	62%
Progesterone blood test CPT 84144 HC SO PROGESTERONE	$90.44	$238.00	—	2% above	62%
Progesterone blood test inpatient CPT 84144 HC SO PROGESTERONE	$90.44	$238.00	—	—	62%
Prolactin blood test CPT 84146 HC PROLACTIN	$84.74	$223.00	—	13% above	62%
Prolactin blood test inpatient CPT 84146 HC PROLACTIN	$84.74	$223.00	—	—	62%
Prothrombin time (PT/INR) clotting test CPT 85610 HC SO PROTHROMBIN TIME	$28.88	$76.00	—	2% below	62%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME	$28.88	$76.00	—	2% below	62%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC SO PROTHROMBIN TIME	$28.88	$76.00	—	—	62%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME	$28.88	$76.00	—	—	62%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HC DRUG TEST PRSMV DIR OPTICAL OBS	$53.20	$140.00	—	106% above	62%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 HC DRUG TEST PRSMV DIR OPTICAL OBS	$53.20	$140.00	—	—	62%
Rapid flu test (influenza antigen) CPT 87804 HC INFLUENZA AB ANTIGEN	$69.92	$184.00	—	11% below	62%
Rapid flu test (influenza antigen) inpatient CPT 87804 HC INFLUENZA AB ANTIGEN	$69.92	$184.00	—	—	62%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC BETA STREP SCREEN	$52.44	$138.00	—	33% above	62%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HC BETA STREP SCREEN	$52.44	$138.00	—	—	62%
Renin blood test CPT 84244 HC SO RENIN	$86.64	$228.00	—	18% above	62%
Renin blood test inpatient CPT 84244 HC SO RENIN	$86.64	$228.00	—	—	62%
Rh blood typing CPT 86901 HC BLOOD TYPING RH(D)	$85.12	$224.00	—	133% above	62%
Rh blood typing CPT 86901 HC SO BLOOD TYPING RH(D)	$85.12	$224.00	—	133% above	62%
Rh blood typing inpatient CPT 86901 HC SO BLOOD TYPING RH(D)	$85.12	$224.00	—	—	62%
Rh blood typing inpatient CPT 86901 HC BLOOD TYPING RH(D)	$85.12	$224.00	—	—	62%
Rheumatoid factor (RF) test CPT 86431 HC SO RA TITER QUANTITATIVE	$31.92	$84.00	—	5% below	62%
Rheumatoid factor (RF) test CPT 86431 HC RA TITER QUANTITATIVE	$31.92	$84.00	—	5% below	62%
Rheumatoid factor (RF) test inpatient CPT 86431 HC RA TITER QUANTITATIVE	$31.92	$84.00	—	—	62%
Rheumatoid factor (RF) test inpatient CPT 86431 HC SO RA TITER QUANTITATIVE	$31.92	$84.00	—	—	62%
Rubella antibody test (immunity check) CPT 86762 HC RUBELLA LATEX TEST	$56.24	$148.00	—	12% above	62%
Rubella antibody test (immunity check) CPT 86762 HC SO RUBELLA LATEX TEST	$56.24	$148.00	—	12% above	62%
Rubella antibody test (immunity check) inpatient CPT 86762 HC RUBELLA LATEX TEST	$56.24	$148.00	—	—	62%
Rubella antibody test (immunity check) inpatient CPT 86762 HC SO RUBELLA LATEX TEST	$56.24	$148.00	—	—	62%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 HC SED RATE	$8.74	$23.00	—	71% below	62%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 HC SED RATE	$8.74	$23.00	—	—	62%
Sodium blood test CPT 84295 HC SODIUMSERUM	$24.70	$65.00	—	4% above	62%
Sodium blood test inpatient CPT 84295 HC SODIUMSERUM	$24.70	$65.00	—	—	62%
Stool ova and parasites exam CPT 87177 HC SO OVA AND PARASITES	$28.88	$76.00	—	21% below	62%
Stool ova and parasites exam inpatient CPT 87177 HC SO OVA AND PARASITES	$28.88	$76.00	—	—	62%
Stool test for hidden blood (guaiac FOBT) CPT 82270 HC OCCULT BLOOD FECES	$53.20	$140.00	—	157% above	62%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HC OCCULT BLOOD FECES	$53.20	$140.00	—	—	62%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 HC OCCULT BLOOD FECAL	$53.20	$140.00	—	31% above	62%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 HC OCCULT BLOOD FECAL	$53.20	$140.00	—	—	62%
Syphilis antibody test (Treponema pallidum) CPT 86780 HC FTA-ABS	$49.02	$129.00	—	8% below	62%
Syphilis antibody test (Treponema pallidum) CPT 86780 HC SO FTA-ABS	$49.02	$129.00	—	8% below	62%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 HC SO FTA-ABS	$49.02	$129.00	—	—	62%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 HC FTA-ABS	$49.02	$129.00	—	—	62%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC SO VDRL / RPR	$48.64	$128.00	—	56% above	62%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC VDRL / RPR	$48.64	$128.00	—	56% above	62%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC VDRL / RPR	$48.64	$128.00	—	—	62%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC SO VDRL / RPR	$48.64	$128.00	—	—	62%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC SO TB TEST CELL IMMUN MEASURE	$174.04	$458.00	—	48% above	62%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HC SO TB TEST CELL IMMUN MEASURE	$174.04	$458.00	—	—	62%
Testosterone blood test, total (not free testosterone) CPT 84403 HC TESTOSTERONE TOTAL	$104.88	$276.00	—	15% above	62%
Testosterone blood test, total (not free testosterone) CPT 84403 HC SO1 TESTOSTERONE FREE	$104.88	$276.00	—	15% above	62%
Testosterone blood test, total (not free testosterone) CPT 84403 HC SO TESTOSTERONE TOTAL	$104.88	$276.00	—	15% above	62%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC TESTOSTERONE TOTAL	$104.88	$276.00	—	—	62%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC SO1 TESTOSTERONE FREE	$104.88	$276.00	—	—	62%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC SO TESTOSTERONE TOTAL	$104.88	$276.00	—	—	62%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC SO MICROSOMAL ANTIBODY	$85.12	$224.00	—	1% below	62%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC SO1 MICROSOMAL ANTIBODY	$85.12	$224.00	—	1% below	62%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC SO1 MICROSOMAL ANTIBODY	$85.12	$224.00	—	—	62%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC SO MICROSOMAL ANTIBODY	$85.12	$224.00	—	—	62%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC THYROID STIMULATING HORMONE	$72.58	$191.00	—	7% below	62%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC SO TSH 3RD GENERATION	$72.58	$191.00	—	7% below	62%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC SO TSH 3RD GENERATION	$72.58	$191.00	—	—	62%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC THYROID STIMULATING HORMONE	$72.58	$191.00	—	—	62%
Total IgE blood test CPT 82785 HC SO IMMUNOGLOBULINIGE	$68.02	$179.00	—	7% above	62%
Total IgE blood test inpatient CPT 82785 HC SO IMMUNOGLOBULINIGE	$68.02	$179.00	—	—	62%
Total cholesterol blood test CPT 82465 HC CHOLESTEROL TOTAL	$28.12	$74.00	—	15% above	62%
Total cholesterol blood test inpatient CPT 82465 HC CHOLESTEROL TOTAL	$28.12	$74.00	—	—	62%
Total thyroxine (T4) blood test CPT 84436 HC SO THYROXINE TOTAL	$30.40	$80.00	—	37% below	62%
Total thyroxine (T4) blood test CPT 84436 HC T-4	$30.40	$80.00	—	37% below	62%
Total thyroxine (T4) blood test inpatient CPT 84436 HC SO THYROXINE TOTAL	$30.40	$80.00	—	—	62%
Total thyroxine (T4) blood test inpatient CPT 84436 HC T-4	$30.40	$80.00	—	—	62%
Total triiodothyronine (T3) blood test CPT 84480 HC SO T-3 BY RIATOTAL	$79.04	$208.00	—	6% below	62%
Total triiodothyronine (T3) blood test CPT 84480 HC T-3 BY RIATOTAL	$79.04	$208.00	—	6% below	62%
Total triiodothyronine (T3) blood test inpatient CPT 84480 HC T-3 BY RIATOTAL	$79.04	$208.00	—	—	62%
Total triiodothyronine (T3) blood test inpatient CPT 84480 HC SO T-3 BY RIATOTAL	$79.04	$208.00	—	—	62%
Transferrin blood test CPT 84466 HC TRANSFERRIN	$53.20	$140.00	—	8% below	62%
Transferrin blood test CPT 84466 HC SO TRANSFERRIN	$53.20	$140.00	—	8% below	62%
Transferrin blood test inpatient CPT 84466 HC TRANSFERRIN	$53.20	$140.00	—	—	62%
Transferrin blood test inpatient CPT 84466 HC SO TRANSFERRIN	$53.20	$140.00	—	—	62%
