Hospital Owosso, MI

Memorial Healthcare

Memorial Healthcare in Owosso, MI publishes cash prices for 418 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 Michigan median for 257 of 417 procedures and above it for 157. By typical cash price it ranks #18 of 86 Michigan hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

826 West King Street, Owosso, MI 48867 Collected Sep 27, 2026 Source price file (989) 723-5211

Acute care hospital Emergency department CMS star rating 3 of 5 CCN 230121 · CMS hospital register

CMS price transparency record

The federal Centers for Medicare & Medicaid Services (CMS) enforces the rule that makes hospitals publish their prices. Its public enforcement list shows 3 actions for a hospital named Memorial Healthcare in Owosso, MI:

May 24, 2023 Warning notice
Sep 19, 2023 Corrective action plan requested
Sep 29, 2023 Case closed

Warning notice: CMS reviewed the hospital and told it that it had found possible violations of the price transparency rules. Corrective action plan requested: CMS asked the hospital to submit a plan to fix the problems it found. Case closed: CMS closed the case after the hospital addressed the problems.

A notice records a step in a CMS review; it is not a court finding. Source: CMS, Hospital Price Transparency Enforcement Activities and Outcomes, actions through Jul 31, 2026.

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Michigan	Off list
Ankle X-ray, complete, 3 or more views both sides CPT 73610 XRAY ANKLE BILATERAL-FAC/TECH	$144.00	$180.00	—	—	20%
Ankle X-ray, complete, 3 or more views CPT 73610 XRAY ANKLE-FAC/TECH	$96.00	$120.00	—	48% below	20%
Ankle X-ray, complete, 3 or more views one side CPT 73610 ANKLE LT	$576.80	$721.00	—	210% above	20%
Ankle X-ray, complete, 3 or more views one side CPT 73610 ANKLE RT	$576.80	$721.00	—	210% above	20%
Ankle X-ray, complete, 3 or more views inpatient both sides CPT 73610 XRAY ANKLE BILATERAL-FAC/TECH	$144.00	$180.00	—	—	20%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 XRAY ANKLE-FAC/TECH	$96.00	$120.00	—	—	20%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 ANKLE LT	$576.80	$721.00	—	—	20%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 ANKLE RT	$576.80	$721.00	—	—	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 DOPPLER PVR U/L EXT ART 2LEVEL	$545.60	$682.00	—	84% above	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 ULTRASOUND PVR U/L EXT 2LEVEL	$545.60	$682.00	—	84% above	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 DOPPLER PVR U/L EXT ART 2LEVEL	$545.60	$682.00	—	—	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 ULTRASOUND PVR U/L EXT 2LEVEL	$545.60	$682.00	—	—	20%
Barium swallow (esophagus X-ray with contrast) CPT 74220 ESOPHOGRAM INCL CHST XRAY	$656.00	$820.00	—	172% above	20%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 ESOPHOGRAM INCL CHST XRAY	$656.00	$820.00	—	—	20%
Bone scan, whole body (nuclear medicine) CPT 78306 BONE SCAN TOTAL	$2,248.80	$2,811.00	—	184% above	20%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 BONE SCAN TOTAL	$2,248.80	$2,811.00	—	—	20%
Breast ultrasound, complete, one breast CPT 76641 ULTRASOUND BREAST BIL COMPLETE	$2,133.60	$2,667.00	—	621% above	20%
Breast ultrasound, complete, one breast one side CPT 76641 ULTRASOUND BRST UNI COMPL LT	$1,067.20	$1,334.00	—	261% above	20%
Breast ultrasound, complete, one breast one side CPT 76641 ULTRASOUND BRST UNI COMPL RT	$1,067.20	$1,334.00	—	261% above	20%
Breast ultrasound, complete, one breast inpatient CPT 76641 ULTRASOUND BREAST BIL COMPLETE	$2,133.60	$2,667.00	—	—	20%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 ULTRASOUND BRST UNI COMPL RT	$1,067.20	$1,334.00	—	—	20%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 ULTRASOUND BRST UNI COMPL LT	$1,067.20	$1,334.00	—	—	20%
Breast ultrasound, limited (one breast or one area) CPT 76642 ULTRASOUND BREAST BIL LIMITED	$2,220.00	$2,775.00	—	923% above	20%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 ULTRASOUND BRST UNI LIMITED LT	$1,109.60	$1,387.00	—	411% above	20%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 ER BREAST ULTRASOUND-LT	$1,109.60	$1,387.00	—	411% above	20%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 ULTRASOUND BRST UNI LIMITED RT	$1,109.60	$1,387.00	—	411% above	20%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 ER BREAST ULTRASOUND-RT	$1,109.60	$1,387.00	—	411% above	20%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 ULTRASOUND BREAST BIL LIMITED	$2,220.00	$2,775.00	—	—	20%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 ER BREAST ULTRASOUND-LT	$1,109.60	$1,387.00	—	—	20%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 ER BREAST ULTRASOUND-RT	$1,109.60	$1,387.00	—	—	20%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 ULTRASOUND BRST UNI LIMITED RT	$1,109.60	$1,387.00	—	—	20%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 ULTRASOUND BRST UNI LIMITED LT	$1,109.60	$1,387.00	—	—	20%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT ANGIO CHEST	$4,477.60	$5,597.00	—	233% above	20%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT ANGIO CHEST	$4,477.60	$5,597.00	—	—	20%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD AND PELVIS W/O CONTRAST	$5,128.80	$6,411.00	—	199% above	20%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD AND PELVIS W/O CONTRAST	$5,128.80	$6,411.00	—	—	20%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD AND PELVIS W CONTRAST	$5,873.60	$7,342.00	—	152% above	20%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD AND PELVIS W CONTRAST	$5,873.60	$7,342.00	—	—	20%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD AND PELVIS W/WO CONTRAS	$7,314.40	$9,143.00	—	216% above	20%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD AND PELVIS W/WO CONTRAS	$7,314.40	$9,143.00	—	—	20%
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN WITH CONTRAST	$3,091.20	$3,864.00	—	140% above	20%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN WITH CONTRAST	$3,091.20	$3,864.00	—	—	20%
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN WITHOUT CONTRAST	$2,703.20	$3,379.00	—	204% above	20%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN WITHOUT CONTRAST	$2,703.20	$3,379.00	—	—	20%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIAL W/O CONTR	$2,552.80	$3,191.00	—	164% above	20%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILLOFACIAL W/O CONTR	$2,552.80	$3,191.00	—	—	20%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD WITHOUT CONTRAST	$2,674.40	$3,343.00	—	229% above	20%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD WITHOUT CONTRAST	$2,674.40	$3,343.00	—	—	20%
CT scan of the head with contrast CPT 70460 CT HEAD WITH CONTRAST	$2,923.20	$3,654.00	—	139% above	20%
CT scan of the head with contrast inpatient CPT 70460 CT HEAD WITH CONTRAST	$2,923.20	$3,654.00	—	—	20%
CT scan of the head without and with contrast CPT 70470 CT HEAD W/WO CONTRAST	$3,476.00	$4,345.00	—	174% above	20%
CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD W/WO CONTRAST	$3,476.00	$4,345.00	—	—	20%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMBAR SPINE W/O CONTRAST	$2,963.20	$3,704.00	—	213% above	20%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT LUMBAR SPINE W/O CONTRAST	$2,963.20	$3,704.00	—	—	20%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT CERVICAL SPINE W/O CONTR	$2,963.20	$3,704.00	—	209% above	20%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT CERVICAL SPINE W/O CONTR	$2,963.20	$3,704.00	—	—	20%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS WITH CONTRAST	$3,077.60	$3,847.00	—	151% above	20%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS WITH CONTRAST	$3,077.60	$3,847.00	—	—	20%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 DOPPLER CAROTID BILATERAL	$1,241.60	$1,552.00	—	—	20%
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 ULTRASOUND DOPPLER CAROTID BIL	$1,241.60	$1,552.00	—	43% above	20%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 DOPPLER CAROTID BILATERAL	$1,241.60	$1,552.00	—	—	20%
Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 ULTRASOUND DOPPLER CAROTID BIL	$1,241.60	$1,552.00	—	—	20%
Chest X-ray, 2 views CPT 71046 XRAY CHEST 2 VIEWS-FAC	$80.00	$100.00	—	50% below	20%
Chest X-ray, 2 views CPT 71046 CHEST 2 VIEW	$462.40	$578.00	—	192% above	20%
Chest X-ray, 2 views inpatient CPT 71046 XRAY CHEST 2 VIEWS-FAC	$80.00	$100.00	—	—	20%
Chest X-ray, 2 views inpatient CPT 71046 CHEST 2 VIEW	$462.40	$578.00	—	—	20%
Chest X-ray, single view CPT 71045 XRAY CHEST 1 VIEW-FAC	$80.00	$100.00	—	39% below	20%
Chest X-ray, single view CPT 71045 CHEST 1 VIEW	$383.20	$479.00	—	193% above	20%
Chest X-ray, single view inpatient CPT 71045 XRAY CHEST 1 VIEW-FAC	$80.00	$100.00	—	—	20%
Chest X-ray, single view inpatient CPT 71045 CHEST 1 VIEW	$383.20	$479.00	—	—	20%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 ULTRASOUND RETROPERITONEAL-FAC	$96.00	$120.00	—	82% below	20%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 ULTRASOUND RETROPERITONEAL	$1,413.60	$1,767.00	—	168% above	20%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 ULTRASOUND RETROPERITONEAL-FAC	$96.00	$120.00	—	—	20%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 ULTRASOUND RETROPERITONEAL	$1,413.60	$1,767.00	—	—	20%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 BONE DENSITY AXIAL	$702.40	$878.00	—	135% above	20%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 BONE DENSITY AXIAL	$702.40	$878.00	—	—	20%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 BONE DENSITY APPENDICULAR	$149.60	$187.00	—	20% above	20%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 BONE DENSITY APPENDICULAR	$149.60	$187.00	—	—	20%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 ULTRASOUND CMPL SNGL FETUS-MMA	$448.80	$561.00	—	22% below	20%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 ULTRASOUND CMPLT SINGLE FETUS	$461.60	$577.00	—	20% below	20%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 ULTRASOUND CMPL SNGL FETUS-MMA	$448.80	$561.00	—	—	20%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 ULTRASOUND CMPLT SINGLE FETUS	$461.60	$577.00	—	—	20%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST HI RESOLUTION W/O CON	$2,470.40	$3,088.00	—	179% above	20%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT THORAX WO CONTRAST	$2,470.40	$3,088.00	—	179% above	20%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST HI RESOLUTION W/O CON	$2,470.40	$3,088.00	—	—	20%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT THORAX WO CONTRAST	$2,470.40	$3,088.00	—	—	20%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT THORAX W CONTRAST	$2,792.00	$3,490.00	—	128% above	20%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT THORAX W CONTRAST	$2,792.00	$3,490.00	—	—	20%
Diagnostic mammogram, both breasts CPT 77066 MAMM BIL DIAG W GG MOD	$720.00	$900.00	—	186% above	20%
Diagnostic mammogram, both breasts CPT 77066 MAMM BIL DIAG	$720.00	$900.00	—	186% above	20%
Diagnostic mammogram, both breasts inpatient CPT 77066 MAMM BIL DIAG W GG MOD	$720.00	$900.00	—	—	20%
Diagnostic mammogram, both breasts inpatient CPT 77066 MAMM BIL DIAG	$720.00	$900.00	—	—	20%
Diagnostic mammogram, one breast one side CPT 77065 MAMM UNI DIAG LT W GG	$586.40	$733.00	—	113% above	20%
Diagnostic mammogram, one breast one side CPT 77065 MAMM UNI DIAG LT	$586.40	$733.00	—	113% above	20%
Diagnostic mammogram, one breast one side CPT 77065 TOMO UNI DIAG RT W GG	$586.40	$733.00	—	113% above	20%
Diagnostic mammogram, one breast one side CPT 77065 MAMM UNI DIAG RT W GG	$586.40	$733.00	—	113% above	20%
Diagnostic mammogram, one breast one side CPT 77065 MAMM UNI DIAG RT	$586.40	$733.00	—	113% above	20%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MAMM UNI DIAG LT	$586.40	$733.00	—	—	20%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MAMM UNI DIAG RT W GG	$586.40	$733.00	—	—	20%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MAMM UNI DIAG RT	$586.40	$733.00	—	—	20%
Diagnostic mammogram, one breast inpatient one side CPT 77065 TOMO UNI DIAG RT W GG	$586.40	$733.00	—	—	20%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MAMM UNI DIAG LT W GG	$586.40	$733.00	—	—	20%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 ULTRASOUND DUP SCAN LWR EXT BI	$1,184.00	$1,480.00	—	—	20%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 ULTRASOUND DUP SCAN LWR EXT BI	$1,184.00	$1,480.00	—	—	20%
Duplex ultrasound of the leg veins, both legs CPT 93970 ULTRASOUND DUP SC EXT VEIN BIL	$1,077.60	$1,347.00	—	75% above	20%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 ULTRASOUND DUP SC EXT VEIN BIL	$1,077.60	$1,347.00	—	—	20%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHO 2D CF DOPP COMPLETE	$2,697.60	$3,372.00	—	108% above	20%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHO 2D CF DOPP COMPLETE	$2,697.60	$3,372.00	—	—	20%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HEPATOBILIARY SCAN	$2,684.80	$3,356.00	—	221% above	20%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HEPATOBILIARY SCAN	$2,684.80	$3,356.00	—	—	20%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 HOME SLEEP TEST	$837.60	$1,047.00	—	105% above	20%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 HOME SLEEP TEST	$837.60	$1,047.00	—	—	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 POLYSOM 6/>YRS W/CPAP 4/>PARAM	$1,998.40	$2,498.00	—	37% below	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 POLYSOM 6/>YRS W/CPAP 4/>PARAM	$1,998.40	$2,498.00	—	—	20%
Knee X-ray, 3 views CPT 73562 XRAY KNEE 3 VIEW BIL-FAC/TECH	$144.00	$180.00	—	10% below	20%
Knee X-ray, 3 views one side CPT 73562 XRAY KNEE 3 VIEW RT-FAC/TEC	$96.00	$120.00	—	40% below	20%
Knee X-ray, 3 views one side CPT 73562 XRAY KNEE 3 VIEW LT-FAC/TEC	$96.00	$120.00	—	40% below	20%
Knee X-ray, 3 views one side CPT 73562 KNEE 3 VIEW-RT	$470.40	$588.00	—	194% above	20%
Knee X-ray, 3 views one side CPT 73562 KNEE 3 VIEW-LT	$470.40	$588.00	—	194% above	20%
Knee X-ray, 3 views inpatient CPT 73562 XRAY KNEE 3 VIEW BIL-FAC/TECH	$144.00	$180.00	—	—	20%
Knee X-ray, 3 views inpatient one side CPT 73562 XRAY KNEE 3 VIEW RT-FAC/TEC	$96.00	$120.00	—	—	20%
Knee X-ray, 3 views inpatient one side CPT 73562 XRAY KNEE 3 VIEW LT-FAC/TEC	$96.00	$120.00	—	—	20%
Knee X-ray, 3 views inpatient one side CPT 73562 KNEE 3 VIEW-RT	$470.40	$588.00	—	—	20%
Knee X-ray, 3 views inpatient one side CPT 73562 KNEE 3 VIEW-LT	$470.40	$588.00	—	—	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ULTRASOUND ABD LIMITED-MMA	$108.00	$135.00	—	74% below	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABD W/IMAGE; LIMITED-ERPRO	$136.80	$171.00	—	67% below	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ER FAST ABD/GALLBLADDER US	$1,415.20	$1,769.00	—	246% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ULTRASOUND ABD LIMITED	$1,415.20	$1,769.00	—	246% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 ULTRASOUND ABD LIMITED-MMA	$108.00	$135.00	—	—	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABD W/IMAGE; LIMITED-ERPRO	$136.80	$171.00	—	—	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 ULTRASOUND ABD LIMITED	$1,415.20	$1,769.00	—	—	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 ER FAST ABD/GALLBLADDER US	$1,415.20	$1,769.00	—	—	20%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT LUNG CANCER SCREENING	$405.60	$507.00	—	49% above	20%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT LUNG CANCER SCREENING	$405.60	$507.00	—	—	20%
MRI of both breasts, without and then with contrast dye CPT 77049 MRI BREAST W/WO CONTR BIL	$3,739.20	$4,674.00	—	61% above	20%
MRI of both breasts, without and then with contrast dye inpatient CPT 77049 MRI BREAST W/WO CONTR BIL	$3,739.20	$4,674.00	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI LWR EXTR JOINT WO CONT BIL	$5,445.60	$6,807.00	—	283% above	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LWR EXTR JOINT WO CONT RT	$3,796.80	$4,746.00	—	167% above	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LWR EXTR JOINT WO CONT LT	$3,796.80	$4,746.00	—	167% above	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI LWR EXTR JOINT WO CONT BIL	$5,445.60	$6,807.00	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI LWR EXTR JOINT WO CONT LT	$3,796.80	$4,746.00	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI LWR EXTR JOINT WO CONT RT	$3,796.80	$4,746.00	—	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI LWR EXTR JNT W/WO CON BIL	$6,004.00	$7,505.00	—	204% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LWR EXTR JOINT W/WO CON LT	$4,003.20	$5,004.00	—	103% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LWR EXTR JOINT W/WO CON RT	$4,003.20	$5,004.00	—	103% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI LWR EXTR JNT W/WO CON BIL	$6,004.00	$7,505.00	—	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI LWR EXTR JOINT W/WO CON LT	$4,003.20	$5,004.00	—	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI LWR EXTR JOINT W/WO CON RT	$4,003.20	$5,004.00	—	—	20%
MRI of the abdomen without contrast CPT 74181 MRI ABD WO CONTR	$3,631.20	$4,539.00	—	150% above	20%
MRI of the abdomen without contrast inpatient CPT 74181 MRI ABD WO CONTR	$3,631.20	$4,539.00	—	—	20%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABD W/WO CONTR	$4,934.40	$6,168.00	—	75% above	20%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABD W/WO CONTR	$4,934.40	$6,168.00	—	—	20%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN WO CONTR	$3,993.60	$4,992.00	—	175% above	20%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN WO CONTR	$3,993.60	$4,992.00	—	—	20%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W/WO CONTR	$5,052.00	$6,315.00	—	129% above	20%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN W/WO CONTR	$5,052.00	$6,315.00	—	—	20%
MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR SPINE WO CONTR	$3,631.20	$4,539.00	—	138% above	20%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI LUMBAR SPINE WO CONTR	$3,631.20	$4,539.00	—	—	20%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI LUMBAR SPINE W/WO CONTR	$5,043.20	$6,304.00	—	91% above	20%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI LUMBAR SPINE W/WO CONTR	$5,043.20	$6,304.00	—	—	20%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI THORACIC SPINE WO CONTR	$3,631.20	$4,539.00	—	137% above	20%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI THORACIC SPINE WO CONTR	$3,631.20	$4,539.00	—	—	20%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI CERVICAL SPINE W/WO CONTR	$4,934.40	$6,168.00	—	98% above	20%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI CERVICAL SPINE W/WO CONTR	$4,934.40	$6,168.00	—	—	20%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI CERVICAL SPINE WO CONTR	$3,631.20	$4,539.00	—	138% above	20%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI CERVICAL SPINE WO CONTR	$3,631.20	$4,539.00	—	—	20%
MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS W/WO CONTR	$4,934.40	$6,168.00	—	87% above	20%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS W/WO CONTR	$4,934.40	$6,168.00	—	—	20%
MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS WO CONTR	$3,631.20	$4,539.00	—	171% above	20%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS WO CONTR	$3,631.20	$4,539.00	—	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI UPPER EXTR JNT WO CONTR LT	$3,631.20	$4,539.00	—	132% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI UPPR EXTR JNT WO CONTR RT	$3,631.20	$4,539.00	—	132% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI UPPR EXTR JNT WO CONTR RT	$3,631.20	$4,539.00	—	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI UPPER EXTR JNT WO CONTR LT	$3,631.20	$4,539.00	—	—	20%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 MYOCARDIAL IMAGE SPECT MULT	$6,863.20	$8,579.00	—	182% above	20%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 MYOCARDIAL IMAGE SPECT MULT	$6,863.20	$8,579.00	—	—	20%
OCT scan of the retina (optical coherence tomography) CPT 92134 CMPTR OPHTH DX IMG POST-FAC	$54.40	$68.00	—	33% below	20%
OCT scan of the retina (optical coherence tomography) inpatient CPT 92134 CMPTR OPHTH DX IMG POST-FAC	$54.40	$68.00	—	—	20%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET/CT IMAGING SKULL-THIGH	$7,809.60	$9,762.00	—	113% above	20%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET/CT IMAGING SKULL-THIGH	$7,809.60	$9,762.00	—	—	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 ULTRASOUND PELVIS LIMITED-MMA	$145.60	$182.00	—	40% below	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 ER BLADDER VOLUME US	$1,460.80	$1,826.00	—	503% above	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 ULTRASOUND LIMITED BLADDER	$1,460.80	$1,826.00	—	503% above	20%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 ULTRASOUND PELVIS LIMITED-MMA	$145.60	$182.00	—	—	20%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 ER BLADDER VOLUME US	$1,460.80	$1,826.00	—	—	20%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 ULTRASOUND LIMITED BLADDER	$1,460.80	$1,826.00	—	—	20%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 ULTRASOUND PELVIC COMPLETE-MMA	$112.80	$141.00	—	77% below	20%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 ULTRASOUND COMPLETE-PELVIC	$1,764.80	$2,206.00	—	261% above	20%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 ULTRASOUND PELVIC COMPLETE-MMA	$112.80	$141.00	—	—	20%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 ULTRASOUND COMPLETE-PELVIC	$1,764.80	$2,206.00	—	—	20%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 ULTRASOUND >=14WKS SGL FET-MMA	$136.00	$170.00	—	70% below	20%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 ULTRASOUND OB COMP >14 WE	$1,868.00	$2,335.00	—	306% above	20%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 ULTRASOUND >=14WKS SGL FET-MMA	$136.00	$170.00	—	—	20%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 ULTRASOUND OB COMP >14 WE	$1,868.00	$2,335.00	—	—	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 ULTRASOUND <14WKS SNGL FET-MMA	$109.60	$137.00	—	73% below	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 ULTRASOUND OB COMP < 14 WE	$1,698.40	$2,123.00	—	326% above	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 ULTRASOUND <14WKS SNGL FET-MMA	$109.60	$137.00	—	—	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 ULTRASOUND OB COMP < 14 WE	$1,698.40	$2,123.00	—	—	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB UTERUS 1/>FETUSES-ERPRO	$127.20	$159.00	—	59% below	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 ULTRASOUND 1MMA	$197.60	$247.00	—	36% below	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 ER TA OB <14 WEEKS US	$1,441.60	$1,802.00	—	370% above	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 ULTRASOUND OB LIMITED	$1,441.60	$1,802.00	—	370% above	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB UTERUS 1/>FETUSES-ERPRO	$127.20	$159.00	—	—	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 ULTRASOUND 1MMA	$197.60	$247.00	—	—	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 ER TA OB <14 WEEKS US	$1,441.60	$1,802.00	—	—	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 ULTRASOUND OB LIMITED	$1,441.60	$1,802.00	—	—	20%
Screening mammogram, both breasts CPT 77067 MAMM BIL SCREEN	$668.80	$836.00	—	159% above	20%
Screening mammogram, both breasts one side CPT 77067 MAMM UNI SCREEN RT	$568.00	$710.00	—	120% above	20%
Screening mammogram, both breasts one side CPT 77067 MAMM UNI SCREEN LT	$568.00	$710.00	—	120% above	20%
Screening mammogram, both breasts inpatient CPT 77067 MAMM BIL SCREEN	$668.80	$836.00	—	—	20%
Screening mammogram, both breasts inpatient one side CPT 77067 MAMM UNI SCREEN RT	$568.00	$710.00	—	—	20%
Screening mammogram, both breasts inpatient one side CPT 77067 MAMM UNI SCREEN LT	$568.00	$710.00	—	—	20%
Shoulder X-ray, complete, 2 or more views CPT 73030 XRAY SHOULDR CMPL BIL-FAC/TECH	$191.20	$239.00	—	2% above	20%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XRAY SHOULDER 2 VW LT-FAC/TEC	$96.00	$120.00	—	49% below	20%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XRAY SHOULDER 2 VW RT-FAC/TEC	$96.00	$120.00	—	49% below	20%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER COMPLETE RT	$616.80	$771.00	—	230% above	20%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER COMPLETE LT	$616.80	$771.00	—	230% above	20%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 XRAY SHOULDR CMPL BIL-FAC/TECH	$191.20	$239.00	—	—	20%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XRAY SHOULDER 2 VW RT-FAC/TEC	$96.00	$120.00	—	—	20%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XRAY SHOULDER 2 VW LT-FAC/TEC	$96.00	$120.00	—	—	20%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 SHOULDER COMPLETE LT	$616.80	$771.00	—	—	20%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 SHOULDER COMPLETE RT	$616.80	$771.00	—	—	20%
Sleep study in a lab (polysomnography) CPT 95810 POLYSOM 6/> YRS 4/> PARAM	$1,998.40	$2,498.00	—	35% below	20%
Sleep study in a lab (polysomnography) inpatient CPT 95810 POLYSOM 6/> YRS 4/> PARAM	$1,998.40	$2,498.00	—	—	20%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 STRESS ECHO W/O CONTRAST	$1,004.80	$1,256.00	—	13% above	20%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 STRESS ECHO W/O CONTRAST	$1,004.80	$1,256.00	—	—	20%
Swallow study (modified barium swallow, video X-ray) CPT 74230 3 PHASE COOKIE SWALLOW FUNCTIO	$1,073.60	$1,342.00	—	217% above	20%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 3 PHASE COOKIE SWALLOW FUNCTIO	$1,073.60	$1,342.00	—	—	20%
Transvaginal pelvic ultrasound CPT 76830 ULTRASOUND NON OB TRANSV-MMA	$131.20	$164.00	—	63% below	20%
Transvaginal pelvic ultrasound CPT 76830 ER NON OB TRANSV US	$1,275.20	$1,594.00	—	258% above	20%
Transvaginal pelvic ultrasound CPT 76830 ULTRASOUND NON-OB TRANSVAGINAL	$1,275.20	$1,594.00	—	258% above	20%
Transvaginal pelvic ultrasound inpatient CPT 76830 ULTRASOUND NON OB TRANSV-MMA	$131.20	$164.00	—	—	20%
Transvaginal pelvic ultrasound inpatient CPT 76830 ULTRASOUND NON-OB TRANSVAGINAL	$1,275.20	$1,594.00	—	—	20%
Transvaginal pelvic ultrasound inpatient CPT 76830 ER NON OB TRANSV US	$1,275.20	$1,594.00	—	—	20%
Transvaginal ultrasound during pregnancy CPT 76817 ULTRASOUND TRANSVAG-MMA	$101.60	$127.00	—	66% below	20%
