Hospital Bangor, ME

Millinocket Regional Hospital

Millinocket Regional Hospital in Millinocket, ME publishes cash prices for 324 common procedures listed here, from its own machine-readable price file (the file does not say when it was last updated). Compared with other hospitals in the state, its outpatient cash prices are above the Maine median for 209 of 322 procedures and below it for 91. By typical cash price it ranks #18 of 27 Maine hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

200 Somerset St, MILLINOCKET, ME, 044621258 Collected Sep 27, 2026 Source price file (207) 723-5161

Critical access hospital (rural, 25 beds or fewer) Emergency department CCN 201307 · 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 2 actions for a hospital named Millinocket Regional Hospital in Millinocket, ME:

Apr 1, 2026 Warning notice
Jul 7, 2026 Case closed

Warning notice: CMS reviewed the hospital and told it that it had found possible violations of the price transparency rules. 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 Maine	Off list
Ankle X-ray, complete, 3 or more views CPT 73610 NPO L ANKLE 3V	$275.40	$306.00	$131.03–$283.36	16% above	10%
Ankle X-ray, complete, 3 or more views CPT 73610 NPO R ANKLE 3V	$275.40	$306.00	$131.03–$283.36	16% above	10%
Ankle X-ray, complete, 3 or more views one side CPT 73610 ANKLE, ANKLE 3V MIN, RT	$275.40	$306.00	$131.03–$283.36	16% above	10%
Ankle X-ray, complete, 3 or more views one side CPT 73610 ANKLE, ANKLE 3V MIN, LT	$275.40	$306.00	$131.03–$283.36	16% above	10%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 NPO L ANKLE 3V	$275.40	$306.00	$131.03–$283.36	—	10%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 NPO R ANKLE 3V	$275.40	$306.00	$131.03–$283.36	—	10%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 ANKLE, ANKLE 3V MIN, RT	$275.40	$306.00	$131.03–$283.36	—	10%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 ANKLE, ANKLE 3V MIN, LT	$275.40	$306.00	$131.03–$283.36	—	10%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 ARTERIAL STUDY- SINGLE LEVEL	$253.80	$282.00	$121.60–$261.13	16% below	10%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 ARTERIAL STUDY- SINGLE LEVEL	$253.80	$282.00	$121.60–$261.13	—	10%
Bone scan, whole body (nuclear medicine) CPT 78306 NM WHOLE BODY BONE SCAN	$1,238.40	$1,376.00	$593.33–$1,274.18	10% below	10%
Bone scan, whole body (nuclear medicine) CPT 78306 NM MECKELS DIVERTICULUM	$1,238.40	$1,376.00	$593.33–$1,274.18	10% below	10%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM WHOLE BODY BONE SCAN	$1,238.40	$1,376.00	$593.33–$1,274.18	—	10%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM MECKELS DIVERTICULUM	$1,238.40	$1,376.00	$593.33–$1,274.18	—	10%
Breast ultrasound, complete, one breast both sides CPT 76641 U/S BREAST BILATERAL	$670.50	$745.00	$321.24–$689.87	—	10%
Breast ultrasound, complete, one breast inpatient both sides CPT 76641 U/S BREAST BILATERAL	$670.50	$745.00	$321.24–$689.87	—	10%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST RT	$437.40	$486.00	$209.56–$450.04	23% above	10%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST LT	$437.40	$486.00	$209.56–$450.04	23% above	10%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US BREAST LT	$437.40	$486.00	$209.56–$450.04	—	10%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US BREAST RT	$437.40	$486.00	$209.56–$450.04	—	10%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA CHEST NON CORO (PE PROTOCO	$1,950.30	$2,167.00	$934.41–$2,131.35	at median	10%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA CHEST NON CORO (PE PROTOCO	$1,950.30	$2,167.00	$934.41–$2,131.35	—	10%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD/PELVIS W/O CONT (IVP)	$2,138.40	$2,376.00	$847.31–$2,200.18	61% above	10%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Abd/Pel w/o cont (No IV)	$2,138.40	$2,376.00	$847.31–$2,200.18	61% above	10%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD/PELVIS W/O CONT (IVP)	$2,138.40	$2,376.00	$847.31–$2,200.18	—	10%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT Abd/Pel w/o cont (No IV)	$2,138.40	$2,376.00	$847.31–$2,200.18	—	10%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abd/Pel with cont	$2,692.80	$2,992.00	$1,290.15–$2,770.59	47% above	10%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abd/Pel with cont	$2,692.80	$2,992.00	$1,290.15–$2,770.59	—	10%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT Abd/Pel W&W/O CONT	$3,217.50	$3,575.00	$1,541.54–$3,310.45	46% above	10%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT Abd/Pel W&W/O CONT	$3,217.50	$3,575.00	$1,541.54–$3,310.45	—	10%
CT scan of the abdomen with contrast both sides CPT 74160 CT BI-PHASIC LIVER W/CONTRAST	$1,695.60	$1,884.00	$812.38–$1,805.97	—	10%
CT scan of the abdomen with contrast CPT 74160 CT ABD W/CONTR	$1,695.60	$1,884.00	$812.38–$1,805.97	25% above	10%
CT scan of the abdomen with contrast inpatient both sides CPT 74160 CT BI-PHASIC LIVER W/CONTRAST	$1,695.60	$1,884.00	$812.38–$1,805.97	—	10%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABD W/CONTR	$1,695.60	$1,884.00	$812.38–$1,805.97	—	10%
CT scan of the abdomen without contrast both sides CPT 74150 CT Bi-phasic Liver W/O Contras	$1,138.50	$1,265.00	$545.47–$1,177.05	—	10%
CT scan of the abdomen without contrast CPT 74150 CT ABD W/O CONTR	$1,138.50	$1,265.00	$545.47–$1,177.05	22% above	10%
CT scan of the abdomen without contrast inpatient both sides CPT 74150 CT Bi-phasic Liver W/O Contras	$1,138.50	$1,265.00	$545.47–$1,177.05	—	10%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABD W/O CONTR	$1,138.50	$1,265.00	$545.47–$1,177.05	—	10%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT HEAD PLAIN MAXILLOFACIAL	$1,125.00	$1,250.00	$539.00–$1,177.05	11% above	10%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT CORONAL FACIAL BONES W/O CO	$1,125.00	$1,250.00	$539.00–$1,177.05	11% above	10%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT LIMITED SINUSES	$1,125.00	$1,250.00	$539.00–$1,177.05	11% above	10%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIAL W/O CONTRAST	$1,125.00	$1,250.00	$539.00–$1,177.05	11% above	10%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT LIMITED SINUSES	$1,125.00	$1,250.00	$539.00–$1,177.05	—	10%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT HEAD PLAIN MAXILLOFACIAL	$1,125.00	$1,250.00	$539.00–$1,177.05	—	10%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT CORONAL FACIAL BONES W/O CO	$1,125.00	$1,250.00	$539.00–$1,177.05	—	10%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILLOFACIAL W/O CONTRAST	$1,125.00	$1,250.00	$539.00–$1,177.05	—	10%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD W/O CONTRAST	$1,215.00	$1,350.00	$582.12–$1,250.10	3% above	10%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD W/O CONTRAST	$1,215.00	$1,350.00	$582.12–$1,250.10	—	10%
CT scan of the head with contrast CPT 70460 CT HEAD WITH CONTRAST	$1,690.20	$1,878.00	$809.79–$1,739.03	2% above	10%
CT scan of the head with contrast inpatient CPT 70460 CT HEAD WITH CONTRAST	$1,690.20	$1,878.00	$809.79–$1,739.03	—	10%
CT scan of the head without and with contrast CPT 70470 CT HEAD W&W/O CONTRAST	$1,636.20	$1,818.00	$783.92–$1,683.47	at median	10%
CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD W&W/O CONTRAST	$1,636.20	$1,818.00	$783.92–$1,683.47	—	10%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMBAR SPINE W/O CONTRAST	$1,251.00	$1,390.00	$599.37–$1,287.14	1% below	10%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT LUMBAR SPINE W/O CONTRAST	$1,251.00	$1,390.00	$599.37–$1,287.14	—	10%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT CERVICAL SPINE W/O CONTRAST	$1,280.70	$1,423.00	$613.60–$1,317.70	21% above	10%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT CERVICAL SPINE W/O CONTRAST	$1,280.70	$1,423.00	$613.60–$1,317.70	—	10%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/ CONTRAST	$1,936.80	$2,152.00	$927.94–$1,992.75	49% above	10%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/ CONTRAST	$1,936.80	$2,152.00	$927.94–$1,992.75	—	10%
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 US CAROTID DPPLR DUPLEX BIL	$954.90	$1,061.00	$457.50–$982.49	at median	10%
Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 US CAROTID DPPLR DUPLEX BIL	$954.90	$1,061.00	$457.50–$982.49	—	10%
Chest X-ray, 2 views CPT 71046 CHEST DECUBITUS 2V	$244.80	$272.00	$117.29–$251.87	20% above	10%
Chest X-ray, 2 views CPT 71046 CHEST, TWO VIEWS	$244.80	$272.00	$117.29–$251.87	20% above	10%
Chest X-ray, 2 views inpatient CPT 71046 CHEST, TWO VIEWS	$244.80	$272.00	$117.29–$251.87	—	10%
Chest X-ray, 2 views inpatient CPT 71046 CHEST DECUBITUS 2V	$244.80	$272.00	$117.29–$251.87	—	10%
Chest X-ray, single view CPT 71045 CHEST, ONE VIEW	$228.60	$254.00	$65.39–$235.20	25% above	10%
Chest X-ray, single view inpatient CPT 71045 CHEST, ONE VIEW	$228.60	$254.00	$65.39–$235.20	—	10%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RENAL W/W/O BLADDER	$684.00	$760.00	$327.71–$703.76	26% above	10%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RENAL W/W/O BLADDER	$684.00	$760.00	$327.71–$703.76	—	10%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DEXA SCAN BONE MINERAL DENSITY	$432.90	$481.00	$207.41–$445.41	23% above	10%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DEXA SCAN BONE MINERAL DENSITY	$432.90	$481.00	$207.41–$445.41	—	10%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 DEXA BONE DENSITY VERT FX	$283.50	$315.00	$117.95–$291.69	60% above	10%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 APPENDICULAR DEXA	$283.50	$315.00	$117.95–$291.69	60% above	10%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 DEXA BONE DENSITY VERT FX	$283.50	$315.00	$117.95–$291.69	—	10%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 APPENDICULAR DEXA	$283.50	$315.00	$117.95–$291.69	—	10%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US OB COMP W/FETAL ANATOMY	$645.30	$717.00	$309.17–$687.89	28% above	10%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US OB COMP W/FETAL ANATOMY	$645.30	$717.00	$309.17–$687.89	—	10%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT F/U 3-6 MOS LDCT W/O	$939.60	$1,044.00	$450.17–$1,044.00	at median	10%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST HI RESOLUTION W/O CON	$1,237.50	$1,375.00	$592.90–$1,273.25	32% above	10%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST W/O CONT	$1,292.40	$1,436.00	$619.20–$1,329.74	38% above	10%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT F/U 3-6 MOS LDCT W/O	$939.60	$1,044.00	$450.17–$1,044.00	—	10%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST HI RESOLUTION W/O CON	$1,237.50	$1,375.00	$592.90–$1,273.25	—	10%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST W/O CONT	$1,292.40	$1,436.00	$619.20–$1,329.74	—	10%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST W/ CONT	$1,688.40	$1,876.00	$808.93–$1,737.18	44% above	10%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT CHEST W/ CONT	$1,688.40	$1,876.00	$808.93–$1,737.18	—	10%