Trichomonas test (NAAT) CPT 87661 HC SO TRICHOMONAS VAGINALIS AMPLIF	$86.64	$228.00	—	3% below	62%
Trichomonas test (NAAT) CPT 87661 HC TRICHOMONAS VAGINALIS AMPLIF	$86.64	$228.00	—	3% below	62%
Trichomonas test (NAAT) inpatient CPT 87661 HC TRICHOMONAS VAGINALIS AMPLIF	$86.64	$228.00	—	—	62%
Trichomonas test (NAAT) inpatient CPT 87661 HC SO TRICHOMONAS VAGINALIS AMPLIF	$86.64	$228.00	—	—	62%
Triglycerides blood test CPT 84478 HC TRIGLYCERIDES	$89.30	$235.00	—	101% above	62%
Triglycerides blood test CPT 84478 HC SO TRIGLYCERIDES	$89.30	$235.00	—	101% above	62%
Triglycerides blood test inpatient CPT 84478 HC SO TRIGLYCERIDES	$89.30	$235.00	—	—	62%
Triglycerides blood test inpatient CPT 84478 HC TRIGLYCERIDES	$89.30	$235.00	—	—	62%
Troponin test, quantitative CPT 84484 HC TROPONIN	$136.42	$359.00	—	71% above	62%
Troponin test, quantitative inpatient CPT 84484 HC TROPONIN	$136.42	$359.00	—	—	62%
Uric acid blood test CPT 84550 HC URIC ACID	$27.36	$72.00	—	12% below	62%
Uric acid blood test inpatient CPT 84550 HC URIC ACID	$27.36	$72.00	—	—	62%
Urinalysis with microscope exam, automated CPT 81001 HC URINALYSIS W/ MICROSCOPY	$41.04	$108.00	—	20% above	62%
Urinalysis with microscope exam, automated inpatient CPT 81001 HC URINALYSIS W/ MICROSCOPY	$41.04	$108.00	—	—	62%
Urinalysis with microscope exam, manual CPT 81000 HC URINALYSIS NONAUTO W/SCOPE	$28.50	$75.00	—	14% above	62%
Urinalysis with microscope exam, manual inpatient CPT 81000 HC URINALYSIS NONAUTO W/SCOPE	$28.50	$75.00	—	—	62%
Urinalysis without microscope exam, automated CPT 81003 HC URINALYSIS AUTO W/O SCOPE	$22.42	$59.00	—	4% above	62%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC URINALYSIS AUTO W/O SCOPE	$22.42	$59.00	—	—	62%
Urinalysis without microscope exam, manual CPT 81002 HC NON-AUTOURINE W/O MICROSCOPY	$18.62	$49.00	—	18% above	62%
Urinalysis without microscope exam, manual inpatient CPT 81002 HC NON-AUTOURINE W/O MICROSCOPY	$18.62	$49.00	—	—	62%
Urine culture for bacteria, with colony count CPT 87086 HC URINE CULT./COLONY COUNT	$64.22	$169.00	—	at median	62%
Urine culture for bacteria, with colony count inpatient CPT 87086 HC URINE CULT./COLONY COUNT	$64.22	$169.00	—	—	62%
Urine microalbumin (albumin) test CPT 82043 HC URINEMICROALBUMINQUANTITATIV	$52.44	$138.00	—	3% above	62%
Urine microalbumin (albumin) test inpatient CPT 82043 HC URINEMICROALBUMINQUANTITATIV	$52.44	$138.00	—	—	62%
Urine pregnancy test, read by color change CPT 81025 HC HCG (URINE) PREGNANCY TEST	$29.64	$78.00	—	6% above	62%
Urine pregnancy test, read by color change inpatient CPT 81025 HC HCG (URINE) PREGNANCY TEST	$29.64	$78.00	—	—	62%
Vitamin B12 (cobalamin) blood test CPT 82607 HC VITAMIN B-12	$124.26	$327.00	—	45% above	62%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 HC VITAMIN B-12	$124.26	$327.00	—	—	62%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC SO VITAMIN D HYDROXYVITAMIN D	$112.10	$295.00	—	2% below	62%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC VITAMIN D HYDROXYVITAMIN D	$112.10	$295.00	—	2% below	62%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HC VITAMIN D HYDROXYVITAMIN D	$112.10	$295.00	—	—	62%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HC SO VITAMIN D HYDROXYVITAMIN D	$112.10	$295.00	—	—	62%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 HC SO DIHYDROXYVITAMIN D 1 25	$164.92	$434.00	—	26% above	62%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 HC SO DIHYDROXYVITAMIN D 1 25	$164.92	$434.00	—	—	62%
Zinc blood test CPT 84630 HC SO ZINC SERUM	$64.22	$169.00	—	52% above	62%
Zinc blood test inpatient CPT 84630 HC SO ZINC SERUM	$64.22	$169.00	—	—	62%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC SO HCG QUANTITATIVE	$86.64	$228.00	—	6% above	62%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC HCG QUANTITATIVE	$86.64	$228.00	—	6% above	62%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC SO HCG QUANTITATIVE	$86.64	$228.00	—	—	62%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC HCG QUANTITATIVE	$86.64	$228.00	—	—	62%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Maine	Off list
Botox injections for chronic migraine CPT 64615 HC CHEMDNR NRV MUSCLE FACIAL TRIG-PBB	$89.30	$235.00	—	58% below	62%
Botox injections for chronic migraine inpatient CPT 64615 HC CHEMDNR NRV MUSCLE FACIAL TRIG-PBB	$89.30	$235.00	—	—	62%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 HC BX BREAST 1ST LESION STRTCTC	$1,615.38	$4,251.00	—	13% below	62%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 HC BX BREAST 1ST LESION STRTCTC	$1,615.38	$4,251.00	—	—	62%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 HC TREAT ANKLE FX	$194.18	$511.00	—	30% below	62%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 HC TREAT ANKLE FX	$194.18	$511.00	—	—	62%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 HC TREAT METATARSAL FX	$194.18	$511.00	—	20% below	62%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 HC TREAT METATARSAL FX	$194.18	$511.00	—	—	62%
Cardiac catheterization with coronary angiogram CPT 93458 HC L HEART W LV & CORONARY	$4,476.40	$11,780.00	—	17% above	62%
Cardiac catheterization with coronary angiogram inpatient CPT 93458 HC L HEART W LV & CORONARY	$4,476.40	$11,780.00	—	—	62%
Cardioversion, elective (restoring heart rhythm) CPT 92960 HC CARDIOVERSION	$474.24	$1,248.00	—	3% below	62%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC CARDIOVERSION	$474.24	$1,248.00	—	—	62%
Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 HC CIRCUM 28 DAYS OR OLDER	$1,689.86	$4,447.00	—	179% above	62%
Circumcision by surgical excision, older than 28 days (children and adults) inpatient CPT 54161 HC CIRCUM 28 DAYS OR OLDER	$1,689.86	$4,447.00	—	—	62%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 HC TREAT RADIUS/ULNA FX	$1,503.28	$3,956.00	—	408% above	62%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 HC TREAT RADIUS/ULNA FX	$1,503.28	$3,956.00	—	—	62%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 HC CYSTOURETHROSCOPY	$552.90	$1,455.00	—	at median	62%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 HC CYSTOURETHROSCOPY	$552.90	$1,455.00	—	—	62%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 HC WOUND CAUTERY ELECTR HI-TEMP	$207.48	$546.00	—	126% above	62%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 HC DESTRUCT BENIGN LESION 1ST	$207.48	$546.00	—	126% above	62%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 HC WOUND CAUTERY ELECTR HI-TEMP	$207.48	$546.00	—	—	62%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 HC DESTRUCT BENIGN LESION 1ST	$207.48	$546.00	—	—	62%
Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 HC PBB TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA	$159.60	$420.00	—	54% below	62%
Ear tube placement (tympanostomy) with local anesthesia, one ear inpatient CPT 69433 HC PBB TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA	$159.60	$420.00	—	—	62%
Earwax removal by irrigation (rinsing), one ear CPT 69209 HC REMOV IMP EAR WAX 1 EAR	$95.00	$250.00	—	90% above	62%
Earwax removal by irrigation (rinsing), one ear CPT 69209 HC REMOVE IMPACTED EAR WAX IRRIGATE/ LVG UNI	$95.00	$250.00	—	90% above	62%
Earwax removal by irrigation (rinsing), one ear CPT 69209 HC REM IMPACT CERUMEN IRRIGAT UNI	$95.00	$250.00	—	90% above	62%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 HC REM IMPACT CERUMEN IRRIGAT UNI	$95.00	$250.00	—	—	62%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 HC REMOV IMP EAR WAX 1 EAR	$95.00	$250.00	—	—	62%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 HC REMOVE IMPACTED EAR WAX IRRIGATE/ LVG UNI	$95.00	$250.00	—	—	62%