Transvaginal ultrasound during pregnancy CPT 76817 ULTRASOUND OB TRANSVAGINAL	$1,214.40	$1,518.00	—	309% above	20%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 ULTRASOUND TRANSVAG-MMA	$101.60	$127.00	—	—	20%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 ULTRASOUND OB TRANSVAGINAL	$1,214.40	$1,518.00	—	—	20%
Ultrasound of the abdomen, complete CPT 76700 ULTRASOUND ABDOMINAL	$1,560.80	$1,951.00	—	180% above	20%
Ultrasound of the abdomen, complete inpatient CPT 76700 ULTRASOUND ABDOMINAL	$1,560.80	$1,951.00	—	—	20%
Ultrasound of the scrotum and testicles CPT 76870 ULTRASOUND SCROTUM-MMA	$110.40	$138.00	—	78% below	20%
Ultrasound of the scrotum and testicles CPT 76870 ULTRASOUND TESTICULAR/SCROTUM	$2,160.80	$2,701.00	—	337% above	20%
Ultrasound of the scrotum and testicles inpatient CPT 76870 ULTRASOUND SCROTUM-MMA	$110.40	$138.00	—	—	20%
Ultrasound of the scrotum and testicles inpatient CPT 76870 ULTRASOUND TESTICULAR/SCROTUM	$2,160.80	$2,701.00	—	—	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 ULTRASOUND HEAD AND NECK-FAC	$111.20	$139.00	—	74% below	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HEAD/NECK US EXAM-ERPRO	$172.00	$215.00	—	60% below	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 ULTRASOUND SOFT TISSUE HEAD/NE	$1,771.20	$2,214.00	—	311% above	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 ER HEAD & NECK US	$1,771.20	$2,214.00	—	311% above	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 ULTRASOUND HEAD AND NECK-FAC	$111.20	$139.00	—	—	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HEAD/NECK US EXAM-ERPRO	$172.00	$215.00	—	—	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 ER HEAD & NECK US	$1,771.20	$2,214.00	—	—	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 ULTRASOUND SOFT TISSUE HEAD/NE	$1,771.20	$2,214.00	—	—	20%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 UPPER GI 1 CONTRAST	$1,005.60	$1,257.00	—	199% above	20%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 UPPER GI 1 CONTRAST	$1,005.60	$1,257.00	—	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 ULTRASOUND DUP SC EXT VEIN UNI	$849.60	$1,062.00	—	76% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 ULTRASOUND DUP SC EXT VEIN UNI	$849.60	$1,062.00	—	—	20%
Wrist X-ray, complete, 3 or more views both sides CPT 73110 XRAY WRIST COMPLETE BILATERAL	$844.80	$1,056.00	—	—	20%
Wrist X-ray, complete, 3 or more views CPT 73110 XRAY WRIST CMPLT BIL-FAC/TECH	$118.40	$148.00	—	29% below	20%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XRAY WRIST 3 VIEW LT-FAC/TEC	$79.20	$99.00	—	52% below	20%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XRAY WRIST 3 VIEW RT-FAC/TEC	$79.20	$99.00	—	52% below	20%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XRAY WRIST COMPLETE RT	$564.00	$705.00	—	240% above	20%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XRAY WRIST COMPLETE LT	$564.00	$705.00	—	240% above	20%
Wrist X-ray, complete, 3 or more views inpatient both sides CPT 73110 XRAY WRIST COMPLETE BILATERAL	$844.80	$1,056.00	—	—	20%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 XRAY WRIST CMPLT BIL-FAC/TECH	$118.40	$148.00	—	—	20%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XRAY WRIST 3 VIEW LT-FAC/TEC	$79.20	$99.00	—	—	20%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XRAY WRIST 3 VIEW RT-FAC/TEC	$79.20	$99.00	—	—	20%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XRAY WRIST COMPLETE RT	$564.00	$705.00	—	—	20%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XRAY WRIST COMPLETE LT	$564.00	$705.00	—	—	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XRAY HIP 2-3 VIEW LT-FAC/TEC	$79.20	$99.00	—	52% below	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XRAY HIP 2-3 VIEW RT-FAC/TEC	$79.20	$99.00	—	52% below	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP UNI 2-3 VIEW LT	$489.60	$612.00	—	198% above	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP UNI 2-3 VIEW RT	$489.60	$612.00	—	198% above	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XRAY HIP 2-3 VIEW RT-FAC/TEC	$79.20	$99.00	—	—	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XRAY HIP 2-3 VIEW LT-FAC/TEC	$79.20	$99.00	—	—	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP UNI 2-3 VIEW LT	$489.60	$612.00	—	—	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP UNI 2-3 VIEW RT	$489.60	$612.00	—	—	20%
X-ray of the abdomen, 1 view CPT 74018 XRAY ABDOMEN 1 VIEW-FAC	$60.80	$76.00	—	57% below	20%
X-ray of the abdomen, 1 view CPT 74018 ABDOMEN 1 VIEW	$369.60	$462.00	—	164% above	20%
X-ray of the abdomen, 1 view inpatient CPT 74018 XRAY ABDOMEN 1 VIEW-FAC	$60.80	$76.00	—	—	20%
X-ray of the abdomen, 1 view inpatient CPT 74018 ABDOMEN 1 VIEW	$369.60	$462.00	—	—	20%
X-ray of the ankle, 2 views CPT 73600 XRAY ANKLE-FAC/TECH	$96.00	$120.00	—	38% below	20%
X-ray of the ankle, 2 views one side CPT 73600 ANKLE 2 VIEW RT	$445.60	$557.00	—	187% above	20%
X-ray of the ankle, 2 views one side CPT 73600 ANKLE 2 VIEW LT	$445.60	$557.00	—	187% above	20%
X-ray of the ankle, 2 views inpatient CPT 73600 XRAY ANKLE-FAC/TECH	$96.00	$120.00	—	—	20%
X-ray of the ankle, 2 views inpatient one side CPT 73600 ANKLE 2 VIEW RT	$445.60	$557.00	—	—	20%
X-ray of the ankle, 2 views inpatient one side CPT 73600 ANKLE 2 VIEW LT	$445.60	$557.00	—	—	20%
X-ray of the finger(s), 2 or more views CPT 73140 XRAY FINGER-FAC/TECH	$60.80	$76.00	—	49% below	20%
X-ray of the finger(s), 2 or more views one side CPT 73140 HAND-DIGITS RT	$504.00	$630.00	—	321% above	20%
X-ray of the finger(s), 2 or more views one side CPT 73140 HAND-DIGITS LT	$504.00	$630.00	—	321% above	20%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 XRAY FINGER-FAC/TECH	$60.80	$76.00	—	—	20%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 HAND-DIGITS LT	$504.00	$630.00	—	—	20%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 HAND-DIGITS RT	$504.00	$630.00	—	—	20%
X-ray of the foot, 2 views CPT 73620 XRAY FOOT 2 VIEW-FAC/TECH	$76.80	$96.00	—	40% below	20%
X-ray of the foot, 2 views CPT 73620 XRAY FOOT 2 VIEW BIL-FAC/TECH	$115.20	$144.00	—	9% below	20%
X-ray of the foot, 2 views one side CPT 73620 FOOT 2 VIEW LT	$445.60	$557.00	—	251% above	20%
X-ray of the foot, 2 views one side CPT 73620 FOOT 2 VIEW RT	$445.60	$557.00	—	251% above	20%
X-ray of the foot, 2 views inpatient CPT 73620 XRAY FOOT 2 VIEW-FAC/TECH	$76.80	$96.00	—	—	20%
X-ray of the foot, 2 views inpatient CPT 73620 XRAY FOOT 2 VIEW BIL-FAC/TECH	$115.20	$144.00	—	—	20%
X-ray of the foot, 2 views inpatient one side CPT 73620 FOOT 2 VIEW LT	$445.60	$557.00	—	—	20%
X-ray of the foot, 2 views inpatient one side CPT 73620 FOOT 2 VIEW RT	$445.60	$557.00	—	—	20%
X-ray of the foot, complete, 3 or more views CPT 73630 XRAY FOOT 3/> VIEW-FAC/TECH	$76.80	$96.00	—	47% below	20%
X-ray of the foot, complete, 3 or more views CPT 73630 XRAY FOOT 3/> VW BIL-FAC/TECH	$115.20	$144.00	—	21% below	20%
X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT RT	$514.40	$643.00	—	252% above	20%
X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT LT	$514.40	$643.00	—	252% above	20%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 XRAY FOOT 3/> VIEW-FAC/TECH	$76.80	$96.00	—	—	20%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 XRAY FOOT 3/> VW BIL-FAC/TECH	$115.20	$144.00	—	—	20%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 FOOT RT	$514.40	$643.00	—	—	20%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 FOOT LT	$514.40	$643.00	—	—	20%
X-ray of the hand, 3 or more views CPT 73130 XRAY HAND 3 VIEW BIL-FAC/TECH	$118.40	$148.00	—	26% below	20%
X-ray of the hand, 3 or more views one side CPT 73130 XRAY HAND 3 VIEW LT-FAC/TEC	$79.20	$99.00	—	50% below	20%
X-ray of the hand, 3 or more views one side CPT 73130 XRAY HAND 3 VIEW RT-FAC/TEC	$79.20	$99.00	—	50% below	20%
X-ray of the hand, 3 or more views one side CPT 73130 HAND RT	$581.60	$727.00	—	265% above	20%
X-ray of the hand, 3 or more views one side CPT 73130 HAND LT	$581.60	$727.00	—	265% above	20%
X-ray of the hand, 3 or more views inpatient CPT 73130 XRAY HAND 3 VIEW BIL-FAC/TECH	$118.40	$148.00	—	—	20%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 XRAY HAND 3 VIEW RT-FAC/TEC	$79.20	$99.00	—	—	20%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 XRAY HAND 3 VIEW LT-FAC/TEC	$79.20	$99.00	—	—	20%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 HAND LT	$581.60	$727.00	—	—	20%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 HAND RT	$581.60	$727.00	—	—	20%
X-ray of the knee, 1 or 2 views CPT 73560 XRAY KNEE 1 OR 2 VW BIL-FAC/TC	$120.80	$151.00	—	5% below	20%
X-ray of the knee, 1 or 2 views one side CPT 73560 XRAY KNEE 1 OR 2 VW RT-FAC/TEC	$79.20	$99.00	—	38% below	20%
X-ray of the knee, 1 or 2 views one side CPT 73560 XRAY KNEE 1 OR 2 VW LT-FAC/TEC	$79.20	$99.00	—	38% below	20%
X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE-LIMITED VIEWS LT	$470.40	$588.00	—	270% above	20%
X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE-LIMITED VIEWS RT	$470.40	$588.00	—	270% above	20%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 XRAY KNEE 1 OR 2 VW BIL-FAC/TC	$120.80	$151.00	—	—	20%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XRAY KNEE 1 OR 2 VW LT-FAC/TEC	$79.20	$99.00	—	—	20%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XRAY KNEE 1 OR 2 VW RT-FAC/TEC	$79.20	$99.00	—	—	20%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 KNEE-LIMITED VIEWS RT	$470.40	$588.00	—	—	20%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 KNEE-LIMITED VIEWS LT	$470.40	$588.00	—	—	20%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XRAY LOWER SPINE-FAC/TECH	$110.40	$138.00	—	45% below	20%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 LOWER SPINE 2 OR 3 VIEW	$568.80	$711.00	—	185% above	20%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 XRAY LOWER SPINE-FAC/TECH	$110.40	$138.00	—	—	20%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 LOWER SPINE 2 OR 3 VIEW	$568.80	$711.00	—	—	20%
X-ray of the lower back, 4 or more views CPT 72110 XRAY LOWER SPINE-FAC/TECH	$110.40	$138.00	—	62% below	20%
X-ray of the lower back, 4 or more views CPT 72110 LOWER SPINE 4 OR MORE VIEW	$813.60	$1,017.00	—	184% above	20%
X-ray of the lower back, 4 or more views inpatient CPT 72110 XRAY LOWER SPINE-FAC/TECH	$110.40	$138.00	—	—	20%
X-ray of the lower back, 4 or more views inpatient CPT 72110 LOWER SPINE 4 OR MORE VIEW	$813.60	$1,017.00	—	—	20%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 XRAY THORACIC SPINE-FAC/TECH	$110.40	$138.00	—	34% below	20%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 SPINE THORACIC	$716.80	$896.00	—	327% above	20%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 XRAY THORACIC SPINE-FAC/TECH	$110.40	$138.00	—	—	20%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 SPINE THORACIC	$716.80	$896.00	—	—	20%
X-ray of the nasal bones, 3 or more views CPT 70160 NASAL BONES	$492.80	$616.00	—	216% above	20%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 NASAL BONES	$492.80	$616.00	—	—	20%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XRAY OF NECK SPINE-FAC	$96.00	$120.00	—	48% below	20%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 NECK SPINE 2 OR 3 VIEWS	$666.40	$833.00	—	258% above	20%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 XRAY OF NECK SPINE-FAC	$96.00	$120.00	—	—	20%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 NECK SPINE 2 OR 3 VIEWS	$666.40	$833.00	—	—	20%
X-ray of the pelvis, 1 or 2 views CPT 72170 XRAY OF PELVIS-FAC/TECH	$110.40	$138.00	—	27% below	20%
X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS 1 OR 2 VIEW	$564.00	$705.00	—	271% above	20%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 XRAY OF PELVIS-FAC/TECH	$110.40	$138.00	—	—	20%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PELVIS 1 OR 2 VIEW	$564.00	$705.00	—	—	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XRAY TAILBONE-FAC/TECH	$60.80	$76.00	—	61% below	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 SACRUM AND COCCYX	$641.60	$802.00	—	311% above	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 XRAY TAILBONE-FAC/TECH	$60.80	$76.00	—	—	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 SACRUM AND COCCYX	$641.60	$802.00	—	—	20%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Michigan	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 SGPT/ALT	$84.80	$106.00	—	290% above	20%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 SGPT/ALT	$84.80	$106.00	—	—	20%
AST (aspartate aminotransferase) enzyme test CPT 84450 SGOT/AST	$84.80	$106.00	—	290% above	20%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 SGOT/AST	$84.80	$106.00	—	—	20%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HEPATITIS PANEL ACUTE MH	$863.20	$1,079.00	—	422% above	20%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HEPATITIS PANEL ACUTE MH	$863.20	$1,079.00	—	—	20%
Allergy blood test, specific IgE, per allergen CPT 86003 BIRD FANCIER ALLERG SENDOUT	$97.60	$122.00	—	1505% above	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 BIRD FANCIER ALLERG SENDOUT	$97.60	$122.00	—	—	20%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP ANTIBODY	$208.00	$260.00	—	302% above	20%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CCP ANTIBODY	$208.00	$260.00	—	—	20%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR AB	$184.00	$230.00	—	218% above	20%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR AB	$184.00	$230.00	—	—	20%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 LABCO NATRIURETIC PEPTIDE	$59.20	$74.00	—	15% below	20%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 LABC NATRIURETIC PEPTD PRO-BNP	$155.20	$194.00	—	122% above	20%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NATRIURETIC PEPTIDE	$359.20	$449.00	—	413% above	20%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 LABCO NATRIURETIC PEPTIDE	$59.20	$74.00	—	—	20%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 LABC NATRIURETIC PEPTD PRO-BNP	$155.20	$194.00	—	—	20%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NATRIURETIC PEPTIDE	$359.20	$449.00	—	—	20%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL	$235.20	$294.00	—	303% above	20%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL	$235.20	$294.00	—	—	20%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 LABC TISSUE EXAM BY PATHOLOGST	$36.80	$46.00	—	61% below	20%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MLAB TISSUE EXAM BY PATHOLOGST	$103.20	$129.00	—	11% above	20%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 LEVEL IV SURG PATH	$411.20	$514.00	—	340% above	20%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 LEVEL IV SURG PATH ADDL	$411.20	$514.00	—	340% above	20%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 LABC TISSUE EXAM BY PATHOLOGST	$36.80	$46.00	—	—	20%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MLAB TISSUE EXAM BY PATHOLOGST	$103.20	$129.00	—	—	20%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 LEVEL IV SURG PATH	$411.20	$514.00	—	—	20%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 LEVEL IV SURG PATH ADDL	$411.20	$514.00	—	—	20%
Blood culture for bacteria CPT 87040 MMSO BACTERIAL BLOOD CULTURE	$51.20	$64.00	—	17% below	20%
Blood culture for bacteria CPT 87040 CULTURE BLOOD	$180.00	$225.00	—	190% above	20%
Blood culture for bacteria inpatient CPT 87040 MMSO BACTERIAL BLOOD CULTURE	$51.20	$64.00	—	—	20%
Blood culture for bacteria inpatient CPT 87040 CULTURE BLOOD	$180.00	$225.00	—	—	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 DRAWING FEE, C2N LAB	$23.20	$29.00	—	80% above	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 DRAWING FEE-ONCF	$23.20	$29.00	—	80% above	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 DRAWING FEE	$23.20	$29.00	—	80% above	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLLECTION FEE NON-DOT SENDOUT	$48.00	$60.00	—	273% above	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLLECTION FEE DOT	$48.00	$60.00	—	273% above	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLLECT FEE PATERNTY TST 86910	$100.80	$126.00	—	683% above	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 DRAWING FEE-ONCF	$23.20	$29.00	—	—	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 DRAWING FEE	$23.20	$29.00	—	—	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 DRAWING FEE, C2N LAB	$23.20	$29.00	—	—	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 COLLECTION FEE DOT	$48.00	$60.00	—	—	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 COLLECTION FEE NON-DOT SENDOUT	$48.00	$60.00	—	—	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 COLLECT FEE PATERNTY TST 86910	$100.80	$126.00	—	—	20%
Blood glucose (sugar) test CPT 82947 GLUCOSE-MMA	$4.80	$6.00	—	80% below	20%
Blood glucose (sugar) test CPT 82947 GLUCOSE QUAN BLOOD	$51.20	$64.00	—	113% above	20%
Blood glucose (sugar) test CPT 82947 GLUCOSE BLOOD X 3	$152.00	$190.00	—	533% above	20%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE-MMA	$4.80	$6.00	—	—	20%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE QUAN BLOOD	$51.20	$64.00	—	—	20%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE BLOOD X 3	$152.00	$190.00	—	—	20%
Blood lead test CPT 83655 ASSAY OF LEAD-MMA	$16.80	$21.00	—	20% above	20%
Blood lead test CPT 83655 LABC ASSAY OF LEAD	$29.60	$37.00	—	111% above	20%
Blood lead test CPT 83655 LEAD BLOOD	$72.00	$90.00	—	414% above	20%
Blood lead test inpatient CPT 83655 ASSAY OF LEAD-MMA	$16.80	$21.00	—	—	20%
Blood lead test inpatient CPT 83655 LABC ASSAY OF LEAD	$29.60	$37.00	—	—	20%
Blood lead test inpatient CPT 83655 LEAD BLOOD	$72.00	$90.00	—	—	20%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HCG SERUM	$145.60	$182.00	—	294% above	20%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HCG SERUM	$145.60	$182.00	—	—	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO	$136.00	$170.00	—	296% above	20%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO	$136.00	$170.00	—	—	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN	$16.00	$20.00	—	53% below	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN	$16.00	$20.00	—	—	20%
C. difficile toxin gene test (stool PCR) CPT 87493 INFECT AGENT DET-C DIFFICILE	$104.00	$130.00	—	1% below	20%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 INFECT AGENT DET-C DIFFICILE	$104.00	$130.00	—	—	20%
CA 19-9 blood test (tumor marker) CPT 86301 LABC IMMUNOASSAY TUMOR CA 19-9	$26.40	$33.00	—	64% below	20%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 LABC IMMUNOASSAY TUMOR CA 19-9	$26.40	$33.00	—	—	20%
CA-125 blood test (ovarian cancer marker) CPT 86304 CA 125	$100.80	$126.00	—	22% above	20%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA 125	$100.80	$126.00	—	—	20%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID 19 AMPLIFIED PROBE-MMA	$110.40	$138.00	—	26% above	20%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID 19 AMPLIFIED PROBE	$129.60	$162.00	—	47% above	20%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COVID 19 AMPLIFIED PROBE-MMA	$110.40	$138.00	—	—	20%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COVID 19 AMPLIFIED PROBE	$129.60	$162.00	—	—	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 LABC CHLMYD TRACH DNA PROBE	$18.80	$23.50	—	75% below	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA T AMPLIF NA PROBE	$168.80	$211.00	—	128% above	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 LABC CHLMYD TRACH DNA PROBE	$18.80	$23.50	—	—	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA T AMPLIF NA PROBE	$168.80	$211.00	—	—	20%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LABC LIPID PANEL	$14.40	$18.00	—	72% below	20%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL-MMA	$16.80	$21.00	—	67% below	20%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PROFILE (QW)	$198.40	$248.00	—	289% above	20%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PROFILE	$198.40	$248.00	—	289% above	20%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LABC LIPID PANEL	$14.40	$18.00	—	—	20%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL-MMA	$16.80	$21.00	—	—	20%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PROFILE (QW)	$198.40	$248.00	—	—	20%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PROFILE	$198.40	$248.00	—	—	20%
Complete blood count (CBC) with differential CPT 85025 CBC WITH AUTO DIFF	$111.20	$139.00	—	171% above	20%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC WITH AUTO DIFF	$111.20	$139.00	—	—	20%
Complete blood count (CBC), no differential CPT 85027 PARTIAL BLOOD COUNT (PBC)	$68.00	$85.00	—	155% above	20%
Complete blood count (CBC), no differential inpatient CPT 85027 PARTIAL BLOOD COUNT (PBC)	$68.00	$85.00	—	—	20%
Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL	$303.20	$379.00	—	304% above	20%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL	$303.20	$379.00	—	—	20%
D-dimer blood test (blood clot marker) CPT 85379 FIBRIN DEGRADATION-SENDOUT	$29.60	$37.00	—	13% below	20%
D-dimer blood test (blood clot marker) inpatient CPT 85379 FIBRIN DEGRADATION-SENDOUT	$29.60	$37.00	—	—	20%
DHEA sulfate (DHEA-S) blood test CPT 82627 LABC DEHYDROPIANDRSTRN(DHEA-S)	$27.20	$34.00	—	58% below	20%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 LABC DEHYDROPIANDRSTRN(DHEA-S)	$27.20	$34.00	—	—	20%
Estradiol blood test CPT 82670 ESTRADIOL	$154.40	$193.00	—	117% above	20%
Estradiol blood test inpatient CPT 82670 ESTRADIOL	$154.40	$193.00	—	—	20%
FSH (follicle-stimulating hormone) test CPT 83001 FSH	$327.20	$409.00	—	336% above	20%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH	$327.20	$409.00	—	—	20%
Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN FECAL	$56.00	$70.00	—	8% below	20%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CALPROTECTIN FECAL	$56.00	$70.00	—	—	20%
Ferritin blood test (iron stores) CPT 82728 FERRITIN	$198.40	$248.00	—	231% above	20%
Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN	$198.40	$248.00	—	—	20%
Folate (folic acid) blood test CPT 82746 FOLIC ACID SERUM	$240.00	$300.00	—	206% above	20%
Folate (folic acid) blood test inpatient CPT 82746 FOLIC ACID SERUM	$240.00	$300.00	—	—	20%
Free T3 thyroid hormone test CPT 84481 T3 FREE	$150.40	$188.00	—	136% above	20%
Free T3 thyroid hormone test inpatient CPT 84481 T3 FREE	$150.40	$188.00	—	—	20%
Free T4 (free thyroxine) thyroid blood test CPT 84439 THYROXINE FREE	$169.60	$212.00	—	440% above	20%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 THYROXINE FREE	$169.60	$212.00	—	—	20%
Free testosterone test CPT 84402 TESTOSTERONE BIOAVAIL	$123.20	$154.00	—	212% above	20%
Free testosterone test inpatient CPT 84402 TESTOSTERONE BIOAVAIL	$123.20	$154.00	—	—	20%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 GENERAL HEALTH SCREEN	$656.80	$821.00	—	320% above	20%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 GENERAL HEALTH SCREEN	$656.80	$821.00	—	—	20%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 1 HR GLUCOSE TOLERANCE NO FBS	$185.60	$232.00	—	733% above	20%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 1 HR GLUCOSE TOLERANCE NO FBS	$185.60	$232.00	—	—	20%
Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE-3 SPECIMEN	$203.20	$254.00	—	256% above	20%
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOLERANCE-3 SPECIMEN	$203.20	$254.00	—	—	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 LABC N.GONORRHOEAE DNA PROBE	$18.80	$23.50	—	80% below	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 NEISSERIA AMPLIF NA PROBE	$168.80	$211.00	—	84% above	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 LABC N.GONORRHOEAE DNA PROBE	$18.80	$23.50	—	—	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 NEISSERIA AMPLIF NA PROBE	$168.80	$211.00	—	—	20%
H. pylori antibody blood test CPT 86677 HELICOBACTER PYLORI	$80.80	$101.00	—	43% above	20%
H. pylori antibody blood test CPT 86677 HELICOBACTER PYLORI X 3	$240.00	$300.00	—	324% above	20%
H. pylori antibody blood test inpatient CPT 86677 HELICOBACTER PYLORI	$80.80	$101.00	—	—	20%
H. pylori antibody blood test inpatient CPT 86677 HELICOBACTER PYLORI X 3	$240.00	$300.00	—	—	20%
H. pylori stool antigen test CPT 87338 HELICOBACTOR PYLORI STOOL	$206.40	$258.00	—	233% above	20%
H. pylori stool antigen test inpatient CPT 87338 HELICOBACTOR PYLORI STOOL	$206.40	$258.00	—	—	20%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 RNA	$1,126.40	$1,408.00	—	547% above	20%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV-1 RNA	$1,126.40	$1,408.00	—	—	20%
HIV-1 and HIV-2 antibody test CPT 86703 ANTI HIV EMPLOYEE	$64.80	$81.00	—	26% above	20%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 ANTI HIV EMPLOYEE	$64.80	$81.00	—	—	20%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 LABC HIV1 AG W/HIV1&2 AB AG IA	$28.80	$36.00	—	33% below	20%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV-1 AG HIV-2 AB	$133.60	$167.00	—	210% above	20%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 LABC HIV1 AG W/HIV1&2 AB AG IA	$28.80	$36.00	—	—	20%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV-1 AG HIV-2 AB	$133.60	$167.00	—	—	20%
HPV test for high-risk types, one combined (pooled) result CPT 87624 COBAS HPV RECTAL-SENDOUT	$38.40	$48.00	—	48% below	20%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV-HIGH RISK	$402.40	$503.00	—	444% above	20%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 COBAS HPV RECTAL-SENDOUT	$38.40	$48.00	—	—	20%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV-HIGH RISK	$402.40	$503.00	—	—	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 GLYCOSYLATED HEMOGLOBIN-MMA	$16.80	$21.00	—	55% below	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 LABCO HEMOGLOBIN A1C	$25.60	$32.00	—	32% below	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 GLYCOHEMOGLOBIN A1C - SENDOUT	$28.00	$35.00	—	25% below	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 GLYCOHEMOGLOBIN (A1C)	$129.60	$162.00	—	246% above	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 GLYCOSYLATED HEMOGLOBIN-MMA	$16.80	$21.00	—	—	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 LABCO HEMOGLOBIN A1C	$25.60	$32.00	—	—	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 GLYCOHEMOGLOBIN A1C - SENDOUT	$28.00	$35.00	—	—	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 GLYCOHEMOGLOBIN (A1C)	$129.60	$162.00	—	—	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURFACE AB	$160.80	$201.00	—	299% above	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B SURFACE AB	$160.80	$201.00	—	—	20%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURFACE AG	$163.20	$204.00	—	337% above	20%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS B SURFACE AG	$163.20	$204.00	—	—	20%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C VIRUS AB TEST	$140.00	$175.00	—	192% above	20%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C VIRUS AB TEST	$140.00	$175.00	—	—	20%