Diagnostic mammogram, both breasts both sides CPT 77066 MAMMOGRAPHY, BILAT DIAG	$870.30	$967.00	$416.97–$895.44	—	10%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MAMMOGRAPHY, BILAT DIAG	$870.30	$967.00	$416.97–$895.44	—	10%
Diagnostic mammogram, one breast one side CPT 77065 UNI DIAG MAMMO RT	$675.90	$751.00	$323.83–$695.43	142% above	10%
Diagnostic mammogram, one breast one side CPT 77065 UNI DIAG MAMMO LT	$675.90	$751.00	$323.83–$695.43	142% above	10%
Diagnostic mammogram, one breast inpatient one side CPT 77065 UNI DIAG MAMMO RT	$675.90	$751.00	$323.83–$695.43	—	10%
Diagnostic mammogram, one breast inpatient one side CPT 77065 UNI DIAG MAMMO LT	$675.90	$751.00	$323.83–$695.43	—	10%
Duplex ultrasound of the leg veins, both legs CPT 93970 US VENOUS DOPP DUPLEX EXT BILA	$1,415.70	$1,573.00	$678.28–$1,456.60	13% above	10%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 US VENOUS DOPP DUPLEX EXT BILA	$1,415.70	$1,573.00	$678.28–$1,456.60	—	10%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 US ECHO W/DOP & COLOR FLOW	$1,629.00	$1,810.00	$780.47–$1,676.06	4% above	10%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 US ECHO W/DOP & COLOR FLOW	$1,629.00	$1,810.00	$780.47–$1,676.06	—	10%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM HEPATOBILIARY SCAN	$1,350.90	$1,501.00	$647.23–$1,501.00	at median	10%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM HEPATOBILIARY SCAN	$1,350.90	$1,501.00	$647.23–$1,501.00	—	10%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 HOME SLEEP STUDY PRO FEE	$144.00	$160.00	$48.70–$148.16	37% below	10%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 HOME SLEEP TEST	$675.00	$750.00	$323.40–$694.50	193% above	10%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 HOME SLEEP STUDY PRO FEE	$144.00	$160.00	$48.70–$148.16	—	10%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 HOME SLEEP TEST	$675.00	$750.00	$323.40–$694.50	—	10%
Knee X-ray, 3 views CPT 73562 NPO L KNEE 3V	$266.40	$296.00	$127.64–$274.10	at median	10%
Knee X-ray, 3 views CPT 73562 NPO R KNEE 3V	$266.40	$296.00	$127.64–$274.10	at median	10%
Knee X-ray, 3 views one side CPT 73562 KNEE, LT 3V	$266.40	$296.00	$127.64–$274.10	at median	10%
Knee X-ray, 3 views one side CPT 73562 KNEE, RT 3V	$266.40	$296.00	$127.64–$274.10	at median	10%
Knee X-ray, 3 views inpatient CPT 73562 NPO R KNEE 3V	$266.40	$296.00	$127.64–$274.10	—	10%
Knee X-ray, 3 views inpatient CPT 73562 NPO L KNEE 3V	$266.40	$296.00	$127.64–$274.10	—	10%
Knee X-ray, 3 views inpatient one side CPT 73562 KNEE, RT 3V	$266.40	$296.00	$127.64–$274.10	—	10%
Knee X-ray, 3 views inpatient one side CPT 73562 KNEE, LT 3V	$266.40	$296.00	$127.64–$274.10	—	10%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US RUQ	$636.30	$707.00	$304.86–$654.68	82% above	10%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US SPLEEN LUQ	$636.30	$707.00	$304.86–$654.68	82% above	10%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMEN LIMITED/MISC	$636.30	$707.00	$304.86–$654.68	82% above	10%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US APPENDIX RLQ	$636.30	$707.00	$304.86–$654.68	82% above	10%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMEN LIMITED/MISC	$636.30	$707.00	$304.86–$654.68	—	10%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US RUQ	$636.30	$707.00	$304.86–$654.68	—	10%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US SPLEEN LUQ	$636.30	$707.00	$304.86–$654.68	—	10%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US APPENDIX RLQ	$636.30	$707.00	$304.86–$654.68	—	10%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT LUNG SCREENING	$476.10	$529.00	$228.10–$529.00	141% above	10%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT LUNG SCREENING	$476.10	$529.00	$228.10–$529.00	—	10%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI RT LE JOINT W/O CONTRAST	$1,632.60	$1,814.00	$782.20–$1,814.00	1% below	10%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LT LE JOINT W/O CONTRAST	$1,632.60	$1,814.00	$782.20–$1,814.00	1% below	10%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI RT LE JOINT W/O CONTRAST	$1,632.60	$1,814.00	$782.20–$1,814.00	—	10%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI LT LE JOINT W/O CONTRAST	$1,632.60	$1,814.00	$782.20–$1,814.00	—	10%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI RT LE JOINT W&W/O CONTRAST	$3,613.50	$4,015.00	$1,731.27–$3,717.89	15% above	10%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LT LE JOINT W&W/O CONTRAST	$3,613.50	$4,015.00	$1,731.27–$3,717.89	15% above	10%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI RT LE JOINT W&W/O CONTRAST	$3,613.50	$4,015.00	$1,731.27–$3,717.89	—	10%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI LT LE JOINT W&W/O CONTRAST	$3,613.50	$4,015.00	$1,731.27–$3,717.89	—	10%
MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN W/OUT CONTRAST	$1,807.20	$2,008.00	$865.85–$2,008.00	4% above	10%
MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN W/OUT CONTRAST	$1,807.20	$2,008.00	$865.85–$2,008.00	—	10%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN W/WO CONTRAST	$3,449.70	$3,833.00	$1,652.79–$3,549.36	13% above	10%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABDOMEN W/WO CONTRAST	$3,449.70	$3,833.00	$1,652.79–$3,549.36	—	10%
MRI of the brain, no contrast dye CPT 70551 MRI HEAD W/O CONTRAST	$1,519.20	$1,688.00	$727.87–$1,688.00	1% above	10%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI HEAD W/O CONTRAST	$1,519.20	$1,688.00	$727.87–$1,688.00	—	10%
MRI of the brain, with and without contrast dye CPT 70553 MRI HEAD W&W/O CONTRAST	$2,091.60	$2,324.00	$1,002.11–$2,324.00	19% below	10%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI HEAD W&W/O CONTRAST	$2,091.60	$2,324.00	$1,002.11–$2,324.00	—	10%
MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR SPINE W/O CONTRAST	$1,485.00	$1,650.00	$711.48–$1,650.00	3% above	10%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI LUMBAR SPINE W/O CONTRAST	$1,485.00	$1,650.00	$711.48–$1,650.00	—	10%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI LUMBAR SPINE W&W/O CONTRAS	$3,279.60	$3,644.00	$1,571.29–$3,374.34	9% above	10%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI LUMBAR SPINE W&W/O CONTRAS	$3,279.60	$3,644.00	$1,571.29–$3,374.34	—	10%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI THORACIC SPINE W/O CONTRAS	$1,893.60	$2,104.00	$907.24–$2,104.00	2% above	10%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI THORACIC SPINE W/O CONTRAS	$1,893.60	$2,104.00	$907.24–$2,104.00	—	10%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI CERVICAL SPINE W&W/O CONTR	$3,269.70	$3,633.00	$1,566.55–$3,364.16	49% above	10%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI CERVICAL SPINE W&W/O CONTR	$3,269.70	$3,633.00	$1,566.55–$3,364.16	—	10%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI CERVICAL SPINE W/O CONTRAS	$1,455.30	$1,617.00	$697.25–$1,617.00	1% above	10%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI CERVICAL SPINE W/O CONTRAS	$1,455.30	$1,617.00	$697.25–$1,617.00	—	10%
MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS W&W/O CONTRAST	$1,953.90	$2,171.00	$936.14–$2,171.00	20% below	10%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS W&W/O CONTRAST	$1,953.90	$2,171.00	$936.14–$2,171.00	—	10%
MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS W/OUT CONTRAST	$2,074.50	$2,305.00	$993.92–$2,134.43	13% above	10%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS W/OUT CONTRAST	$2,074.50	$2,305.00	$993.92–$2,134.43	—	10%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI LT UE JOINT W/O CONTRAST	$1,551.60	$1,724.00	$743.39–$1,724.00	3% below	10%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI RT UE JOINT W/O CONTRAST	$1,551.60	$1,724.00	$743.39–$1,724.00	3% below	10%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI LT UE JOINT W/O CONTRAST	$1,551.60	$1,724.00	$743.39–$1,724.00	—	10%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI RT UE JOINT W/O CONTRAST	$1,551.60	$1,724.00	$743.39–$1,724.00	—	10%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM CARDIAC STRESS/LEXIS	$2,730.60	$3,034.00	$1,308.26–$2,809.48	1% below	10%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM CARDIAC STRESS/TREAD	$2,730.60	$3,034.00	$1,308.26–$2,809.48	1% below	10%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM CARDIAC STRESS/TREAD	$2,730.60	$3,034.00	$1,308.26–$2,809.48	—	10%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM CARDIAC STRESS/LEXIS	$2,730.60	$3,034.00	$1,308.26–$2,809.48	—	10%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIS LIMITED OR FOLLOW UP	$450.90	$501.00	$216.03–$463.93	281% above	10%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US BLADDER	$450.90	$501.00	$216.03–$463.93	281% above	10%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US BLADDER	$450.90	$501.00	$216.03–$463.93	—	10%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIS LIMITED OR FOLLOW UP	$450.90	$501.00	$216.03–$463.93	—	10%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIS GYN	$648.90	$721.00	$310.90–$667.65	58% above	10%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIS GYN	$648.90	$721.00	$310.90–$667.65	—	10%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB1st TRIMESTER	$342.00	$380.00	$163.86–$380.00	3% above	10%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OB1st TRIMESTER	$342.00	$380.00	$163.86–$380.00	—	10%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB LIMITED	$436.50	$485.00	$209.13–$449.11	173% above	10%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB LIMITED	$436.50	$485.00	$209.13–$449.11	—	10%