Earwax removal with instruments, one ear CPT 69210 HC REMOVE IMPACTED CERUMEN	$77.52	$204.00	—	34% above	62%
Earwax removal with instruments, one ear one side CPT 69210 HC REMOVAL IMPACTED CERUMEN UNILATERAL	$77.52	$204.00	—	34% above	62%
Earwax removal with instruments, one ear inpatient CPT 69210 HC REMOVE IMPACTED CERUMEN	$77.52	$204.00	—	—	62%
Earwax removal with instruments, one ear inpatient one side CPT 69210 HC REMOVAL IMPACTED CERUMEN UNILATERAL	$77.52	$204.00	—	—	62%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 HC ENDOMETRIAL BIOPSY	$156.94	$413.00	—	21% below	62%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 HC ENDOMETRIAL BIOPSY	$156.94	$413.00	—	—	62%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 HC NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN	$1,413.60	$3,720.00	—	51% above	62%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 HC NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN	$1,413.60	$3,720.00	—	—	62%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 HC INJ ANES/STEROID L/S FACET SG	$1,078.44	$2,838.00	—	9% above	62%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 HC N BLOCK PARAVERT LUMBAR 1ST	$1,078.44	$2,838.00	—	9% above	62%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 HC N BLOCK PARAVERT LUMBAR 1ST	$1,078.44	$2,838.00	—	—	62%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 HC INJ ANES/STEROID L/S FACET SG	$1,078.44	$2,838.00	—	—	62%
Gallbladder removal, laparoscopic CPT 47562 HC LAP CHOLECYSTECTOMY	$4,655.76	$12,252.00	—	at median	62%
Gallbladder removal, laparoscopic inpatient CPT 47562 HC LAP CHOLECYSTECTOMY	$4,655.76	$12,252.00	—	—	62%
Hemorrhoid banding (rubber band ligation) CPT 46221 HC PHEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATION	$764.56	$2,012.00	—	1% above	62%
Hemorrhoid banding (rubber band ligation) CPT 46221 HC HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS	$764.56	$2,012.00	—	1% above	62%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 HC PHEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATION	$764.56	$2,012.00	—	—	62%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 HC HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS	$764.56	$2,012.00	—	—	62%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HC CATH/INTRO SAL CONT HYST	$64.98	$171.00	—	81% below	62%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 HC CATH/INTRO SAL CONT HYST	$64.98	$171.00	—	—	62%
IUD insertion (the device itself billed separately) CPT 58300 HC INSERT INTRAUTERINE DEVICE	$864.50	$2,275.00	—	419% above	62%
IUD insertion (the device itself billed separately) inpatient CPT 58300 HC INSERT INTRAUTERINE DEVICE	$864.50	$2,275.00	—	—	62%
Incision and drainage of a simple or single skin abscess CPT 10060 HC INCISION & DRAINAGE-SIMPLE	$210.14	$553.00	—	31% above	62%
Incision and drainage of a simple or single skin abscess CPT 10060 HC I & D SUBCUTANEOUS ABSCESS-SIMPLE	$210.14	$553.00	—	31% above	62%
Incision and drainage of a simple or single skin abscess CPT 10060 HC I & D SIMPLE	$210.14	$553.00	—	31% above	62%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC INCISION & DRAINAGE-SIMPLE	$210.14	$553.00	—	—	62%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC I & D SUBCUTANEOUS ABSCESS-SIMPLE	$210.14	$553.00	—	—	62%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC I & D SIMPLE	$210.14	$553.00	—	—	62%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC INJ TENDON SHEATH/LIGAMENT	$237.50	$625.00	—	26% above	62%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC INJ TENDON SHEATH/LIGAMNT	$237.50	$625.00	—	26% above	62%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC INJECT TENDON SHEATH LIGAMENT	$237.50	$625.00	—	26% above	62%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 HC INJECT TENDON SHEATH LIGAMENT	$237.50	$625.00	—	—	62%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 HC INJ TENDON SHEATH/LIGAMENT	$237.50	$625.00	—	—	62%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 HC INJ TENDON SHEATH/LIGAMNT	$237.50	$625.00	—	—	62%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC JOINT INJECTION/ASPIR LARGE WO US	$310.84	$818.00	—	18% above	62%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC ARTHROCENT/ASPIRATION MAJ JNT	$310.84	$818.00	—	18% above	62%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC ASP INJECTION MAJOR JOINT	$310.84	$818.00	—	18% above	62%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC ASP INJECTION MAJOR JOINT	$310.84	$818.00	—	—	62%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC ARTHROCENT/ASPIRATION MAJ JNT	$310.84	$818.00	—	—	62%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC JOINT INJECTION/ASPIR LARGE WO US	$310.84	$818.00	—	—	62%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 HC INSERT DRUG IMPLANT DEVICE	$102.98	$271.00	—	11% below	62%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 HC INSERT DRUG IMPLANT DEVICE	$102.98	$271.00	—	—	62%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC ASP INJ INTERMEDIATE JOINT	$294.12	$774.00	—	62% above	62%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC JOINT INJECTION/ASPIR MEDIUM WO US	$294.12	$774.00	—	62% above	62%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC JOINT INJECTION/ASPIR MEDIUM WO US	$294.12	$774.00	—	—	62%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC ASP INJ INTERMEDIATE JOINT	$294.12	$774.00	—	—	62%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC JOINT INJECTION/ASPIR SMALL WO US	$285.38	$751.00	—	42% above	62%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC INJECTION SMALL JOINT/BURSA	$285.38	$751.00	—	42% above	62%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC INJECTION SMALL JOINT/BURSA	$285.38	$751.00	—	—	62%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC JOINT INJECTION/ASPIR SMALL WO US	$285.38	$751.00	—	—	62%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC WND CLOSURE - 2.5CM OR LESS	$311.60	$820.00	—	8% above	62%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC LYR CLOS SC TK EXT <2.5 CM	$311.60	$820.00	—	8% above	62%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HC WND CLOSURE - 2.5CM OR LESS	$311.60	$820.00	—	—	62%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HC LYR CLOS SC TK EXT <2.5 CM	$311.60	$820.00	—	—	62%
Lower-back epidural injection, with imaging guidance CPT 62323 HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN	$1,413.60	$3,720.00	—	52% above	62%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN	$1,413.60	$3,720.00	—	—	62%
Lower-back epidural injection, without imaging guidance CPT 62322 HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN	$1,415.88	$3,726.00	—	56% above	62%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN	$1,415.88	$3,726.00	—	—	62%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC INJ A/S TRANSFORAM LUMBAR	$965.58	$2,541.00	—	at median	62%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HC INJ A/S TRANSFORAM LUMBAR	$965.58	$2,541.00	—	—	62%
Miscarriage treatment with D&C, first trimester CPT 59820 HC TX MISSED ABORTION FIRST TRIMESTER SURGICAL	$2,475.32	$6,514.00	—	51% above	62%