Hepatitis C viral load (HCV RNA) test CPT 87522 HEPATITIS C QUANT	$347.20	$434.00	—	308% above	20%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEPATITIS C QUANT	$347.20	$434.00	—	—	20%
Herpes blood test, HSV-1 antibody CPT 86695 LABC HERPES SIMPLEX TYPE 1 TST	$31.20	$39.00	—	25% below	20%
Herpes blood test, HSV-1 antibody CPT 86695 HERPES SIMPLEX VIR I IGG	$79.20	$99.00	—	90% above	20%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 LABC HERPES SIMPLEX TYPE 1 TST	$31.20	$39.00	—	—	20%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HERPES SIMPLEX VIR I IGG	$79.20	$99.00	—	—	20%
Herpes blood test, HSV-2 antibody CPT 86696 HERPES SIMPLEX VIR II IGG	$175.20	$219.00	—	321% above	20%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HERPES SIMPLEX VIR II IGG	$175.20	$219.00	—	—	20%
High-sensitivity CRP (hs-CRP) test CPT 86141 CRP ULTRA QUANT	$447.20	$559.00	—	883% above	20%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 CRP ULTRA QUANT	$447.20	$559.00	—	—	20%
Homocysteine blood test CPT 83090 HOMOCYSTINE	$35.20	$44.00	—	47% below	20%
Homocysteine blood test inpatient CPT 83090 HOMOCYSTINE	$35.20	$44.00	—	—	20%
Insulin blood test CPT 83525 INSULIN	$23.20	$29.00	—	43% below	20%
Insulin blood test inpatient CPT 83525 INSULIN	$23.20	$29.00	—	—	20%
Iron blood test (serum iron) CPT 83540 IRON SERUM	$64.00	$80.00	—	119% above	20%
Iron blood test (serum iron) CPT 83540 IRON TISSUE	$64.00	$80.00	—	119% above	20%
Iron blood test (serum iron) inpatient CPT 83540 IRON TISSUE	$64.00	$80.00	—	—	20%
Iron blood test (serum iron) inpatient CPT 83540 IRON SERUM	$64.00	$80.00	—	—	20%
Iron-binding capacity (TIBC) test CPT 83550 TIBC WITHIN PROFILE	$97.60	$122.00	—	146% above	20%
Iron-binding capacity (TIBC) test inpatient CPT 83550 TIBC WITHIN PROFILE	$97.60	$122.00	—	—	20%
Kidney function blood test panel CPT 80069 RENAL FAILURE PANEL	$272.00	$340.00	—	336% above	20%
Kidney function blood test panel inpatient CPT 80069 RENAL FAILURE PANEL	$272.00	$340.00	—	—	20%
LH (luteinizing hormone) test CPT 83002 LABC GONADOTROPIN; LH ECL	$40.80	$51.00	—	46% below	20%
LH (luteinizing hormone) test inpatient CPT 83002 LABC GONADOTROPIN; LH ECL	$40.80	$51.00	—	—	20%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE BODY FLUID-SENDOUT	$91.20	$114.00	—	226% above	20%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE	$161.60	$202.00	—	477% above	20%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE BODY FLUID-SENDOUT	$91.20	$114.00	—	—	20%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE	$161.60	$202.00	—	—	20%
Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL	$184.00	$230.00	—	269% above	20%
Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL	$184.00	$230.00	—	—	20%
Lyme disease antibody test CPT 86618 LYME DISEASE ANTIBODY	$42.40	$53.00	—	62% above	20%
Lyme disease antibody test CPT 86618 LYME DISEASE ANTIBODY X 2	$84.00	$105.00	—	220% above	20%
Lyme disease antibody test CPT 86618 LYME DISEASE ANTIBODY DUPLICAT	$93.60	$117.00	—	257% above	20%
Lyme disease antibody test inpatient CPT 86618 LYME DISEASE ANTIBODY	$42.40	$53.00	—	—	20%
Lyme disease antibody test inpatient CPT 86618 LYME DISEASE ANTIBODY X 2	$84.00	$105.00	—	—	20%
Lyme disease antibody test inpatient CPT 86618 LYME DISEASE ANTIBODY DUPLICAT	$93.60	$117.00	—	—	20%
Magnesium blood test CPT 83735 LABC ASSAY OF MAGNESIUM	$7.60	$9.50	—	62% below	20%
Magnesium blood test CPT 83735 MAGNESIUM	$95.20	$119.00	—	376% above	20%
Magnesium blood test inpatient CPT 83735 LABC ASSAY OF MAGNESIUM	$7.60	$9.50	—	—	20%
Magnesium blood test inpatient CPT 83735 MAGNESIUM	$95.20	$119.00	—	—	20%
Measles (rubeola) antibody test CPT 86765 LABC RUBEOLA AB (MEASLES)	$25.60	$32.00	—	9% above	20%
Measles (rubeola) antibody test CPT 86765 RUBEOLA (MEASLES) AB	$116.00	$145.00	—	393% above	20%
Measles (rubeola) antibody test CPT 86765 RUBEOLA (MEASLES) AB X 2	$230.40	$288.00	—	879% above	20%
Measles (rubeola) antibody test inpatient CPT 86765 LABC RUBEOLA AB (MEASLES)	$25.60	$32.00	—	—	20%
Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA (MEASLES) AB	$116.00	$145.00	—	—	20%
Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA (MEASLES) AB X 2	$230.40	$288.00	—	—	20%
Mono test (heterophile antibody, Monospot) CPT 86308 HETEROPHILE ANTIBODIES-MMA	$8.00	$10.00	—	80% below	20%
Mono test (heterophile antibody, Monospot) CPT 86308 MONOSCREEN	$216.00	$270.00	—	436% above	20%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HETEROPHILE ANTIBODIES-MMA	$8.00	$10.00	—	—	20%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONOSCREEN	$216.00	$270.00	—	—	20%
Obstetric blood test panel CPT 80055 OBSTETRIC PANEL	$967.20	$1,209.00	—	664% above	20%
Obstetric blood test panel inpatient CPT 80055 OBSTETRIC PANEL	$967.20	$1,209.00	—	—	20%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA FREE	$117.60	$147.00	—	105% above	20%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA FREE	$117.60	$147.00	—	—	20%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA TOTAL	$89.60	$112.00	—	86% above	20%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA TOTAL	$89.60	$112.00	—	—	20%
Pap test (liquid-based, automated screening with review) CPT 88175 CRWL CYTOPATH C/V PAP SCREEN	$42.40	$53.00	—	41% below	20%
Pap test (liquid-based, automated screening with review) CPT 88175 CYTOPAH CERVICAL/VAGINAL	$120.80	$151.00	—	67% above	20%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 CRWL CYTOPATH C/V PAP SCREEN	$42.40	$53.00	—	—	20%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 CYTOPAH CERVICAL/VAGINAL	$120.80	$151.00	—	—	20%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 CP CERV/VAG MANUAL SCR-MMA	$21.60	$27.00	—	69% below	20%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 CRWL CYTOPATH C/V MNL SCRN	$42.40	$53.00	—	38% below	20%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 CYTOLOGY SMEAR TP DIAG	$159.20	$199.00	—	131% above	20%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 CP CERV/VAG MANUAL SCR-MMA	$21.60	$27.00	—	—	20%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 CRWL CYTOPATH C/V MNL SCRN	$42.40	$53.00	—	—	20%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 CYTOLOGY SMEAR TP DIAG	$159.20	$199.00	—	—	20%
Parathyroid hormone (PTH) blood test CPT 83970 PTH INTACT (IRMA)	$340.00	$425.00	—	170% above	20%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH INTACT (IRMA)	$340.00	$425.00	—	—	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 LABC THROMBOPLASTIN TIME PARTL	$25.80	$32.25	—	17% below	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 PARTIAL THROMBO TIME WHOLE BL	$104.00	$130.00	—	235% above	20%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 LABC THROMBOPLASTIN TIME PARTL	$25.80	$32.25	—	—	20%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PARTIAL THROMBO TIME WHOLE BL	$104.00	$130.00	—	—	20%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 INFORMASEQ FETAL CHROM ANEUPL	$1,219.20	$1,524.00	—	306% above	20%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 INFORMASEQ FETAL CHROM ANEUPL	$1,219.20	$1,524.00	—	—	20%
Progesterone blood test CPT 84144 PROGESTERONE	$40.80	$51.00	—	33% below	20%
Progesterone blood test inpatient CPT 84144 PROGESTERONE	$40.80	$51.00	—	—	20%
Prolactin blood test CPT 84146 PROLACTIN	$344.00	$430.00	—	385% above	20%
Prolactin blood test inpatient CPT 84146 PROLACTIN	$344.00	$430.00	—	—	20%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME-MMA	$6.40	$8.00	—	54% below	20%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME-PCF	$72.80	$91.00	—	428% above	20%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME	$72.80	$91.00	—	428% above	20%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME-ANTICOAG	$72.80	$91.00	—	428% above	20%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME-MMA	$6.40	$8.00	—	—	20%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME-ANTICOAG	$72.80	$91.00	—	—	20%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME-PCF	$72.80	$91.00	—	—	20%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME	$72.80	$91.00	—	—	20%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 DRUG SCREEN-CLIENT	$61.60	$77.00	—	81% above	20%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 DRUG SCREEN-CLIENT	$61.60	$77.00	—	—	20%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA B AG (59)	$242.40	$303.00	—	408% above	20%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA A AG	$242.40	$303.00	—	408% above	20%
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA B AG (59)	$242.40	$303.00	—	—	20%
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA A AG	$242.40	$303.00	—	—	20%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 RAPID STREP A THROAT	$144.80	$181.00	—	205% above	20%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 RAPID STREP A THROAT	$144.80	$181.00	—	—	20%
Rheumatoid factor (RF) test CPT 86431 LABCO RHEUMATOID FACTOR	$57.60	$72.00	—	74% above	20%
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR	$139.20	$174.00	—	320% above	20%
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR X3	$417.60	$522.00	—	1160% above	20%
Rheumatoid factor (RF) test inpatient CPT 86431 LABCO RHEUMATOID FACTOR	$57.60	$72.00	—	—	20%
Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR	$139.20	$174.00	—	—	20%
Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR X3	$417.60	$522.00	—	—	20%
Rubella antibody test (immunity check) CPT 86762 RUBELLA AB	$208.00	$260.00	—	400% above	20%
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA AB	$208.00	$260.00	—	—	20%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 LABC RBC SED RATE AUTOMATED	$25.60	$32.00	—	7% above	20%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 LABC RBC SED RATE AUTOMATED	$25.60	$32.00	—	—	20%
Stool ova and parasites exam CPT 87177 OVA & PARASITES SMEARS-SENDOUT	$32.80	$41.00	—	14% below	20%
Stool ova and parasites exam CPT 87177 OVA AND PARASITE EXAM	$304.00	$380.00	—	693% above	20%
Stool ova and parasites exam inpatient CPT 87177 OVA & PARASITES SMEARS-SENDOUT	$32.80	$41.00	—	—	20%
Stool ova and parasites exam inpatient CPT 87177 OVA AND PARASITE EXAM	$304.00	$380.00	—	—	20%
Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLOOD OTH SOURCE-MMA	$4.80	$6.00	—	73% below	20%
Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLOOD STOOL SCREEN MHC	$88.80	$111.00	—	406% above	20%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 OCCULT BLOOD OTH SOURCE-MMA	$4.80	$6.00	—	—	20%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 OCCULT BLOOD STOOL SCREEN MHC	$88.80	$111.00	—	—	20%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 BLOOD OCCULT STOOL HGB-MMA	$16.80	$21.00	—	55% below	20%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 OCCULT BLOOD STOOL HGB	$88.80	$111.00	—	140% above	20%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 BLOOD OCCULT STOOL HGB-MMA	$16.80	$21.00	—	—	20%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 OCCULT BLOOD STOOL HGB	$88.80	$111.00	—	—	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RAPID PLASMA REAGIN	$22.40	$28.00	—	29% above	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 LABCO SYPHILIS DETECTION TEST	$24.80	$31.00	—	43% above	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RAPID PLASMA REAGIN	$22.40	$28.00	—	—	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 LABCO SYPHILIS DETECTION TEST	$24.80	$31.00	—	—	20%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 M TUBERCULOSIS BY QUANTIFE	$296.80	$371.00	—	134% above	20%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 M TUBERCULOSIS BY QUANTIFE	$296.80	$371.00	—	—	20%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE	$50.40	$63.00	—	23% below	20%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE	$50.40	$63.00	—	—	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 MICROSOMAL AB EACH	$86.40	$108.00	—	95% above	20%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 MICROSOMAL AB EACH	$86.40	$108.00	—	—	20%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 MAYO ASSAY TSH, SENSITIVE	$44.00	$55.00	—	32% below	20%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID STIMULATING HORMONE	$230.40	$288.00	—	258% above	20%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 MAYO ASSAY TSH, SENSITIVE	$44.00	$55.00	—	—	20%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 THYROID STIMULATING HORMONE	$230.40	$288.00	—	—	20%
Trichomonas test (NAAT) CPT 87661 LABC TRICHOMONAS VAGINALIS PRB	$21.60	$27.00	—	66% below	20%
Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS	$99.20	$124.00	—	55% above	20%
Trichomonas test (NAAT) inpatient CPT 87661 LABC TRICHOMONAS VAGINALIS PRB	$21.60	$27.00	—	—	20%
Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS VAGINALIS	$99.20	$124.00	—	—	20%
Uric acid blood test CPT 84550 URIC ACID BLOOD	$68.00	$85.00	—	202% above	20%
Uric acid blood test inpatient CPT 84550 URIC ACID BLOOD	$68.00	$85.00	—	—	20%
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS/COMPLETE	$82.40	$103.00	—	312% above	20%
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS/COMPLETE	$82.40	$103.00	—	—	20%
Urinalysis with microscope exam, manual CPT 81000 URINALYSIS NONAUTO W/SCOPE-MMA	$5.60	$7.00	—	44% below	20%
Urinalysis with microscope exam, manual inpatient CPT 81000 URINALYSIS NONAUTO W/SCOPE-MMA	$5.60	$7.00	—	—	20%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS AUTO W/O SCOPE-MMA	$4.80	$6.00	—	53% below	20%
Urinalysis without microscope exam, automated CPT 81003 URINALYS AUTOM WO MICRO	$44.00	$55.00	—	327% above	20%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS AUTO W/O SCOPE-MMA	$4.80	$6.00	—	—	20%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYS AUTOM WO MICRO	$44.00	$55.00	—	—	20%
Urinalysis without microscope exam, manual CPT 81002 URINALYSIS NONAUTO-MMA	$5.60	$7.00	—	57% below	20%
Urinalysis without microscope exam, manual CPT 81002 URINALYS WO MICRO	$44.00	$55.00	—	237% above	20%
Urinalysis without microscope exam, manual inpatient CPT 81002 URINALYSIS NONAUTO-MMA	$5.60	$7.00	—	—	20%
Urinalysis without microscope exam, manual inpatient CPT 81002 URINALYS WO MICRO	$44.00	$55.00	—	—	20%
Urine culture for bacteria, with colony count CPT 87086 CULTURE URINE	$136.80	$171.00	—	149% above	20%
Urine culture for bacteria, with colony count inpatient CPT 87086 CULTURE URINE	$136.80	$171.00	—	—	20%
Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY TST-MMA	$9.60	$12.00	—	54% below	20%
Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY QUALITATIVE	$137.60	$172.00	—	555% above	20%
Urine pregnancy test, read by color change inpatient CPT 81025 URINE PREGNANCY TST-MMA	$9.60	$12.00	—	—	20%
Urine pregnancy test, read by color change inpatient CPT 81025 URINE PREGNANCY QUALITATIVE	$137.60	$172.00	—	—	20%
Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B12	$204.80	$256.00	—	254% above	20%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B12	$204.80	$256.00	—	—	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25 HYDROXY-SENDOUT	$75.20	$94.00	—	15% below	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25 HYDROXY	$83.20	$104.00	—	6% below	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D 25 HYDROXY-SENDOUT	$75.20	$94.00	—	—	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D 25 HYDROXY	$83.20	$104.00	—	—	20%
Zinc blood test CPT 84630 ZINC SERUM	$140.80	$176.00	—	796% above	20%
Zinc blood test inpatient CPT 84630 ZINC SERUM	$140.80	$176.00	—	—	20%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 GONADOTROPIN (hCG) QUANT	$34.40	$43.00	—	41% below	20%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 GONADOTROPIN (hCG) QUANT	$34.40	$43.00	—	—	20%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Michigan	Off list
Adenoid removal (adenoidectomy), child under 12 CPT 42830 REM ADENOIDS PRIMRY </12-PhHOS	$396.80	$496.00	—	12% below	20%
Adenoid removal (adenoidectomy), child under 12 inpatient CPT 42830 REM ADENOIDS PRIMRY </12-PhHOS	$396.80	$496.00	—	—	20%
Anterior cervical discectomy and fusion (ACDF), one level CPT 22551 NECK SPNE FUS&REM BEL C2-PhHOS	$2,612.80	$3,266.00	—	28% below	20%
Anterior cervical discectomy and fusion (ACDF), one level inpatient CPT 22551 NECK SPNE FUS&REM BEL C2-PhHOS	$2,612.80	$3,266.00	—	—	20%
Appendectomy for a ruptured appendix with abscess or peritonitis CPT 44960 APPENDECTOMY-PhHOS	$1,342.40	$1,678.00	—	19% below	20%
Appendectomy for a ruptured appendix with abscess or peritonitis inpatient CPT 44960 APPENDECTOMY-PhHOS	$1,342.40	$1,678.00	—	—	20%
Appendectomy, open surgery CPT 44950 APPENDECTOMY-PhHOS	$985.60	$1,232.00	—	33% below	20%
Appendectomy, open surgery inpatient CPT 44950 APPENDECTOMY-PhHOS	$985.60	$1,232.00	—	—	20%
Arthroscopic ACL reconstruction or repair of the knee CPT 29888 KNEE ARTHRO/SURG-PhHOS	$1,664.80	$2,081.00	—	61% below	20%
Arthroscopic ACL reconstruction or repair of the knee inpatient CPT 29888 KNEE ARTHRO/SURG-PhHOS	$1,664.80	$2,081.00	—	—	20%
Arthroscopic rotator cuff repair of the shoulder CPT 29827 ARTHRO ROTATOR CUFF REPR-PhHOS	$1,658.40	$2,073.00	—	16% below	20%
Arthroscopic rotator cuff repair of the shoulder inpatient CPT 29827 ARTHRO ROTATOR CUFF REPR-PhHOS	$1,658.40	$2,073.00	—	—	20%
Botox injections for chronic migraine CPT 64615 CHEMODEN MUSC MIGRAINE-FAC	$236.80	$296.00	—	58% below	20%
Botox injections for chronic migraine CPT 64615 CHEMODENERV MUSC-MHCP	$500.00	$625.00	—	12% below	20%
Botox injections for chronic migraine CPT 64615 CHEMODENERV MUSC MIGRAINE-PCP	$500.00	$625.00	—	12% below	20%
Botox injections for chronic migraine CPT 64615 CHEMODENERV MUSC-MHCF	$644.00	$805.00	—	13% above	20%
Botox injections for chronic migraine CPT 64615 CHEMODENERV MUSC MIGRAINE-PCF	$676.00	$845.00	—	19% above	20%
Botox injections for chronic migraine inpatient CPT 64615 CHEMODEN MUSC MIGRAINE-FAC	$236.80	$296.00	—	—	20%
Botox injections for chronic migraine inpatient CPT 64615 CHEMODENERV MUSC MIGRAINE-PCP	$500.00	$625.00	—	—	20%
Botox injections for chronic migraine inpatient CPT 64615 CHEMODENERV MUSC-MHCP	$500.00	$625.00	—	—	20%
Botox injections for chronic migraine inpatient CPT 64615 CHEMODENERV MUSC-MHCF	$644.00	$805.00	—	—	20%
Botox injections for chronic migraine inpatient CPT 64615 CHEMODENERV MUSC MIGRAINE-PCF	$676.00	$845.00	—	—	20%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 BX BREAST STEREO LT	$1,765.60	$2,207.00	—	22% below	20%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 BX BREAST STEREO RT	$1,765.60	$2,207.00	—	22% below	20%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient one side CPT 19081 BX BREAST STEREO RT	$1,765.60	$2,207.00	—	—	20%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient one side CPT 19081 BX BREAST STEREO LT	$1,765.60	$2,207.00	—	—	20%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 TREAT ANKLE FX-FAC	$216.00	$270.00	—	36% below	20%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 TX OF ANKLE FX-PhHOS	$350.40	$438.00	—	3% above	20%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 TREAT ANKLE FX-FAC	$216.00	$270.00	—	—	20%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 TX OF ANKLE FX-PhHOS	$350.40	$438.00	—	—	20%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 TREAT METATARSAL FX-FAC	$216.00	$270.00	—	36% below	20%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 TX METATARSAL FX-PhHOS	$252.80	$316.00	—	25% below	20%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 TREAT METATARSAL FX-FAC	$216.00	$270.00	—	—	20%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 TX METATARSAL FX-PhHOS	$252.80	$316.00	—	—	20%
Bunion correction with a bone cut near the head of the first metatarsal CPT 28296 CORRECTION OF BUNION-PhHOS	$820.80	$1,026.00	—	58% below	20%
Bunion correction with a bone cut near the head of the first metatarsal inpatient CPT 28296 CORRECTION OF BUNION-PhHOS	$820.80	$1,026.00	—	—	20%
Bunion correction with removal of part of the big toe joint CPT 28292 COR HLX VLGS RSC PRX PHLX-PhHO	$784.00	$980.00	—	38% below	20%
Bunion correction with removal of part of the big toe joint inpatient CPT 28292 COR HLX VLGS RSC PRX PHLX-PhHO	$784.00	$980.00	—	—	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION EXTERNAL-ERPRO	$184.80	$231.00	—	80% below	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION EXTERNAL	$3,685.60	$4,607.00	—	306% above	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 ER CARDIO,ELEC CONVER OF ARRHY	$3,870.40	$4,838.00	—	326% above	20%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION EXTERNAL-ERPRO	$184.80	$231.00	—	—	20%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION EXTERNAL	$3,685.60	$4,607.00	—	—	20%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 ER CARDIO,ELEC CONVER OF ARRHY	$3,870.40	$4,838.00	—	—	20%
Carpal tunnel release, open surgery CPT 64721 CARPAL TUNNEL SURG-PhHOS	$662.40	$828.00	—	64% below	20%
Carpal tunnel release, open surgery CPT 64721 CARPAL TUNNEL BIL SURG-PhHOS	$1,012.80	$1,266.00	—	46% below	20%
Carpal tunnel release, open surgery inpatient CPT 64721 CARPAL TUNNEL SURG-PhHOS	$662.40	$828.00	—	—	20%
Carpal tunnel release, open surgery inpatient CPT 64721 CARPAL TUNNEL BIL SURG-PhHOS	$1,012.80	$1,266.00	—	—	20%
Cataract surgery with lens implant CPT 66984 CATRCT REM,CM SURG-PhHOSP	$774.40	$968.00	—	45% below	20%
Cataract surgery with lens implant CPT 66984 CATRCT REM-PhHOSP	$967.20	$1,209.00	—	31% below	20%
Cataract surgery with lens implant inpatient CPT 66984 CATRCT REM,CM SURG-PhHOSP	$774.40	$968.00	—	—	20%
Cataract surgery with lens implant inpatient CPT 66984 CATRCT REM-PhHOSP	$967.20	$1,209.00	—	—	20%
Cervical biopsy CPT 57500 BX OF CERVIX-PhHOS	$92.00	$115.00	—	87% below	20%
Cervical biopsy CPT 57500 BX OF CERVIX-FAC	$617.60	$772.00	—	15% below	20%
Cervical biopsy inpatient CPT 57500 BX OF CERVIX-PhHOS	$92.00	$115.00	—	—	20%
Cervical biopsy inpatient CPT 57500 BX OF CERVIX-FAC	$617.60	$772.00	—	—	20%
Cesarean delivery, including prenatal and postpartum care CPT 59510 CESAREAN DELIVERY-PhHOS	$3,628.80	$4,536.00	—	4% below	20%
Cesarean delivery, including prenatal and postpartum care inpatient CPT 59510 CESAREAN DELIVERY-PhHOS	$3,628.80	$4,536.00	—	—	20%
Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 CIRCUM 28 DAYS OR OLDER-PhHOS	$297.60	$372.00	—	44% below	20%
Circumcision by surgical excision, older than 28 days (children and adults) inpatient CPT 54161 CIRCUM 28 DAYS OR OLDER-PhHOS	$297.60	$372.00	—	—	20%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION W/REGNL BLCK-PhHO	$148.00	$185.00	—	88% below	20%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION W/BLOCK-FAC	$1,855.20	$2,319.00	—	46% above	20%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION W/REGIONAL BLOCK	$3,892.00	$4,865.00	—	206% above	20%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 CIRCUMCISION W/REGNL BLCK-PhHO	$148.00	$185.00	—	—	20%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 CIRCUMCISION W/BLOCK-FAC	$1,855.20	$2,319.00	—	—	20%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 CIRCUMCISION W/REGIONAL BLOCK	$3,892.00	$4,865.00	—	—	20%
Circumcision, surgical, older than a newborn CPT 54160 CIRCUMCISION NEONATE-PhHOS	$228.00	$285.00	—	42% below	20%
Circumcision, surgical, older than a newborn inpatient CPT 54160 CIRCUMCISION NEONATE-PhHOS	$228.00	$285.00	—	—	20%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 TREAT RADIUS & ULNAR FX-FAC	$216.00	$270.00	—	39% below	20%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 TX FX RADIUS/ULNA-PhHOS	$379.20	$474.00	—	7% above	20%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 TREAT RADIUS & ULNAR FX-FAC	$216.00	$270.00	—	—	20%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 TX FX RADIUS/ULNA-PhHOS	$379.20	$474.00	—	—	20%
Colonoscopy with endoscopic ultrasound CPT 45391 COLONOSCOPY W/ENDOSCP US-PhHOS	$390.40	$488.00	—	24% above	20%
Colonoscopy with endoscopic ultrasound inpatient CPT 45391 COLONOSCOPY W/ENDOSCP US-PhHOS	$390.40	$488.00	—	—	20%
Colonoscopy with polyp removal CPT 45385 LES REM COLONOSC-PhHOS	$476.80	$596.00	—	58% below	20%
Colonoscopy with polyp removal inpatient CPT 45385 LES REM COLONOSC-PhHOS	$476.80	$596.00	—	—	20%
Colonoscopy with tissue sample CPT 45380 COLONOSC AND BX-PhHOS	$632.80	$791.00	—	44% below	20%
Colonoscopy with tissue sample inpatient CPT 45380 COLONOSC AND BX-PhHOS	$632.80	$791.00	—	—	20%
Colonoscopy, diagnostic CPT 45378 DIAGNOSTIC COLONOSC-PhHOS	$336.80	$421.00	—	61% below	20%
Colonoscopy, diagnostic inpatient CPT 45378 DIAGNOSTIC COLONOSC-PhHOS	$336.80	$421.00	—	—	20%
Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 BX CERVIX W/SCOPE LEEP-PhHOS	$254.40	$318.00	—	90% below	20%
Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 BX OF CERVIX W/SCOPE LEEP-FAC	$2,700.80	$3,376.00	—	1% above	20%
Colposcopy with LEEP (loop electrosurgical excision) inpatient CPT 57460 BX CERVIX W/SCOPE LEEP-PhHOS	$254.40	$318.00	—	—	20%
Colposcopy with LEEP (loop electrosurgical excision) inpatient CPT 57460 BX OF CERVIX W/SCOPE LEEP-FAC	$2,700.80	$3,376.00	—	—	20%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 BX/CURETT OF CERVIX W/SC-PhHOS	$165.60	$207.00	—	48% below	20%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 BX/CURETT CERVIX W SCOPE-FAC	$267.20	$334.00	—	17% below	20%
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 BX/CURETT OF CERVIX W/SC-PhHOS	$165.60	$207.00	—	—	20%
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 BX/CURETT CERVIX W SCOPE-FAC	$267.20	$334.00	—	—	20%
Complex cataract surgery with lens implant CPT 66982 CATRCT REM CMPX,CM SURG-PhHOSP	$961.60	$1,202.00	—	31% below	20%
Complex cataract surgery with lens implant CPT 66982 CATRCT REM CMPLX-PhHOSP	$1,202.40	$1,503.00	—	14% below	20%
Complex cataract surgery with lens implant inpatient CPT 66982 CATRCT REM CMPX,CM SURG-PhHOSP	$961.60	$1,202.00	—	—	20%
Complex cataract surgery with lens implant inpatient CPT 66982 CATRCT REM CMPLX-PhHOSP	$1,202.40	$1,503.00	—	—	20%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOSCOPY-PhHOS	$190.40	$238.00	—	74% below	20%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOSCOPY-FAC	$623.20	$779.00	—	16% below	20%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 CYSTOSCOPY-PhHOS	$190.40	$238.00	—	—	20%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 CYSTOSCOPY-FAC	$623.20	$779.00	—	—	20%