Screening mammogram, both breasts CPT 77067 MAMMOGRAPHY, SCREENING	$359.10	$399.00	$82.11–$399.00	90% above	10%
Screening mammogram, both breasts one side CPT 77067 MAMMO UNI SCREENING RT	$359.10	$399.00	$82.11–$399.00	90% above	10%
Screening mammogram, both breasts one side CPT 77067 MAMMO UNI SCREENING LT	$359.10	$399.00	$82.11–$399.00	90% above	10%
Screening mammogram, both breasts inpatient CPT 77067 MAMMOGRAPHY, SCREENING	$359.10	$399.00	$82.11–$399.00	—	10%
Screening mammogram, both breasts inpatient one side CPT 77067 MAMMO UNI SCREENING RT	$359.10	$399.00	$82.11–$399.00	—	10%
Screening mammogram, both breasts inpatient one side CPT 77067 MAMMO UNI SCREENING LT	$359.10	$399.00	$82.11–$399.00	—	10%
Shoulder X-ray, complete, 2 or more views CPT 73030 NPO R SHOULDER 2V	$297.90	$331.00	$122.31–$306.51	32% above	10%
Shoulder X-ray, complete, 2 or more views CPT 73030 NPO L SHOULDER2V	$297.90	$331.00	$122.31–$306.51	32% above	10%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER COMP-RT-MIN 2V	$297.90	$331.00	$122.31–$306.51	32% above	10%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER COMP-LT-MIN 2V	$297.90	$331.00	$122.31–$306.51	32% above	10%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 NPO L SHOULDER2V	$297.90	$331.00	$122.31–$306.51	—	10%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 NPO R SHOULDER 2V	$297.90	$331.00	$122.31–$306.51	—	10%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 SHOULDER COMP-LT-MIN 2V	$297.90	$331.00	$122.31–$306.51	—	10%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 SHOULDER COMP-RT-MIN 2V	$297.90	$331.00	$122.31–$306.51	—	10%
Transvaginal pelvic ultrasound CPT 76830 US PELVIS TRANSVAGINAL	$506.70	$563.00	$242.77–$521.34	144% above	10%
Transvaginal pelvic ultrasound inpatient CPT 76830 US PELVIS TRANSVAGINAL	$506.70	$563.00	$242.77–$521.34	—	10%
Transvaginal ultrasound during pregnancy CPT 76817 US OB TRANSVAGINAL	$443.70	$493.00	$212.58–$456.52	120% above	10%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US OB TRANSVAGINAL	$443.70	$493.00	$212.58–$456.52	—	10%
Ultrasound of the abdomen, complete CPT 76700 US ABD COMPLETE	$772.20	$858.00	$369.97–$794.51	6% above	10%
Ultrasound of the abdomen, complete inpatient CPT 76700 US ABD COMPLETE	$772.20	$858.00	$369.97–$794.51	—	10%
Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM/TESTES	$594.00	$660.00	$284.59–$611.16	73% above	10%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM/TESTES	$594.00	$660.00	$284.59–$611.16	—	10%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US THYROID	$548.10	$609.00	$262.60–$563.93	179% above	10%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US NECK & HEAD	$548.10	$609.00	$262.60–$563.93	179% above	10%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US THYROID	$548.10	$609.00	$262.60–$563.93	—	10%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US NECK & HEAD	$548.10	$609.00	$262.60–$563.93	—	10%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US LT EXTREMITY STUDY UNI/LIM	$646.20	$718.00	$309.60–$664.87	3% above	10%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US RT EXTREMITY STUDY UNI/LIM	$646.20	$718.00	$309.60–$664.87	3% above	10%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US RT EXTREMITY STUDY UNI/LIM	$646.20	$718.00	$309.60–$664.87	—	10%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US LT EXTREMITY STUDY UNI/LIM	$646.20	$718.00	$309.60–$664.87	—	10%
Wrist X-ray, complete, 3 or more views CPT 73110 NPO L WRIST 3V	$266.40	$296.00	$127.64–$274.10	at median	10%
Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST-COMP RT-MIN 3V	$266.40	$296.00	$127.64–$274.10	at median	10%
Wrist X-ray, complete, 3 or more views one side CPT 73110 NPO RT WRIST 3V	$266.40	$296.00	$127.64–$274.10	at median	10%
Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST-COMP LT-MIN 3V	$266.40	$296.00	$127.64–$274.10	at median	10%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 NPO L WRIST 3V	$266.40	$296.00	$127.64–$274.10	—	10%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 NPO RT WRIST 3V	$266.40	$296.00	$127.64–$274.10	—	10%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 WRIST-COMP LT-MIN 3V	$266.40	$296.00	$127.64–$274.10	—	10%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 WRIST-COMP RT-MIN 3V	$266.40	$296.00	$127.64–$274.10	—	10%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 NPO R HIP 2-3V	$255.60	$284.00	$122.46–$262.98	20% above	10%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 NPO L HIP 2-3V	$255.60	$284.00	$122.46–$262.98	20% above	10%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP, 2-3V, LT	$255.60	$284.00	$122.46–$262.98	20% above	10%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP, 2-3V, RT	$255.60	$284.00	$122.46–$262.98	20% above	10%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 NPO R HIP 2-3V	$255.60	$284.00	$122.46–$262.98	—	10%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 NPO L HIP 2-3V	$255.60	$284.00	$122.46–$262.98	—	10%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP, 2-3V, LT	$255.60	$284.00	$122.46–$262.98	—	10%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP, 2-3V, RT	$255.60	$284.00	$122.46–$262.98	—	10%
X-ray of the abdomen, 1 view CPT 74018 KUB, SCOUT FILM OR ABDOMEN 1	$233.10	$259.00	$111.17–$239.83	8% above	10%
X-ray of the abdomen, 1 view CPT 74018 ABDOMEN 1V, KUB, SCOUT FILM	$233.10	$259.00	$111.17–$239.83	8% above	10%
X-ray of the abdomen, 1 view inpatient CPT 74018 KUB, SCOUT FILM OR ABDOMEN 1	$233.10	$259.00	$111.17–$239.83	—	10%
X-ray of the abdomen, 1 view inpatient CPT 74018 ABDOMEN 1V, KUB, SCOUT FILM	$233.10	$259.00	$111.17–$239.83	—	10%
X-ray of the ankle, 2 views CPT 73600 NPO R ANKLE 2V	$235.80	$262.00	$111.35–$242.61	14% above	10%
X-ray of the ankle, 2 views CPT 73600 NPO L ANKLE 2V	$235.80	$262.00	$111.35–$242.61	14% above	10%
X-ray of the ankle, 2 views one side CPT 73600 ANKLE, 2V, LT	$235.80	$262.00	$111.35–$242.61	14% above	10%
X-ray of the ankle, 2 views one side CPT 73600 ANKLE, 2V, RT	$235.80	$262.00	$111.35–$242.61	14% above	10%
X-ray of the ankle, 2 views inpatient CPT 73600 NPO L ANKLE 2V	$235.80	$262.00	$111.35–$242.61	—	10%
X-ray of the ankle, 2 views inpatient CPT 73600 NPO R ANKLE 2V	$235.80	$262.00	$111.35–$242.61	—	10%
X-ray of the ankle, 2 views inpatient one side CPT 73600 ANKLE, 2V, RT	$235.80	$262.00	$111.35–$242.61	—	10%
X-ray of the ankle, 2 views inpatient one side CPT 73600 ANKLE, 2V, LT	$235.80	$262.00	$111.35–$242.61	—	10%
X-ray of the finger(s), 2 or more views CPT 73140 NPO FINGER(S) 2V	$233.10	$259.00	$111.68–$239.83	8% above	10%
X-ray of the finger(s), 2 or more views one side CPT 73140 FINGER, LT 4TH DIGIT	$233.10	$259.00	$111.68–$239.83	8% above	10%
X-ray of the finger(s), 2 or more views one side CPT 73140 FINGER, LT THUMB	$233.10	$259.00	$111.68–$239.83	8% above	10%
X-ray of the finger(s), 2 or more views one side CPT 73140 FINGER, LT 2ND DIGIT	$233.10	$259.00	$111.68–$239.83	8% above	10%
X-ray of the finger(s), 2 or more views one side CPT 73140 FINGER, LT 3RD DIGIT	$233.10	$259.00	$111.68–$239.83	8% above	10%
X-ray of the finger(s), 2 or more views one side CPT 73140 FINGER, LT 5TH DIGIT	$233.10	$259.00	$111.68–$239.83	8% above	10%
X-ray of the finger(s), 2 or more views one side CPT 73140 FINGER, RT THUMB	$233.10	$259.00	$111.68–$239.83	8% above	10%
X-ray of the finger(s), 2 or more views one side CPT 73140 FINGER, RT 2ND DIGIT	$233.10	$259.00	$111.68–$239.83	8% above	10%
X-ray of the finger(s), 2 or more views one side CPT 73140 FINGER, RT 3RD DIGIT	$233.10	$259.00	$111.68–$239.83	8% above	10%
X-ray of the finger(s), 2 or more views one side CPT 73140 FINGER, RT 4TH DIGIT	$233.10	$259.00	$111.68–$239.83	8% above	10%
X-ray of the finger(s), 2 or more views one side CPT 73140 FINGER, RT 5TH DIGIT	$233.10	$259.00	$111.68–$239.83	8% above	10%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 NPO FINGER(S) 2V	$233.10	$259.00	$111.68–$239.83	—	10%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 FINGER, RT 3RD DIGIT	$233.10	$259.00	$111.68–$239.83	—	10%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 FINGER, RT 2ND DIGIT	$233.10	$259.00	$111.68–$239.83	—	10%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 FINGER, RT 4TH DIGIT	$233.10	$259.00	$111.68–$239.83	—	10%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 FINGER, RT 5TH DIGIT	$233.10	$259.00	$111.68–$239.83	—	10%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 FINGER, LT 5TH DIGIT	$233.10	$259.00	$111.68–$239.83	—	10%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 FINGER, LT 4TH DIGIT	$233.10	$259.00	$111.68–$239.83	—	10%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 FINGER, LT 3RD DIGIT	$233.10	$259.00	$111.68–$239.83	—	10%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 FINGER, LT 2ND DIGIT	$233.10	$259.00	$111.68–$239.83	—	10%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 FINGER, LT THUMB	$233.10	$259.00	$111.68–$239.83	—	10%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 FINGER, RT THUMB	$233.10	$259.00	$111.68–$239.83	—	10%
X-ray of the foot, 2 views CPT 73620 NPO R FOOT 2V	$228.60	$254.00	$106.99–$235.20	11% above	10%
X-ray of the foot, 2 views CPT 73620 NPO L FOOT 2V	$228.60	$254.00	$106.99–$235.20	11% above	10%
X-ray of the foot, 2 views one side CPT 73620 FOOT, 2V, RT	$228.60	$254.00	$106.99–$235.20	11% above	10%
X-ray of the foot, 2 views one side CPT 73620 FOOT, 2V, LT	$228.60	$254.00	$106.99–$235.20	11% above	10%
X-ray of the foot, 2 views inpatient CPT 73620 NPO L FOOT 2V	$228.60	$254.00	$106.99–$235.20	—	10%
X-ray of the foot, 2 views inpatient CPT 73620 NPO R FOOT 2V	$228.60	$254.00	$106.99–$235.20	—	10%