Miscarriage treatment with D&C, first trimester inpatient CPT 59820 HC TX MISSED ABORTION FIRST TRIMESTER SURGICAL	$2,475.32	$6,514.00	—	—	62%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 HC EXCIS BENIGN LES TO 0.5 CM; TRUNK/ARMS/LEGS	$612.18	$1,611.00	—	258% above	62%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 HC EXC TR-EXT B9+MARG 0.5 CM<	$612.18	$1,611.00	—	258% above	62%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 HC EXC SKIN BENIG <5MM TRUNKARMLEG	$612.18	$1,611.00	—	258% above	62%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 HC EXCIS BENIGN LES TO 0.5 CM; TRUNK/ARMS/LEGS	$612.18	$1,611.00	—	—	62%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 HC EXC TR-EXT B9+MARG 0.5 CM<	$612.18	$1,611.00	—	—	62%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 HC EXC SKIN BENIG <5MM TRUNKARMLEG	$612.18	$1,611.00	—	—	62%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 HC EXC LESION 0 - 0.5 CM - FACE EARS EYELIDS NOSE LIPS MUCOUS MEMBRAN	$665.38	$1,751.00	—	147% above	62%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 HC EXC FACE-MM B9+MARG 0.5 CM/<	$665.38	$1,751.00	—	147% above	62%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 HC EXC FACE-MM B9+MARG 0.5 CM/<	$665.38	$1,751.00	—	—	62%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 HC EXC LESION 0 - 0.5 CM - FACE EARS EYELIDS NOSE LIPS MUCOUS MEMBRAN	$665.38	$1,751.00	—	—	62%
Nail removal (partial or complete), one nail CPT 11730 HC ED AVULSION NAIL PLATE SINGLE	$207.48	$546.00	—	59% above	62%
Nail removal (partial or complete), one nail CPT 11730 HC AVULSION OF NAIL PLATE	$207.48	$546.00	—	59% above	62%
Nail removal (partial or complete), one nail CPT 11730 HC AVULSION NAIL PLATE SINGLE	$207.48	$546.00	—	59% above	62%
Nail removal (partial or complete), one nail inpatient CPT 11730 HC AVULSION NAIL PLATE SINGLE	$207.48	$546.00	—	—	62%
Nail removal (partial or complete), one nail inpatient CPT 11730 HC AVULSION OF NAIL PLATE	$207.48	$546.00	—	—	62%
Nail removal (partial or complete), one nail inpatient CPT 11730 HC ED AVULSION NAIL PLATE SINGLE	$207.48	$546.00	—	—	62%
Occipital nerve block (injection for headaches) CPT 64405 HC INJ CERV OCCIPITAL NERV	$112.86	$297.00	—	62% below	62%
Occipital nerve block (injection for headaches) CPT 64405 HC INJ AA&/STRD GREATER OCCIPITAL NERVE	$112.86	$297.00	—	62% below	62%
Occipital nerve block (injection for headaches) inpatient CPT 64405 HC INJ AA&/STRD GREATER OCCIPITAL NERVE	$112.86	$297.00	—	—	62%
Occipital nerve block (injection for headaches) inpatient CPT 64405 HC INJ CERV OCCIPITAL NERV	$112.86	$297.00	—	—	62%
Pacemaker implant (dual chamber) CPT 33208 HC INS/REPL OF DUAL CHAM PPM LEAD	$9,145.08	$24,066.00	—	6% below	62%
Pacemaker implant (dual chamber) inpatient CPT 33208 HC INS/REPL OF DUAL CHAM PPM LEAD	$9,145.08	$24,066.00	—	—	62%
Paracentesis with imaging guidance CPT 49083 HC ABD PARACENTESIS W GUIDE	$738.72	$1,944.00	—	9% below	62%
Paracentesis with imaging guidance CPT 49083 HC ABDOM PARACENTESIS DX/THER W IMAGING GUIDANCE	$738.72	$1,944.00	—	9% below	62%
Paracentesis with imaging guidance inpatient CPT 49083 HC ABD PARACENTESIS W GUIDE	$738.72	$1,944.00	—	—	62%
Paracentesis with imaging guidance inpatient CPT 49083 HC ABDOM PARACENTESIS DX/THER W IMAGING GUIDANCE	$738.72	$1,944.00	—	—	62%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC REMOVAL OF NAIL BED	$500.46	$1,317.00	—	53% above	62%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC EXCIS NAIL MATRIX PERM RMVL	$500.46	$1,317.00	—	53% above	62%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC EXCISION OF NAIL & NAIL MATRIX	$500.46	$1,317.00	—	53% above	62%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 HC EXCISION OF NAIL & NAIL MATRIX	$500.46	$1,317.00	—	—	62%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 HC REMOVAL OF NAIL BED	$500.46	$1,317.00	—	—	62%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 HC EXCIS NAIL MATRIX PERM RMVL	$500.46	$1,317.00	—	—	62%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 HC RF DESTRUCT LUM SINGLE	$1,906.46	$5,017.00	—	31% above	62%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 HC RF DESTRUCT LUM SINGLE	$1,906.46	$5,017.00	—	—	62%
Removal of a foreign object under the skin, simple CPT 10120 HC REMOVAL FB - SUBCUTANEOUS	$497.42	$1,309.00	—	117% above	62%
Removal of a foreign object under the skin, simple CPT 10120 HC REMOVAL FB SKIN	$497.42	$1,309.00	—	117% above	62%
Removal of a foreign object under the skin, simple inpatient CPT 10120 HC REMOVAL FB SKIN	$497.42	$1,309.00	—	—	62%
Removal of a foreign object under the skin, simple inpatient CPT 10120 HC REMOVAL FB - SUBCUTANEOUS	$497.42	$1,309.00	—	—	62%
Short arm cast (elbow to hand) CPT 29075 HC CAST - SHORT ARM	$228.00	$600.00	—	30% above	62%
Short arm cast (elbow to hand) inpatient CPT 29075 HC CAST - SHORT ARM	$228.00	$600.00	—	—	62%
Short arm splint (forearm and hand) CPT 29125 HC SPLINT - SHORT ARM	$177.08	$466.00	—	54% above	62%
Short arm splint (forearm and hand) CPT 29125 HC SPLINT APP SHORT ARM STAT	$177.08	$466.00	—	54% above	62%
Short arm splint (forearm and hand) inpatient CPT 29125 HC SPLINT - SHORT ARM	$177.08	$466.00	—	—	62%
Short arm splint (forearm and hand) inpatient CPT 29125 HC SPLINT APP SHORT ARM STAT	$177.08	$466.00	—	—	62%
Short leg cast (below the knee) CPT 29405 HC APPLY SHORT LEG CAST	$228.00	$600.00	—	42% above	62%
Short leg cast (below the knee) CPT 29405 HC CAST SHORT LEG	$228.00	$600.00	—	42% above	62%
Short leg cast (below the knee) inpatient CPT 29405 HC APPLY SHORT LEG CAST	$228.00	$600.00	—	—	62%
Short leg cast (below the knee) inpatient CPT 29405 HC CAST SHORT LEG	$228.00	$600.00	—	—	62%
Short leg splint (calf to foot) CPT 29515 HC SPLINT APP/SHORT LEG	$72.58	$191.00	—	43% below	62%
Short leg splint (calf to foot) CPT 29515 HC SPLINT - SHORT LEG	$72.58	$191.00	—	43% below	62%
Short leg splint (calf to foot) inpatient CPT 29515 HC SPLINT - SHORT LEG	$72.58	$191.00	—	—	62%
Short leg splint (calf to foot) inpatient CPT 29515 HC SPLINT APP/SHORT LEG	$72.58	$191.00	—	—	62%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC REPR SUPERF WND BODY <2.5CM	$164.54	$433.00	—	11% above	62%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC REP LAC SMP NOT FACE <2.5CM	$164.54	$433.00	—	11% above	62%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HC REPR SUPERF WND BODY <2.5CM	$164.54	$433.00	—	—	62%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HC REP LAC SMP NOT FACE <2.5CM	$164.54	$433.00	—	—	62%
Skin biopsy, punch, one lesion CPT 11104 HC PUNCH BIOPSY SKIN SINGLE LESION	$185.44	$488.00	—	28% below	62%
Skin biopsy, punch, one lesion inpatient CPT 11104 HC PUNCH BIOPSY SKIN SINGLE LESION	$185.44	$488.00	—	—	62%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 HC EXC SKIN MALIG <5MM TRUNK,ARM,LEG	$571.14	$1,503.00	—	75% above	62%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 HC EXC SKIN MALIG <5MM TRUNK,ARM,LEG	$571.14	$1,503.00	—	—	62%
Skin tag removal, up to 15 tags CPT 11200 HC EXCISION UP TO 15 SKIN TAGS	$153.14	$403.00	—	17% above	62%