D&C (dilation and curettage), not related to pregnancy CPT 58120 DILATION AND CURETTAGE-PhHOS	$340.00	$425.00	—	56% below	20%
D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 DILATION AND CURETTAGE-PhHOS	$340.00	$425.00	—	—	20%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DEST BENIGN/PREMLG LES-PhHOS	$68.80	$86.00	—	24% below	20%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTROY BEGIGN/PREMIG LES-FAC	$180.00	$225.00	—	98% above	20%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 DEST BENIGN/PREMLG LES-PhHOS	$68.80	$86.00	—	—	20%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 DESTROY BEGIGN/PREMIG LES-FAC	$180.00	$225.00	—	—	20%
Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 CREATE EARDRUM OPENING-PhHOS	$253.60	$317.00	—	55% below	20%
Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 CREATE EARDRUM BIL OPEN-PhHOS	$381.60	$477.00	—	32% below	20%
Ear tube placement (tympanostomy) under general anesthesia, one ear inpatient CPT 69436 CREATE EARDRUM OPENING-PhHOS	$253.60	$317.00	—	—	20%
Ear tube placement (tympanostomy) under general anesthesia, one ear inpatient CPT 69436 CREATE EARDRUM BIL OPEN-PhHOS	$381.60	$477.00	—	—	20%
Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 CREATE EARDRUM OPENING-PhHOS	$164.80	$206.00	—	15% above	20%
Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 CREATE EARDRUM OPENING-FAC	$465.60	$582.00	—	224% above	20%
Ear tube placement (tympanostomy) with local anesthesia, one ear inpatient CPT 69433 CREATE EARDRUM OPENING-PhHOS	$164.80	$206.00	—	—	20%
Ear tube placement (tympanostomy) with local anesthesia, one ear inpatient CPT 69433 CREATE EARDRUM OPENING-FAC	$465.60	$582.00	—	—	20%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REM IMPACTED EARWAX UNI-ERPRO	$25.60	$32.00	—	64% below	20%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REM IMPACTED EARWAX BIL-ERPRO	$38.40	$48.00	—	46% below	20%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REM IMPACTED EARWAX UNI-FAC	$53.60	$67.00	—	24% below	20%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REM IMPACTED EARWAX BIL-FAC	$80.00	$100.00	—	13% above	20%
Earwax removal by irrigation (rinsing), one ear CPT 69209 ER REMOVE IMPACTED EAR WAX UNI	$90.40	$113.00	—	28% above	20%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 REM IMPACTED EARWAX UNI-ERPRO	$25.60	$32.00	—	—	20%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 REM IMPACTED EARWAX BIL-ERPRO	$38.40	$48.00	—	—	20%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 REM IMPACTED EARWAX UNI-FAC	$53.60	$67.00	—	—	20%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 REM IMPACTED EARWAX BIL-FAC	$80.00	$100.00	—	—	20%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 ER REMOVE IMPACTED EAR WAX UNI	$90.40	$113.00	—	—	20%
Earwax removal with instruments, one ear CPT 69210 REM IMPACTED EAR WAX-PhHOS	$39.20	$49.00	—	53% below	20%
Earwax removal with instruments, one ear CPT 69210 REM IMPACT EARWAX W/TOOL-ERPRO	$40.00	$50.00	—	52% below	20%
Earwax removal with instruments, one ear CPT 69210 REM IMPCT EARWAX W/TOOL-FAC	$54.40	$68.00	—	35% below	20%
Earwax removal with instruments, one ear CPT 69210 REM IMPCT EARWX W/TOOL BIL-ERP	$60.00	$75.00	—	28% below	20%
Earwax removal with instruments, one ear CPT 69210 REM IMPCT WAX W/TOOL BIL-FAC	$80.80	$101.00	—	4% below	20%
Earwax removal with instruments, one ear CPT 69210 ER REMOVE IMPACT EAR WAX UNI	$241.60	$302.00	—	188% above	20%
Earwax removal with instruments, one ear inpatient CPT 69210 REM IMPACTED EAR WAX-PhHOS	$39.20	$49.00	—	—	20%
Earwax removal with instruments, one ear inpatient CPT 69210 REM IMPACT EARWAX W/TOOL-ERPRO	$40.00	$50.00	—	—	20%
Earwax removal with instruments, one ear inpatient CPT 69210 REM IMPCT EARWAX W/TOOL-FAC	$54.40	$68.00	—	—	20%
Earwax removal with instruments, one ear inpatient CPT 69210 REM IMPCT EARWX W/TOOL BIL-ERP	$60.00	$75.00	—	—	20%
Earwax removal with instruments, one ear inpatient CPT 69210 REM IMPCT WAX W/TOOL BIL-FAC	$80.80	$101.00	—	—	20%
Earwax removal with instruments, one ear inpatient CPT 69210 ER REMOVE IMPACT EAR WAX UNI	$241.60	$302.00	—	—	20%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 BX OF UTERUS LINING-PhHOS	$107.20	$134.00	—	53% below	20%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 BX OF UTERUS LINING-FAC	$225.60	$282.00	—	at median	20%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 BX OF UTERUS LINING-PhHOS	$107.20	$134.00	—	—	20%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 BX OF UTERUS LINING-FAC	$225.60	$282.00	—	—	20%
Endoscopic sinus surgery: full ethmoid sinus opening CPT 31255 REM OF ETHMOID SINUS-PhHOS	$612.80	$766.00	—	19% above	20%
Endoscopic sinus surgery: full ethmoid sinus opening inpatient CPT 31255 REM OF ETHMOID SINUS-PhHOS	$612.80	$766.00	—	—	20%
Endoscopic sinus surgery: opening the frontal sinus CPT 31276 SINUS ENDO SURGICAL-PhHOS	$775.20	$969.00	—	26% above	20%
Endoscopic sinus surgery: opening the frontal sinus inpatient CPT 31276 SINUS ENDO SURGICAL-PhHOS	$775.20	$969.00	—	—	20%
Endoscopic sinus surgery: opening the maxillary (cheek) sinus CPT 31256 EXPLORE MAXILLARY SINUS-PhHOS	$284.00	$355.00	—	12% above	20%
Endoscopic sinus surgery: opening the maxillary (cheek) sinus inpatient CPT 31256 EXPLORE MAXILLARY SINUS-PhHOS	$284.00	$355.00	—	—	20%
Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue CPT 31267 ENDO MAXILLARY SINUS-PhHOS	$487.20	$609.00	—	19% above	20%
Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue inpatient CPT 31267 ENDO MAXILLARY SINUS-PhHOS	$487.20	$609.00	—	—	20%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 EPI STER INJ CRV/THO W/IMA-PCP	$1,185.60	$1,482.00	—	54% above	20%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 EPI STER INJ CRV/TH W/IMA-MHCP	$1,185.60	$1,482.00	—	54% above	20%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 EPI STER INJ CRV/TH W/IMA-MHCF	$1,994.40	$2,493.00	—	158% above	20%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 EPI STER INJ CRV/THO W/IMA-PCF	$1,994.40	$2,493.00	—	158% above	20%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 EPI STER INJ CRV/TH W/IMA-MHCP	$1,185.60	$1,482.00	—	—	20%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 EPI STER INJ CRV/THO W/IMA-PCP	$1,185.60	$1,482.00	—	—	20%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 EPI STER INJ CRV/TH W/IMA-MHCF	$1,994.40	$2,493.00	—	—	20%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 EPI STER INJ CRV/THO W/IMA-PCF	$1,994.40	$2,493.00	—	—	20%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 DX/TH PAVAV JNT L/S 1 LVL-FAC	$806.40	$1,008.00	—	24% below	20%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 FACET LUM/SACRAL LI BIL-MHCP	$2,240.00	$2,800.00	—	112% above	20%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 FACET LUM/SACRAL LI BIL-PCP	$2,240.00	$2,800.00	—	112% above	20%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 FACET LUM/SACRAL LI BIL-PCF	$3,276.00	$4,095.00	—	210% above	20%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 FACET LUM/SACRAL LI BIL-MHCF	$3,276.00	$4,095.00	—	210% above	20%
Facet joint injection, lower back, one level, with imaging guidance one side CPT 64493 FACET LUM/SACRAL LV1 RT-MHCP	$1,493.60	$1,867.00	—	41% above	20%
Facet joint injection, lower back, one level, with imaging guidance one side CPT 64493 FACET LUM/SACRAL LV1 RT-PCP	$1,493.60	$1,867.00	—	41% above	20%
Facet joint injection, lower back, one level, with imaging guidance one side CPT 64493 FACET LUM/SACRAL LV1 LT-MHCP	$1,493.60	$1,867.00	—	41% above	20%
Facet joint injection, lower back, one level, with imaging guidance one side CPT 64493 FACET LUM/SACRAL LV1 LT-PCP	$1,493.60	$1,867.00	—	41% above	20%
Facet joint injection, lower back, one level, with imaging guidance one side CPT 64493 FACET LUM/SACRAL LV1 LT-MHCF	$2,314.40	$2,893.00	—	119% above	20%
Facet joint injection, lower back, one level, with imaging guidance one side CPT 64493 FACET LUM/SACRAL LV1 RT-PCF	$2,314.40	$2,893.00	—	119% above	20%
Facet joint injection, lower back, one level, with imaging guidance one side CPT 64493 FACET LUM/SACRAL LV1 LT-PCF	$2,314.40	$2,893.00	—	119% above	20%
Facet joint injection, lower back, one level, with imaging guidance one side CPT 64493 FACET LUM/SACRAL LV1 RT-MHCF	$2,314.40	$2,893.00	—	119% above	20%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 DX/TH PAVAV JNT L/S 1 LVL-FAC	$806.40	$1,008.00	—	—	20%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 FACET LUM/SACRAL LI BIL-PCP	$2,240.00	$2,800.00	—	—	20%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 FACET LUM/SACRAL LI BIL-MHCP	$2,240.00	$2,800.00	—	—	20%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 FACET LUM/SACRAL LI BIL-MHCF	$3,276.00	$4,095.00	—	—	20%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 FACET LUM/SACRAL LI BIL-PCF	$3,276.00	$4,095.00	—	—	20%
Facet joint injection, lower back, one level, with imaging guidance inpatient one side CPT 64493 FACET LUM/SACRAL LV1 LT-PCP	$1,493.60	$1,867.00	—	—	20%
Facet joint injection, lower back, one level, with imaging guidance inpatient one side CPT 64493 FACET LUM/SACRAL LV1 LT-MHCP	$1,493.60	$1,867.00	—	—	20%
Facet joint injection, lower back, one level, with imaging guidance inpatient one side CPT 64493 FACET LUM/SACRAL LV1 RT-MHCP	$1,493.60	$1,867.00	—	—	20%
Facet joint injection, lower back, one level, with imaging guidance inpatient one side CPT 64493 FACET LUM/SACRAL LV1 RT-PCP	$1,493.60	$1,867.00	—	—	20%
Facet joint injection, lower back, one level, with imaging guidance inpatient one side CPT 64493 FACET LUM/SACRAL LV1 RT-MHCF	$2,314.40	$2,893.00	—	—	20%
Facet joint injection, lower back, one level, with imaging guidance inpatient one side CPT 64493 FACET LUM/SACRAL LV1 LT-PCF	$2,314.40	$2,893.00	—	—	20%
Facet joint injection, lower back, one level, with imaging guidance inpatient one side CPT 64493 FACET LUM/SACRAL LV1 LT-MHCF	$2,314.40	$2,893.00	—	—	20%
Facet joint injection, lower back, one level, with imaging guidance inpatient one side CPT 64493 FACET LUM/SACRAL LV1 RT-PCF	$2,314.40	$2,893.00	—	—	20%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 RPR AA HRN 1ST 3-10 RDC-PhHOSP	$549.60	$687.00	—	45% below	20%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm inpatient CPT 49593 RPR AA HRN 1ST 3-10 RDC-PhHOSP	$549.60	$687.00	—	—	20%
First repair of a front abdominal hernia larger than 10 cm CPT 49595 RPR AA HRN 1ST > 10 RDC-PhHOS	$740.00	$925.00	—	7% below	20%
First repair of a front abdominal hernia larger than 10 cm inpatient CPT 49595 RPR AA HRN 1ST > 10 RDC-PhHOS	$740.00	$925.00	—	—	20%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 RPR AA HRN 1ST < 3 CM RDC-PhHO	$328.00	$410.00	—	45% below	20%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm inpatient CPT 49591 RPR AA HRN 1ST < 3 CM RDC-PhHO	$328.00	$410.00	—	—	20%
Gallbladder removal, laparoscopic CPT 47562 LAPAROSC CHOLECYSTECTOMY-PhHOS	$1,028.00	$1,285.00	—	54% below	20%
Gallbladder removal, laparoscopic inpatient CPT 47562 LAPAROSC CHOLECYSTECTOMY-PhHOS	$1,028.00	$1,285.00	—	—	20%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 LAPARO CHOLECYSTECT/GR-PhHOS	$1,099.20	$1,374.00	—	29% below	20%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery inpatient CPT 47563 LAPARO CHOLECYSTECT/GR-PhHOS	$1,099.20	$1,374.00	—	—	20%
Gallbladder removal, open surgery through a larger incision CPT 47600 REM OF GALLBLADDER-PhHOS	$1,641.60	$2,052.00	—	8% below	20%
Gallbladder removal, open surgery through a larger incision inpatient CPT 47600 REM OF GALLBLADDER-PhHOS	$1,641.60	$2,052.00	—	—	20%
Hammertoe correction surgery CPT 28285 REP OF HAMMERTOE-PhHOS	$611.20	$764.00	—	27% below	20%
Hammertoe correction surgery inpatient CPT 28285 REP OF HAMMERTOE-PhHOS	$611.20	$764.00	—	—	20%
Hemorrhoid banding (rubber band ligation) CPT 46221 LIGATION OF HEMORRHOID-PhHOS	$236.00	$295.00	—	54% below	20%
Hemorrhoid banding (rubber band ligation) CPT 46221 LIGATION OF HEMORRHOIDS-FAC	$712.00	$890.00	—	39% above	20%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 LIGATION OF HEMORRHOID-PhHOS	$236.00	$295.00	—	—	20%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 LIGATION OF HEMORRHOIDS-FAC	$712.00	$890.00	—	—	20%
Hemorrhoidectomy (internal and external), one area CPT 46255 HEMORRHOIDECTOMY-PhHOS	$549.60	$687.00	—	52% below	20%
Hemorrhoidectomy (internal and external), one area inpatient CPT 46255 HEMORRHOIDECTOMY-PhHOS	$549.60	$687.00	—	—	20%
Hip replacement after an earlier hip surgery (conversion to total hip) CPT 27132 TOTAL HIP ARTHROPLASTY-PhHOS	$2,577.60	$3,222.00	—	35% below	20%
Hip replacement after an earlier hip surgery (conversion to total hip) inpatient CPT 27132 TOTAL HIP ARTHROPLASTY-PhHOS	$2,577.60	$3,222.00	—	—	20%
Hysterectomy through an abdominal incision (total) CPT 58150 TOTAL HYSTER-PhHOS	$1,553.60	$1,942.00	—	41% below	20%
Hysterectomy through an abdominal incision (total) inpatient CPT 58150 TOTAL HYSTER-PhHOS	$1,553.60	$1,942.00	—	—	20%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 INJ PROC HYSTEROSALP	$576.80	$721.00	—	52% above	20%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 INJ PROC HYSTEROSALP	$576.80	$721.00	—	—	20%
Hysteroscopy with endometrial ablation CPT 58563 HYSTEROSC ABLATION-PhHOS	$532.80	$666.00	—	85% below	20%
Hysteroscopy with endometrial ablation inpatient CPT 58563 HYSTEROSC ABLATION-PhHOS	$532.80	$666.00	—	—	20%
Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 HYSTEROSC BX-PhHOS	$415.20	$519.00	—	85% below	20%
Hysteroscopy with uterine lining sampling and/or polyp removal inpatient CPT 58558 HYSTEROSC BX-PhHOS	$415.20	$519.00	—	—	20%
IUD insertion (the device itself billed separately) CPT 58300 INSERT INTRAUTERINE DEV-PhHOS	$60.00	$75.00	—	76% below	20%
IUD insertion (the device itself billed separately) CPT 58300 INSERT INTRAUTERINE DEV-FAC	$88.80	$111.00	—	64% below	20%
IUD insertion (the device itself billed separately) inpatient CPT 58300 INSERT INTRAUTERINE DEV-PhHOS	$60.00	$75.00	—	—	20%
IUD insertion (the device itself billed separately) inpatient CPT 58300 INSERT INTRAUTERINE DEV-FAC	$88.80	$111.00	—	—	20%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS SIMPL/SINGLE-PhHOS	$116.80	$146.00	—	53% below	20%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS SIMPL/SINGLE-ERPRO	$134.40	$168.00	—	45% below	20%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS SIMPLE/SINGLE-FAC	$169.60	$212.00	—	31% below	20%
Incision and drainage of a simple or single skin abscess CPT 10060 ER I&D ABSCESS SIMPLE/SINGLE	$1,123.20	$1,404.00	—	357% above	20%
Incision and drainage of a simple or single skin abscess CPT 10060 INCISION & DRAINAGE SIMPLE	$1,123.20	$1,404.00	—	357% above	20%
Incision and drainage of a simple or single skin abscess CPT 10060 INCISION & DRAINAGE SIMPLE-3S	$1,123.20	$1,404.00	—	357% above	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D ABSCESS SIMPL/SINGLE-PhHOS	$116.80	$146.00	—	—	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D ABSCESS SIMPL/SINGLE-ERPRO	$134.40	$168.00	—	—	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D ABSCESS SIMPLE/SINGLE-FAC	$169.60	$212.00	—	—	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 ER I&D ABSCESS SIMPLE/SINGLE	$1,123.20	$1,404.00	—	—	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 INCISION & DRAINAGE SIMPLE	$1,123.20	$1,404.00	—	—	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 INCISION & DRAINAGE SIMPLE-3S	$1,123.20	$1,404.00	—	—	20%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 PRP HERN INIT REDUC >5YR-PhHOS	$803.20	$1,004.00	—	32% below	20%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 PRP HERN INIT>5YR RDC BIL-PhHO	$1,248.00	$1,560.00	—	6% above	20%
Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 PRP HERN INIT REDUC >5YR-PhHOS	$803.20	$1,004.00	—	—	20%
Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 PRP HERN INIT>5YR RDC BIL-PhHO	$1,248.00	$1,560.00	—	—	20%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ TEND SHEATH/LIGAM-PhHOS	$49.60	$62.00	—	87% below	20%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJECTION TENDON SHEATH-FAC	$236.80	$296.00	—	37% below	20%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ TENDON SHEATH/LIG BIL-FAC	$355.20	$444.00	—	5% below	20%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ TENDON SHEATH/LIGAMNT-MHCP	$540.00	$675.00	—	45% above	20%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ TENDON SHEATH/LIGAMENT-PCP	$540.00	$675.00	—	45% above	20%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ TENDON SHEATH/LIGAMNT-MHCF	$696.80	$871.00	—	87% above	20%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ TENDON SHEATH/LIGAMENT-PCF	$731.20	$914.00	—	96% above	20%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJ TEND SHEATH/LIGAM-PhHOS	$49.60	$62.00	—	—	20%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJECTION TENDON SHEATH-FAC	$236.80	$296.00	—	—	20%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJ TENDON SHEATH/LIG BIL-FAC	$355.20	$444.00	—	—	20%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJ TENDON SHEATH/LIGAMNT-MHCP	$540.00	$675.00	—	—	20%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJ TENDON SHEATH/LIGAMENT-PCP	$540.00	$675.00	—	—	20%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJ TENDON SHEATH/LIGAMNT-MHCF	$696.80	$871.00	—	—	20%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJ TENDON SHEATH/LIGAMENT-PCF	$731.20	$914.00	—	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRN/INJ MAJOR JNT/BURSA-ERPRO	$56.80	$71.00	—	85% below	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJECT JNT/BURSA-PhHOS	$73.60	$92.00	—	81% below	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJECT JOINT/BURSA-FAC	$256.80	$321.00	—	33% below	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJECT JNT/BURSA BIL-FAC	$384.80	$481.00	—	1% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRN/INJ LG JNT/BURSA-PCP	$540.00	$675.00	—	42% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJ LG JNT/BURSA-MHCP	$540.00	$675.00	—	42% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJ MAJ JNT BURSA-RAD	$602.40	$753.00	—	58% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJ MAJ JNT BURSA W/O US	$602.40	$753.00	—	58% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJ LG JNT/BURSA-MHCF	$696.80	$871.00	—	83% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRN/INJ LG JNT/BURSA-PCF	$731.20	$914.00	—	92% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ER ARTHRO MAJOR JOINT	$731.20	$914.00	—	92% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJ LG JNT/BURS BIL-MHCP	$810.40	$1,013.00	—	113% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRN/INJ LG JNT/BURSA BIL-PCP	$810.40	$1,013.00	—	113% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJ LG JNT/BURS BIL-MHCF	$1,044.00	$1,305.00	—	174% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRN/INJ LG JNT/BURSA BIL-PCF	$1,096.80	$1,371.00	—	188% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRN/INJ MAJOR JNT/BURSA-ERPRO	$56.80	$71.00	—	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRAIN/INJECT JNT/BURSA-PhHOS	$73.60	$92.00	—	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRAIN/INJECT JOINT/BURSA-FAC	$256.80	$321.00	—	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRAIN/INJECT JNT/BURSA BIL-FAC	$384.80	$481.00	—	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRN/INJ LG JNT/BURSA-PCP	$540.00	$675.00	—	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRAIN/INJ LG JNT/BURSA-MHCP	$540.00	$675.00	—	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRAIN/INJ MAJ JNT BURSA W/O US	$602.40	$753.00	—	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRAIN/INJ MAJ JNT BURSA-RAD	$602.40	$753.00	—	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRAIN/INJ LG JNT/BURSA-MHCF	$696.80	$871.00	—	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ER ARTHRO MAJOR JOINT	$731.20	$914.00	—	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRN/INJ LG JNT/BURSA-PCF	$731.20	$914.00	—	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRN/INJ LG JNT/BURSA BIL-PCP	$810.40	$1,013.00	—	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRAIN/INJ LG JNT/BURS BIL-MHCP	$810.40	$1,013.00	—	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRAIN/INJ LG JNT/BURS BIL-MHCF	$1,044.00	$1,305.00	—	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRN/INJ LG JNT/BURSA BIL-PCF	$1,096.80	$1,371.00	—	—	20%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 INSERT DRUG IMPLANT DEV-PhHOS	$124.00	$155.00	—	18% below	20%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 INSERT DRUG IMPLANT DEV-FAC	$132.00	$165.00	—	13% below	20%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 INSERT DRUG IMPLANT DEV-PhHOS	$124.00	$155.00	—	—	20%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 INSERT DRUG IMPLANT DEV-FAC	$132.00	$165.00	—	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRN/INJ INTMD JNT/BURSA-ERPRO	$46.40	$58.00	—	85% below	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/INJECT JNT/BURSA-PhHOS	$63.20	$79.00	—	80% below	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/INJ JOINT/BURSA-FAC	$236.80	$296.00	—	26% below	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRN/INJ JNT/BRSA WO US BIL-FAC	$378.40	$473.00	—	19% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/INJ MED JNT/BURSA-MHCP	$540.00	$675.00	—	70% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRN/INJ MED JNT/BURSA-PCP	$540.00	$675.00	—	70% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/INJ MED JNT/BURSA-MHCF	$696.80	$871.00	—	119% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRN/INJ MED JNT/BURSA-PCF	$731.20	$914.00	—	130% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ER INTERMED JOINT,BURSA OR CYS	$731.20	$914.00	—	130% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRN/INJ MED JNT/BURS BIL-PCP	$810.40	$1,013.00	—	155% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/INJ MED JNT/BUR BIL-MHCP	$810.40	$1,013.00	—	155% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/INJ MED JNT/BUR BIL-MHCF	$1,044.00	$1,305.00	—	228% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRN/INJ MED JNT/BURS BIL-PCF	$1,096.80	$1,371.00	—	245% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 DRN/INJ INTMD JNT/BURSA-ERPRO	$46.40	$58.00	—	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 DRAIN/INJECT JNT/BURSA-PhHOS	$63.20	$79.00	—	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 DRAIN/INJ JOINT/BURSA-FAC	$236.80	$296.00	—	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 DRN/INJ JNT/BRSA WO US BIL-FAC	$378.40	$473.00	—	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 DRAIN/INJ MED JNT/BURSA-MHCP	$540.00	$675.00	—	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 DRN/INJ MED JNT/BURSA-PCP	$540.00	$675.00	—	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 DRAIN/INJ MED JNT/BURSA-MHCF	$696.80	$871.00	—	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ER INTERMED JOINT,BURSA OR CYS	$731.20	$914.00	—	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 DRN/INJ MED JNT/BURSA-PCF	$731.20	$914.00	—	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 DRAIN/INJ MED JNT/BUR BIL-MHCP	$810.40	$1,013.00	—	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 DRN/INJ MED JNT/BURS BIL-PCP	$810.40	$1,013.00	—	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 DRAIN/INJ MED JNT/BUR BIL-MHCF	$1,044.00	$1,305.00	—	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 DRN/INJ MED JNT/BURS BIL-PCF	$1,096.80	$1,371.00	—	—	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAIN/INJECT JNT/BURSA-PhHOS	$42.40	$53.00	—	88% below	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAN/INJ JNT/BRSA W/O US-ERPRO	$44.80	$56.00	—	87% below	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAIN/INJECT JOINT/BURSA-FAC	$236.80	$296.00	—	31% below	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAIN/INJ JNT/BURSA BIL-FAC	$448.80	$561.00	—	31% above	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRN/INJ SM JNT/BURSA-PCP	$540.00	$675.00	—	57% above	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRN/INJ SM JNT/BURSA-MHCP	$540.00	$675.00	—	57% above	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ER DRAIN/INJ JNT/BURSA W/O US	$557.60	$697.00	—	62% above	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRN/INJ SM JNT/BURSA-MHCF	$696.80	$871.00	—	103% above	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRN/INJ SM JNT/BURSA-PCF	$731.20	$914.00	—	113% above	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAIN/INJ SM JNT/BURS BIL-MHCP	$810.40	$1,013.00	—	136% above	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRN/INJ SM JNT/BURSA BIL-PCP	$810.40	$1,013.00	—	136% above	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAIN/INJ SM JNT/BURS BIL-MHCF	$1,044.00	$1,305.00	—	204% above	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRN/INJ SM JNT/BURSA BIL-PCF	$1,096.80	$1,371.00	—	219% above	20%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 DRAIN/INJECT JNT/BURSA-PhHOS	$42.40	$53.00	—	—	20%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 DRAN/INJ JNT/BRSA W/O US-ERPRO	$44.80	$56.00	—	—	20%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 DRAIN/INJECT JOINT/BURSA-FAC	$236.80	$296.00	—	—	20%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 DRAIN/INJ JNT/BURSA BIL-FAC	$448.80	$561.00	—	—	20%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 DRN/INJ SM JNT/BURSA-PCP	$540.00	$675.00	—	—	20%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 DRN/INJ SM JNT/BURSA-MHCP	$540.00	$675.00	—	—	20%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ER DRAIN/INJ JNT/BURSA W/O US	$557.60	$697.00	—	—	20%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 DRN/INJ SM JNT/BURSA-MHCF	$696.80	$871.00	—	—	20%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 DRN/INJ SM JNT/BURSA-PCF	$731.20	$914.00	—	—	20%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 DRN/INJ SM JNT/BURSA BIL-PCP	$810.40	$1,013.00	—	—	20%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 DRAIN/INJ SM JNT/BURS BIL-MHCP	$810.40	$1,013.00	—	—	20%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 DRAIN/INJ SM JNT/BURS BIL-MHCF	$1,044.00	$1,305.00	—	—	20%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 DRN/INJ SM JNT/BURSA BIL-PCF	$1,096.80	$1,371.00	—	—	20%