X-ray of the foot, 2 views inpatient one side CPT 73620 FOOT, 2V, RT	$228.60	$254.00	$106.99–$235.20	—	10%
X-ray of the foot, 2 views inpatient one side CPT 73620 FOOT, 2V, LT	$228.60	$254.00	$106.99–$235.20	—	10%
X-ray of the foot, complete, 3 or more views CPT 73630 NPO L FOOT 3V	$261.90	$291.00	$125.48–$269.47	16% above	10%
X-ray of the foot, complete, 3 or more views CPT 73630 NPO R FOOT 3V	$261.90	$291.00	$125.48–$269.47	16% above	10%
X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT COMP-MIN 3V-LT	$261.90	$291.00	$125.48–$269.47	16% above	10%
X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT COMP-MIN 3V-RT	$261.90	$291.00	$125.48–$269.47	16% above	10%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 NPO R FOOT 3V	$261.90	$291.00	$125.48–$269.47	—	10%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 NPO L FOOT 3V	$261.90	$291.00	$125.48–$269.47	—	10%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 FOOT COMP-MIN 3V-LT	$261.90	$291.00	$125.48–$269.47	—	10%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 FOOT COMP-MIN 3V-RT	$261.90	$291.00	$125.48–$269.47	—	10%
X-ray of the hand, 3 or more views CPT 73130 NPO R HAND 3V	$276.30	$307.00	$131.03–$284.28	28% above	10%
X-ray of the hand, 3 or more views CPT 73130 NPO L HAND 3V	$276.30	$307.00	$131.03–$284.28	28% above	10%
X-ray of the hand, 3 or more views one side CPT 73130 HAND, 4V, RT	$276.30	$307.00	$131.03–$284.28	28% above	10%
X-ray of the hand, 3 or more views one side CPT 73130 HAND, 4V, LT	$276.30	$307.00	$131.03–$284.28	28% above	10%
X-ray of the hand, 3 or more views inpatient CPT 73130 NPO R HAND 3V	$276.30	$307.00	$131.03–$284.28	—	10%
X-ray of the hand, 3 or more views inpatient CPT 73130 NPO L HAND 3V	$276.30	$307.00	$131.03–$284.28	—	10%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 HAND, 4V, RT	$276.30	$307.00	$131.03–$284.28	—	10%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 HAND, 4V, LT	$276.30	$307.00	$131.03–$284.28	—	10%
X-ray of the knee, 1 or 2 views CPT 73560 NPO R KNEE 1-2V	$228.60	$254.00	$109.52–$235.20	2% above	10%
X-ray of the knee, 1 or 2 views CPT 73560 NPO L KNEE 1-2V	$228.60	$254.00	$109.52–$235.20	2% above	10%
X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE, 1 OR 2V, LT	$228.60	$254.00	$109.52–$235.20	2% above	10%
X-ray of the knee, 1 or 2 views one side CPT 73560 PATELLA-RT-1 OR 2V	$228.60	$254.00	$109.52–$235.20	2% above	10%
X-ray of the knee, 1 or 2 views one side CPT 73560 PATELLA-LT-1 OR 2V	$228.60	$254.00	$109.52–$235.20	2% above	10%
X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE, 1 OR 2V, RT	$228.60	$254.00	$109.52–$235.20	2% above	10%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 NPO L KNEE 1-2V	$228.60	$254.00	$109.52–$235.20	—	10%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 NPO R KNEE 1-2V	$228.60	$254.00	$109.52–$235.20	—	10%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 PATELLA-LT-1 OR 2V	$228.60	$254.00	$109.52–$235.20	—	10%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 KNEE, 1 OR 2V, RT	$228.60	$254.00	$109.52–$235.20	—	10%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 PATELLA-RT-1 OR 2V	$228.60	$254.00	$109.52–$235.20	—	10%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 KNEE, 1 OR 2V, LT	$228.60	$254.00	$109.52–$235.20	—	10%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 LUMBAR SPINE, 2 OR 3 VIEWS	$395.10	$439.00	$163.78–$406.51	50% above	10%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 NPO LS SPINE 2-3V	$395.10	$439.00	$163.78–$406.51	50% above	10%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 LUMBAR SPINE, 2 OR 3 VIEWS	$395.10	$439.00	$163.78–$406.51	—	10%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 NPO LS SPINE 2-3V	$395.10	$439.00	$163.78–$406.51	—	10%
X-ray of the lower back, 4 or more views CPT 72110 LUMBAR SPINE, MIN 4V	$550.80	$612.00	$229.30–$566.71	71% above	10%
X-ray of the lower back, 4 or more views inpatient CPT 72110 LUMBAR SPINE, MIN 4V	$550.80	$612.00	$229.30–$566.71	—	10%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 NPO THORACIC SPINE 2V	$345.60	$384.00	$135.39–$355.58	44% above	10%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 THORACIC SPINE, 2V	$345.60	$384.00	$135.39–$355.58	44% above	10%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 NPO THORACIC SPINE 2V	$345.60	$384.00	$135.39–$355.58	—	10%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 THORACIC SPINE, 2V	$345.60	$384.00	$135.39–$355.58	—	10%
X-ray of the nasal bones, 3 or more views CPT 70160 NASAL BONES-MIN 3V	$228.60	$254.00	$109.52–$235.20	18% below	10%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 NASAL BONES-MIN 3V	$228.60	$254.00	$109.52–$235.20	—	10%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 NPO C-SPINE 2-3V	$344.70	$383.00	$152.88–$354.66	22% above	10%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 CERVICAL SPINE, 2-3V	$344.70	$383.00	$152.88–$354.66	22% above	10%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 NPO C-SPINE 2-3V	$344.70	$383.00	$152.88–$354.66	—	10%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 CERVICAL SPINE, 2-3V	$344.70	$383.00	$152.88–$354.66	—	10%
X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS, AP, 1 OR 2V	$297.90	$331.00	$102.63–$306.51	43% above	10%
X-ray of the pelvis, 1 or 2 views CPT 72170 NPO PELVIS 1-2V	$297.90	$331.00	$102.63–$306.51	43% above	10%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PELVIS, AP, 1 OR 2V	$297.90	$331.00	$102.63–$306.51	—	10%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 NPO PELVIS 1-2V	$297.90	$331.00	$102.63–$306.51	—	10%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 SACRUM	$273.60	$304.00	$124.49–$281.50	4% above	10%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 COCCYX	$273.60	$304.00	$124.49–$281.50	4% above	10%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 SACRUM-COCCYX COMB-MIN 2V	$320.40	$356.00	$124.49–$329.66	22% above	10%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 SACRUM	$273.60	$304.00	$124.49–$281.50	—	10%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 COCCYX	$273.60	$304.00	$124.49–$281.50	—	10%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 SACRUM-COCCYX COMB-MIN 2V	$320.40	$356.00	$124.49–$329.66	—	10%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Maine	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALT/SGPT	$45.90	$51.00	$21.99–$47.23	40% above	10%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALT/SGPT	$45.90	$51.00	$21.99–$47.23	—	10%
AST (aspartate aminotransferase) enzyme test CPT 84450 AST/SGOT	$45.90	$51.00	$21.99–$47.23	56% above	10%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 AST/SGOT	$45.90	$51.00	$21.99–$47.23	—	10%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE HEPATITIS PANEL (IGM)	$272.70	$303.00	$130.65–$303.00	81% above	10%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HEPATITIS PANEL - COMPLETE	$272.70	$303.00	$130.65–$303.00	81% above	10%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 ACUTE HEPATITIS PANEL (IGM)	$272.70	$303.00	$130.65–$303.00	—	10%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HEPATITIS PANEL - COMPLETE	$272.70	$303.00	$130.65–$303.00	—	10%
Allergy blood test, specific IgE, per allergen CPT 86003 RAST Panel	$13.50	$15.00	$6.47–$15.00	29% below	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Fruit IGE	$35.10	$39.00	$16.82–$39.00	84% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergy Panel 13 Stinging	$171.90	$191.00	$42.45–$176.87	801% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 FOOD ALLERGY PROFILE	$207.00	$230.00	$42.45–$212.98	985% above	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RAST Panel	$13.50	$15.00	$6.47–$15.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Fruit IGE	$35.10	$39.00	$16.82–$39.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergy Panel 13 Stinging	$171.90	$191.00	$42.45–$176.87	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 FOOD ALLERGY PROFILE	$207.00	$230.00	$42.45–$212.98	—	10%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CITRULLINE PEPTIDE AB (CCP)	$158.40	$176.00	$75.89–$162.98	136% above	10%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CITRULLINE PEPTIDE AB (CCP)	$158.40	$176.00	$75.89–$162.98	—	10%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA to (QD)	$60.30	$67.00	$28.89–$67.00	28% above	10%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA	$67.50	$75.00	$32.34–$75.00	43% above	10%
Antinuclear antibody (ANA) blood test, screen CPT 86038 CENTROMERE AB	$78.30	$87.00	$37.51–$87.00	66% above	10%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA to (QD)	$60.30	$67.00	$28.89–$67.00	—	10%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA	$67.50	$75.00	$32.34–$75.00	—	10%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 CENTROMERE AB	$78.30	$87.00	$37.51–$87.00	—	10%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NT-PRO BNP	$198.00	$220.00	$94.86–$220.00	61% above	10%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 BNP - B-TYPE NATRIURETIC PEPTI	$216.00	$240.00	$103.49–$240.00	76% above	10%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NT-PRO BNP	$198.00	$220.00	$94.86–$220.00	—	10%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 BNP - B-TYPE NATRIURETIC PEPTI	$216.00	$240.00	$103.49–$240.00	—	10%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL	$97.20	$108.00	$46.57–$100.01	21% above	10%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL	$97.20	$108.00	$46.57–$100.01	—	10%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO-SURGICAL BX - 88305	$113.40	$126.00	$64.95–$116.68	21% below	10%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO-SURGICAL BX - 88305	$113.40	$126.00	$64.95–$116.68	—	10%
Blood culture for bacteria CPT 87040 CULTURE BLOOD	$111.60	$124.00	$53.47–$114.82	27% above	10%
Blood culture for bacteria inpatient CPT 87040 CULTURE BLOOD	$111.60	$124.00	$53.47–$114.82	—	10%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE	$12.60	$14.00	$6.04–$6.16	2% above	10%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 ROUTINE VENIPUNCTURE	$12.60	$14.00	$6.04–$6.16	2% above	10%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE	$12.60	$14.00	$6.04–$6.16	—	10%