Skin tag removal, up to 15 tags inpatient CPT 11200 HC EXCISION UP TO 15 SKIN TAGS	$153.14	$403.00	—	—	62%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC DIAGNOSTIC LUMBAR PUNCTURE	$441.18	$1,161.00	—	9% below	62%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC SPINAL PUNCTURE LUMBAR DIAGNOS	$441.18	$1,161.00	—	9% below	62%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC SPINAL PUNCTURE LUMBAR DIAGNOSTIC	$441.18	$1,161.00	—	9% below	62%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC SPINAL PUNCTURE LUMBAR DIAGNOSTIC	$441.18	$1,161.00	—	—	62%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC SPINAL PUNCTURE LUMBAR DIAGNOS	$441.18	$1,161.00	—	—	62%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC DIAGNOSTIC LUMBAR PUNCTURE	$441.18	$1,161.00	—	—	62%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC RPR LAC SMP SCALP 2.6-7.5	$165.30	$435.00	—	11% below	62%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC REPR SUP NPTERF WND BODY 2.6-7.5	$165.30	$435.00	—	11% below	62%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC REPR SMP NOT FACE 2.6-7.5CM	$165.30	$435.00	—	11% below	62%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 HC RPR LAC SMP SCALP 2.6-7.5	$165.30	$435.00	—	—	62%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 HC REPR SMP NOT FACE 2.6-7.5CM	$165.30	$435.00	—	—	62%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 HC REPR SUP NPTERF WND BODY 2.6-7.5	$165.30	$435.00	—	—	62%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HC SIMPLE REP WND FACE <2.5 CM	$163.78	$431.00	—	1% below	62%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HC REPR SUPERF WND FACE <2.5CM	$163.78	$431.00	—	1% below	62%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 HC SIMPLE REP WND FACE <2.5 CM	$163.78	$431.00	—	—	62%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 HC REPR SUPERF WND FACE <2.5CM	$163.78	$431.00	—	—	62%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC TANGENTIAL BIOPSY SKIN SINGLE LESION	$289.94	$763.00	—	48% above	62%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 HC TANGENTIAL BIOPSY SKIN SINGLE LESION	$289.94	$763.00	—	—	62%
Thoracentesis with imaging guidance CPT 32555 HC ASPIRATE PLEURA W/ IMAGING	$745.56	$1,962.00	—	11% above	62%
Thoracentesis with imaging guidance CPT 32555 HC SP THORA FOR ASPIRATION	$745.56	$1,962.00	—	11% above	62%
Thoracentesis with imaging guidance inpatient CPT 32555 HC SP THORA FOR ASPIRATION	$745.56	$1,962.00	—	—	62%
Thoracentesis with imaging guidance inpatient CPT 32555 HC ASPIRATE PLEURA W/ IMAGING	$745.56	$1,962.00	—	—	62%
Trigger finger release surgery CPT 26055 HC INCISE FINGER TENDON SHEATH	$1,314.42	$3,459.00	—	45% below	62%
Trigger finger release surgery inpatient CPT 26055 HC INCISE FINGER TENDON SHEATH	$1,314.42	$3,459.00	—	—	62%
Trigger point injections, 1 or 2 muscles CPT 20552 HC INJ TRIGGER PT 1-2 MUSC GRPS	$112.86	$297.00	—	41% below	62%
Trigger point injections, 1 or 2 muscles CPT 20552 HC INJECT TRIGGER POINT 1/2 MUSCLE	$112.86	$297.00	—	41% below	62%
Trigger point injections, 1 or 2 muscles CPT 20552 HC INJ TRIGGER POINTS 1-2 MUSC	$301.72	$794.00	—	57% above	62%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC INJECT TRIGGER POINT 1/2 MUSCLE	$112.86	$297.00	—	—	62%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC INJ TRIGGER PT 1-2 MUSC GRPS	$112.86	$297.00	—	—	62%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC INJ TRIGGER POINTS 1-2 MUSC	$301.72	$794.00	—	—	62%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 HC BX BREAST 1ST LESION US IMG	$1,238.42	$3,259.00	—	10% below	62%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 HC BX BREAST 1ST LESION US IMG	$1,238.42	$3,259.00	—	—	62%
Vein ablation, radiofrequency, first vein CPT 36475 HC ENDOVENOUS RF 1ST VEIN	$2,489.00	$6,550.00	—	36% below	62%
Vein ablation, radiofrequency, first vein inpatient CPT 36475 HC ENDOVENOUS RF 1ST VEIN	$2,489.00	$6,550.00	—	—	62%
Wart removal, up to 14 warts CPT 17110 HC DESTRUCT BENIGN LESIONS	$119.32	$314.00	—	30% below	62%
Wart removal, up to 14 warts CPT 17110 HC DESTRUCT B9 LESION 1-14	$119.32	$314.00	—	30% below	62%
Wart removal, up to 14 warts CPT 17110 HC DESTRUCT LESIONS UP TO 14	$119.32	$314.00	—	30% below	62%
Wart removal, up to 14 warts inpatient CPT 17110 HC DESTRUCT BENIGN LESIONS	$119.32	$314.00	—	—	62%
Wart removal, up to 14 warts inpatient CPT 17110 HC DESTRUCT LESIONS UP TO 14	$119.32	$314.00	—	—	62%
Wart removal, up to 14 warts inpatient CPT 17110 HC DESTRUCT B9 LESION 1-14	$119.32	$314.00	—	—	62%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC DEBRIDE SUBQ FIRST 20 SQ CM	$384.94	$1,013.00	—	107% above	62%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC DEB SUBQ TISSUE 20 SQ CM/<	$384.94	$1,013.00	—	107% above	62%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC DEBRIDE SKIN AND SUBCU	$384.94	$1,013.00	—	107% above	62%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HC DEB SUBQ TISSUE 20 SQ CM/<	$384.94	$1,013.00	—	—	62%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HC DEBRIDE SKIN AND SUBCU	$384.94	$1,013.00	—	—	62%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HC DEBRIDE SUBQ FIRST 20 SQ CM	$384.94	$1,013.00	—	—	62%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Maine	Off list
Blood transfusion (giving blood or blood components) CPT 36430 HC BLOOD ADMINISTRATION	$500.84	$1,318.00	—	2% above	62%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC BLOOD ADMINISTRATION	$500.84	$1,318.00	—	—	62%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC AEROSOL HHN MDI IPPB	$175.94	$463.00	—	4% below	62%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC SPUTUM INDUCTION	$175.94	$463.00	—	4% below	62%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC SPUTUM INDUCTION	$175.94	$463.00	—	—	62%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC AEROSOL HHN MDI IPPB	$175.94	$463.00	—	—	62%
Chemotherapy IV infusion, first hour CPT 96413 HC CHEMO INFUSION 1ST HOUR CHEMO	$300.96	$792.00	—	23% below	62%
Chemotherapy IV infusion, first hour inpatient CPT 96413 HC CHEMO INFUSION 1ST HOUR CHEMO	$300.96	$792.00	—	—	62%
Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 HC COMPREHENSIVE HEARING EVAL	$125.02	$329.00	—	at median	62%
Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 HC COMPREHENSIVE HEARING EVAL	$125.02	$329.00	—	—	62%
Critical care, first 30 to 74 minutes CPT 99291 HC E/M CRIT CAREER 1ST 30-74MIN	$1,026.00	$2,700.00	—	at median	62%
Critical care, first 30 to 74 minutes inpatient CPT 99291 HC E/M CRIT CAREER 1ST 30-74MIN	$1,026.00	$2,700.00	—	—	62%
EEG (brain wave test), awake and drowsy, routine CPT 95816 HC EEG AWAKE & DROWSY	$239.78	$631.00	—	33% below	62%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 HC EEG AWAKE & DROWSY	$239.78	$631.00	—	—	62%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 HC ELECTROCARDIOGRAM COMPLETE	$26.60	$70.00	—	80% below	62%
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 HC ELECTROCARDIOGRAM COMPLETE	$26.60	$70.00	—	—	62%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC >= 12 LEAD EKG	$139.84	$368.00	—	24% above	62%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 HC >= 12 LEAD EKG	$139.84	$368.00	—	—	62%
Electroconvulsive therapy (ECT), one session CPT 90870 HC ECT	$462.84	$1,218.00	—	54% below	62%
Electroconvulsive therapy (ECT), one session inpatient CPT 90870 HC ECT	$462.84	$1,218.00	—	—	62%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 HC ER LEVEL 1	$88.92	$234.00	—	14% below	62%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 HC ER LEVEL 1	$88.92	$234.00	—	—	62%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 HC ER LEVEL 2	$118.18	$311.00	—	43% below	62%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 HC ER LEVEL 2	$118.18	$311.00	—	—	62%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 HC ER LEVEL 3	$236.74	$623.00	—	29% below	62%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 HC ER LEVEL 3	$236.74	$623.00	—	—	62%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC ER LEVEL 4	$428.26	$1,127.00	—	30% below	62%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HC ER LEVEL 4	$428.26	$1,127.00	—	—	62%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC ER LEVEL 5	$770.26	$2,027.00	—	22% below	62%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HC ER LEVEL 5	$770.26	$2,027.00	—	—	62%