Knee arthroscopy with meniscus repair (one side of the knee) CPT 29882 KNEE ARTHRO/SURG-PhHOS	$1,110.40	$1,388.00	—	41% below	20%
Knee arthroscopy with meniscus repair (one side of the knee) inpatient CPT 29882 KNEE ARTHRO/SURG-PhHOS	$1,110.40	$1,388.00	—	—	20%
Knee arthroscopy with meniscus trim CPT 29881 KNEE ARTHRO/SURG-PhHOS	$918.40	$1,148.00	—	49% below	20%
Knee arthroscopy with meniscus trim inpatient CPT 29881 KNEE ARTHRO/SURG-PhHOS	$918.40	$1,148.00	—	—	20%
Knee arthroscopy with removal of both torn meniscus parts CPT 29880 KNEE ARTHRO/SURG-PhHOS	$953.60	$1,192.00	—	56% below	20%
Knee arthroscopy with removal of both torn meniscus parts inpatient CPT 29880 KNEE ARTHRO/SURG-PhHOS	$953.60	$1,192.00	—	—	20%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 KNEE ARTHRO/SURG-PhHOS	$1,053.60	$1,317.00	—	43% below	20%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) inpatient CPT 29877 KNEE ARTHRO/SURG-PhHOS	$1,053.60	$1,317.00	—	—	20%
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 LAPAROSC APPENDECTOMY-PhHOS	$925.60	$1,157.00	—	31% below	20%
Laparoscopic appendectomy (appendix removal through small cuts) inpatient CPT 44970 LAPAROSC APPENDECTOMY-PhHOS	$925.60	$1,157.00	—	—	20%
Laparoscopic fundoplication (anti-reflux surgery) CPT 43280 LAPAROSCOPY FUNDOPLASTY-PhHOS	$1,672.80	$2,091.00	—	44% below	20%
Laparoscopic fundoplication (anti-reflux surgery) inpatient CPT 43280 LAPAROSCOPY FUNDOPLASTY-PhHOS	$1,672.80	$2,091.00	—	—	20%
Laparoscopic hysterectomy (uterus 250 g or less) CPT 58570 LAP SURG W/TOTAL HYSTER-PhHOS	$1,446.40	$1,808.00	—	17% below	20%
Laparoscopic hysterectomy (uterus 250 g or less) inpatient CPT 58570 LAP SURG W/TOTAL HYSTER-PhHOS	$1,446.40	$1,808.00	—	—	20%
Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries CPT 58571 LAPAROS TOTAL HYSTER-PhHOS	$1,613.60	$2,017.00	—	14% below	20%
Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries inpatient CPT 58571 LAPAROS TOTAL HYSTER-PhHOS	$1,613.60	$2,017.00	—	—	20%
Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 LAPARO HERN REP INITIAL-PhHOS	$699.20	$874.00	—	33% below	20%
Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 LAP HERN REP INITIAL BIL-PhHOS	$1,048.00	$1,310.00	—	at median	20%
Laparoscopic inguinal (groin) hernia repair, first repair on that side inpatient CPT 49650 LAPARO HERN REP INITIAL-PhHOS	$699.20	$874.00	—	—	20%
Laparoscopic inguinal (groin) hernia repair, first repair on that side inpatient CPT 49650 LAP HERN REP INITIAL BIL-PhHOS	$1,048.00	$1,310.00	—	—	20%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 LAPARO HERN REP RECUR-PhHOS	$912.00	$1,140.00	—	18% below	20%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 LAP HERN REP RECUR BIL-PhHOS	$1,368.00	$1,710.00	—	23% above	20%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia inpatient CPT 49651 LAPARO HERN REP RECUR-PhHOS	$912.00	$1,140.00	—	—	20%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia inpatient CPT 49651 LAP HERN REP RECUR BIL-PhHOS	$1,368.00	$1,710.00	—	—	20%
Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 LAPAROSC REM ADNEXA-PhHOS	$1,033.60	$1,292.00	—	47% below	20%
Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 LAPAROSC REM ADNEXA BIL-PhHOS	$1,549.60	$1,937.00	—	21% below	20%
Laparoscopic removal of fallopian tubes and/or ovaries inpatient CPT 58661 LAPAROSC REM ADNEXA-PhHOS	$1,033.60	$1,292.00	—	—	20%
Laparoscopic removal of fallopian tubes and/or ovaries inpatient CPT 58661 LAPAROSC REM ADNEXA BIL-PhHOS	$1,549.60	$1,937.00	—	—	20%
Laser treatment of clouding after cataract surgery (YAG) CPT 66821 POST CATARACT LASER-PhHOSP	$472.80	$591.00	—	58% below	20%
Laser treatment of clouding after cataract surgery (YAG) CPT 66821 AFTER CATARACT LASER SUR-FAC	$477.60	$597.00	—	58% below	20%
Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 POST CATARACT LASER-PhHOSP	$472.80	$591.00	—	—	20%
Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 AFTER CATARACT LASER SUR-FAC	$477.60	$597.00	—	—	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 INTMD RPR WND 2.5CM/<-PhHOS	$186.40	$233.00	—	51% below	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 RPR INTMD S/A/T 2.5/<CM-ERPRO	$188.80	$236.00	—	51% below	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 INTMD RPR WND 2.5CM/<-FAC	$300.80	$376.00	—	21% below	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 ER WOUND REP INTERMED 2.5/LESS	$424.00	$530.00	—	11% above	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 INTMD RPR WND 2.5CM/<-PhHOS	$186.40	$233.00	—	—	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 RPR INTMD S/A/T 2.5/<CM-ERPRO	$188.80	$236.00	—	—	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 INTMD RPR WND 2.5CM/<-FAC	$300.80	$376.00	—	—	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 ER WOUND REP INTERMED 2.5/LESS	$424.00	$530.00	—	—	20%
Lower-back epidural injection, with imaging guidance CPT 62323 NJX INTERLAMINAR LMBR/SAC-FAC	$599.20	$749.00	—	10% below	20%
Lower-back epidural injection, with imaging guidance CPT 62323 EPI STER INJ LUMB/SAC W/I-PCP	$1,185.60	$1,482.00	—	79% above	20%
Lower-back epidural injection, with imaging guidance CPT 62323 EPI STER INJ LUMB/SAC W/I-MHCP	$1,185.60	$1,482.00	—	79% above	20%
Lower-back epidural injection, with imaging guidance CPT 62323 EPI STER INJ LUMB/SAC W/I-MHCF	$1,994.40	$2,493.00	—	201% above	20%
Lower-back epidural injection, with imaging guidance CPT 62323 EPI STER INJ LUMB/SAC W/I-PCF	$1,994.40	$2,493.00	—	201% above	20%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 NJX INTERLAMINAR LMBR/SAC-FAC	$599.20	$749.00	—	—	20%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 EPI STER INJ LUMB/SAC W/I-MHCP	$1,185.60	$1,482.00	—	—	20%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 EPI STER INJ LUMB/SAC W/I-PCP	$1,185.60	$1,482.00	—	—	20%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 EPI STER INJ LUMB/SAC W/I-PCF	$1,994.40	$2,493.00	—	—	20%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 EPI STER INJ LUMB/SAC W/I-MHCF	$1,994.40	$2,493.00	—	—	20%
Lower-back epidural injection, without imaging guidance CPT 62322 INTERLAMINAR L/S INJ-FAC	$588.00	$735.00	—	37% below	20%
Lower-back epidural injection, without imaging guidance CPT 62322 EPI STER INJ LUMSAC WO IM-MHCP	$1,185.60	$1,482.00	—	26% above	20%
Lower-back epidural injection, without imaging guidance CPT 62322 EPI STER INJ LUM/SAC W/O I-PCP	$1,185.60	$1,482.00	—	26% above	20%
Lower-back epidural injection, without imaging guidance CPT 62322 EPI STER INJ LUM/SAC W/O I-PCF	$1,917.60	$2,397.00	—	104% above	20%
Lower-back epidural injection, without imaging guidance CPT 62322 EPI STER INJ LUMSAC WO IM-MHCF	$1,917.60	$2,397.00	—	104% above	20%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 INTERLAMINAR L/S INJ-FAC	$588.00	$735.00	—	—	20%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 EPI STER INJ LUM/SAC W/O I-PCP	$1,185.60	$1,482.00	—	—	20%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 EPI STER INJ LUMSAC WO IM-MHCP	$1,185.60	$1,482.00	—	—	20%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 EPI STER INJ LUM/SAC W/O I-PCF	$1,917.60	$2,397.00	—	—	20%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 EPI STER INJ LUMSAC WO IM-MHCF	$1,917.60	$2,397.00	—	—	20%
Lower-back nerve root steroid injection, with imaging guidance both sides CPT 64483 TRANSF EPI INJ L/SACL1 BI-MHCP	$2,240.00	$2,800.00	—	—	20%
Lower-back nerve root steroid injection, with imaging guidance both sides CPT 64483 TRANSF EPI INJ L/SACL1 BI-PCP	$2,240.00	$2,800.00	—	—	20%
Lower-back nerve root steroid injection, with imaging guidance both sides CPT 64483 TRANSF EPI INJ L/SACL1 BI-PCF	$3,276.00	$4,095.00	—	—	20%
Lower-back nerve root steroid injection, with imaging guidance both sides CPT 64483 TRANSF EPI INJ L/SACL1 BI-MHCF	$3,276.00	$4,095.00	—	—	20%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 ANES/STER L/S SNGL LVL-FAC	$764.00	$955.00	—	28% below	20%
Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 TRANSF EPI INJ L/SACL1 LT-MHCP	$1,493.60	$1,867.00	—	41% above	20%
Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 TRANSF EPI INJ L/SACL1 RT-MHCP	$1,493.60	$1,867.00	—	41% above	20%
Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 TRANSF EPI INJ L/SACL1 LT-PCP	$1,493.60	$1,867.00	—	41% above	20%
Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 TRANSF EPI INJ L/SACL1 RT-PCP	$1,493.60	$1,867.00	—	41% above	20%
Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 TRANSF EPI INJ L/SACL1 RT-PCF	$2,314.40	$2,893.00	—	118% above	20%
Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 TRANSF EPI INJ L/SACL1 LT-MHCF	$2,314.40	$2,893.00	—	118% above	20%
Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 TRANSF EPI INJ L/SACL1 RT-MHCF	$2,314.40	$2,893.00	—	118% above	20%
Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 TRANSF EPI INJ L/SACL1 LT-PCF	$2,314.40	$2,893.00	—	118% above	20%
Lower-back nerve root steroid injection, with imaging guidance inpatient both sides CPT 64483 TRANSF EPI INJ L/SACL1 BI-MHCP	$2,240.00	$2,800.00	—	—	20%
Lower-back nerve root steroid injection, with imaging guidance inpatient both sides CPT 64483 TRANSF EPI INJ L/SACL1 BI-PCP	$2,240.00	$2,800.00	—	—	20%
Lower-back nerve root steroid injection, with imaging guidance inpatient both sides CPT 64483 TRANSF EPI INJ L/SACL1 BI-PCF	$3,276.00	$4,095.00	—	—	20%
Lower-back nerve root steroid injection, with imaging guidance inpatient both sides CPT 64483 TRANSF EPI INJ L/SACL1 BI-MHCF	$3,276.00	$4,095.00	—	—	20%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 ANES/STER L/S SNGL LVL-FAC	$764.00	$955.00	—	—	20%
Lower-back nerve root steroid injection, with imaging guidance inpatient one side CPT 64483 TRANSF EPI INJ L/SACL1 LT-MHCP	$1,493.60	$1,867.00	—	—	20%
Lower-back nerve root steroid injection, with imaging guidance inpatient one side CPT 64483 TRANSF EPI INJ L/SACL1 RT-PCP	$1,493.60	$1,867.00	—	—	20%
Lower-back nerve root steroid injection, with imaging guidance inpatient one side CPT 64483 TRANSF EPI INJ L/SACL1 LT-PCP	$1,493.60	$1,867.00	—	—	20%
Lower-back nerve root steroid injection, with imaging guidance inpatient one side CPT 64483 TRANSF EPI INJ L/SACL1 RT-MHCP	$1,493.60	$1,867.00	—	—	20%
Lower-back nerve root steroid injection, with imaging guidance inpatient one side CPT 64483 TRANSF EPI INJ L/SACL1 LT-MHCF	$2,314.40	$2,893.00	—	—	20%
Lower-back nerve root steroid injection, with imaging guidance inpatient one side CPT 64483 TRANSF EPI INJ L/SACL1 RT-MHCF	$2,314.40	$2,893.00	—	—	20%
Lower-back nerve root steroid injection, with imaging guidance inpatient one side CPT 64483 TRANSF EPI INJ L/SACL1 RT-PCF	$2,314.40	$2,893.00	—	—	20%
Lower-back nerve root steroid injection, with imaging guidance inpatient one side CPT 64483 TRANSF EPI INJ L/SACL1 LT-PCF	$2,314.40	$2,893.00	—	—	20%
Lumbar discectomy or laminotomy to free a nerve root, one level CPT 63030 LOW BACK DISK SURGERY-PhHOS	$2,078.40	$2,598.00	—	43% below	20%
Lumbar discectomy or laminotomy to free a nerve root, one level CPT 63030 BIL LOW BACK DISK SURG-PhHOS	$2,876.00	$3,595.00	—	21% below	20%
Lumbar discectomy or laminotomy to free a nerve root, one level inpatient CPT 63030 LOW BACK DISK SURGERY-PhHOS	$2,078.40	$2,598.00	—	—	20%
Lumbar discectomy or laminotomy to free a nerve root, one level inpatient CPT 63030 BIL LOW BACK DISK SURG-PhHOS	$2,876.00	$3,595.00	—	—	20%
Lumbar laminectomy (spinal decompression), one level CPT 63047 REM SPINE LAMINA 1 LMBR-PhHOS	$1,832.80	$2,291.00	—	58% below	20%
Lumbar laminectomy (spinal decompression), one level inpatient CPT 63047 REM SPINE LAMINA 1 LMBR-PhHOS	$1,832.80	$2,291.00	—	—	20%
Lumbar spinal fusion (posterior), one level CPT 22612 LUMBAR SPINE FUSION-PhHOS	$2,628.00	$3,285.00	—	39% below	20%
Lumbar spinal fusion (posterior), one level inpatient CPT 22612 LUMBAR SPINE FUSION-PhHOS	$2,628.00	$3,285.00	—	—	20%
Lumpectomy (partial mastectomy) CPT 19301 MASTECTOMY PARTIAL-PhHOS	$1,000.80	$1,251.00	—	7% above	20%
Lumpectomy (partial mastectomy) inpatient CPT 19301 MASTECTOMY PARTIAL-PhHOS	$1,000.80	$1,251.00	—	—	20%
Mastectomy (total removal of the breast) CPT 19303 MASTECTOMY SIMPLE COMPL-PhHOS	$1,548.80	$1,936.00	—	16% below	20%
Mastectomy (total removal of the breast) CPT 19303 MASTECTOMY SMPL COMP-BIL-PhHOS	$2,322.40	$2,903.00	—	26% above	20%
Mastectomy (total removal of the breast) inpatient CPT 19303 MASTECTOMY SIMPLE COMPL-PhHOS	$1,548.80	$1,936.00	—	—	20%
Mastectomy (total removal of the breast) inpatient CPT 19303 MASTECTOMY SMPL COMP-BIL-PhHOS	$2,322.40	$2,903.00	—	—	20%
Miscarriage treatment with D&C, first trimester CPT 59820 CARE OF MISCARRIAGE-PhHOS	$561.60	$702.00	—	38% below	20%
Miscarriage treatment with D&C, first trimester inpatient CPT 59820 CARE OF MISCARRIAGE-PhHOS	$561.60	$702.00	—	—	20%
Mohs surgery for skin cancer, first stage, head, neck, hands, feet or genitals CPT 17311 MOHS 1 STAGE H/N/HF/G-PhHOSP	$292.00	$365.00	—	71% below	20%
Mohs surgery for skin cancer, first stage, head, neck, hands, feet or genitals CPT 17311 MOHS 1 STAGE H/N/HF/G-FAC	$495.20	$619.00	—	51% below	20%
Mohs surgery for skin cancer, first stage, head, neck, hands, feet or genitals inpatient CPT 17311 MOHS 1 STAGE H/N/HF/G-PhHOSP	$292.00	$365.00	—	—	20%
Mohs surgery for skin cancer, first stage, head, neck, hands, feet or genitals inpatient CPT 17311 MOHS 1 STAGE H/N/HF/G-FAC	$495.20	$619.00	—	—	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EX TR EX B9 0.5 <CM-PhHOS	$96.80	$121.00	—	82% below	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EX TR EXT BENIGN 0.5<CM-FAC	$553.60	$692.00	—	at median	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 ER EXC TR-EXT B9 0.5 CM<	$709.60	$887.00	—	28% above	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EX TR EX B9 0.5 <CM-PhHOS	$96.80	$121.00	—	—	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EX TR EXT BENIGN 0.5<CM-FAC	$553.60	$692.00	—	—	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 ER EXC TR-EXT B9 0.5 CM<	$709.60	$887.00	—	—	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EX FC-MM B9 0.5 <CM-PhHOS	$127.20	$159.00	—	78% below	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EX FACE MM BENIGN .5<CM-FAC	$553.60	$692.00	—	2% below	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 EX FC-MM B9 0.5 <CM-PhHOS	$127.20	$159.00	—	—	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 EX FACE MM BENIGN .5<CM-FAC	$553.60	$692.00	—	—	20%
Nail removal (partial or complete), one nail CPT 11730 REM OF NAIL PLATE-PhHOS	$59.20	$74.00	—	71% below	20%
Nail removal (partial or complete), one nail CPT 11730 RMVL NAIL PLATE SMP/SNGL-ERPRO	$67.20	$84.00	—	67% below	20%
Nail removal (partial or complete), one nail CPT 11730 REM NAIL PLATE-FAC	$169.60	$212.00	—	16% below	20%
Nail removal (partial or complete), one nail CPT 11730 ER AVUL NAIL PLATE SIMPLE	$257.60	$322.00	—	27% above	20%
Nail removal (partial or complete), one nail inpatient CPT 11730 REM OF NAIL PLATE-PhHOS	$59.20	$74.00	—	—	20%
Nail removal (partial or complete), one nail inpatient CPT 11730 RMVL NAIL PLATE SMP/SNGL-ERPRO	$67.20	$84.00	—	—	20%
Nail removal (partial or complete), one nail inpatient CPT 11730 REM NAIL PLATE-FAC	$169.60	$212.00	—	—	20%
Nail removal (partial or complete), one nail inpatient CPT 11730 ER AVUL NAIL PLATE SIMPLE	$257.60	$322.00	—	—	20%
Occipital nerve block (injection for headaches) CPT 64405 N BL INJ OCCIPITAL-PhHOS	$147.20	$184.00	—	65% below	20%
Occipital nerve block (injection for headaches) CPT 64405 N BLOCK INJ OCCIP-FAC	$256.80	$321.00	—	39% below	20%
Occipital nerve block (injection for headaches) CPT 64405 N BLOCK INJ OCCIP BIL-FAC	$384.80	$481.00	—	9% below	20%
Occipital nerve block (injection for headaches) CPT 64405 ER N BLOCK INJ, OCCIPITAL	$731.20	$914.00	—	73% above	20%
Occipital nerve block (injection for headaches) CPT 64405 NB OCCIPITAL BIL-MHCF	$1,044.00	$1,305.00	—	147% above	20%
Occipital nerve block (injection for headaches) CPT 64405 NB OCCIPITAL BIL-MHCP	$1,080.00	$1,350.00	—	156% above	20%
Occipital nerve block (injection for headaches) CPT 64405 NB OCCIPITAL BIL-PCP	$1,080.00	$1,350.00	—	156% above	20%
Occipital nerve block (injection for headaches) CPT 64405 NB OCCIPITAL BIL-PCF	$1,096.80	$1,371.00	—	160% above	20%
Occipital nerve block (injection for headaches) CPT 64405 ER N BLOCK INJ, OCCIPITAL BIL	$1,461.60	$1,827.00	—	246% above	20%
Occipital nerve block (injection for headaches) one side CPT 64405 NB OCCIPITAL LT-PCP	$540.00	$675.00	—	28% above	20%
Occipital nerve block (injection for headaches) one side CPT 64405 NB OCCIPITAL LT-MHCP	$540.00	$675.00	—	28% above	20%
Occipital nerve block (injection for headaches) one side CPT 64405 NB OCCIPITAL RT-MHCP	$540.00	$675.00	—	28% above	20%
Occipital nerve block (injection for headaches) one side CPT 64405 NB OCCIPITAL RT-PCP	$540.00	$675.00	—	28% above	20%
Occipital nerve block (injection for headaches) one side CPT 64405 NB OCCIPITAL RT-MHCF	$696.80	$871.00	—	65% above	20%
Occipital nerve block (injection for headaches) one side CPT 64405 NB OCCIPITAL LT-MHCF	$696.80	$871.00	—	65% above	20%
Occipital nerve block (injection for headaches) one side CPT 64405 NB OCCIPITAL RT-PCF	$731.20	$914.00	—	73% above	20%
Occipital nerve block (injection for headaches) one side CPT 64405 NB OCCIPITAL LT-PCF	$731.20	$914.00	—	73% above	20%
Occipital nerve block (injection for headaches) inpatient CPT 64405 N BL INJ OCCIPITAL-PhHOS	$147.20	$184.00	—	—	20%
Occipital nerve block (injection for headaches) inpatient CPT 64405 N BLOCK INJ OCCIP-FAC	$256.80	$321.00	—	—	20%
Occipital nerve block (injection for headaches) inpatient CPT 64405 N BLOCK INJ OCCIP BIL-FAC	$384.80	$481.00	—	—	20%
Occipital nerve block (injection for headaches) inpatient CPT 64405 ER N BLOCK INJ, OCCIPITAL	$731.20	$914.00	—	—	20%
Occipital nerve block (injection for headaches) inpatient CPT 64405 NB OCCIPITAL BIL-MHCF	$1,044.00	$1,305.00	—	—	20%
Occipital nerve block (injection for headaches) inpatient CPT 64405 NB OCCIPITAL BIL-MHCP	$1,080.00	$1,350.00	—	—	20%
Occipital nerve block (injection for headaches) inpatient CPT 64405 NB OCCIPITAL BIL-PCP	$1,080.00	$1,350.00	—	—	20%
Occipital nerve block (injection for headaches) inpatient CPT 64405 NB OCCIPITAL BIL-PCF	$1,096.80	$1,371.00	—	—	20%
Occipital nerve block (injection for headaches) inpatient CPT 64405 ER N BLOCK INJ, OCCIPITAL BIL	$1,461.60	$1,827.00	—	—	20%
Occipital nerve block (injection for headaches) inpatient one side CPT 64405 NB OCCIPITAL RT-PCP	$540.00	$675.00	—	—	20%
Occipital nerve block (injection for headaches) inpatient one side CPT 64405 NB OCCIPITAL RT-MHCP	$540.00	$675.00	—	—	20%
Occipital nerve block (injection for headaches) inpatient one side CPT 64405 NB OCCIPITAL LT-MHCP	$540.00	$675.00	—	—	20%
Occipital nerve block (injection for headaches) inpatient one side CPT 64405 NB OCCIPITAL LT-PCP	$540.00	$675.00	—	—	20%
Occipital nerve block (injection for headaches) inpatient one side CPT 64405 NB OCCIPITAL LT-MHCF	$696.80	$871.00	—	—	20%
Occipital nerve block (injection for headaches) inpatient one side CPT 64405 NB OCCIPITAL RT-MHCF	$696.80	$871.00	—	—	20%
Occipital nerve block (injection for headaches) inpatient one side CPT 64405 NB OCCIPITAL LT-PCF	$731.20	$914.00	—	—	20%
Occipital nerve block (injection for headaches) inpatient one side CPT 64405 NB OCCIPITAL RT-PCF	$731.20	$914.00	—	—	20%
Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS W/IMAGE-PhHOS	$165.60	$207.00	—	85% below	20%
Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS W/IMAGE-ERPRO	$165.60	$207.00	—	85% below	20%
Paracentesis with imaging guidance CPT 49083 PARACENTESIS-RAD	$783.20	$979.00	—	27% below	20%
Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS W/IMAGE-FAC	$783.20	$979.00	—	27% below	20%
Paracentesis with imaging guidance CPT 49083 ER PARACENTESIS	$783.20	$979.00	—	27% below	20%
Paracentesis with imaging guidance inpatient CPT 49083 ABD PARACENTESIS W/IMAGE-ERPRO	$165.60	$207.00	—	—	20%
Paracentesis with imaging guidance inpatient CPT 49083 ABD PARACENTESIS W/IMAGE-PhHOS	$165.60	$207.00	—	—	20%
Paracentesis with imaging guidance inpatient CPT 49083 ER PARACENTESIS	$783.20	$979.00	—	—	20%
Paracentesis with imaging guidance inpatient CPT 49083 PARACENTESIS-RAD	$783.20	$979.00	—	—	20%
Paracentesis with imaging guidance inpatient CPT 49083 ABD PARACENTESIS W/IMAGE-FAC	$783.20	$979.00	—	—	20%
Partial knee replacement (one compartment) CPT 27446 ARTHROPLASTY KNEE MED/L-PhHOSP	$1,781.60	$2,227.00	—	60% below	20%
Partial knee replacement (one compartment) inpatient CPT 27446 ARTHROPLASTY KNEE MED/L-PhHOSP	$1,781.60	$2,227.00	—	—	20%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 REM OF NAIL BED-PhHOS	$208.80	$261.00	—	57% below	20%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 REM NAIL BED-FAC	$376.80	$471.00	—	23% below	20%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 ER NAIL BED EXC PART/COMPLETE	$943.20	$1,179.00	—	93% above	20%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 REM OF NAIL BED-PhHOS	$208.80	$261.00	—	—	20%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 REM NAIL BED-FAC	$376.80	$471.00	—	—	20%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 ER NAIL BED EXC PART/COMPLETE	$943.20	$1,179.00	—	—	20%
Prostate removal (prostatectomy), laparoscopic CPT 55866 LAPSUR PRST8ECT RPBIC RAD-PhHO	$1,857.60	$2,322.00	—	44% below	20%
Prostate removal (prostatectomy), laparoscopic inpatient CPT 55866 LAPSUR PRST8ECT RPBIC RAD-PhHO	$1,857.60	$2,322.00	—	—	20%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 DEST L/S FACET JNT-FAC	$1,616.80	$2,021.00	—	1% below	20%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 DEST PARAVERT NRV L/S-PCP	$3,654.40	$4,568.00	—	123% above	20%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 DEST PARAVERT NRV L/S-MHCP	$3,654.40	$4,568.00	—	123% above	20%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 DEST PARAVERT NRV L/S-MHCF	$5,096.80	$6,371.00	—	211% above	20%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 DEST PARAVERT NRV L/S-PCF	$5,332.80	$6,666.00	—	226% above	20%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 DEST PARAVERT NRV L/S BIL-PCP	$5,480.80	$6,851.00	—	235% above	20%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 DEST PARAVERT NRV L/S BIL-MHCP	$5,480.80	$6,851.00	—	235% above	20%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 DEST PARAVERT NRV L/S BIL-MHCF	$7,450.40	$9,313.00	—	355% above	20%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 DEST PARAVERT NRV L/S BIL-PCF	$7,803.20	$9,754.00	—	377% above	20%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 DEST L/S FACET JNT-FAC	$1,616.80	$2,021.00	—	—	20%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 DEST PARAVERT NRV L/S-PCP	$3,654.40	$4,568.00	—	—	20%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 DEST PARAVERT NRV L/S-MHCP	$3,654.40	$4,568.00	—	—	20%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 DEST PARAVERT NRV L/S-MHCF	$5,096.80	$6,371.00	—	—	20%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 DEST PARAVERT NRV L/S-PCF	$5,332.80	$6,666.00	—	—	20%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 DEST PARAVERT NRV L/S BIL-MHCP	$5,480.80	$6,851.00	—	—	20%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 DEST PARAVERT NRV L/S BIL-PCP	$5,480.80	$6,851.00	—	—	20%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 DEST PARAVERT NRV L/S BIL-MHCF	$7,450.40	$9,313.00	—	—	20%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 DEST PARAVERT NRV L/S BIL-PCF	$7,803.20	$9,754.00	—	—	20%
Removal of a breast lump, open surgery CPT 19120 REM OF BRST LES-PhHOS	$636.80	$796.00	—	76% below	20%
Removal of a breast lump, open surgery CPT 19120 REM BREAST LESION-FAC	$2,687.20	$3,359.00	—	1% below	20%
Removal of a breast lump, open surgery inpatient CPT 19120 REM OF BRST LES-PhHOS	$636.80	$796.00	—	—	20%
Removal of a breast lump, open surgery inpatient CPT 19120 REM BREAST LESION-FAC	$2,687.20	$3,359.00	—	—	20%
Removal of a foreign object under the skin, simple CPT 10120 INC&REM FB SUBQ TIS SMPL-PhHOS	$161.60	$202.00	—	55% below	20%
Removal of a foreign object under the skin, simple CPT 10120 I&RMVL FB SUBQ TISS SMPL-ERPRO	$168.00	$210.00	—	53% below	20%
Removal of a foreign object under the skin, simple CPT 10120 REM FOREIGN BODY;SIMPLE-FAC	$300.80	$376.00	—	16% below	20%
Removal of a foreign object under the skin, simple CPT 10120 ER FB REMOVAL SUB-Q SIMPLE	$404.80	$506.00	—	13% above	20%
Removal of a foreign object under the skin, simple inpatient CPT 10120 INC&REM FB SUBQ TIS SMPL-PhHOS	$161.60	$202.00	—	—	20%
Removal of a foreign object under the skin, simple inpatient CPT 10120 I&RMVL FB SUBQ TISS SMPL-ERPRO	$168.00	$210.00	—	—	20%
Removal of a foreign object under the skin, simple inpatient CPT 10120 REM FOREIGN BODY;SIMPLE-FAC	$300.80	$376.00	—	—	20%
Removal of a foreign object under the skin, simple inpatient CPT 10120 ER FB REMOVAL SUB-Q SIMPLE	$404.80	$506.00	—	—	20%
Removal of one lobe of the thyroid (lobectomy) CPT 60220 PARTIAL REM OF THYROID-PhHOS	$1,096.80	$1,371.00	—	52% below	20%
Removal of one lobe of the thyroid (lobectomy) inpatient CPT 60220 PARTIAL REM OF THYROID-PhHOS	$1,096.80	$1,371.00	—	—	20%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 COLON CA SCRN NOT HI RSK-PhHOS	$627.20	$784.00	—	28% below	20%
Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 COLON CA SCRN NOT HI RSK-PhHOS	$627.20	$784.00	—	—	20%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 COLORECT SCRN;HI RSK IND-PhHOS	$336.80	$421.00	—	61% below	20%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 COLORECT SCRN;HI RSK IND-PhHOS	$336.80	$421.00	—	—	20%
Septoplasty to straighten the nasal septum CPT 30520 REP OF NASAL SEPTUM-PhHOS	$982.40	$1,228.00	—	36% below	20%
Septoplasty to straighten the nasal septum inpatient CPT 30520 REP OF NASAL SEPTUM-PhHOS	$982.40	$1,228.00	—	—	20%
Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 FRAGMENTING KIDNEY STONE-PhHOS	$932.80	$1,166.00	—	60% below	20%
Shock-wave lithotripsy to break up kidney stones (from outside the body) inpatient CPT 50590 FRAGMENTING KIDNEY STONE-PhHOS	$932.80	$1,166.00	—	—	20%
Short arm cast (elbow to hand) CPT 29075 APPLY FOREARM CAST-PhHOS	$76.00	$95.00	—	65% below	20%
Short arm cast (elbow to hand) CPT 29075 APPLY FOREARM CAST-FAC	$225.60	$282.00	—	4% above	20%
Short arm cast (elbow to hand) inpatient CPT 29075 APPLY FOREARM CAST-PhHOS	$76.00	$95.00	—	—	20%