Blood glucose (sugar) test CPT 82947 Glucose Quantitative- Blood	$22.50	$25.00	$10.78–$25.00	3% below	10%
Blood glucose (sugar) test inpatient CPT 82947 Glucose Quantitative- Blood	$22.50	$25.00	$10.78–$25.00	—	10%
Blood lead test CPT 83655 LEAD, RANDOM URINE	$23.40	$26.00	$11.21–$26.00	47% below	10%
Blood lead test CPT 83655 LEAD	$29.70	$33.00	$14.23–$33.00	32% below	10%
Blood lead test CPT 83655 LEAD (STATE)	$50.40	$56.00	$24.15–$56.00	15% above	10%
Blood lead test inpatient CPT 83655 LEAD, RANDOM URINE	$23.40	$26.00	$11.21–$26.00	—	10%
Blood lead test inpatient CPT 83655 LEAD	$29.70	$33.00	$14.23–$33.00	—	10%
Blood lead test inpatient CPT 83655 LEAD (STATE)	$50.40	$56.00	$24.15–$56.00	—	10%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 PREGNANCY TEST QUALITATIVE	$41.40	$46.00	$19.84–$46.00	at median	10%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 PREGNANCY TEST QUALITATIVE	$41.40	$46.00	$19.84–$46.00	—	10%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO GROUP	$25.20	$28.00	$12.07–$25.93	49% below	10%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO GROUP	$25.20	$28.00	$12.07–$25.93	—	10%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 CR-P to (QD)	$30.60	$34.00	$14.66–$34.00	14% below	10%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 CR-P to (QD)	$30.60	$34.00	$14.66–$34.00	—	10%
C. difficile toxin gene test (stool PCR) CPT 87493 C. DIFFICILE, TOXIN B, BY PCR	$178.20	$198.00	$85.38–$198.00	101% above	10%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C. DIFFICILE, TOXIN B, BY PCR	$178.20	$198.00	$85.38–$198.00	—	10%
CA 19-9 blood test (tumor marker) CPT 86301 CA 19-9	$128.70	$143.00	$61.66–$143.00	191% above	10%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA 19-9	$128.70	$143.00	$61.66–$143.00	—	10%
CA-125 blood test (ovarian cancer marker) CPT 86304 CA 125 (OA 125)	$128.70	$143.00	$61.66–$143.00	50% above	10%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA 125 (OA 125)	$128.70	$143.00	$61.66–$143.00	—	10%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia Trachom, amp probe	$101.70	$113.00	$48.73–$113.00	52% above	10%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia Trachom, amp probe	$101.70	$113.00	$48.73–$113.00	—	10%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL	$84.60	$94.00	$40.53–$94.00	22% above	10%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL	$84.60	$94.00	$40.53–$94.00	—	10%
Complete blood count (CBC) with differential CPT 85025 CBC - AUTO DIFF	$55.80	$62.00	$26.73–$62.00	32% above	10%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC - AUTO DIFF	$55.80	$62.00	$26.73–$62.00	—	10%
Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL	$168.30	$187.00	$80.63–$173.16	50% above	10%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL	$168.30	$187.00	$80.63–$173.16	—	10%
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA-SULFATE	$234.00	$260.00	$112.11–$240.76	173% above	10%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA-SULFATE	$234.00	$260.00	$112.11–$240.76	—	10%
Estradiol blood test CPT 82670 ESTRADIOL	$159.30	$177.00	$76.32–$177.00	63% above	10%
Estradiol blood test inpatient CPT 82670 ESTRADIOL	$159.30	$177.00	$76.32–$177.00	—	10%
FSH (follicle-stimulating hormone) test CPT 83001 FSH	$131.40	$146.00	$62.96–$146.00	66% above	10%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH	$131.40	$146.00	$62.96–$146.00	—	10%
Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN, STOOL	$236.70	$263.00	$113.41–$243.54	55% above	10%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CALPROTECTIN, STOOL	$236.70	$263.00	$113.41–$243.54	—	10%
Ferritin blood test (iron stores) CPT 82728 FERRITIN	$70.20	$78.00	$33.63–$78.00	1% above	10%
Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN	$70.20	$78.00	$33.63–$78.00	—	10%
Folate (folic acid) blood test CPT 82746 FOLIC ACID SERUM	$37.80	$42.00	$18.11–$42.00	45% below	10%
Folate (folic acid) blood test inpatient CPT 82746 FOLIC ACID SERUM	$37.80	$42.00	$18.11–$42.00	—	10%
Free T3 thyroid hormone test CPT 84481 FREE T3	$160.20	$178.00	$76.75–$164.83	111% above	10%
Free T3 thyroid hormone test inpatient CPT 84481 FREE T3	$160.20	$178.00	$76.75–$164.83	—	10%
Free T4 (free thyroxine) thyroid blood test CPT 84439 FREE T4	$37.80	$42.00	$18.11–$42.00	31% below	10%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 FREE T4	$37.80	$42.00	$18.11–$42.00	—	10%
Free testosterone test CPT 84402 TESTOSTERONE, FREE	$131.40	$146.00	$62.96–$146.00	58% above	10%
Free testosterone test inpatient CPT 84402 TESTOSTERONE, FREE	$131.40	$146.00	$62.96–$146.00	—	10%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GTT - 1 HOUR SCREEN WITHOUT FB	$36.90	$41.00	$17.68–$38.60	1% above	10%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GTT-1,2hr Gestational 1 specim	$36.90	$41.00	$17.68–$38.60	1% above	10%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GTT-1,2hr Gestational 1 specim	$36.90	$41.00	$17.68–$38.60	—	10%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GTT - 1 HOUR SCREEN WITHOUT FB	$36.90	$41.00	$17.68–$38.60	—	10%
Glucose tolerance test, 3 samples CPT 82951 GESTATIONAL GTT (3 HOUR)	$89.10	$99.00	$42.69–$99.00	39% above	10%
Glucose tolerance test, 3 samples CPT 82951 GTT - 2 HOUR NON-GESTATIONAL	$102.60	$114.00	$49.16–$105.56	60% above	10%
Glucose tolerance test, 3 samples inpatient CPT 82951 GESTATIONAL GTT (3 HOUR)	$89.10	$99.00	$42.69–$99.00	—	10%
Glucose tolerance test, 3 samples inpatient CPT 82951 GTT - 2 HOUR NON-GESTATIONAL	$102.60	$114.00	$49.16–$105.56	—	10%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Neisseria Gonorrhoeae, amp pro	$101.70	$113.00	$48.73–$113.00	86% above	10%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Neisseria Gonorrhoeae, amp pro	$101.70	$113.00	$48.73–$113.00	—	10%
H. pylori stool antigen test CPT 87338 H. PYLORI STOOL ANTIGEN, EIA	$163.80	$182.00	$78.48–$168.53	42% above	10%
H. pylori stool antigen test inpatient CPT 87338 H. PYLORI STOOL ANTIGEN, EIA	$163.80	$182.00	$78.48–$168.53	—	10%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 RNA, QUANT. PCR	$418.50	$465.00	$200.51–$457.04	122% above	10%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV-1 RNA, QUANT. PCR	$418.50	$465.00	$200.51–$457.04	—	10%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV - DIAGNOSTIC (1&2) EIA	$57.60	$64.00	$27.60–$64.00	51% above	10%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV - DIAGNOSTIC (1&2) EIA	$57.60	$64.00	$27.60–$64.00	—	10%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV DNA ASSAY, HI RISK 87624	$71.10	$79.00	$34.06–$79.00	at median	10%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV DNA ASSAY, HI RISK 87624	$71.10	$79.00	$34.06–$79.00	—	10%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1c Glycosylated	$89.10	$99.00	$42.69–$91.67	120% above	10%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1c with eAG	$89.10	$99.00	$42.69–$91.67	120% above	10%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hemoglobin A1c Glycosylated	$89.10	$99.00	$42.69–$91.67	—	10%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hemoglobin A1c with eAG	$89.10	$99.00	$42.69–$91.67	—	10%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS BSAb - Immune Status	$50.40	$56.00	$24.15–$56.00	14% above	10%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS BSAb - Immune Status	$50.40	$56.00	$24.15–$56.00	—	10%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS BSAg EIA	$59.40	$66.00	$28.46–$66.00	27% above	10%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS BSAg EIA	$59.40	$66.00	$28.46–$66.00	—	10%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ANTIBODY SCREENING	$92.70	$103.00	$44.41–$95.38	36% above	10%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C ANTIBODY SCREENING	$92.70	$103.00	$44.41–$95.38	—	10%
Hepatitis C viral load (HCV RNA) test CPT 87522 HEP C RNA BY PCR VIRAL LOAD QT	$316.80	$352.00	$151.78–$348.37	84% above	10%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEP C RNA BY PCR VIRAL LOAD QT	$316.80	$352.00	$151.78–$348.37	—	10%
Herpes blood test, HSV-1 antibody CPT 86695 HSV 1 - IgG	$81.90	$91.00	$39.24–$91.00	76% above	10%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HSV 1 - IgG	$81.90	$91.00	$39.24–$91.00	—	10%
Herpes blood test, HSV-2 antibody CPT 86696 HSV 2 - IgG	$118.80	$132.00	$56.92–$132.00	91% above	10%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HSV 2 - IgG	$118.80	$132.00	$56.92–$132.00	—	10%
High-sensitivity CRP (hs-CRP) test CPT 86141 CRPHS	$43.20	$48.00	$20.70–$48.00	12% below	10%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 CRPHS	$43.20	$48.00	$20.70–$48.00	—	10%
Homocysteine blood test CPT 83090 HOMOCYSTEINE	$122.40	$136.00	$58.64–$136.00	82% above	10%
Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINE	$122.40	$136.00	$58.64–$136.00	—	10%
Insulin blood test CPT 83525 INSULIN TOTAL	$101.70	$113.00	$48.73–$104.64	106% above	10%
Insulin blood test inpatient CPT 83525 INSULIN TOTAL	$101.70	$113.00	$48.73–$104.64	—	10%
Iron blood test (serum iron) CPT 83540 IRON	$39.60	$44.00	$18.97–$44.00	22% above	10%
Iron blood test (serum iron) inpatient CPT 83540 IRON	$39.60	$44.00	$18.97–$44.00	—	10%
Iron-binding capacity (TIBC) test CPT 83550 IRON/IRON BINDING CAPACITY	$50.40	$56.00	$24.15–$56.00	30% above	10%
Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON/IRON BINDING CAPACITY	$50.40	$56.00	$24.15–$56.00	—	10%
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL	$109.80	$122.00	$52.61–$112.97	64% above	10%
Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL	$109.80	$122.00	$52.61–$112.97	—	10%
LH (luteinizing hormone) test CPT 83002 LH	$70.20	$78.00	$33.63–$78.00	15% below	10%
LH (luteinizing hormone) test inpatient CPT 83002 LH	$70.20	$78.00	$33.63–$78.00	—	10%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE	$63.90	$71.00	$30.62–$65.75	45% above	10%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE	$63.90	$71.00	$30.62–$65.75	—	10%
Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL	$90.90	$101.00	$43.55–$93.53	9% above	10%
Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL	$90.90	$101.00	$43.55–$93.53	—	10%
Lyme disease antibody test CPT 86618 LYME AB - SCREENING	$102.60	$114.00	$49.16–$114.00	43% above	10%
Lyme disease antibody test inpatient CPT 86618 LYME AB - SCREENING	$102.60	$114.00	$49.16–$114.00	—	10%
Magnesium blood test CPT 83735 MAGNESIUM	$37.80	$42.00	$18.11–$42.00	6% below	10%
Magnesium blood test CPT 83735 MAGNESIUM - RBC	$41.40	$46.00	$19.84–$46.00	3% above	10%
Magnesium blood test CPT 83735 MAGNESIUM, 24 HR URINE	$54.00	$60.00	$25.87–$55.56	35% above	10%
Magnesium blood test CPT 83735 MAGNESIUM, URINE WITH CREATINI	$197.10	$219.00	$54.48–$202.79	392% above	10%
Magnesium blood test inpatient CPT 83735 MAGNESIUM	$37.80	$42.00	$18.11–$42.00	—	10%
Magnesium blood test inpatient CPT 83735 MAGNESIUM - RBC	$41.40	$46.00	$19.84–$46.00	—	10%
Magnesium blood test inpatient CPT 83735 MAGNESIUM, 24 HR URINE	$54.00	$60.00	$25.87–$55.56	—	10%
Magnesium blood test inpatient CPT 83735 MAGNESIUM, URINE WITH CREATINI	$197.10	$219.00	$54.48–$202.79	—	10%
Measles (rubeola) antibody test CPT 86765 RUBEOLA IgG (Immune)	$27.00	$30.00	$12.94–$30.00	15% below	10%
Measles (rubeola) antibody test CPT 86765 RUBEOLA IgM	$194.40	$216.00	$93.14–$200.02	511% above	10%
Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA IgG (Immune)	$27.00	$30.00	$12.94–$30.00	—	10%
Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA IgM	$194.40	$216.00	$93.14–$200.02	—	10%
Mono test (heterophile antibody, Monospot) CPT 86308 MONOTEST	$37.80	$42.00	$18.11–$42.00	9% above	10%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONOTEST	$37.80	$42.00	$18.11–$42.00	—	10%
PSA (prostate-specific antigen) blood test, free CPT 84154 FREE & TOTAL PSA	$56.70	$63.00	$27.17–$63.00	36% below	10%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 FREE & TOTAL PSA	$56.70	$63.00	$27.17–$63.00	—	10%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA DIAGNOSTIC	$70.20	$78.00	$33.63–$78.00	16% above	10%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA, REFLEX TO FREE PSA	$73.80	$82.00	$35.36–$82.00	22% above	10%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA REFLEX T0 FREE	$88.20	$98.00	$42.26–$98.00	45% above	10%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA DIAGNOSTIC	$70.20	$78.00	$33.63–$78.00	—	10%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA, REFLEX TO FREE PSA	$73.80	$82.00	$35.36–$82.00	—	10%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA REFLEX T0 FREE	$88.20	$98.00	$42.26–$98.00	—	10%
Pap test (liquid-based, automated screening with review) CPT 88175 PAP SMEAR THIN LAYER PREP	$58.50	$65.00	$28.03–$65.00	10% below	10%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 PAP SMEAR THIN LAYER PREP	$58.50	$65.00	$28.03–$65.00	—	10%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 SUREPATH PAP	$54.00	$60.00	$25.87–$60.00	20% below	10%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 SUREPATH PAP	$54.00	$60.00	$25.87–$60.00	—	10%
Parathyroid hormone (PTH) blood test CPT 83970 PTH INTACT	$214.20	$238.00	$102.63–$238.00	135% above	10%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH INTACT	$214.20	$238.00	$102.63–$238.00	—	10%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT	$55.80	$62.00	$26.73–$57.41	44% above	10%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT	$55.80	$62.00	$26.73–$57.41	—	10%
Progesterone blood test CPT 84144 PROGESTERONE	$147.60	$164.00	$70.72–$164.00	70% above	10%
Progesterone blood test inpatient CPT 84144 PROGESTERONE	$147.60	$164.00	$70.72–$164.00	—	10%
Prolactin blood test CPT 84146 PROLACTIN	$189.00	$210.00	$90.55–$194.46	157% above	10%
Prolactin blood test inpatient CPT 84146 PROLACTIN	$189.00	$210.00	$90.55–$194.46	—	10%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME / INR	$37.80	$42.00	$18.11–$38.89	35% above	10%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME/INR	$37.80	$42.00	$18.11–$38.89	35% above	10%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME / INR	$37.80	$42.00	$18.11–$38.89	—	10%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA A&B RAPID TEST	$48.60	$54.00	$23.28–$54.00	18% below	10%
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA A&B RAPID TEST	$48.60	$54.00	$23.28–$54.00	—	10%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREPTOCOCCUS GROUP A	$39.60	$44.00	$18.97–$44.00	at median	10%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREP SCREEN - RAPID ID + NEG	$48.60	$54.00	$23.28–$54.00	23% above	10%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 STREP SCREEN - RAPID ID + NEG	$48.60	$54.00	$23.28–$54.00	—	10%
Rheumatoid factor (RF) test CPT 86431 RF to (QD)	$30.60	$34.00	$14.66–$34.00	5% below	10%
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR, QUANT	$34.20	$38.00	$16.39–$38.00	7% above	10%
Rheumatoid factor (RF) test inpatient CPT 86431 RF to (QD)	$30.60	$34.00	$14.66–$34.00	—	10%
Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR, QUANT	$34.20	$38.00	$16.39–$38.00	—	10%
Rubella antibody test (immunity check) CPT 86762 RUBELLA IgG (IMMUNE)	$27.00	$30.00	$12.94–$30.00	26% below	10%
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA IgG (IMMUNE)	$27.00	$30.00	$12.94–$30.00	—	10%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 SEDRATE	$29.70	$33.00	$14.23–$30.56	4% below	10%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 SEDRATE	$29.70	$33.00	$14.23–$30.56	—	10%
Stool ova and parasites exam CPT 87177 STOOL CONCENTRATE & PERM SMEAR	$28.80	$32.00	$13.80–$32.00	9% below	10%
Stool ova and parasites exam inpatient CPT 87177 STOOL CONCENTRATE & PERM SMEAR	$28.80	$32.00	$13.80–$32.00	—	10%
Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLOOD-CA SCREEN	$20.70	$23.00	$9.92–$23.00	12% above	10%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 OCCULT BLOOD-CA SCREEN	$20.70	$23.00	$9.92–$23.00	—	10%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 DIAGNOSTIC iFOB	$60.30	$67.00	$28.89–$67.00	33% above	10%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 DIAGNOSTIC iFOB	$60.30	$67.00	$28.89–$67.00	—	10%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 VDRL Spinal Fluid Only	$25.20	$28.00	$12.07–$28.00	13% below	10%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR (RAPID PLASMIN REAGIN)	$28.80	$32.00	$13.80–$32.00	at median	10%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 VDRL Spinal Fluid Only	$25.20	$28.00	$12.07–$28.00	—	10%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR (RAPID PLASMIN REAGIN)	$28.80	$32.00	$13.80–$32.00	—	10%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QuantiFERON TB Gold(ONE TUBE)	$194.40	$216.00	$93.14–$216.00	82% above	10%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 QuantiFERON TB Gold(ONE TUBE)	$194.40	$216.00	$93.14–$216.00	—	10%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE, TOTAL - Male>/=	$108.90	$121.00	$52.18–$121.00	39% above	10%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE, TOTAL - Male<18	$108.90	$121.00	$52.18–$121.00	39% above	10%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE PANEL ADULT MALE	$762.30	$847.00	$210.00–$784.32	874% above	10%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE, TOTAL - Male<18	$108.90	$121.00	$52.18–$121.00	—	10%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE, TOTAL - Male>/=	$108.90	$121.00	$52.18–$121.00	—	10%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE PANEL ADULT MALE	$762.30	$847.00	$210.00–$784.32	—	10%
Thyroid peroxidase (TPO) antibody test CPT 86376 THYROID PEROXIDASE AB	$98.10	$109.00	$47.00–$109.00	33% above	10%
Thyroid peroxidase (TPO) antibody test CPT 86376 LIVER KIDNEY MICROSOMAL	$136.80	$152.00	$65.54–$140.75	85% above	10%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 THYROID PEROXIDASE AB	$98.10	$109.00	$47.00–$109.00	—	10%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 LIVER KIDNEY MICROSOMAL	$136.80	$152.00	$65.54–$140.75	—	10%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 REFLEX TSH	$70.20	$78.00	$33.63–$78.00	2% below	10%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH	$70.20	$78.00	$33.63–$78.00	2% below	10%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 REFLEX TSH	$70.20	$78.00	$33.63–$78.00	—	10%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH	$70.20	$78.00	$33.63–$78.00	—	10%
Trichomonas test (NAAT) CPT 87661 Trichomonas Vaginalis, amp pro	$101.70	$113.00	$48.73–$113.00	20% above	10%
Trichomonas test (NAAT) inpatient CPT 87661 Trichomonas Vaginalis, amp pro	$101.70	$113.00	$48.73–$113.00	—	10%
Uric acid blood test CPT 84550 URIC ACID (BLOOD)	$35.10	$39.00	$16.82–$36.71	23% above	10%
Uric acid blood test inpatient CPT 84550 URIC ACID (BLOOD)	$35.10	$39.00	$16.82–$36.71	—	10%
Urinalysis with microscope exam, automated CPT 81001 Urinalysis w/ Microscopic	$32.40	$36.00	$15.52–$33.34	4% below	10%
Urinalysis with microscope exam, automated inpatient CPT 81001 Urinalysis w/ Microscopic	$32.40	$36.00	$15.52–$33.34	—	10%
Urinalysis with microscope exam, manual CPT 81000 UA	$23.40	$26.00	$11.21–$25.79	at median	10%
Urinalysis without microscope exam, automated CPT 81003 Urinalysis w/o Microscopic	$20.70	$23.00	$9.92–$21.30	9% above	10%
Urinalysis without microscope exam, automated CPT 81003 UA AUTOMATED WO MICROSCOPY	$20.70	$23.00	$9.92–$21.30	9% above	10%
Urinalysis without microscope exam, automated CPT 81003 Urine Screen	$20.70	$23.00	$9.92–$21.30	9% above	10%
Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis w/o Microscopic	$20.70	$23.00	$9.92–$21.30	—	10%
Urinalysis without microscope exam, automated inpatient CPT 81003 UA AUTOMATED WO MICROSCOPY	$20.70	$23.00	$9.92–$21.30	—	10%
Urinalysis without microscope exam, automated inpatient CPT 81003 Urine Screen	$20.70	$23.00	$9.92–$21.30	—	10%
Urinalysis without microscope exam, manual CPT 81002 SPECIFIC GRAVITY	$15.30	$17.00	$7.33–$17.00	3% below	10%
Urinalysis without microscope exam, manual inpatient CPT 81002 SPECIFIC GRAVITY	$15.30	$17.00	$7.33–$17.00	—	10%
Urine culture for bacteria, with colony count CPT 87086 CULTURE URINE	$53.10	$59.00	$25.44–$59.00	9% below	10%
Urine culture for bacteria, with colony count inpatient CPT 87086 CULTURE URINE	$53.10	$59.00	$25.44–$59.00	—	10%
Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY TEST	$25.20	$28.00	$12.07–$28.00	10% below	10%
Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B12	$37.80	$42.00	$18.11–$42.00	53% below	10%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B12	$37.80	$42.00	$18.11–$42.00	—	10%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25 HYDROXY	$140.40	$156.00	$67.27–$156.00	39% above	10%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D 25 HYDROXY	$140.40	$156.00	$67.27–$156.00	—	10%
Zinc blood test CPT 84630 ZINC	$87.30	$97.00	$41.83–$92.63	136% above	10%
Zinc blood test inpatient CPT 84630 ZINC	$87.30	$97.00	$41.83–$92.63	—	10%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG -TUMOR MARKER	$51.30	$57.00	$24.58–$57.00	22% below	10%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG SERUM QUANTITATIVE	$74.70	$83.00	$35.79–$83.00	13% above	10%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCG -TUMOR MARKER	$51.30	$57.00	$24.58–$57.00	—	10%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCG SERUM QUANTITATIVE	$74.70	$83.00	$35.79–$83.00	—	10%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Maine	Off list
Appendectomy for a ruptured appendix with abscess or peritonitis CPT 44960 APPENDECTOMY PERFORATED	$2,278.80	$2,532.00	$856.70–$2,344.63	at median	10%
Appendectomy, open surgery CPT 44950 APPENDECTOMY	$1,917.90	$2,131.00	$629.72–$1,973.31	13% above	10%
Arthroscopic ACL reconstruction or repair of the knee CPT 29888 ARTHROSCOPIC LIGAMENT REPAIR	$4,938.30	$5,487.00	$933.47–$5,080.96	75% above	10%
Arthroscopic ACL reconstruction or repair of the knee inpatient CPT 29888 ARTHROSCOPIC LIGAMENT REPAIR	$4,938.30	$5,487.00	$933.47–$5,080.96	—	10%
Arthroscopic rotator cuff repair of the shoulder CPT 29827 ARTHROSCOPY W/ROTATOR CUFF	$2,574.00	$2,860.00	$1,023.84–$2,648.36	22% above	10%
Arthroscopic rotator cuff repair of the shoulder inpatient CPT 29827 ARTHROSCOPY W/ROTATOR CUFF	$2,574.00	$2,860.00	$1,023.84–$2,648.36	—	10%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 NEEDLE CORE BX, PERCUTANEOUS	$3,184.20	$3,538.00	$1,525.59–$3,276.19	34% above	10%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 NEEDLE CORE BX, PERCUTANEOUS	$3,184.20	$3,538.00	$1,525.59–$3,276.19	—	10%
Bunion correction with a bone cut near the head of the first metatarsal CPT 28296 CORRECTION OF BUNION	$2,040.30	$2,267.00	$517.17–$2,099.24	24% above	10%
Bunion correction with a bone cut near the head of the first metatarsal inpatient CPT 28296 CORRECTION OF BUNION	$2,040.30	$2,267.00	$517.17–$2,099.24	—	10%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION DEFIBRILLATION	$185.40	$206.00	$88.83–$190.76	61% below	10%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION / DEFIBRILLATION	$462.60	$514.00	$102.55–$475.96	2% below	10%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION DEFIBRILLATION	$185.40	$206.00	$88.83–$190.76	—	10%
Carpal tunnel release, open surgery CPT 64721 NEUROPLASTY MEDIAN NERVE CARPA	$1,758.60	$1,954.00	$442.28–$1,809.40	76% above	10%
Carpal tunnel release, open surgery inpatient CPT 64721 NEUROPLASTY MEDIAN NERVE CARPA	$1,758.60	$1,954.00	$442.28–$1,809.40	—	10%
Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 CIRCU EXCEPT NEWBORN	$1,483.20	$1,648.00	$192.75–$1,526.05	86% above	10%
Circumcision by surgical excision, older than 28 days (children and adults) inpatient CPT 54161 CIRCU EXCEPT NEWBORN	$1,483.20	$1,648.00	$192.75–$1,526.05	—	10%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION USING CLAMP	$333.90	$371.00	$90.15–$343.55	18% above	10%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 CIRCUMCISION USING CLAMP	$333.90	$371.00	$90.15–$343.55	—	10%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 CLOSED TX DISTAL RAD FX W O MA	$444.60	$494.00	$213.01–$443.56	70% above	10%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 CLOSED TX DISTAL RAD FX W O MA	$444.60	$494.00	$213.01–$443.56	—	10%
Colonoscopy with polyp removal CPT 45385 COLONOSCOPY W REMOVAL SNARE	$1,198.80	$1,332.00	$239.39–$1,233.43	17% below	10%
Colonoscopy with tissue sample CPT 45380 COLONOSCOPY W BIOPSY	$1,072.80	$1,192.00	$189.98–$1,103.79	26% below	10%
Colonoscopy, diagnostic CPT 45378 COLONOSCOPY FLEXIBLE	$893.70	$993.00	$175.71–$919.52	21% below	10%
Cystoscopy with ureteral stent placement CPT 52332 CYSTO W/INSERT OF INDWELL URET	$692.10	$769.00	$149.00–$712.09	83% below	10%
Cystoscopy with ureteral stent placement inpatient CPT 52332 CYSTO W/INSERT OF INDWELL URET	$692.10	$769.00	$149.00–$712.09	—	10%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOURETHROSCOPY	$518.40	$576.00	$76.01–$533.38	12% above	10%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOURETHROSCOPY	$1,296.00	$1,440.00	$620.93–$1,292.98	180% above	10%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 CYSTOURETHROSCOPY	$518.40	$576.00	$76.01–$533.38	—	10%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCTION 9 LESION 1ST	$103.50	$115.00	$49.59–$103.26	13% above	10%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCTION B9 LESION FIRST	$103.50	$115.00	$49.59–$103.26	13% above	10%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 DESTRUCTION B9 LESION FIRST	$103.50	$115.00	$49.59–$103.26	—	10%
Earwax removal by irrigation (rinsing), one ear CPT 69209 CERUMEN REMOVAL IRRIGATION/LAV	$45.00	$50.00	$17.55–$46.30	at median	10%
Earwax removal by irrigation (rinsing), one ear CPT 69209 CERUMEN REMOVAL IRRIGATION/LAV	$52.20	$58.00	$25.01–$53.71	16% above	10%
Earwax removal by irrigation (rinsing), one ear CPT 69209 RMVL IMP CERUMEN IRRIGATION/LV	$75.60	$84.00	$36.22–$75.42	68% above	10%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 CERUMEN REMOVAL IRRIGATION/LAV	$52.20	$58.00	$25.01–$53.71	—	10%
Earwax removal with instruments, one ear both sides CPT 69210 CERUMEN REMOVAL BILATERAL	$141.30	$157.00	$67.70–$145.38	—	10%
Earwax removal with instruments, one ear CPT 69210 CERUMEN REMOVAL W/INSTRUMENTAT	$77.40	$86.00	$29.05–$79.64	37% above	10%
Earwax removal with instruments, one ear CPT 69210 CERUMEN REMOVAL W/INSTRUMENTAT	$94.50	$105.00	$45.28–$97.23	67% above	10%
Earwax removal with instruments, one ear CPT 69210 RMVL OF IMP CERUMEN ONE OR BOT	$128.70	$143.00	$61.66–$128.40	128% above	10%
Earwax removal with instruments, one ear CPT 69210 RMVL IMP CERUMEN 1 OR BOTH	$128.70	$143.00	$61.66–$128.40	128% above	10%
Earwax removal with instruments, one ear one side CPT 69210 CERUMEN REMOVAL RIGHT	$94.50	$105.00	$45.28–$97.23	67% above	10%
Earwax removal with instruments, one ear one side CPT 69210 CERUMEN REMOVAL LEFT	$94.50	$105.00	$45.28–$97.23	67% above	10%
Earwax removal with instruments, one ear inpatient both sides CPT 69210 CERUMEN REMOVAL BILATERAL	$141.30	$157.00	$67.70–$145.38	—	10%
Earwax removal with instruments, one ear inpatient CPT 69210 CERUMEN REMOVAL W/INSTRUMENTAT	$94.50	$105.00	$45.28–$97.23	—	10%
Earwax removal with instruments, one ear inpatient CPT 69210 RMVL OF IMP CERUMEN ONE OR BOT	$128.70	$143.00	$61.66–$128.40	—	10%
Earwax removal with instruments, one ear inpatient one side CPT 69210 CERUMEN REMOVAL LEFT	$94.50	$105.00	$45.28–$97.23	—	10%
Earwax removal with instruments, one ear inpatient one side CPT 69210 CERUMEN REMOVAL RIGHT	$94.50	$105.00	$45.28–$97.23	—	10%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 NJX DX/THER SBST INTRLMNR CRV/	$294.30	$327.00	$102.75–$302.80	63% below	10%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 STEROID INJ THORACIC W/ IMAGIN	$342.00	$380.00	$102.75–$351.88	57% below	10%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 NJX DX/THER SBST INTRLMNR CRV/	$294.30	$327.00	$102.75–$302.80	—	10%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 STEROID INJ THORACIC W/ IMAGIN	$342.00	$380.00	$102.75–$351.88	—	10%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 NJX DX/THER AGT PVRT FACET JT	$209.70	$233.00	$87.39–$215.76	77% below	10%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 NJX DX/THER AGT PVRT FACET JT	$209.70	$233.00	$87.39–$215.76	—	10%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 RPR AA HERNIA 1ST 3-10 CM REDU	$1,564.20	$1,738.00	$545.24–$1,609.39	at median	10%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 RPR AA HERNIA 1ST < 3CM RED	$880.20	$978.00	$328.05–$905.63	at median	10%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 FLEXIBLE SIGMOIDOSCOPY	$355.50	$395.00	$56.88–$365.77	18% below	10%
Gallbladder removal, laparoscopic CPT 47562 LAPAROSCOPY CHOLE	$2,469.60	$2,744.00	$656.03–$2,540.94	10% above	10%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 LAP CHOLE W CHOLANGIOGRAPHY	$2,962.80	$3,292.00	$710.28–$3,048.39	80% above	10%
Gallbladder removal, open surgery through a larger incision CPT 47600 CHOLECYSTECTOMY	$2,920.50	$3,245.00	$1,050.12–$3,004.87	13% above	10%
Hammertoe correction surgery CPT 28285 CORRECTION HAMMERTOE	$1,077.30	$1,197.00	$393.95–$1,108.42	12% above	10%
Hammertoe correction surgery inpatient CPT 28285 CORRECTION HAMMERTOE	$1,077.30	$1,197.00	$393.95–$1,108.42	—	10%
Hemorrhoid banding (rubber band ligation) CPT 46221 Hemorrhoidectomy ProFee	$742.50	$825.00	$207.21–$763.95	1% below	10%