Exercise stress test, tracing only, the hospital charge CPT 93017 HC CARDIAC STRESS TEST	$344.28	$906.00	—	41% below	62%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HC CARDIAC STRESS TEST	$344.28	$906.00	—	—	62%
Family therapy with the patient, 50 minutes CPT 90847 HC PHP FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS	$122.36	$322.00	—	31% below	62%
Family therapy with the patient, 50 minutes inpatient CPT 90847 HC PHP FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS	$122.36	$322.00	—	—	62%
Family therapy without the patient, 50 minutes CPT 90846 HC OP FAMILY TX WO PT PPRESENT 50MIN	$122.36	$322.00	—	10% below	62%
Family therapy without the patient, 50 minutes inpatient CPT 90846 HC OP FAMILY TX WO PT PPRESENT 50MIN	$122.36	$322.00	—	—	62%
Group psychotherapy session CPT 90853 HC PHP GROUP PSYCHOTHERAPY	$122.36	$322.00	—	101% above	62%
Group psychotherapy session CPT 90853 HC PHP INTERACTIVE GRP PSYC 45-50MINUTES	$122.36	$322.00	—	101% above	62%
Group psychotherapy session inpatient CPT 90853 HC PHP INTERACTIVE GRP PSYC 45-50MINUTES	$122.36	$322.00	—	—	62%
Group psychotherapy session inpatient CPT 90853 HC PHP GROUP PSYCHOTHERAPY	$122.36	$322.00	—	—	62%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC INF 1ST HOUR HYD	$223.82	$589.00	—	6% above	62%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC INF 1ST HOUR HYD	$223.82	$589.00	—	—	62%
IV infusion of a medicine, first hour CPT 96365 HC IV 1ST HOUR INIT DRUG	$241.30	$635.00	—	26% below	62%
IV infusion of a medicine, first hour inpatient CPT 96365 HC IV 1ST HOUR INIT DRUG	$241.30	$635.00	—	—	62%
IV push of a medicine, first drug CPT 96374 HC IV PUSH INITIAL DRUG	$135.28	$356.00	—	31% below	62%
IV push of a medicine, first drug CPT 96374 HC INJECTION DEPO PROVERA	$135.28	$356.00	—	31% below	62%
IV push of a medicine, first drug inpatient CPT 96374 HC INJECTION DEPO PROVERA	$135.28	$356.00	—	—	62%
IV push of a medicine, first drug inpatient CPT 96374 HC IV PUSH INITIAL DRUG	$135.28	$356.00	—	—	62%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC INJECTION IM SUB Q	$63.84	$168.00	—	8% below	62%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC INJECTION IM SUB Q	$63.84	$168.00	—	—	62%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC PHP PSYCH EVALUATION	$167.96	$442.00	—	22% below	62%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC PHP PSYCH EVALUATION	$167.96	$442.00	—	—	62%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 HC NERVE CONDUCTION 7-8 STUDIES	$797.62	$2,099.00	—	270% above	62%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 HC NERVE CONDUCTION 7-8 STUDIES	$797.62	$2,099.00	—	—	62%
New patient office visit, about 30 minutes CPT 99203 HC NEW PT E/M LEVEL 3	$48.26	$127.00	—	66% below	62%
New patient office visit, about 30 minutes CPT 99203 HC NEW PT OUTPT VISIT LEVEL 3 W/ PROCEDURE	$154.28	$406.00	—	7% above	62%
New patient office visit, about 30 minutes CPT 99203 HC NEW PT OUTPT VISIT LEVEL 3	$154.28	$406.00	—	7% above	62%
New patient office visit, about 30 minutes inpatient CPT 99203 HC NEW PT E/M LEVEL 3	$48.26	$127.00	—	—	62%
New patient office visit, about 30 minutes inpatient CPT 99203 HC NEW PT OUTPT VISIT LEVEL 3 W/ PROCEDURE	$154.28	$406.00	—	—	62%
New patient office visit, about 30 minutes inpatient CPT 99203 HC NEW PT OUTPT VISIT LEVEL 3	$154.28	$406.00	—	—	62%
New patient office visit, about 45 minutes CPT 99204 HC NEW PT E/M LEVEL 4	$48.26	$127.00	—	77% below	62%
New patient office visit, about 45 minutes CPT 99204 HC NEW PT OUTPT VISIT LEVEL 4 W/ PROCEDURE	$196.46	$517.00	—	6% below	62%
New patient office visit, about 45 minutes CPT 99204 HC NEW PT OUTPT VISIT LEVEL 4	$196.46	$517.00	—	6% below	62%
New patient office visit, about 45 minutes inpatient CPT 99204 HC NEW PT E/M LEVEL 4	$48.26	$127.00	—	—	62%
New patient office visit, about 45 minutes inpatient CPT 99204 HC NEW PT OUTPT VISIT LEVEL 4	$196.46	$517.00	—	—	62%
New patient office visit, about 45 minutes inpatient CPT 99204 HC NEW PT OUTPT VISIT LEVEL 4 W/ PROCEDURE	$196.46	$517.00	—	—	62%
New patient office visit, about 60 minutes CPT 99205 HC NEW PT E/M LEVEL 5	$48.26	$127.00	—	85% below	62%
New patient office visit, about 60 minutes CPT 99205 HC NEW PT OUTPT VISIT LEVEL 5 W/ PROCEDURE	$289.18	$761.00	—	13% below	62%
New patient office visit, about 60 minutes CPT 99205 HC NEW PT OUTPT VISIT LEVEL 5	$289.18	$761.00	—	13% below	62%
New patient office visit, about 60 minutes inpatient CPT 99205 HC NEW PT E/M LEVEL 5	$48.26	$127.00	—	—	62%
New patient office visit, about 60 minutes inpatient CPT 99205 HC NEW PT OUTPT VISIT LEVEL 5 W/ PROCEDURE	$289.18	$761.00	—	—	62%
New patient office visit, about 60 minutes inpatient CPT 99205 HC NEW PT OUTPT VISIT LEVEL 5	$289.18	$761.00	—	—	62%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC NEW PT E/M LEVEL 2	$48.26	$127.00	—	45% below	62%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC NEW PT OUTPT VISIT LEVEL 2 W/ PROCEDURE	$121.60	$320.00	—	38% above	62%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC NEW PT OUTPT VISIT LEVEL 2	$121.60	$320.00	—	38% above	62%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC NEW PT E/M LEVEL 2	$48.26	$127.00	—	—	62%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC NEW PT OUTPT VISIT LEVEL 2 W/ PROCEDURE	$121.60	$320.00	—	—	62%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC NEW PT OUTPT VISIT LEVEL 2	$121.60	$320.00	—	—	62%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC MED NUT THERAPY IND INIT 15 MIN	$47.12	$124.00	—	3% above	62%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HC MED NUT THERAPY IND INIT 15 MIN	$47.12	$124.00	—	—	62%
Preventive checkup, new patient aged 18–39 CPT 99385 HC PREV VISIT NEW AGE18-39	$104.12	$274.00	—	28% below	62%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 HC PREV VISIT NEW AGE18-39	$104.12	$274.00	—	—	62%
Preventive checkup, returning patient aged 40–64 CPT 99396 HC PREV VISIT EST AGE 40-64	$120.84	$318.00	—	7% above	62%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 HC PREV VISIT EST AGE 40-64	$120.84	$318.00	—	—	62%
Psychiatric evaluation with medical services CPT 90792 HC IOP PSYCH EVAL W/MED SRVC	$121.60	$320.00	—	46% below	62%
Psychiatric evaluation with medical services inpatient CPT 90792 HC IOP PSYCH EVAL W/MED SRVC	$121.60	$320.00	—	—	62%
Psychological testing evaluation by a psychologist or physician, first hour CPT 96130 HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR	$239.78	$631.00	—	62% above	62%
Psychological testing evaluation by a psychologist or physician, first hour inpatient CPT 96130 HC PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR	$239.78	$631.00	—	—	62%
Psychotherapy for crisis, first 60 minutes CPT 90839 HC PHP PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES	$128.44	$338.00	—	54% below	62%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 HC PHP PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES	$128.44	$338.00	—	—	62%