Short arm cast (elbow to hand) inpatient CPT 29075 APPLY FOREARM CAST-FAC	$225.60	$282.00	—	—	20%
Short arm splint (forearm and hand) CPT 29125 APPLY FOREARM SPLINT-PhHOS	$62.40	$78.00	—	64% below	20%
Short arm splint (forearm and hand) CPT 29125 APPLY SHORT ARM SPLINT-ERPRO	$64.80	$81.00	—	63% below	20%
Short arm splint (forearm and hand) CPT 29125 APPLY FOREARM SPLINT-FAC	$203.20	$254.00	—	16% above	20%
Short arm splint (forearm and hand) CPT 29125 ER APPLIC SHORT ARM SPLINT	$629.60	$787.00	—	259% above	20%
Short arm splint (forearm and hand) inpatient CPT 29125 APPLY FOREARM SPLINT-PhHOS	$62.40	$78.00	—	—	20%
Short arm splint (forearm and hand) inpatient CPT 29125 APPLY SHORT ARM SPLINT-ERPRO	$64.80	$81.00	—	—	20%
Short arm splint (forearm and hand) inpatient CPT 29125 APPLY FOREARM SPLINT-FAC	$203.20	$254.00	—	—	20%
Short arm splint (forearm and hand) inpatient CPT 29125 ER APPLIC SHORT ARM SPLINT	$629.60	$787.00	—	—	20%
Short leg cast (below the knee) CPT 29405 APPLY SHORT LEG CAST-PhHOS	$72.80	$91.00	—	73% below	20%
Short leg cast (below the knee) CPT 29405 APPLY SHORT LEG CAST-FAC	$228.00	$285.00	—	15% below	20%
Short leg cast (below the knee) CPT 29405 ER APPLICATION CYLINDER CAST	$376.80	$471.00	—	41% above	20%
Short leg cast (below the knee) inpatient CPT 29405 APPLY SHORT LEG CAST-PhHOS	$72.80	$91.00	—	—	20%
Short leg cast (below the knee) inpatient CPT 29405 APPLY SHORT LEG CAST-FAC	$228.00	$285.00	—	—	20%
Short leg cast (below the knee) inpatient CPT 29405 ER APPLICATION CYLINDER CAST	$376.80	$471.00	—	—	20%
Short leg splint (calf to foot) CPT 29515 APPLY LOWER LEG SPLINT-PhHOS	$77.60	$97.00	—	51% below	20%
Short leg splint (calf to foot) CPT 29515 APPLY SHORT LEG SPLINT-ERPRO	$80.00	$100.00	—	50% below	20%
Short leg splint (calf to foot) CPT 29515 APPLY LOWER LEG SPLINT-FAC	$132.80	$166.00	—	16% below	20%
Short leg splint (calf to foot) CPT 29515 ER APPLIC SHORT LEG SPLINT	$651.20	$814.00	—	310% above	20%
Short leg splint (calf to foot) inpatient CPT 29515 APPLY LOWER LEG SPLINT-PhHOS	$77.60	$97.00	—	—	20%
Short leg splint (calf to foot) inpatient CPT 29515 APPLY SHORT LEG SPLINT-ERPRO	$80.00	$100.00	—	—	20%
Short leg splint (calf to foot) inpatient CPT 29515 APPLY LOWER LEG SPLINT-FAC	$132.80	$166.00	—	—	20%
Short leg splint (calf to foot) inpatient CPT 29515 ER APPLIC SHORT LEG SPLINT	$651.20	$814.00	—	—	20%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 SHOULDER ARTHRO/SURG-PhHOS	$1,145.60	$1,432.00	—	20% below	20%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) inpatient CPT 29824 SHOULDER ARTHRO/SURG-PhHOS	$1,145.60	$1,432.00	—	—	20%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 SHOULDER ARTHRO/SURG-PhHOS	$294.40	$368.00	—	34% below	20%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 SHOULDER ARTHRO/SURG-PhHOS	$294.40	$368.00	—	—	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 RPR SUPERFCL WND 2.5CM/<-PhHOS	$69.60	$87.00	—	67% below	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 RPR SIMP S/N/T 2.5CM/<-ERPRO	$70.40	$88.00	—	66% below	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 REPAIR WOUND SUPERFICIAL-FAC	$178.40	$223.00	—	15% below	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 ER WOUND REPAIR SIM 2.5/LESS	$651.20	$814.00	—	210% above	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 RPR SUPERFCL WND 2.5CM/<-PhHOS	$69.60	$87.00	—	—	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 RPR SIMP S/N/T 2.5CM/<-ERPRO	$70.40	$88.00	—	—	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 REPAIR WOUND SUPERFICIAL-FAC	$178.40	$223.00	—	—	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 ER WOUND REPAIR SIM 2.5/LESS	$651.20	$814.00	—	—	20%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BX SKIN SINGLE LES-FAC	$346.40	$433.00	—	9% above	20%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BX SKIN SNGL LES-2N	$421.60	$527.00	—	33% above	20%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BX SKIN SNGL LES-3S	$421.60	$527.00	—	33% above	20%
Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BX SKIN SINGLE LES-FAC	$346.40	$433.00	—	—	20%
Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BX SKIN SNGL LES-2N	$421.60	$527.00	—	—	20%
Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BX SKIN SNGL LES-3S	$421.60	$527.00	—	—	20%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 EX TR EX MLG 0.5<CM-PhHOS	$185.60	$232.00	—	32% below	20%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 EX MAL LESION TR/EXT-FAC	$637.60	$797.00	—	135% above	20%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 EX TR EX MLG 0.5<CM-PhHOS	$185.60	$232.00	—	—	20%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 EX MAL LESION TR/EXT-FAC	$637.60	$797.00	—	—	20%
Skin tag removal, up to 15 tags CPT 11200 REM OF SK TAGS-PhHOS	$88.80	$111.00	—	46% below	20%
Skin tag removal, up to 15 tags CPT 11200 REM SKIN TAGS-FAC	$169.60	$212.00	—	3% above	20%
Skin tag removal, up to 15 tags CPT 11200 ER REMOVAL OF SKIN TAGS	$232.80	$291.00	—	42% above	20%
Skin tag removal, up to 15 tags inpatient CPT 11200 REM OF SK TAGS-PhHOS	$88.80	$111.00	—	—	20%
Skin tag removal, up to 15 tags inpatient CPT 11200 REM SKIN TAGS-FAC	$169.60	$212.00	—	—	20%
Skin tag removal, up to 15 tags inpatient CPT 11200 ER REMOVAL OF SKIN TAGS	$232.80	$291.00	—	—	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 DX SPINAL PUNCT,LUMBAR-ERPRO	$101.60	$127.00	—	87% below	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL FLUID TAP DX-PhHOS	$120.80	$151.00	—	85% below	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL PUNCTURE LUMBAR-FAC	$597.60	$747.00	—	25% below	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL PUNCTURE,LUMBAR-PCP	$1,220.00	$1,525.00	—	53% above	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL PUNCTURE,LUMBAR-PCF	$1,650.40	$2,063.00	—	107% above	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 ER SPINAL PUNCTURE,LUMBAR	$1,650.40	$2,063.00	—	107% above	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL PUNCTURE LUMBAR DX	$1,650.40	$2,063.00	—	107% above	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL PUNCTURE LUMBAR DX-4S	$1,650.40	$2,063.00	—	107% above	20%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 DX SPINAL PUNCT,LUMBAR-ERPRO	$101.60	$127.00	—	—	20%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL FLUID TAP DX-PhHOS	$120.80	$151.00	—	—	20%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL PUNCTURE LUMBAR-FAC	$597.60	$747.00	—	—	20%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL PUNCTURE,LUMBAR-PCP	$1,220.00	$1,525.00	—	—	20%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 ER SPINAL PUNCTURE,LUMBAR	$1,650.40	$2,063.00	—	—	20%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL PUNCTURE LUMBAR DX-4S	$1,650.40	$2,063.00	—	—	20%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL PUNCTURE,LUMBAR-PCF	$1,650.40	$2,063.00	—	—	20%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL PUNCTURE LUMBAR DX	$1,650.40	$2,063.00	—	—	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 RPR SPRFCL WND 2.6-7.5CM-PhHOS	$91.20	$114.00	—	62% below	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 RPR SIMP S/N/T 2.6-7.5CM-ERPRO	$92.80	$116.00	—	61% below	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 REPAIR SUPERFICIAL WOUND-FAC	$208.00	$260.00	—	14% below	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 ER SIMPLE REPAIR 2.6 TO 7.5 CM	$703.20	$879.00	—	192% above	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 RPR SPRFCL WND 2.6-7.5CM-PhHOS	$91.20	$114.00	—	—	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 RPR SIMP S/N/T 2.6-7.5CM-ERPRO	$92.80	$116.00	—	—	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 REPAIR SUPERFICIAL WOUND-FAC	$208.00	$260.00	—	—	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 ER SIMPLE REPAIR 2.6 TO 7.5 CM	$703.20	$879.00	—	—	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 RPR SUPERFCL WND 2.5CM/<-PhHOS	$87.20	$109.00	—	63% below	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 RPR SMP F/E/N/L 2.5CM/<-ERPRO	$88.00	$110.00	—	63% below	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 REPAIR WOUND SUPERFICIAL-FAC	$169.60	$212.00	—	28% below	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 ER WOUND REPAIR 2.5CM/LESS	$651.20	$814.00	—	176% above	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 RPR SUPERFCL WND 2.5CM/<-PhHOS	$87.20	$109.00	—	—	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 RPR SMP F/E/N/L 2.5CM/<-ERPRO	$88.00	$110.00	—	—	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 REPAIR WOUND SUPERFICIAL-FAC	$169.60	$212.00	—	—	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 ER WOUND REPAIR 2.5CM/LESS	$651.20	$814.00	—	—	20%
TURP (transurethral resection of the prostate) CPT 52601 PROSTATECTOMY (TURP)-PhHOS	$1,269.60	$1,587.00	—	50% below	20%
TURP (transurethral resection of the prostate) inpatient CPT 52601 PROSTATECTOMY (TURP)-PhHOS	$1,269.60	$1,587.00	—	—	20%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGNTL BX SKIN SINGL LES-FAC	$169.60	$212.00	—	22% below	20%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 TANGNTL BX SKIN SINGL LES-FAC	$169.60	$212.00	—	—	20%
Thoracentesis with imaging guidance CPT 32555 ASP PLEURA W/ IMAGING-PhHOS	$172.00	$215.00	—	83% below	20%
Thoracentesis with imaging guidance CPT 32555 THORACENTESIS W/IMAGING-FAC	$1,093.60	$1,367.00	—	6% above	20%
Thoracentesis with imaging guidance CPT 32555 ULTRASOUND THORACENTESIS	$1,220.00	$1,525.00	—	19% above	20%
Thoracentesis with imaging guidance CPT 32555 ER THORACENTESIS W/IMAGING	$1,220.00	$1,525.00	—	19% above	20%
Thoracentesis with imaging guidance one side CPT 32555 CT THORACENTESIS W/ IMAGING RT	$1,220.00	$1,525.00	—	19% above	20%
Thoracentesis with imaging guidance one side CPT 32555 CT THORACENTESIS W/ IMAGING LT	$1,220.00	$1,525.00	—	19% above	20%
Thoracentesis with imaging guidance inpatient CPT 32555 ASP PLEURA W/ IMAGING-PhHOS	$172.00	$215.00	—	—	20%
Thoracentesis with imaging guidance inpatient CPT 32555 THORACENTESIS W/IMAGING-FAC	$1,093.60	$1,367.00	—	—	20%
Thoracentesis with imaging guidance inpatient CPT 32555 ULTRASOUND THORACENTESIS	$1,220.00	$1,525.00	—	—	20%
Thoracentesis with imaging guidance inpatient CPT 32555 ER THORACENTESIS W/IMAGING	$1,220.00	$1,525.00	—	—	20%
Thoracentesis with imaging guidance inpatient one side CPT 32555 CT THORACENTESIS W/ IMAGING LT	$1,220.00	$1,525.00	—	—	20%
Thoracentesis with imaging guidance inpatient one side CPT 32555 CT THORACENTESIS W/ IMAGING RT	$1,220.00	$1,525.00	—	—	20%
Tonsil and adenoid removal, age 12 or older CPT 42821 REM TONSILS AND ADENOIDS-PhHOS	$475.20	$594.00	—	45% below	20%
Tonsil and adenoid removal, age 12 or older inpatient CPT 42821 REM TONSILS AND ADENOIDS-PhHOS	$475.20	$594.00	—	—	20%
Tonsil and adenoid removal, child under 12 CPT 42820 REM TONSILS AND ADENOIDS-PhHOS	$456.80	$571.00	—	37% below	20%
Tonsil and adenoid removal, child under 12 inpatient CPT 42820 REM TONSILS AND ADENOIDS-PhHOS	$456.80	$571.00	—	—	20%
Tonsil removal (tonsillectomy) only, age 12 or older CPT 42826 REM OF TONSILS-PhHOS	$396.80	$496.00	—	47% below	20%
Tonsil removal (tonsillectomy) only, age 12 or older inpatient CPT 42826 REM OF TONSILS-PhHOS	$396.80	$496.00	—	—	20%
Tonsil removal (tonsillectomy) only, child under 12 CPT 42825 REM OF TONSILS-PhHOS	$415.20	$519.00	—	52% above	20%
Tonsil removal (tonsillectomy) only, child under 12 inpatient CPT 42825 REM OF TONSILS-PhHOS	$415.20	$519.00	—	—	20%
Total hip replacement CPT 27130 TOTAL HIP ARTHROPLASTY-PhHOS	$2,421.60	$3,027.00	—	57% below	20%
Total hip replacement inpatient CPT 27130 TOTAL HIP ARTHROPLASTY-PhHOS	$2,421.60	$3,027.00	—	—	20%
Total knee replacement CPT 27447 TOTAL KNEE ARTHROPLASTY-PhHOS	$2,585.60	$3,232.00	—	54% below	20%
Total knee replacement inpatient CPT 27447 TOTAL KNEE ARTHROPLASTY-PhHOS	$2,585.60	$3,232.00	—	—	20%
Total shoulder replacement CPT 23472 RECONSTR SHOULDER JNT-PhHOS	$2,251.20	$2,814.00	—	30% below	20%
Total shoulder replacement inpatient CPT 23472 RECONSTR SHOULDER JNT-PhHOS	$2,251.20	$2,814.00	—	—	20%
Total thyroid removal (thyroidectomy) CPT 60240 REM OF THYROID-PhHOS	$1,419.20	$1,774.00	—	44% below	20%
Total thyroid removal (thyroidectomy) inpatient CPT 60240 REM OF THYROID-PhHOS	$1,419.20	$1,774.00	—	—	20%
Trigger finger release surgery CPT 26055 INC FINGER TEND SHEATH-PhHOS	$482.40	$603.00	—	67% below	20%
Trigger finger release surgery inpatient CPT 26055 INC FINGER TEND SHEATH-PhHOS	$482.40	$603.00	—	—	20%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIG POINT 1/2 MUSCL-PhHOS	$58.40	$73.00	—	84% below	20%
Trigger point injections, 1 or 2 muscles CPT 20552 TRIGGER PNT INJ 1-2 MUSC-FAC	$236.80	$296.00	—	37% below	20%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER PNT 1/2 MISCL-MHCP	$540.00	$675.00	—	44% above	20%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER PNT 1/2 MUSCL-PCP	$540.00	$675.00	—	44% above	20%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER PNT 1/2 MISCL-MHCF	$696.80	$871.00	—	85% above	20%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER PNT 1/2 MUSCL-PCF	$731.20	$914.00	—	95% above	20%
Trigger point injections, 1 or 2 muscles CPT 20552 ER REPAIR FOREARM TENDON/MUSCL	$731.20	$914.00	—	95% above	20%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ TRIG POINT 1/2 MUSCL-PhHOS	$58.40	$73.00	—	—	20%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 TRIGGER PNT INJ 1-2 MUSC-FAC	$236.80	$296.00	—	—	20%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ TRIGGER PNT 1/2 MISCL-MHCP	$540.00	$675.00	—	—	20%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ TRIGGER PNT 1/2 MUSCL-PCP	$540.00	$675.00	—	—	20%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ TRIGGER PNT 1/2 MISCL-MHCF	$696.80	$871.00	—	—	20%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 ER REPAIR FOREARM TENDON/MUSCL	$731.20	$914.00	—	—	20%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ TRIGGER PNT 1/2 MUSCL-PCF	$731.20	$914.00	—	—	20%
Tubal ligation, laparoscopic (tubes sealed by cautery) CPT 58670 LAPAROSC TUBAL CAUTERY-PhHOS	$569.60	$712.00	—	43% below	20%
Tubal ligation, laparoscopic (tubes sealed by cautery) inpatient CPT 58670 LAPAROSC TUBAL CAUTERY-PhHOS	$569.60	$712.00	—	—	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 BX BREAST 1ST LESION US-FAC	$1,312.80	$1,641.00	—	19% below	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 BX BREAST US RT	$1,766.40	$2,208.00	—	9% above	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 BX BREAST US LT	$1,766.40	$2,208.00	—	9% above	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 BX BREAST 1ST LESION US-FAC	$1,312.80	$1,641.00	—	—	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 BX BREAST US LT	$1,766.40	$2,208.00	—	—	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 BX BREAST US RT	$1,766.40	$2,208.00	—	—	20%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 ESOPH ENDO DILATION-PhHOS	$269.60	$337.00	—	84% below	20%
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 ESOPH ENDO DILATION-PhHOS	$269.60	$337.00	—	—	20%
Upper endoscopy (EGD) with biopsy CPT 43239 UPPER GI ENDO BX-PhHOS	$267.20	$334.00	—	69% below	20%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 UPPER GI ENDO BX-PhHOS	$267.20	$334.00	—	—	20%
Upper endoscopy (EGD) with injection into the lining CPT 43236 UPPR GI SC W/SUBMUC INJ-PhHOS	$272.00	$340.00	—	30% below	20%
Upper endoscopy (EGD) with injection into the lining inpatient CPT 43236 UPPR GI SC W/SUBMUC INJ-PhHOS	$272.00	$340.00	—	—	20%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 OPERATIVE UPPER GI ENDO-PhHOS	$338.40	$423.00	—	58% below	20%
Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 OPERATIVE UPPER GI ENDO-PhHOS	$338.40	$423.00	—	—	20%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 UPPR GI ENDO/GU WIRE-PhHOS	$292.00	$365.00	—	58% below	20%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire inpatient CPT 43248 UPPR GI ENDO/GU WIRE-PhHOS	$292.00	$365.00	—	—	20%
Upper endoscopy (EGD), diagnostic CPT 43235 UPPR GI ENDO DIAGNOSIS-PhHOS	$226.40	$283.00	—	74% below	20%
Upper endoscopy (EGD), diagnostic CPT 43235 ER UPPR GI ENDOSCOPY, DIAG	$2,595.20	$3,244.00	—	199% above	20%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 UPPR GI ENDO DIAGNOSIS-PhHOS	$226.40	$283.00	—	—	20%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 ER UPPR GI ENDOSCOPY, DIAG	$2,595.20	$3,244.00	—	—	20%
Upper endoscopy with drainage of a pseudocyst through the stomach wall CPT 43240 EGD TRANSMUR DRAIN CYST-PhHOS	$596.80	$746.00	—	25% above	20%
Upper endoscopy with drainage of a pseudocyst through the stomach wall inpatient CPT 43240 EGD TRANSMUR DRAIN CYST-PhHOS	$596.80	$746.00	—	—	20%
Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 CYSTO/URET W/LITHOTRIPSY-PhHOS	$600.80	$751.00	—	22% below	20%
Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 CYSTO/URET W/LITHO BIL-PhHOS	$904.00	$1,130.00	—	17% above	20%
Ureteroscopy with laser stone breaking (lithotripsy) inpatient CPT 52353 CYSTO/URET W/LITHOTRIPSY-PhHOS	$600.80	$751.00	—	—	20%
Ureteroscopy with laser stone breaking (lithotripsy) inpatient CPT 52353 CYSTO/URET W/LITHO BIL-PhHOS	$904.00	$1,130.00	—	—	20%
Ureteroscopy with laser stone breaking and stent placement CPT 52356 CYSTO/URET W/LITHO & STNT-PhHO	$615.20	$769.00	—	69% below	20%
Ureteroscopy with laser stone breaking and stent placement CPT 52356 CYSTO/URET &LITH/STNT BIL-PhHO	$958.40	$1,198.00	—	52% below	20%
Ureteroscopy with laser stone breaking and stent placement inpatient CPT 52356 CYSTO/URET W/LITHO & STNT-PhHO	$615.20	$769.00	—	—	20%
Ureteroscopy with laser stone breaking and stent placement inpatient CPT 52356 CYSTO/URET &LITH/STNT BIL-PhHO	$958.40	$1,198.00	—	—	20%
Vaginal delivery, including prenatal and postpartum care CPT 59400 OBSTETRICAL CARE-PhHOS	$3,283.20	$4,104.00	—	2% below	20%
Vaginal delivery, including prenatal and postpartum care inpatient CPT 59400 OBSTETRICAL CARE-PhHOS	$3,283.20	$4,104.00	—	—	20%
Vasectomy, one or both sides, including follow-up semen testing CPT 55250 REM OF SPERM DUCT-PhHOS	$268.00	$335.00	—	91% below	20%
Vasectomy, one or both sides, including follow-up semen testing CPT 55250 REM OF SPERM DUCT-FAC	$1,797.60	$2,247.00	—	40% below	20%
Vasectomy, one or both sides, including follow-up semen testing inpatient CPT 55250 REM OF SPERM DUCT-PhHOS	$268.00	$335.00	—	—	20%
Vasectomy, one or both sides, including follow-up semen testing inpatient CPT 55250 REM OF SPERM DUCT-FAC	$1,797.60	$2,247.00	—	—	20%
Vein ablation, radiofrequency, first vein CPT 36475 ENDOVENOUS RF 1ST VEIN-PhHOS	$551.20	$689.00	—	74% below	20%
Vein ablation, radiofrequency, first vein inpatient CPT 36475 ENDOVENOUS RF 1ST VEIN-PhHOS	$551.20	$689.00	—	—	20%
Wart removal, up to 14 warts CPT 17110 DESTRUCT LES 1-14-PhHOS	$85.60	$107.00	—	53% below	20%
Wart removal, up to 14 warts CPT 17110 DESTRUCT LESION 1-14-FAC	$180.00	$225.00	—	1% below	20%
Wart removal, up to 14 warts inpatient CPT 17110 DESTRUCT LES 1-14-PhHOS	$85.60	$107.00	—	—	20%
Wart removal, up to 14 warts inpatient CPT 17110 DESTRUCT LESION 1-14-FAC	$180.00	$225.00	—	—	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDE SK/TISSUE-PhHOS	$95.20	$119.00	—	79% below	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDE SKIN/TISSUE-FAC	$629.60	$787.00	—	39% above	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DBRDMT SUBQ TIS 1ST 20SQCM/<	$726.40	$908.00	—	60% above	20%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDE SK/TISSUE-PhHOS	$95.20	$119.00	—	—	20%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDE SKIN/TISSUE-FAC	$629.60	$787.00	—	—	20%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DBRDMT SUBQ TIS 1ST 20SQCM/<	$726.40	$908.00	—	—	20%
Wrist fracture surgery (plate and screws), distal radius CPT 25607 TX FX RAD EXRA-ARTICUL-PhHOS	$1,136.00	$1,420.00	—	2% above	20%
Wrist fracture surgery (plate and screws), distal radius inpatient CPT 25607 TX FX RAD EXRA-ARTICUL-PhHOS	$1,136.00	$1,420.00	—	—	20%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Michigan	Off list
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSFUSION-PCU	$2,013.60	$2,517.00	—	221% above	20%
Blood transfusion (giving blood or blood components) CPT 36430 ER BLOOD TRANSFUSION	$2,013.60	$2,517.00	—	221% above	20%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSFUSION-4S	$2,013.60	$2,517.00	—	221% above	20%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSFUSION-INF	$2,013.60	$2,517.00	—	221% above	20%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSFUSION-3N/OB	$2,013.60	$2,517.00	—	221% above	20%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSFUSION-3S	$2,013.60	$2,517.00	—	221% above	20%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSFUSION-2N	$2,013.60	$2,517.00	—	221% above	20%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSFUSION-AC	$2,013.60	$2,517.00	—	221% above	20%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSFUSION-ICU	$2,013.60	$2,517.00	—	221% above	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD TRANSFUSION-4S	$2,013.60	$2,517.00	—	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD TRANSFUSION-ICU	$2,013.60	$2,517.00	—	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD TRANSFUSION-AC	$2,013.60	$2,517.00	—	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 ER BLOOD TRANSFUSION	$2,013.60	$2,517.00	—	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD TRANSFUSION-PCU	$2,013.60	$2,517.00	—	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD TRANSFUSION-2N	$2,013.60	$2,517.00	—	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD TRANSFUSION-3S	$2,013.60	$2,517.00	—	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD TRANSFUSION-3N/OB	$2,013.60	$2,517.00	—	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD TRANSFUSION-INF	$2,013.60	$2,517.00	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AIRWAY INHALATION TREAT-MMA	$173.60	$217.00	—	2% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AIRWAY INHALATION TX	$277.60	$347.00	—	64% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 ER AIRWAY INHALATION TREATMENT	$388.80	$486.00	—	129% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AIRWAY INHALATION TREAT-MMA	$173.60	$217.00	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AIRWAY INHALATION TX	$277.60	$347.00	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 ER AIRWAY INHALATION TREATMENT	$388.80	$486.00	—	—	20%
Chemotherapy IV infusion, first hour CPT 96413 CHEMO IV INFUSION 1ST HR-2N	$792.00	$990.00	—	70% above	20%
Chemotherapy IV infusion, first hour CPT 96413 CHEMO IV INFUSION 1ST HR-AC	$792.00	$990.00	—	70% above	20%
Chemotherapy IV infusion, first hour CPT 96413 CHEMO IV INFUSION 1ST HR-3S	$792.00	$990.00	—	70% above	20%
Chemotherapy IV infusion, first hour CPT 96413 CHEMO IV INFUSION 1ST HR-PCU	$792.00	$990.00	—	70% above	20%
Chemotherapy IV infusion, first hour CPT 96413 CHEMO IV INFUSION 1ST HR-ICU	$792.00	$990.00	—	70% above	20%
Chemotherapy IV infusion, first hour CPT 96413 CHEMO IV INFUSION 1ST HR-INF	$792.00	$990.00	—	70% above	20%
Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO IV INFUSION 1ST HR-3S	$792.00	$990.00	—	—	20%
Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO IV INFUSION 1ST HR-ICU	$792.00	$990.00	—	—	20%
Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO IV INFUSION 1ST HR-PCU	$792.00	$990.00	—	—	20%
Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO IV INFUSION 1ST HR-AC	$792.00	$990.00	—	—	20%
Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO IV INFUSION 1ST HR-INF	$792.00	$990.00	—	—	20%
Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO IV INFUSION 1ST HR-2N	$792.00	$990.00	—	—	20%
Comprehensive eye exam by an eye doctor, new patient CPT 92004 EYE EXAM NEW PT-FAC	$112.00	$140.00	—	2% above	20%
Comprehensive eye exam by an eye doctor, new patient inpatient CPT 92004 EYE EXAM NEW PT-FAC	$112.00	$140.00	—	—	20%
Comprehensive eye exam, returning patient CPT 92014 EYE EXAM & TX-FAC	$112.00	$140.00	—	2% above	20%
Comprehensive eye exam, returning patient inpatient CPT 92014 EYE EXAM & TX-FAC	$112.00	$140.00	—	—	20%
Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 COMPREHENSIVE HEARING TST-FAC	$130.40	$163.00	—	33% below	20%
Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 COMPREHENSIVE HEARING TST-FAC	$130.40	$163.00	—	—	20%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE E&M 1ST HR-ERPRO	$332.80	$416.00	—	79% below	20%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE 1ST HOUR-PhHOS	$333.60	$417.00	—	79% below	20%
Critical care, first 30 to 74 minutes CPT 99291 ER CRITICAL CARE, E&M 1ST HR	$4,200.00	$5,250.00	—	163% above	20%
Critical care, first 30 to 74 minutes inpatient CPT 99291 CRITICAL CARE E&M 1ST HR-ERPRO	$332.80	$416.00	—	—	20%
Critical care, first 30 to 74 minutes inpatient CPT 99291 CRITICAL CARE 1ST HOUR-PhHOS	$333.60	$417.00	—	—	20%
Critical care, first 30 to 74 minutes inpatient CPT 99291 ER CRITICAL CARE, E&M 1ST HR	$4,200.00	$5,250.00	—	—	20%
EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG AWAKE AND DROWSY-READ	$1,194.40	$1,493.00	—	80% above	20%
EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG AWAKE AND DROWSY	$1,616.00	$2,020.00	—	143% above	20%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 EEG AWAKE AND DROWSY-READ	$1,194.40	$1,493.00	—	—	20%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 EEG AWAKE AND DROWSY	$1,616.00	$2,020.00	—	—	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG TRACING-FAC	$79.20	$99.00	—	29% below	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ER EKG TRACING	$114.40	$143.00	—	2% above	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG TRACING	$248.00	$310.00	—	122% above	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG TRACING-FAC	$79.20	$99.00	—	—	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ER EKG TRACING	$114.40	$143.00	—	—	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG TRACING	$248.00	$310.00	—	—	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER DEPT VISIT X REQ QHP-PhHOS	$32.00	$40.00	—	76% below	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER DEPT TREATMENT LEVEL 1	$420.00	$525.00	—	221% above	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ER DEPT VISIT X REQ QHP-PhHOS	$32.00	$40.00	—	—	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ER DEPT TREATMENT LEVEL 1	$420.00	$525.00	—	—	20%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ER DEPT TREATMENT LVL 2-ERPRO	$65.60	$82.00	—	79% below	20%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ER DEPT VISIT SF MDM-PhHOS	$65.60	$82.00	—	79% below	20%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ER DEPT TREATMENT LEVEL 2	$628.00	$785.00	—	97% above	20%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ER DEPT VISIT SF MDM-PhHOS	$65.60	$82.00	—	—	20%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ER DEPT TREATMENT LVL 2-ERPRO	$65.60	$82.00	—	—	20%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ER DEPT TREATMENT LEVEL 2	$628.00	$785.00	—	—	20%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ER DEPT TREATMENT LVL 3-ERPRO	$110.40	$138.00	—	79% below	20%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ER DEPT VISIT LOW MDM-PhHOS	$110.40	$138.00	—	79% below	20%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ER DEPT TREATMENT LEVEL 3	$1,141.60	$1,427.00	—	116% above	20%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ER DEPT TREATMENT LVL 3-ERPRO	$110.40	$138.00	—	—	20%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ER DEPT VISIT LOW MDM-PhHOS	$110.40	$138.00	—	—	20%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ER DEPT TREATMENT LEVEL 3	$1,141.60	$1,427.00	—	—	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ER DEPT TREATMENT LVL 4-ERPRO	$188.80	$236.00	—	79% below	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ER DEPT VISIT MOD MDM-PhHOS	$188.80	$236.00	—	79% below	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ER DEPT TREATMENT LEVEL 4	$2,100.00	$2,625.00	—	134% above	20%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ER DEPT VISIT MOD MDM-PhHOS	$188.80	$236.00	—	—	20%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ER DEPT TREATMENT LVL 4-ERPRO	$188.80	$236.00	—	—	20%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ER DEPT TREATMENT LEVEL 4	$2,100.00	$2,625.00	—	—	20%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ER DEPT TREATMENT LVL 5-ERPRO	$272.80	$341.00	—	78% below	20%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ER DEPT VISIT HI MDM-PhHOS	$272.80	$341.00	—	78% below	20%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ER DEPT TREATMENT LEVEL 5	$2,940.00	$3,675.00	—	138% above	20%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ER DEPT VISIT HI MDM-PhHOS	$272.80	$341.00	—	—	20%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ER DEPT TREATMENT LVL 5-ERPRO	$272.80	$341.00	—	—	20%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ER DEPT TREATMENT LEVEL 5	$2,940.00	$3,675.00	—	—	20%
Exercise stress test, tracing only, the hospital charge CPT 93017 EXERCISE STRESS TEST	$1,306.40	$1,633.00	—	69% above	20%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 EXERCISE STRESS TEST	$1,306.40	$1,633.00	—	—	20%
Eye exam, returning patient, intermediate CPT 92012 INTERM EYE EXAM EST PT-FAC	$112.00	$140.00	—	at median	20%
Eye exam, returning patient, intermediate inpatient CPT 92012 INTERM EYE EXAM EST PT-FAC	$112.00	$140.00	—	—	20%
Family therapy with the patient, 50 minutes CPT 90847 VIRT FAM PSYTX W/PT 50MIN-FAC	$145.60	$182.00	—	14% above	20%
Family therapy with the patient, 50 minutes inpatient CPT 90847 VIRT FAM PSYTX W/PT 50MIN-FAC	$145.60	$182.00	—	—	20%
Family therapy without the patient, 50 minutes CPT 90846 VIRT FAM PSYTX W/O PT 50M-FAC	$145.60	$182.00	—	17% above	20%
Family therapy without the patient, 50 minutes inpatient CPT 90846 VIRT FAM PSYTX W/O PT 50M-FAC	$145.60	$182.00	—	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV THERAPY HYDRATION INIT-INF	$579.20	$724.00	—	130% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV THERAPY HYDRATION INIT-3S	$579.20	$724.00	—	130% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV THERAPY HYDRATION INIT-AC	$579.20	$724.00	—	130% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV THERAPY HYDRATION INIT-2N	$579.20	$724.00	—	130% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV THERAPY HYDRATION INIT-ICU	$579.20	$724.00	—	130% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV THERAPY HYDRATION INIT-PCU	$579.20	$724.00	—	130% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV THERAPY HYDRATION INIT-4S	$579.20	$724.00	—	130% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV THERAPY HYDRATION INIT-OKI	$579.20	$724.00	—	130% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 ER IV THERAPY HYDRATION INITAL	$579.20	$724.00	—	130% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV THERAPY HYDRATION INI-OB/3N	$579.20	$724.00	—	130% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV THERAPY HYDRATION INIT-3S	$579.20	$724.00	—	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV THERAPY HYDRATION INIT-2N	$579.20	$724.00	—	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV THERAPY HYDRATION INIT-ICU	$579.20	$724.00	—	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV THERAPY HYDRATION INIT-PCU	$579.20	$724.00	—	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV THERAPY HYDRATION INIT-4S	$579.20	$724.00	—	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV THERAPY HYDRATION INIT-OKI	$579.20	$724.00	—	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 ER IV THERAPY HYDRATION INITAL	$579.20	$724.00	—	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV THERAPY HYDRATION INI-OB/3N	$579.20	$724.00	—	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV THERAPY HYDRATION INIT-INF	$579.20	$724.00	—	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV THERAPY HYDRATION INIT-AC	$579.20	$724.00	—	—	20%
IV infusion of a medicine, first hour CPT 96365 IV THERAPY DIAG 1ST HR-PCP	$474.40	$593.00	—	62% above	20%
IV infusion of a medicine, first hour CPT 96365 ER NONCORP IV THERAPY 1ST HR	$582.00	$727.50	—	99% above	20%
IV infusion of a medicine, first hour CPT 96365 IV THERAPY DIAG 1ST HR-OKI	$642.40	$803.00	—	120% above	20%
IV infusion of a medicine, first hour CPT 96365 IV THERAPY DIAG 1ST HR-PCU	$642.40	$803.00	—	120% above	20%
IV infusion of a medicine, first hour CPT 96365 IV THERAPY DIAG 1ST HR-NUR	$642.40	$803.00	—	120% above	20%
IV infusion of a medicine, first hour CPT 96365 IV THERAPY DIAG 1ST HR-AC	$642.40	$803.00	—	120% above	20%
IV infusion of a medicine, first hour CPT 96365 IV THERAPY DIAG 1ST HR-INF	$642.40	$803.00	—	120% above	20%
IV infusion of a medicine, first hour CPT 96365 ER IV THERAPY DIAG 1ST HR	$642.40	$803.00	—	120% above	20%
IV infusion of a medicine, first hour CPT 96365 IV THERAPY DIAG 1ST HR-3S	$642.40	$803.00	—	120% above	20%
IV infusion of a medicine, first hour CPT 96365 IV THERAPY DIAG 1ST HR-PCF	$642.40	$803.00	—	120% above	20%
IV infusion of a medicine, first hour CPT 96365 IV THERAPY DIAG 1ST HR-2N	$642.40	$803.00	—	120% above	20%
IV infusion of a medicine, first hour CPT 96365 IV THERAPY DIAG 1ST HR-OB/3N	$642.40	$803.00	—	120% above	20%
IV infusion of a medicine, first hour CPT 96365 IV THERAPY DIAG 1ST HR-COV ICU	$642.40	$803.00	—	120% above	20%
IV infusion of a medicine, first hour CPT 96365 IV THERAPY DIAG 1ST HR-4W	$642.40	$803.00	—	120% above	20%
IV infusion of a medicine, first hour CPT 96365 IV THERAPY DIAG 1ST HR-ICU	$642.40	$803.00	—	120% above	20%
IV infusion of a medicine, first hour CPT 96365 IV THERAPY DIAG 1ST HR-4S	$642.40	$803.00	—	120% above	20%
IV infusion of a medicine, first hour inpatient CPT 96365 IV THERAPY DIAG 1ST HR-PCP	$474.40	$593.00	—	—	20%
IV infusion of a medicine, first hour inpatient CPT 96365 ER NONCORP IV THERAPY 1ST HR	$582.00	$727.50	—	—	20%
IV infusion of a medicine, first hour inpatient CPT 96365 IV THERAPY DIAG 1ST HR-PCU	$642.40	$803.00	—	—	20%
IV infusion of a medicine, first hour inpatient CPT 96365 IV THERAPY DIAG 1ST HR-4S	$642.40	$803.00	—	—	20%
IV infusion of a medicine, first hour inpatient CPT 96365 IV THERAPY DIAG 1ST HR-OKI	$642.40	$803.00	—	—	20%
IV infusion of a medicine, first hour inpatient CPT 96365 IV THERAPY DIAG 1ST HR-ICU	$642.40	$803.00	—	—	20%
IV infusion of a medicine, first hour inpatient CPT 96365 ER IV THERAPY DIAG 1ST HR	$642.40	$803.00	—	—	20%
IV infusion of a medicine, first hour inpatient CPT 96365 IV THERAPY DIAG 1ST HR-COV ICU	$642.40	$803.00	—	—	20%
IV infusion of a medicine, first hour inpatient CPT 96365 IV THERAPY DIAG 1ST HR-4W	$642.40	$803.00	—	—	20%
IV infusion of a medicine, first hour inpatient CPT 96365 IV THERAPY DIAG 1ST HR-2N	$642.40	$803.00	—	—	20%
IV infusion of a medicine, first hour inpatient CPT 96365 IV THERAPY DIAG 1ST HR-OB/3N	$642.40	$803.00	—	—	20%
IV infusion of a medicine, first hour inpatient CPT 96365 IV THERAPY DIAG 1ST HR-AC	$642.40	$803.00	—	—	20%
IV infusion of a medicine, first hour inpatient CPT 96365 IV THERAPY DIAG 1ST HR-NUR	$642.40	$803.00	—	—	20%
IV infusion of a medicine, first hour inpatient CPT 96365 IV THERAPY DIAG 1ST HR-3S	$642.40	$803.00	—	—	20%
IV infusion of a medicine, first hour inpatient CPT 96365 IV THERAPY DIAG 1ST HR-PCF	$642.40	$803.00	—	—	20%
IV infusion of a medicine, first hour inpatient CPT 96365 IV THERAPY DIAG 1ST HR-INF	$642.40	$803.00	—	—	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DIAG INJ-MMA	$57.60	$72.00	—	37% below	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION THER/PROPH/DIAG-PCP	$116.80	$146.00	—	28% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJ THER/PROPH/DIAG SC/IM-2N	$157.60	$197.00	—	73% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJ THER/PROPH/DIA SC/IM-OB/3N	$157.60	$197.00	—	73% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 ER INJ THER/PROPH/DIAG SC/IM	$157.60	$197.00	—	73% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJ THER/PROPH/DIAG SC/IM-PCU	$157.60	$197.00	—	73% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJ THER/PROPH/DIAG SC/IM-ICU	$157.60	$197.00	—	73% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJ THER/PROPH/DIAG SC/IM-INF	$157.60	$197.00	—	73% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJ THER/PROPH/DIAG SC/IM-4W	$157.60	$197.00	—	73% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJ THER/PROPH/DIAG SC/IM-4S	$157.60	$197.00	—	73% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJ THER/PROPH/DIAG SC/IM-AC	$157.60	$197.00	—	73% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJ THER/PROPH/DIAG SC/IM-3S	$157.60	$197.00	—	73% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION THER/PROPH/DIAG-PCF	$157.60	$197.00	—	73% above	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THER/PROPH/DIAG INJ-MMA	$57.60	$72.00	—	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJECTION THER/PROPH/DIAG-PCP	$116.80	$146.00	—	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJ THER/PROPH/DIAG SC/IM-PCU	$157.60	$197.00	—	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJ THER/PROPH/DIA SC/IM-OB/3N	$157.60	$197.00	—	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJECTION THER/PROPH/DIAG-PCF	$157.60	$197.00	—	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 ER INJ THER/PROPH/DIAG SC/IM	$157.60	$197.00	—	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJ THER/PROPH/DIAG SC/IM-3S	$157.60	$197.00	—	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJ THER/PROPH/DIAG SC/IM-AC	$157.60	$197.00	—	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJ THER/PROPH/DIAG SC/IM-4S	$157.60	$197.00	—	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJ THER/PROPH/DIAG SC/IM-4W	$157.60	$197.00	—	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJ THER/PROPH/DIAG SC/IM-2N	$157.60	$197.00	—	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJ THER/PROPH/DIAG SC/IM-INF	$157.60	$197.00	—	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJ THER/PROPH/DIAG SC/IM-ICU	$157.60	$197.00	—	—	20%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 VIRTUAL PSYCHIATRIC EVAL-FAC	$145.60	$182.00	—	35% below	20%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 PSY DX EVALUATION-PhHOS	$189.60	$237.00	—	15% below	20%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 VIRTUAL PSYCHIATRIC EVAL-FAC	$145.60	$182.00	—	—	20%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 PSY DX EVALUATION-PhHOS	$189.60	$237.00	—	—	20%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 MOTOR&SENS 7-8 NRV CONDJ-FAC	$272.00	$340.00	—	41% below	20%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 MOTOR&SENS 7-8 NRV CONDJ-FAC	$272.00	$340.00	—	—	20%
Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSCULAR REED EA 15MIN	$253.60	$317.00	—	221% above	20%
Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSCULA REED EA 15MIN	$253.60	$317.00	—	221% above	20%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEUROMUSCULAR REED EA 15MIN	$253.60	$317.00	—	—	20%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEUROMUSCULA REED EA 15MIN	$253.60	$317.00	—	—	20%
New patient office visit, about 30 minutes CPT 99203 PHONE NEW E/M LOW 30MIN-FAC	$112.00	$140.00	—	2% above	20%
New patient office visit, about 30 minutes CPT 99203 OFFICE NEW E/M LOW 30MIN-FAC	$112.00	$140.00	—	2% above	20%
New patient office visit, about 30 minutes CPT 99203 VIRTUAL NEW E/M LOW 30MIN-FAC	$112.00	$140.00	—	2% above	20%
New patient office visit, about 30 minutes CPT 99203 OFFICE/OUTPT VISIT NEW-PhHOS	$116.80	$146.00	—	6% above	20%
New patient office visit, about 30 minutes CPT 99203 VIRTUAL OUTP LEVEL3 NEW-PhHOSP	$116.80	$146.00	—	6% above	20%
New patient office visit, about 30 minutes CPT 99203 OFFICE NEW E/M LOW 30MIN-PCP	$208.00	$260.00	—	89% above	20%
New patient office visit, about 30 minutes CPT 99203 VIRTUAL NEW E/M LOW 30MIN-PCF	$268.80	$336.00	—	144% above	20%
New patient office visit, about 30 minutes CPT 99203 PHONE NEW E/M LOW 30MIN-PCF	$268.80	$336.00	—	144% above	20%
New patient office visit, about 30 minutes CPT 99203 LEVEL 3 VISIT NEW PT	$268.80	$336.00	—	144% above	20%
New patient office visit, about 30 minutes CPT 99203 OFFICE NEW E/M LOW 30MIN-PCF	$282.40	$353.00	—	157% above	20%
New patient office visit, about 30 minutes CPT 99203 SP VIRTUAL/PHONE LEV 3 NEW-PCF	$336.00	$420.00	—	205% above	20%
New patient office visit, about 30 minutes CPT 99203 SP VIRTUAL/PHONE LEV 3 NEW-PCF	$336.00	$420.00	—	205% above	20%
New patient office visit, about 30 minutes inpatient CPT 99203 PHONE NEW E/M LOW 30MIN-FAC	$112.00	$140.00	—	—	20%
New patient office visit, about 30 minutes inpatient CPT 99203 VIRTUAL NEW E/M LOW 30MIN-FAC	$112.00	$140.00	—	—	20%
New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE NEW E/M LOW 30MIN-FAC	$112.00	$140.00	—	—	20%
New patient office visit, about 30 minutes inpatient CPT 99203 VIRTUAL OUTP LEVEL3 NEW-PhHOSP	$116.80	$146.00	—	—	20%
New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE/OUTPT VISIT NEW-PhHOS	$116.80	$146.00	—	—	20%
New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE NEW E/M LOW 30MIN-PCP	$208.00	$260.00	—	—	20%
New patient office visit, about 30 minutes inpatient CPT 99203 LEVEL 3 VISIT NEW PT	$268.80	$336.00	—	—	20%
New patient office visit, about 30 minutes inpatient CPT 99203 PHONE NEW E/M LOW 30MIN-PCF	$268.80	$336.00	—	—	20%
New patient office visit, about 30 minutes inpatient CPT 99203 VIRTUAL NEW E/M LOW 30MIN-PCF	$268.80	$336.00	—	—	20%
New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE NEW E/M LOW 30MIN-PCF	$282.40	$353.00	—	—	20%
New patient office visit, about 30 minutes inpatient CPT 99203 SP VIRTUAL/PHONE LEV 3 NEW-PCF	$336.00	$420.00	—	—	20%
New patient office visit, about 30 minutes inpatient CPT 99203 SP VIRTUAL/PHONE LEV 3 NEW-PCF	$336.00	$420.00	—	—	20%
New patient office visit, about 45 minutes CPT 99204 PHONE NEW E/M MOD 45MIN-FAC	$112.00	$140.00	—	5% below	20%
New patient office visit, about 45 minutes CPT 99204 VIRTUAL NEW E/M MOD 45MIN-FAC	$112.00	$140.00	—	5% below	20%
New patient office visit, about 45 minutes CPT 99204 OFFICE NEW E/M MOD 45MIN-FAC	$112.00	$140.00	—	5% below	20%
New patient office visit, about 45 minutes CPT 99204 VIRTUAL OUTP LEVEL 4 NEW-PhHOS	$166.40	$208.00	—	41% above	20%
New patient office visit, about 45 minutes CPT 99204 OFFICE/OUTPT VISIT NEW-PhHOS	$177.60	$222.00	—	50% above	20%
New patient office visit, about 45 minutes CPT 99204 OFFICE NEW E/M MOD 45MIN-PCP	$217.60	$272.00	—	84% above	20%
New patient office visit, about 45 minutes CPT 99204 LEVEL 4 VISIT NEW PT	$280.00	$350.00	—	137% above	20%
New patient office visit, about 45 minutes CPT 99204 PHONE NEW E/M MOD 45MIN-PCF	$309.60	$387.00	—	162% above	20%
New patient office visit, about 45 minutes CPT 99204 VIRTUAL NEW E/M MOD 45MIN-PCF	$309.60	$387.00	—	162% above	20%
New patient office visit, about 45 minutes CPT 99204 OFFICE NEW E/M MOD 45MIN-PCF	$309.60	$387.00	—	162% above	20%
New patient office visit, about 45 minutes CPT 99204 SP VIRTUAL/PHONE LEV 4 NEW-PCF	$387.20	$484.00	—	228% above	20%
New patient office visit, about 45 minutes CPT 99204 SP VIRTUAL/PHONE LEV 4 NEW-PCF	$387.20	$484.00	—	228% above	20%
New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE NEW E/M MOD 45MIN-FAC	$112.00	$140.00	—	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 VIRTUAL NEW E/M MOD 45MIN-FAC	$112.00	$140.00	—	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 PHONE NEW E/M MOD 45MIN-FAC	$112.00	$140.00	—	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 VIRTUAL OUTP LEVEL 4 NEW-PhHOS	$166.40	$208.00	—	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE/OUTPT VISIT NEW-PhHOS	$177.60	$222.00	—	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE NEW E/M MOD 45MIN-PCP	$217.60	$272.00	—	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 LEVEL 4 VISIT NEW PT	$280.00	$350.00	—	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 PHONE NEW E/M MOD 45MIN-PCF	$309.60	$387.00	—	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE NEW E/M MOD 45MIN-PCF	$309.60	$387.00	—	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 VIRTUAL NEW E/M MOD 45MIN-PCF	$309.60	$387.00	—	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 SP VIRTUAL/PHONE LEV 4 NEW-PCF	$387.20	$484.00	—	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 SP VIRTUAL/PHONE LEV 4 NEW-PCF	$387.20	$484.00	—	—	20%
New patient office visit, about 60 minutes CPT 99205 VIRTUAL NEW E/M HIGH 60MIN-FAC	$112.00	$140.00	—	24% below	20%
New patient office visit, about 60 minutes CPT 99205 OFFICE NEW E/M HIGH 60MIN-FAC	$112.00	$140.00	—	24% below	20%
New patient office visit, about 60 minutes CPT 99205 PHONE NEW E/M HIGH 60MIN-FAC	$112.00	$140.00	—	24% below	20%
New patient office visit, about 60 minutes CPT 99205 OFFICE/OUTPT VISIT NEW-PhHOS	$222.40	$278.00	—	51% above	20%
New patient office visit, about 60 minutes CPT 99205 VIRTUAL OUTP LEVEL 5 NEW-PhHOS	$223.20	$279.00	—	52% above	20%
New patient office visit, about 60 minutes CPT 99205 OFFICE NEW E/M HIGH 60MIN-PCP	$241.60	$302.00	—	64% above	20%
New patient office visit, about 60 minutes CPT 99205 LEVEL 5 VISIT NEW PT	$311.20	$389.00	—	111% above	20%
New patient office visit, about 60 minutes CPT 99205 OFFICE NEW E/M HIGH 60MIN-PCF	$332.00	$415.00	—	125% above	20%
New patient office visit, about 60 minutes CPT 99205 PHONE NEW E/M HIGH 60MIN-PCF	$332.00	$415.00	—	125% above	20%
New patient office visit, about 60 minutes CPT 99205 VIRTUAL NEW E/M HIGH 60MIN-PCF	$332.00	$415.00	—	125% above	20%
New patient office visit, about 60 minutes CPT 99205 SP VIRTUAL/PHONE LEV 5 NEW-PCF	$415.20	$519.00	—	182% above	20%
New patient office visit, about 60 minutes CPT 99205 SP VIRTUAL/PHONE LEV 5 NEW-PCF	$415.20	$519.00	—	182% above	20%
New patient office visit, about 60 minutes inpatient CPT 99205 VIRTUAL NEW E/M HIGH 60MIN-FAC	$112.00	$140.00	—	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 PHONE NEW E/M HIGH 60MIN-FAC	$112.00	$140.00	—	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 OFFICE NEW E/M HIGH 60MIN-FAC	$112.00	$140.00	—	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 OFFICE/OUTPT VISIT NEW-PhHOS	$222.40	$278.00	—	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 VIRTUAL OUTP LEVEL 5 NEW-PhHOS	$223.20	$279.00	—	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 OFFICE NEW E/M HIGH 60MIN-PCP	$241.60	$302.00	—	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 LEVEL 5 VISIT NEW PT	$311.20	$389.00	—	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 OFFICE NEW E/M HIGH 60MIN-PCF	$332.00	$415.00	—	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 VIRTUAL NEW E/M HIGH 60MIN-PCF	$332.00	$415.00	—	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 PHONE NEW E/M HIGH 60MIN-PCF	$332.00	$415.00	—	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 SP VIRTUAL/PHONE LEV 5 NEW-PCF	$415.20	$519.00	—	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 SP VIRTUAL/PHONE LEV 5 NEW-PCF	$415.20	$519.00	—	—	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 OFFICE/OUTPT VISIT NEW-PhHOS	$83.20	$104.00	—	17% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 VIRTUAL NEW E/M SF 15MIN-FAC	$112.00	$140.00	—	57% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 PHONE NEW E/M SF 15MIN-FAC	$112.00	$140.00	—	57% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 OFFICE NEW E/M SF 15MIN-FAC	$112.00	$140.00	—	57% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 OFFICE NEW E/M SF 15MIN-PCP	$200.00	$250.00	—	180% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 PHONE NEW E/M SF 15MIN-PCF	$257.60	$322.00	—	261% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 VIRTUAL NEW E/M SF 15MIN-PCF	$257.60	$322.00	—	261% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 LEVEL 2 VISIT NEW PT	$257.60	$322.00	—	261% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 OFFICE NEW E/M SF 15MIN-PCF	$270.40	$338.00	—	279% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 SP VIRTUAL/PHONE LEV 2 NEW-PCF	$321.60	$402.00	—	350% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 SP VIRTUAL/PHONE LEV 2 NEW-PCF	$321.60	$402.00	—	350% above	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 OFFICE/OUTPT VISIT NEW-PhHOS	$83.20	$104.00	—	—	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 OFFICE NEW E/M SF 15MIN-FAC	$112.00	$140.00	—	—	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 PHONE NEW E/M SF 15MIN-FAC	$112.00	$140.00	—	—	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 VIRTUAL NEW E/M SF 15MIN-FAC	$112.00	$140.00	—	—	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 OFFICE NEW E/M SF 15MIN-PCP	$200.00	$250.00	—	—	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 PHONE NEW E/M SF 15MIN-PCF	$257.60	$322.00	—	—	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 VIRTUAL NEW E/M SF 15MIN-PCF	$257.60	$322.00	—	—	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 LEVEL 2 VISIT NEW PT	$257.60	$322.00	—	—	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 OFFICE NEW E/M SF 15MIN-PCF	$270.40	$338.00	—	—	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 SP VIRTUAL/PHONE LEV 2 NEW-PCF	$321.60	$402.00	—	—	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 SP VIRTUAL/PHONE LEV 2 NEW-PCF	$321.60	$402.00	—	—	20%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MED NUTRITION INDIV IN-PhHOS	$50.40	$63.00	—	20% above	20%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MED NUTRITI INDI INT 15MIN	$92.00	$115.00	—	118% above	20%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 SP MNT NUTRITION INDIV 1HR	$152.80	$191.00	—	263% above	20%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MED NUTRITION INDIV IN-PhHOS	$50.40	$63.00	—	—	20%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MED NUTRITI INDI INT 15MIN	$92.00	$115.00	—	—	20%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 SP MNT NUTRITION INDIV 1HR	$152.80	$191.00	—	—	20%
Occupational therapy evaluation, low complexity CPT 97165 SP OCC THERAPY EVAL	$157.60	$197.00	—	20% below	20%
Occupational therapy evaluation, low complexity CPT 97165 EVAL OT LOW COMPLEX	$532.00	$665.00	—	169% above	20%
Occupational therapy evaluation, low complexity inpatient CPT 97165 SP OCC THERAPY EVAL	$157.60	$197.00	—	—	20%
Occupational therapy evaluation, low complexity inpatient CPT 97165 EVAL OT LOW COMPLEX	$532.00	$665.00	—	—	20%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 EVAL PT HIGH COMPLEX	$532.00	$665.00	—	142% above	20%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 EVAL PT HIGH COMPLEX	$532.00	$665.00	—	—	20%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 SP PHYSICAL THERAPY EVAL	$157.60	$197.00	—	18% below	20%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 EVAL PT LOW COMPLEX	$532.00	$665.00	—	177% above	20%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 SP PHYSICAL THERAPY EVAL	$157.60	$197.00	—	—	20%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 EVAL PT LOW COMPLEX	$532.00	$665.00	—	—	20%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 EVAL PT MODERATE COMPLEX	$532.00	$665.00	—	137% above	20%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 EVAL PT MODERATE COMPLEX	$532.00	$665.00	—	—	20%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THERAPY EA 15MIN	$196.00	$245.00	—	143% above	20%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MANUAL THERAPY EA 15MIN	$196.00	$245.00	—	—	20%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EX/PROC EA 15MIN	$204.00	$255.00	—	173% above	20%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC EX/PROC EA 15MIN	$204.00	$255.00	—	—	20%
Preventive checkup, new patient aged 18–39 CPT 99385 PREV VISIT NEW AGE 18-39-FAC	$112.00	$140.00	—	3% below	20%
Preventive checkup, new patient aged 18–39 CPT 99385 VIRTUAL PREV NEW 18-39YR-FAC	$112.00	$140.00	—	3% below	20%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 VIRTUAL PREV NEW 18-39YR-FAC	$112.00	$140.00	—	—	20%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 PREV VISIT NEW AGE 18-39-FAC	$112.00	$140.00	—	—	20%
Preventive checkup, new patient aged 40–64 CPT 99386 PREV VISIT NEW AGE 40-64-FAC	$112.00	$140.00	—	33% below	20%
Preventive checkup, new patient aged 40–64 CPT 99386 VIRTUAL PREV NEW 40-64YR-FAC	$112.00	$140.00	—	33% below	20%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 PREV VISIT NEW AGE 40-64-FAC	$112.00	$140.00	—	—	20%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 VIRTUAL PREV NEW 40-64YR-FAC	$112.00	$140.00	—	—	20%
Preventive checkup, new patient aged 65 or older CPT 99387 VIRTUAL PREV NEW 65FAC	$112.00	$140.00	—	49% below	20%
Preventive checkup, new patient aged 65 or older CPT 99387 PREV VISIT NEW 65 & OVER-FAC	$112.00	$140.00	—	49% below	20%
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 PREV VISIT NEW 65 & OVER-FAC	$112.00	$140.00	—	—	20%
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 VIRTUAL PREV NEW 65FAC	$112.00	$140.00	—	—	20%
Preventive checkup, returning patient aged 18–39 CPT 99395 VIRTUAL PREV EST 18-39YR-FAC	$112.00	$140.00	—	4% below	20%
Preventive checkup, returning patient aged 18–39 CPT 99395 PREV VISIT EST AGE 18-39-FAC	$112.00	$140.00	—	4% below	20%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 PREV VISIT EST AGE 18-39-FAC	$112.00	$140.00	—	—	20%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 VIRTUAL PREV EST 18-39YR-FAC	$112.00	$140.00	—	—	20%
Preventive checkup, returning patient aged 40–64 CPT 99396 VIRTUAL PREV EST 40-64YR-FAC	$112.00	$140.00	—	17% below	20%
Preventive checkup, returning patient aged 40–64 CPT 99396 PREV VISIT EST AGE 40-64-FAC	$112.00	$140.00	—	17% below	20%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 VIRTUAL PREV EST 40-64YR-FAC	$112.00	$140.00	—	—	20%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 PREV VISIT EST AGE 40-64-FAC	$112.00	$140.00	—	—	20%
Preventive checkup, returning patient aged 65 or older CPT 99397 PREV VISIT EST 65 & OVER-FAC	$112.00	$140.00	—	41% below	20%
Preventive checkup, returning patient aged 65 or older CPT 99397 VIRTUAL PREV EST 65FAC	$112.00	$140.00	—	41% below	20%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 VIRTUAL PREV EST 65FAC	$112.00	$140.00	—	—	20%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 PREV VISIT EST 65 & OVER-FAC	$112.00	$140.00	—	—	20%
Psychiatric evaluation with medical services CPT 90792 VIRT PSYCH EVAL W/MED SRVC-FAC	$145.60	$182.00	—	6% below	20%
Psychiatric evaluation with medical services CPT 90792 PSY DX EVAL W/MEDICAL SERV-PRO	$203.20	$254.00	—	31% above	20%
Psychiatric evaluation with medical services CPT 90792 PSY DX EVAL W/MED SERV-PhHOS	$208.00	$260.00	—	34% above	20%
Psychiatric evaluation with medical services inpatient CPT 90792 VIRT PSYCH EVAL W/MED SRVC-FAC	$145.60	$182.00	—	—	20%
Psychiatric evaluation with medical services inpatient CPT 90792 PSY DX EVAL W/MEDICAL SERV-PRO	$203.20	$254.00	—	—	20%
Psychiatric evaluation with medical services inpatient CPT 90792 PSY DX EVAL W/MED SERV-PhHOS	$208.00	$260.00	—	—	20%
Psychotherapy session, 30 minutes CPT 90832 VIRTUAL PSYTX W/PT; 30MIN-FAC	$145.60	$182.00	—	3% above	20%
Psychotherapy session, 30 minutes inpatient CPT 90832 VIRTUAL PSYTX W/PT; 30MIN-FAC	$145.60	$182.00	—	—	20%
Psychotherapy session, 45 minutes CPT 90834 VIRTUAL PSYTX W/PT; 45MIN-FAC	$145.60	$182.00	—	5% below	20%
Psychotherapy session, 45 minutes inpatient CPT 90834 VIRTUAL PSYTX W/PT; 45MIN-FAC	$145.60	$182.00	—	—	20%
Psychotherapy session, 60 minutes CPT 90837 VIRTUAL PSYTX W/PT; 1HR-FAC	$145.60	$182.00	—	31% below	20%
Psychotherapy session, 60 minutes inpatient CPT 90837 VIRTUAL PSYTX W/PT; 1HR-FAC	$145.60	$182.00	—	—	20%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 SMOKE/TOB COUNSEL 3-10M-PCP	$14.40	$18.00	—	55% below	20%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 SMOKING CESSATION 3-10M-PhHOS	$14.40	$18.00	—	55% below	20%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 SMOKING CESSATION TEACHING	$42.40	$53.00	—	33% above	20%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 SMOKE/TOB COUNSEL 3-10M-PCP	$14.40	$18.00	—	—	20%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 SMOKING CESSATION 3-10M-PhHOS	$14.40	$18.00	—	—	20%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 SMOKING CESSATION TEACHING	$42.40	$53.00	—	—	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE EST E/M HIGH 40MIN-FAC	$112.00	$140.00	—	5% below	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 VIRTUAL EST E/M HIGH 40MIN-FAC	$112.00	$140.00	—	5% below	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 PHONE EST E/M HIGH 40MIN-FAC	$112.00	$140.00	—	5% below	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE/OUTPT VISIT EST-PhHOS	$156.80	$196.00	—	33% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 VIRTUAL OUTPT VISIT EST-PhHOSP	$156.80	$196.00	—	33% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE EST E/M HIGH 40MIN-PCP	$241.60	$302.00	—	104% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 VIRTUAL EST E/M HIGH 40MIN-PCF	$311.20	$389.00	—	163% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 LEVEL 5 VISIT EST PT	$311.20	$389.00	—	163% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 PHONE EST E/M HIGH 40MIN-PCF	$311.20	$389.00	—	163% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE EST E/M HIGH 40MIN-PCF	$327.20	$409.00	—	177% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 SP VIRTUAL/PHONE LEV 5 EST-PCF	$388.80	$486.00	—	229% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 SP VIRTUAL/PHONE LEV 5 EST-PCF	$388.80	$486.00	—	229% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 LEVEL 5 W/CONTRACTIONS W/S4005	$1,295.20	$1,619.00	—	996% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 LEVEL 5 W/CONTRACTIONS-OB	$1,295.20	$1,619.00	—	996% above	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 PHONE EST E/M HIGH 40MIN-FAC	$112.00	$140.00	—	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 VIRTUAL EST E/M HIGH 40MIN-FAC	$112.00	$140.00	—	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OFFICE EST E/M HIGH 40MIN-FAC	$112.00	$140.00	—	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 VIRTUAL OUTPT VISIT EST-PhHOSP	$156.80	$196.00	—	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OFFICE/OUTPT VISIT EST-PhHOS	$156.80	$196.00	—	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OFFICE EST E/M HIGH 40MIN-PCP	$241.60	$302.00	—	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 VIRTUAL EST E/M HIGH 40MIN-PCF	$311.20	$389.00	—	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 PHONE EST E/M HIGH 40MIN-PCF	$311.20	$389.00	—	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 LEVEL 5 VISIT EST PT	$311.20	$389.00	—	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OFFICE EST E/M HIGH 40MIN-PCF	$327.20	$409.00	—	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 SP VIRTUAL/PHONE LEV 5 EST-PCF	$388.80	$486.00	—	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 SP VIRTUAL/PHONE LEV 5 EST-PCF	$388.80	$486.00	—	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 LEVEL 5 W/CONTRACTIONS W/S4005	$1,295.20	$1,619.00	—	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 LEVEL 5 W/CONTRACTIONS-OB	$1,295.20	$1,619.00	—	—	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE/OUTPT VISIT EST-PhHOS	$80.00	$100.00	—	4% below	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 VIRTUAL OUTPT VISIT EST-PhHOSP	$80.00	$100.00	—	4% below	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 PHONE EST E/M LOW 20MIN-FAC	$112.00	$140.00	—	35% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE EST E/M LOW 20MIN-FAC	$112.00	$140.00	—	35% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 VIRTUAL EST E/M LOW 20MIN-FAC	$112.00	$140.00	—	35% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE EST E/M LOW 20MIN-PCP	$208.00	$260.00	—	150% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 VIRTUAL EST E/M LOW 20MIN-PCF	$268.80	$336.00	—	223% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 PHONE EST E/M LOW 20MIN-PCF	$268.80	$336.00	—	223% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 LEVEL 3 VISIT EST PT	$268.80	$336.00	—	223% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE EST E/M LOW 20MIN-PCF	$282.40	$353.00	—	239% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 SP VIRTUAL/PHONE LEV 3 EST-PCF	$336.00	$420.00	—	304% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 SP VIRTUAL/PHONE LEV 3 EST-PCF	$336.00	$420.00	—	304% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 LEVEL 3 W/CONTRACTIONS-OB	$1,076.00	$1,345.00	—	1193% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 LEVEL 3 W/CONTRACTIONS W/S4005	$1,076.00	$1,345.00	—	1193% above	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 VIRTUAL OUTPT VISIT EST-PhHOSP	$80.00	$100.00	—	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OFFICE/OUTPT VISIT EST-PhHOS	$80.00	$100.00	—	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OFFICE EST E/M LOW 20MIN-FAC	$112.00	$140.00	—	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 PHONE EST E/M LOW 20MIN-FAC	$112.00	$140.00	—	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 VIRTUAL EST E/M LOW 20MIN-FAC	$112.00	$140.00	—	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OFFICE EST E/M LOW 20MIN-PCP	$208.00	$260.00	—	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 VIRTUAL EST E/M LOW 20MIN-PCF	$268.80	$336.00	—	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 LEVEL 3 VISIT EST PT	$268.80	$336.00	—	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 PHONE EST E/M LOW 20MIN-PCF	$268.80	$336.00	—	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OFFICE EST E/M LOW 20MIN-PCF	$282.40	$353.00	—	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 SP VIRTUAL/PHONE LEV 3 EST-PCF	$336.00	$420.00	—	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 SP VIRTUAL/PHONE LEV 3 EST-PCF	$336.00	$420.00	—	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 LEVEL 3 W/CONTRACTIONS-OB	$1,076.00	$1,345.00	—	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 LEVEL 3 W/CONTRACTIONS W/S4005	$1,076.00	$1,345.00	—	—	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 PHONE EST E/M MOD 30MIN-FAC	$112.00	$140.00	—	4% below	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 VIRTUAL EST E/M MOD 30MIN-FAC	$112.00	$140.00	—	4% below	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE EST E/M MOD 30MIN-FAC	$112.00	$140.00	—	4% below	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 VIRTUAL OUTPT VISIT EST-PhHOSP	$117.60	$147.00	—	1% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE/OUTPT VISIT EST-PhHOS	$124.00	$155.00	—	6% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE EST E/M MOD 30MIN-PCP	$217.60	$272.00	—	87% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 PHONE EST E/M MOD 30MIN-PCF	$280.00	$350.00	—	140% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 LEVEL 4 VISIT EST PT	$280.00	$350.00	—	140% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 VIRTUAL EST E/M MOD 30MIN-PCF	$280.00	$350.00	—	140% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE EST E/M MOD 30MIN-PCF	$294.40	$368.00	—	153% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 SP VIRTUAL/PHONE LEV 4 EST-PCF	$350.40	$438.00	—	201% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 SP VIRTUAL/PHONE LEV 4 EST-PCF	$350.40	$438.00	—	201% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 LEVEL 4 W/CONTRACTIONS W/S4005	$1,175.20	$1,469.00	—	909% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 LEVEL 4 W/CONTRACTIONS-OB	$1,175.20	$1,469.00	—	909% above	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 VIRTUAL EST E/M MOD 30MIN-FAC	$112.00	$140.00	—	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 PHONE EST E/M MOD 30MIN-FAC	$112.00	$140.00	—	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OFFICE EST E/M MOD 30MIN-FAC	$112.00	$140.00	—	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 VIRTUAL OUTPT VISIT EST-PhHOSP	$117.60	$147.00	—	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OFFICE/OUTPT VISIT EST-PhHOS	$124.00	$155.00	—	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OFFICE EST E/M MOD 30MIN-PCP	$217.60	$272.00	—	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 LEVEL 4 VISIT EST PT	$280.00	$350.00	—	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 VIRTUAL EST E/M MOD 30MIN-PCF	$280.00	$350.00	—	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 PHONE EST E/M MOD 30MIN-PCF	$280.00	$350.00	—	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OFFICE EST E/M MOD 30MIN-PCF	$294.40	$368.00	—	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 SP VIRTUAL/PHONE LEV 4 EST-PCF	$350.40	$438.00	—	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 SP VIRTUAL/PHONE LEV 4 EST-PCF	$350.40	$438.00	—	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 LEVEL 4 W/CONTRACTIONS W/S4005	$1,175.20	$1,469.00	—	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 LEVEL 4 W/CONTRACTIONS-OB	$1,175.20	$1,469.00	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE/OUTPT VISIT EST-PhHOS	$49.60	$62.00	—	11% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 VIRTUAL OUTPT VISIT EST-PhHOSP	$49.60	$62.00	—	11% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE EST E/M SF 10MIN-FAC	$112.00	$140.00	—	152% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 PHONE EST E/M SF 10MIN-FAC	$112.00	$140.00	—	152% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 VIRTUAL EST E/M SF 10MIN-FAC	$112.00	$140.00	—	152% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE EST E/M SF 10MIN-PCP	$200.00	$250.00	—	350% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 LEVEL 2 VISIT EST PT	$257.60	$322.00	—	479% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 VIRTUAL EST E/M SF 10MIN-PCF	$257.60	$322.00	—	479% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 PHONE EST E/M SF 10MIN-PCF	$257.60	$322.00	—	479% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE EST E/M SF 10MIN-PCF	$270.40	$338.00	—	508% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 SP VIRTUAL/PHONE LEV 2 EST-PCF	$321.60	$402.00	—	623% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 SP VIRTUAL/PHONE LEV 2 EST-PCF	$321.60	$402.00	—	623% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 LEVEL 2 W/CONTRACTIONS-OB	$985.60	$1,232.00	—	2115% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 LEVEL 2 W/CONTRACTIONS W/S4005	$985.60	$1,232.00	—	2115% above	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 VIRTUAL OUTPT VISIT EST-PhHOSP	$49.60	$62.00	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OFFICE/OUTPT VISIT EST-PhHOS	$49.60	$62.00	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OFFICE EST E/M SF 10MIN-FAC	$112.00	$140.00	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 PHONE EST E/M SF 10MIN-FAC	$112.00	$140.00	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 VIRTUAL EST E/M SF 10MIN-FAC	$112.00	$140.00	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OFFICE EST E/M SF 10MIN-PCP	$200.00	$250.00	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 PHONE EST E/M SF 10MIN-PCF	$257.60	$322.00	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 VIRTUAL EST E/M SF 10MIN-PCF	$257.60	$322.00	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 LEVEL 2 VISIT EST PT	$257.60	$322.00	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OFFICE EST E/M SF 10MIN-PCF	$270.40	$338.00	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 SP VIRTUAL/PHONE LEV 2 EST-PCF	$321.60	$402.00	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 SP VIRTUAL/PHONE LEV 2 EST-PCF	$321.60	$402.00	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 LEVEL 2 W/CONTRACTIONS-OB	$985.60	$1,232.00	—	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 LEVEL 2 W/CONTRACTIONS W/S4005	$985.60	$1,232.00	—	—	20%
Specialist consultation, low complexity or 30+ minutes CPT 99243 OFFICE CONSULT LOW LEVEL-FAC	$112.00	$140.00	—	18% below	20%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 OFFICE CONSULT LOW LEVEL-FAC	$112.00	$140.00	—	—	20%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 OFFICE CONSULT MOD LEVEL-FAC	$112.00	$140.00	—	41% below	20%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 OFFICE CONSULT MOD LEVEL-FAC	$112.00	$140.00	—	—	20%
Speech and language evaluation CPT 92523 SP SPEECH THERAPY EVAL	$231.20	$289.00	—	32% below	20%
Speech and language evaluation CPT 92523 SPEECH SOUND /LANG EVAL	$475.20	$594.00	—	39% above	20%
Speech and language evaluation inpatient CPT 92523 SP SPEECH THERAPY EVAL	$231.20	$289.00	—	—	20%
Speech and language evaluation inpatient CPT 92523 SPEECH SOUND /LANG EVAL	$475.20	$594.00	—	—	20%
Speech therapy session, individual CPT 92507 SP SPEECH THERAPY TX	$79.20	$99.00	—	62% below	20%
Speech therapy session, individual CPT 92507 SPEECH LANGUAGE TREATMENT	$504.00	$630.00	—	143% above	20%
Speech therapy session, individual inpatient CPT 92507 SP SPEECH THERAPY TX	$79.20	$99.00	—	—	20%
Speech therapy session, individual inpatient CPT 92507 SPEECH LANGUAGE TREATMENT	$504.00	$630.00	—	—	20%
Spirometry (breathing test) CPT 94010 SPIROMETRY (BREATH CAP)-READ	$44.00	$55.00	—	75% below	20%
Spirometry (breathing test) CPT 94010 BREATHING CAPACITY TST-FAC	$189.60	$237.00	—	10% above	20%
Spirometry (breathing test) CPT 94010 SPIROMETRY	$497.60	$622.00	—	188% above	20%
Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY (BREATH CAP)-READ	$44.00	$55.00	—	—	20%
Spirometry (breathing test) inpatient CPT 94010 BREATHING CAPACITY TST-FAC	$189.60	$237.00	—	—	20%
Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY	$497.60	$622.00	—	—	20%
Spirometry before and after a bronchodilator CPT 94060 EVALUATION OF WHEEZING-FAC	$272.00	$340.00	—	30% below	20%
Spirometry before and after a bronchodilator CPT 94060 BRONCHOSPASM PRE/POST-SPIROMET	$576.80	$721.00	—	49% above	20%
Spirometry before and after a bronchodilator inpatient CPT 94060 EVALUATION OF WHEEZING-FAC	$272.00	$340.00	—	—	20%
Spirometry before and after a bronchodilator inpatient CPT 94060 BRONCHOSPASM PRE/POST-SPIROMET	$576.80	$721.00	—	—	20%
Therapeutic activities (functional training), 15 minutes CPT 97530 SP PHYSICAL THERAPY TX/15MIN	$36.80	$46.00	—	52% below	20%
Therapeutic activities (functional training), 15 minutes CPT 97530 OT THERAPY ACTIVITY EA 15MIN	$193.60	$242.00	—	151% above	20%
Therapeutic activities (functional training), 15 minutes CPT 97530 PT THERAPY ACTIVITY EA 15MIN	$193.60	$242.00	—	151% above	20%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 SP PHYSICAL THERAPY TX/15MIN	$36.80	$46.00	—	—	20%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 OT THERAPY ACTIVITY EA 15MIN	$193.60	$242.00	—	—	20%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 PT THERAPY ACTIVITY EA 15MIN	$193.60	$242.00	—	—	20%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY THERAPEUTIC	$528.00	$660.00	—	151% above	20%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY THERAPEUTIC	$528.00	$660.00	—	—	20%
Visual field test, extended CPT 92083 VISUAL FIELD EXAM-FAC	$103.20	$129.00	—	44% below	20%
Visual field test, extended inpatient CPT 92083 VISUAL FIELD EXAM-FAC	$103.20	$129.00	—	—	20%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Michigan	Off list
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 SARSCOV2 VAC 30mcg TRS-SUC IM	$140.00	$175.00	—	30% below	20%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 SARSCOV2 VAC 30mcg TRS-SUC IM	$140.00	$175.00	—	—	20%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 CHICKEN POX VACCINE SC-MMA	$187.20	$234.00	—	7% below	20%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 Varivax 1350 units	$1,844.30	$2,305.38	—	813% above	20%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 CHICKEN POX VACCINE SC-MMA	$187.20	$234.00	—	—	20%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 Varivax 1350 units	$1,844.30	$2,305.38	—	—	20%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLU IIV3 VAC NO PRSV 0.5ML-MMA	$21.60	$27.00	—	12% below	20%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLU IIV3 VAC NO PRSV 0.5ML-MMA	$21.60	$27.00	—	—	20%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HPV VACCINE NON VALENT IM-MMA	$298.40	$373.00	—	at median	20%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HPV VACCINE NON VALENT IM-MMA	$298.40	$373.00	—	—	20%
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 HEP A/HEP B VAC ADULT IM-MMA	$93.60	$117.00	—	44% below	20%
Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 HEP A/HEP B VAC ADULT IM-MMA	$93.60	$117.00	—	—	20%
Hepatitis A vaccine, adult dose CPT 90632 HEPA VACCINE ADULT IM	$81.60	$102.00	—	25% below	20%
Hepatitis A vaccine, adult dose CPT 90632 Vaqta Adult	$764.02	$955.02	—	601% above	20%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPA VACCINE ADULT IM	$81.60	$102.00	—	—	20%
Hepatitis A vaccine, adult dose inpatient CPT 90632 Vaqta Adult	$764.02	$955.02	—	—	20%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEP B VACCINE ADULT IM-MMA	$68.80	$86.00	—	10% below	20%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEP B VACCINE ADULT IM-MMA	$68.80	$86.00	—	—	20%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 FLU VAC PRSV FREE-MMA	$75.20	$94.00	—	11% above	20%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 FLU VAC PRSV FREE-MMA	$75.20	$94.00	—	—	20%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MMR VACCINE	$95.20	$119.00	—	27% below	20%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MMR	$919.10	$1,148.88	—	608% above	20%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MMR VACCINE	$95.20	$119.00	—	—	20%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MMR	$919.10	$1,148.88	—	—	20%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOCOCCAL ACWY VACC IM-MMA	$163.20	$204.00	—	9% below	20%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENINGOCOCCAL ACWY VACC IM-MMA	$163.20	$204.00	—	—	20%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENINGOCOCCAL B 4C VACC-MMA	$224.80	$281.00	—	24% below	20%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 MENINGOCOCCAL B 4C VACC-MMA	$224.80	$281.00	—	—	20%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PREVNAR 20 SYRINGE	$2,238.17	$2,797.71	—	487% above	20%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PREVNAR 20 SYRINGE	$2,238.17	$2,797.71	—	—	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PPSV23 VACC 2 YRS SUBQ/IM	$212.80	$266.00	—	48% above	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Pneumovax 23	$1,123.97	$1,404.96	—	681% above	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PPSV23 VACC 2 YRS SUBQ/IM	$212.80	$266.00	—	—	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 Pneumovax 23	$1,123.97	$1,404.96	—	—	20%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 RSV BEYFORTUS 0.5ML IM-MMA	$548.00	$685.00	—	27% below	20%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 BEYFORTUS <5 kg Dose	$2,618.26	$3,272.83	—	249% above	20%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 RSV BEYFORTUS 0.5ML IM-MMA	$548.00	$685.00	—	—	20%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 BEYFORTUS <5 kg Dose	$2,618.26	$3,272.83	—	—	20%
Rabies vaccine, one dose CPT 90675 Imovax	$3,676.46	$4,595.58	—	613% above	20%
Rabies vaccine, one dose inpatient CPT 90675 Imovax	$3,676.46	$4,595.58	—	—	20%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 HZV VAC RECOMBINANT-MMA	$204.00	$255.00	—	9% below	20%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 HZV VAC RECOMBINANT-MMA	$204.00	$255.00	—	—	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TD VACC NO PRESV 7 YRS IM	$38.40	$48.00	—	26% below	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 Tenivac	$426.34	$532.92	—	726% above	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TD VACC NO PRESV 7 YRS IM	$38.40	$48.00	—	—	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 Tenivac	$426.34	$532.92	—	—	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDAP VACCINE >=7 YRS 0.5ML IM	$52.00	$65.00	—	20% below	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Adacel	$468.77	$585.96	—	620% above	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TDAP VACCINE >=7 YRS 0.5ML IM	$52.00	$65.00	—	—	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Adacel	$468.77	$585.96	—	—	20%
Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 TYPHOID VACCINE IM-MMA	$100.80	$126.00	—	35% below	20%
Typhoid vaccine, injectable (Vi polysaccharide) inpatient CPT 90691 TYPHOID VACCINE IM-MMA	$100.80	$126.00	—	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 SP VFC VACCINE ADMIN-MMA	$23.03	$28.79	—	at median	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN-MMA	$58.40	$73.00	—	154% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ER NONCORP IMMUNIZATION ADMIN	$136.80	$171.00	—	494% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN-INF	$151.20	$189.00	—	557% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN-ICU	$151.20	$189.00	—	557% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN-3S	$151.20	$189.00	—	557% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN-AC	$151.20	$189.00	—	557% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN-LTC	$151.20	$189.00	—	557% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN-2N	$151.20	$189.00	—	557% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ER IMMUNIZATION ADMIN	$151.20	$189.00	—	557% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN-3N/OB	$151.20	$189.00	—	557% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN-PCU	$151.20	$189.00	—	557% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 SP VFC VACCINE ADMIN-MMA	$23.03	$28.79	—	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMIN-MMA	$58.40	$73.00	—	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ER NONCORP IMMUNIZATION ADMIN	$136.80	$171.00	—	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMIN-INF	$151.20	$189.00	—	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMIN-3S	$151.20	$189.00	—	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMIN-ICU	$151.20	$189.00	—	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMIN-3N/OB	$151.20	$189.00	—	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMIN-PCU	$151.20	$189.00	—	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ER IMMUNIZATION ADMIN	$151.20	$189.00	—	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMIN-2N	$151.20	$189.00	—	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMIN-LTC	$151.20	$189.00	—	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMIN-AC	$151.20	$189.00	—	—	20%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNE ADMIN EA ADD-MMA	$24.80	$31.00	—	27% above	20%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 ER IMMUNI ADMIN ADD VACCINE	$62.40	$78.00	—	219% above	20%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMINIS ADD'L	$62.40	$78.00	—	219% above	20%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUNE ADMIN EA ADD-MMA	$24.80	$31.00	—	—	20%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 ER IMMUNI ADMIN ADD VACCINE	$62.40	$78.00	—	—	20%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUNIZATION ADMINIS ADD'L	$62.40	$78.00	—	—	20%

Source file: https://memorialhealthcare.org/wp-content/uploads/2026/03/381358208_memorial-healthcare_standardcharges-1.json