Psychotherapy session, 30 minutes CPT 90832 HC OP PSYCH TX 30 MIN	$138.32	$364.00	—	3% above	62%
Psychotherapy session, 30 minutes CPT 90832 HC PHP PSYCHOTHERAPY W/PATIENT 30 MINUTES	$138.32	$364.00	—	3% above	62%
Psychotherapy session, 30 minutes inpatient CPT 90832 HC PHP PSYCHOTHERAPY W/PATIENT 30 MINUTES	$138.32	$364.00	—	—	62%
Psychotherapy session, 30 minutes inpatient CPT 90832 HC OP PSYCH TX 30 MIN	$138.32	$364.00	—	—	62%
Psychotherapy session, 45 minutes CPT 90834 HC PHP PSYCHOTHERAPY W/PATIENT 45 MINUTES	$122.36	$322.00	—	30% below	62%
Psychotherapy session, 45 minutes inpatient CPT 90834 HC PHP PSYCHOTHERAPY W/PATIENT 45 MINUTES	$122.36	$322.00	—	—	62%
Psychotherapy session, 60 minutes CPT 90837 HC PHP PSYCHOTHERAPY W/PATIENT 60 MINUTES	$122.36	$322.00	—	28% below	62%
Psychotherapy session, 60 minutes inpatient CPT 90837 HC PHP PSYCHOTHERAPY W/PATIENT 60 MINUTES	$122.36	$322.00	—	—	62%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 HC SMOKE/TOBAC COUNSEL 3-10	$22.04	$58.00	—	11% below	62%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 HC SMOKE/TOBAC COUNSEL 3-10	$22.04	$58.00	—	—	62%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC EST PT E/M LEVEL 5	$48.26	$127.00	—	67% below	62%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC EST PT OUTPT VISIT LEVEL 5 W/ PROCEDURE	$119.70	$315.00	—	18% below	62%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC EST PT OUTPT VISIT LEVEL 5	$119.70	$315.00	—	18% below	62%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC EST PT E/M LEVEL 5	$48.26	$127.00	—	—	62%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC EST PT OUTPT VISIT LEVEL 5 W/ PROCEDURE	$119.70	$315.00	—	—	62%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC EST PT OUTPT VISIT LEVEL 5	$119.70	$315.00	—	—	62%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC EST PT E/M LEVEL 3	$48.26	$127.00	—	34% below	62%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC EST PT OUTPT VISIT LEVEL 3	$69.92	$184.00	—	4% below	62%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC EST PT OUTPT VISIT LEVEL 3 W/ PROCEDURE	$69.92	$184.00	—	4% below	62%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC EST PT E/M LEVEL 3	$48.26	$127.00	—	—	62%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC EST PT OUTPT VISIT LEVEL 3 W/ PROCEDURE	$69.92	$184.00	—	—	62%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC EST PT OUTPT VISIT LEVEL 3	$69.92	$184.00	—	—	62%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC EST PT E/M LEVEL 4	$48.26	$127.00	—	54% below	62%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC EST PT OUTPT VISIT LEVEL 4 W/ PROCEDURE	$96.52	$254.00	—	9% below	62%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC EST PT OUTPT VISIT LEVEL 4	$96.52	$254.00	—	9% below	62%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC EST PT E/M LEVEL 4	$48.26	$127.00	—	—	62%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC EST PT OUTPT VISIT LEVEL 4 W/ PROCEDURE	$96.52	$254.00	—	—	62%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC EST PT OUTPT VISIT LEVEL 4	$96.52	$254.00	—	—	62%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC EST PT E/M LEVEL 2	$48.26	$127.00	—	14% below	62%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC EST PT OUTPT VISIT LEVEL 2 W/ PROCEDURE	$60.80	$160.00	—	8% above	62%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC EST PT OUTPT VISIT LEVEL 2	$60.80	$160.00	—	8% above	62%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC EST PT E/M LEVEL 2	$48.26	$127.00	—	—	62%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC EST PT OUTPT VISIT LEVEL 2	$60.80	$160.00	—	—	62%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC EST PT OUTPT VISIT LEVEL 2 W/ PROCEDURE	$60.80	$160.00	—	—	62%
Spirometry (breathing test) CPT 94010 HC SPIROMETRY / TVC / MVV	$166.82	$439.00	—	18% above	62%
Spirometry (breathing test) inpatient CPT 94010 HC SPIROMETRY / TVC / MVV	$166.82	$439.00	—	—	62%
Spirometry before and after a bronchodilator CPT 94060 HC BEFORE / AFTER BRONCHODILATOR	$316.92	$834.00	—	1% below	62%
Spirometry before and after a bronchodilator inpatient CPT 94060 HC BEFORE / AFTER BRONCHODILATOR	$316.92	$834.00	—	—	62%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HC PHLEBOTOMYTX	$135.66	$357.00	—	12% below	62%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HC PHLEBOTOMY THERAPEUTIC	$135.66	$357.00	—	12% below	62%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 HC PHLEBOTOMYTX	$135.66	$357.00	—	—	62%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 HC PHLEBOTOMY THERAPEUTIC	$135.66	$357.00	—	—	62%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Maine	Off list
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 HC SARSCOV2 VACCINE 50 MCG/0.5 ML FOR IM USE	$128.44	$338.00	—	20% below	62%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 HC SARSCOV2 VACCINE 50 MCG/0.5 ML FOR IM USE	$128.44	$338.00	—	—	62%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 HC SARSCOV2 VACC 30MCG/0.3ML TRIS-SUCROSE IM USE	$115.14	$303.00	—	—	62%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 HC SARSCOV2 VACC 30MCG/0.3ML TRIS-SUCROSE IM USE	$115.14	$303.00	—	—	62%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 HC VAR VACCINE LIVE FOR SUBCUTANEOUS USE	$103.36	$272.00	—	33% below	62%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 HC VAR VACCINE LIVE FOR SUBCUTANEOUS USE	$103.36	$272.00	—	—	62%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 HC DTAP-IPV VACCINE CHILD 4-6 YRS FOR IM USE	$48.64	$128.00	—	22% below	62%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 HC DTAP-IPV VACCINE CHILD 4-6 YRS FOR IM USE	$48.64	$128.00	—	—	62%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 HC DTAP VACCINE < 7 YRS IM	$13.68	$36.00	—	42% below	62%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 HC DTAP VACCINE < 7 YRS IM	$13.68	$36.00	—	—	62%
Flu shot, recombinant, egg-free (Flublok) CPT 90673 HC RIV3 VACCINE NO PRESERV IM	$69.92	$184.00	—	8% above	62%
Flu shot, recombinant, egg-free (Flublok) inpatient CPT 90673 HC RIV3 VACCINE NO PRESERV IM	$69.92	$184.00	—	—	62%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 HC IIV3 VACC PRESERVATIVE FREE 0.5 ML DOSAGE IM USE	$22.04	$58.00	—	at median	62%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 HC IIV3 VACC PRESERVATIVE FREE 0.5 ML DOSAGE IM USE	$22.04	$58.00	—	—	62%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HC 9VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE	$119.70	$315.00	—	19% below	62%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HC 9VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE	$119.70	$315.00	—	—	62%
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 HC HEPA/HEPB VACCINE ADULT IM	$70.68	$186.00	—	45% below	62%
Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 HC HEPA/HEPB VACCINE ADULT IM	$70.68	$186.00	—	—	62%
Hepatitis A vaccine, adult dose CPT 90632 HC HEPA VACCINE ADULT IM	$55.10	$145.00	—	44% below	62%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HC HEPA VACCINE ADULT IM	$55.10	$145.00	—	—	62%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HC HEPATITIS B VACCINE	$46.36	$122.00	—	27% below	62%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HC HEPATITIS B VACCINE	$46.36	$122.00	—	—	62%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) CPT 90739 HC HEPB VACCINE ADULT 2 DOSE SCHEDULE FOR IM USE	$205.58	$541.00	—	8% above	62%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) inpatient CPT 90739 HC HEPB VACCINE ADULT 2 DOSE SCHEDULE FOR IM USE	$205.58	$541.00	—	—	62%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HC HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM	$18.62	$49.00	—	47% below	62%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HC HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM	$18.62	$49.00	—	—	62%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 HC HIB PRP-OMP VACC 3 DOSE IM	$15.58	$41.00	—	53% below	62%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) inpatient CPT 90647 HC HIB PRP-OMP VACC 3 DOSE IM	$15.58	$41.00	—	—	62%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 HC HIB PRP-T VACCINE 4 DOSE SCHEDULE IM USE	$21.28	$56.00	—	7% above	62%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 HC HIB PRP-T VACCINE 4 DOSE SCHEDULE IM USE	$21.28	$56.00	—	—	62%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 HC IIV VACCINE PRESERV FREE INCREASED AG COUNT IM	$71.82	$189.00	—	at median	62%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 HC IIV VACCINE PRESERV FREE INCREASED AG COUNT IM	$71.82	$189.00	—	—	62%
MMR vaccine (measles, mumps and rubella), live CPT 90707 HC MMR VIRUS IMMUNIZATION SUBCUT	$42.56	$112.00	—	67% below	62%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 HC MMR VIRUS IMMUNIZATION SUBCUT	$42.56	$112.00	—	—	62%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 HC COMBINED VACCINEMMR+VARICELLASUB-Q	$162.64	$428.00	—	28% below	62%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 HC COMBINED VACCINEMMR+VARICELLASUB-Q	$162.64	$428.00	—	—	62%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 HC MENINGOCOCCAL CONJ VACCINE QUADRAVALENT IM	$95.00	$250.00	—	8% below	62%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 HC MENINGOCOCCAL CONJ VACCINE QUADRAVALENT IM	$95.00	$250.00	—	—	62%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 HC PCV20 VACCINE IM	$228.00	$600.00	—	41% below	62%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 HC PCV20 VACCINE IM	$228.00	$600.00	—	—	62%
Pneumonia vaccine, 21-valent conjugate (Capvaxive) CPT 90684 HC PNEUMOCOCCAL CONJUGATE VACCINE 21 VALENT (PCV21) FOR IM	$308.94	$813.00	—	54% above	62%
Pneumonia vaccine, 21-valent conjugate (Capvaxive) inpatient CPT 90684 HC PNEUMOCOCCAL CONJUGATE VACCINE 21 VALENT (PCV21) FOR IM	$308.94	$813.00	—	—	62%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 HC PNEUMOCOCCAL VACCINE	$52.44	$138.00	—	45% below	62%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 HC PNEUMOCOCCAL VACCINE	$52.44	$138.00	—	—	62%
Polio vaccine, inactivated (IPV) CPT 90713 HC POLIOMYELITIS IMMUNIZATNINACTVSUB-Q	$155.80	$410.00	—	261% above	62%
Polio vaccine, inactivated (IPV) inpatient CPT 90713 HC POLIOMYELITIS IMMUNIZATNINACTVSUB-Q	$155.80	$410.00	—	—	62%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 HC RSV VACCINE SYNCYTIAL MONOCLONAL 1ML DOSE FOR IM	$1,275.28	$3,356.00	—	143% above	62%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 HC RSV VACCINE SYNCYTIAL MONOCLONAL 1ML DOSE FOR IM	$1,275.28	$3,356.00	—	—	62%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 HC RSV VACCINE SYNCYTIAL MONOCLONAL 0.5ML DOSE FOR IM	$1,275.28	$3,356.00	—	—	62%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 HC RSV VACCINE SYNCYTIAL MONOCLONAL 0.5ML DOSE FOR IM	$1,275.28	$3,356.00	—	—	62%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 HC RSV VACCINE PREF SUBUNIT BIVALENT FOR IM USE	$215.08	$566.00	—	16% above	62%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 HC RSV MAB IM 50MG	$271.32	$714.00	—	46% above	62%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 HC RSV VACCINE PREF SUBUNIT BIVALENT FOR IM USE	$215.08	$566.00	—	—	62%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 HC RSV MAB IM 50MG	$271.32	$714.00	—	—	62%
Rabies vaccine, one dose CPT 90675 HC RABIES VACCINE IM	$743.28	$1,956.00	—	at median	62%
Rabies vaccine, one dose inpatient CPT 90675 HC RABIES VACCINE IM	$743.28	$1,956.00	—	—	62%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) CPT 90681 HC RH1 VACC 2 DOES LIVE ORAL	$83.22	$219.00	—	20% below	62%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) inpatient CPT 90681 HC RH1 VACC 2 DOES LIVE ORAL	$83.22	$219.00	—	—	62%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 HC HZV VACC RECOMBINANT IM	$84.36	$222.00	—	2% below	62%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 HC HZV VACC RECOMBINANT IM	$84.36	$222.00	—	—	62%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 HC TD VACCINE PRESERVATIVE FREE =>7YO IM	$17.10	$45.00	—	58% below	62%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 HC TD VACCINE PRESERVATIVE FREE =>7YO IM	$17.10	$45.00	—	—	62%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 HC TDAP VACCINE >7 IM	$31.54	$83.00	—	29% below	62%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 HC TDAP VACCINE >7 IM	$31.54	$83.00	—	—	62%
Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 HC TYPHOID VACCINE, IM	$47.88	$126.00	—	67% below	62%
Typhoid vaccine, injectable (Vi polysaccharide) inpatient CPT 90691 HC TYPHOID VACCINE, IM	$47.88	$126.00	—	—	62%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC IMMUNIZATION ADMINISTRATION	$53.58	$141.00	—	204% above	62%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC IMMUNIZATION ADMINISTRATION	$53.58	$141.00	—	—	62%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 HC SUBSEQUENT IMMUN ADMIN	$53.58	$141.00	—	204% above	62%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 HC SUBSEQUENT IMMUN ADMIN	$53.58	$141.00	—	—	62%

Procedure The service, with its billing code (CPT or HCPCS) and, in small type, the line exactly as the hospital wrote it in its price file. More

Cash price The hospital's own price for a patient paying without insurance (“discounted cash” in its price file). Hospitals must publish it under federal law, 45 CFR 180.50. Call to confirm it before booking. More

List price The hospital's full chargemaster price (“gross charge”) before any discount. Almost nobody pays it; the gap to the cash price shows what the self-pay discount is worth. More

Insurers pay The lowest and highest rates this hospital has agreed with insurance plans for the same item, from its price file. If the cash price is below what your plan pays and you have not met your deductible, paying cash can cost you less. More

Against the state median This hospital's cash price compared with the median cash price of hospitals in the state for the same code. Shown when at least three hospitals in the state price it.

Off list How much lower the cash price is than the list price.

No cash discount This line's cash price equals the hospital's full list price. Many hospitals still reduce bills for uninsured patients: ask the billing office for its self-pay discount in writing. More

At or below Medicare This cash price is at or below what Medicare pays a hospital for the same service, which is unusually low. It is what the hospital's file says; confirm it and what it includes before booking. More

Check the item The description in the hospital file looks like a supply or device (a catheter, a brace, an implant), not this procedure. The hospital may have filed it under the wrong code: ask before relying on this price.

Source file: https://stmarysmaine.com/CMS%20Files/010211551_st-mary-_s-regional-medical-center_standardcharges.csv