Hemorrhoidectomy (internal and external), one area CPT 46255 HEMORRHOIDECTOMY INT/EXT SIMPL	$1,228.50	$1,365.00	$368.00–$1,263.99	at median	10%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS	$198.00	$220.00	$94.86–$203.72	31% above	10%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D SIMPLE ABSCESS	$330.30	$367.00	$158.25–$329.53	119% above	10%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D SIMPLE ABSCESS	$330.30	$367.00	$158.25–$329.53	119% above	10%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D SIMPLE ABSCESS	$330.30	$367.00	$158.25–$329.53	—	10%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 HERNIA INGUINAL >5 YEARS	$1,358.10	$1,509.00	$527.12–$1,397.33	1% above	10%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ TENDON SHEATH/LIGAMENT	$117.00	$130.00	$56.06–$120.38	30% below	10%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ TENDON SHEATH/LIGAMENT	$117.00	$130.00	$56.06–$116.73	30% below	10%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ TENDON SHEATH/LIG RHC	$117.00	$130.00	$56.06–$116.73	30% below	10%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJ TENDON SHEATH/LIGAMENT	$117.00	$130.00	$56.06–$116.73	—	10%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHROCENTESIS ASP MAJOR JNT	$76.50	$85.00	$36.65–$78.71	60% below	10%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ASPIRATION/INJ MAJOR JOINT/BUR	$148.50	$165.00	$42.07–$152.79	22% below	10%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ASP/INJ MAJOR JOINT/BURSA	$148.50	$165.00	$42.07–$152.79	22% below	10%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHROCENTESIS ASP A/OR INJ	$148.50	$165.00	$42.07–$152.79	22% below	10%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHROCENTESIS ASPIR&/INJ MAJO	$148.50	$165.00	$42.07–$152.79	22% below	10%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ASPIR/INJ MAJOR JOINT/BURSA	$190.80	$212.00	$91.41–$190.35	at median	10%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ASPIRATION/INJ MAJOR JOINT/BUR	$244.80	$272.00	$117.29–$244.23	29% above	10%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ASPIRATION/INJ MAJOR JOINT/BUR	$148.50	$165.00	$42.07–$152.79	—	10%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ASPIR/INJ MAJOR JOINT/BURSA	$190.80	$212.00	$91.41–$190.35	—	10%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 ASSIST INSERT DRUG DEL IMPLANT	$176.40	$196.00	$57.78–$181.50	60% above	10%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 INSERT NONBIODEGRAD DRUG	$230.40	$256.00	$57.78–$237.06	109% above	10%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 INSERT DRUG DELIVERY IMPLANT	$230.40	$256.00	$57.78–$237.06	109% above	10%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 INSERTION NONBIODEGRAD DRUG	$441.00	$490.00	$211.29–$439.97	299% above	10%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 ASSIST INSERT DRUG DEL IMPLANT	$176.40	$196.00	$57.78–$181.50	—	10%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 INSERT NONBIODEGRAD DRUG	$230.40	$256.00	$57.78–$237.06	—	10%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 INSERT DRUG DELIVERY IMPLANT	$230.40	$256.00	$57.78–$237.06	—	10%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 INSERTION NONBIODEGRAD DRUG	$441.00	$490.00	$211.29–$439.97	—	10%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHROCENTESIS ASP A/OR INJ	$67.50	$75.00	$32.34–$69.45	63% below	10%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHROCENTESIS ASPIR&/INJ	$85.50	$95.00	$34.34–$87.97	53% below	10%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ASPIR/INJ INTERM JOINT/BURSA	$142.20	$158.00	$68.13–$141.87	22% below	10%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ASPIRATION/INJ INTERM JNT/BURS	$142.20	$158.00	$68.13–$141.87	22% below	10%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ARTHROCENTESIS ASPIR&/INJ	$85.50	$95.00	$34.34–$87.97	—	10%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ASPIR/INJ INTERM JOINT/BURSA	$142.20	$158.00	$68.13–$141.87	—	10%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS ASP A/OR INJ T1	$81.90	$91.00	$33.58–$84.27	59% below	10%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ASPIRATION/INJ SMALL JOINT/BUR	$136.80	$152.00	$65.54–$136.48	32% below	10%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ASPIR/INJ SMALL JOINT/BURSA	$136.80	$152.00	$65.54–$136.48	32% below	10%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS ASP A/OR INJ F1	$188.10	$209.00	$90.12–$193.53	6% below	10%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS ASP A/OR INJ F7	$188.10	$209.00	$90.12–$193.53	6% below	10%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS ASP A/OR INJ F6	$188.10	$209.00	$90.12–$193.53	6% below	10%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS ASP A/OR INJ	$188.10	$209.00	$90.12–$193.53	6% below	10%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS ASP A/OR INJ F9	$188.10	$209.00	$90.12–$193.53	6% below	10%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS ASP A/OR INJ TA	$188.10	$209.00	$90.12–$193.53	6% below	10%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS ASP A/OR INJ F8	$188.10	$209.00	$90.12–$193.53	6% below	10%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS ASP A/OR INJ F3	$188.10	$209.00	$90.12–$193.53	6% below	10%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS ASP A/OR INJ F2	$188.10	$209.00	$90.12–$193.53	6% below	10%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS ASP A/OR INJ T9	$188.10	$209.00	$90.12–$193.53	6% below	10%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS ASP A/OR INJ T8	$188.10	$209.00	$90.12–$193.53	6% below	10%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS ASP A/OR INJ T7	$188.10	$209.00	$90.12–$193.53	6% below	10%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS ASP A/OR INJ T6	$188.10	$209.00	$90.12–$193.53	6% below	10%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS ASP A/OR INJ T5	$188.10	$209.00	$90.12–$193.53	6% below	10%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS ASP A/OR INJ T4	$188.10	$209.00	$90.12–$193.53	6% below	10%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS ASP A/OR INJ T3	$188.10	$209.00	$90.12–$193.53	6% below	10%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS ASP A/OR INJ T2	$188.10	$209.00	$90.12–$193.53	6% below	10%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS ASP A/OR INJ F4	$188.10	$209.00	$90.12–$193.53	6% below	10%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS ASP A/OR INJ F5	$188.10	$209.00	$90.12–$193.53	6% below	10%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS ASP A/OR INJ T1	$188.10	$209.00	$90.12–$193.53	6% below	10%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS ASP A/OR INJ FA	$188.10	$209.00	$90.12–$193.53	6% below	10%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ASPIR/INJ SMALL JOINT/BURSA	$136.80	$152.00	$65.54–$136.48	—	10%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCENTESIS ASP A/OR INJ F8	$188.10	$209.00	$90.12–$193.53	—	10%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCENTESIS ASP A/OR INJ F9	$188.10	$209.00	$90.12–$193.53	—	10%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCENTESIS ASP A/OR INJ F7	$188.10	$209.00	$90.12–$193.53	—	10%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCENTESIS ASP A/OR INJ F6	$188.10	$209.00	$90.12–$193.53	—	10%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCENTESIS ASP A/OR INJ F5	$188.10	$209.00	$90.12–$193.53	—	10%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCENTESIS ASP A/OR INJ F4	$188.10	$209.00	$90.12–$193.53	—	10%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCENTESIS ASP A/OR INJ F3	$188.10	$209.00	$90.12–$193.53	—	10%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCENTESIS ASP A/OR INJ F2	$188.10	$209.00	$90.12–$193.53	—	10%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCENTESIS ASP A/OR INJ T9	$188.10	$209.00	$90.12–$193.53	—	10%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCENTESIS ASP A/OR INJ T8	$188.10	$209.00	$90.12–$193.53	—	10%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCENTESIS ASP A/OR INJ T7	$188.10	$209.00	$90.12–$193.53	—	10%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCENTESIS ASP A/OR INJ T6	$188.10	$209.00	$90.12–$193.53	—	10%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCENTESIS ASP A/OR INJ T5	$188.10	$209.00	$90.12–$193.53	—	10%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCENTESIS ASP A/OR INJ T4	$188.10	$209.00	$90.12–$193.53	—	10%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCENTESIS ASP A/OR INJ T3	$188.10	$209.00	$90.12–$193.53	—	10%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCENTESIS ASP A/OR INJ T2	$188.10	$209.00	$90.12–$193.53	—	10%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCENTESIS ASP A/OR INJ T1	$188.10	$209.00	$90.12–$193.53	—	10%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCENTESIS ASP A/OR INJ TA	$188.10	$209.00	$90.12–$193.53	—	10%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCENTESIS ASP A/OR INJ F1	$188.10	$209.00	$90.12–$193.53	—	10%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCENTESIS ASP A/OR INJ FA	$188.10	$209.00	$90.12–$193.53	—	10%
Knee arthroscopy with meniscus trim CPT 29881 ASSIST ARTHROSCOPY W/MENISC ME	$1,374.30	$1,527.00	$539.63–$1,414.00	4% above	10%
Knee arthroscopy with meniscus trim CPT 29881 ARTHROSCOPY W/MENISCECT MED/LA	$2,803.50	$3,115.00	$539.63–$2,884.49	113% above	10%
Knee arthroscopy with meniscus trim inpatient CPT 29881 ASSIST ARTHROSCOPY W/MENISC ME	$1,374.30	$1,527.00	$539.63–$1,414.00	—	10%
Knee arthroscopy with meniscus trim inpatient CPT 29881 ARTHROSCOPY W/MENISCECT MED/LA	$2,803.50	$3,115.00	$539.63–$2,884.49	—	10%
Knee arthroscopy with removal of both torn meniscus parts CPT 29880 ASSIST ARTHRO W/MESISCECTOMY M	$1,133.10	$1,259.00	$557.94–$1,165.83	15% below	10%
Knee arthroscopy with removal of both torn meniscus parts CPT 29880 ARTHROSCOY W/MESISCECT MED & L	$2,961.90	$3,291.00	$557.94–$3,047.47	121% above	10%
Knee arthroscopy with removal of both torn meniscus parts inpatient CPT 29880 ASSIST ARTHRO W/MESISCECTOMY M	$1,133.10	$1,259.00	$557.94–$1,165.83	—	10%
Knee arthroscopy with removal of both torn meniscus parts inpatient CPT 29880 ARTHROSCOY W/MESISCECT MED & L	$2,961.90	$3,291.00	$557.94–$3,047.47	—	10%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 ARTHROSCOPY DEBRIDEMENT SHAVE	$2,664.00	$2,960.00	$614.22–$2,740.96	46% above	10%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) inpatient CPT 29877 ARTHROSCOPY DEBRIDEMENT SHAVE	$2,664.00	$2,960.00	$614.22–$2,740.96	—	10%
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 LAPAROSCOPIC APPENDECTOMY	$1,801.80	$2,002.00	$600.51–$1,853.85	at median	10%
Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 IND ING HERNIA REP-GRAFT	$965.70	$1,073.00	$440.21–$993.60	at median	10%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 LAPS SURG RPR RECURRENT INGUIN	$1,889.10	$2,099.00	$570.86–$1,943.67	40% above	10%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 INTERMEDIATE <2.5 CM	$260.10	$289.00	$141.47–$322.34	10% below	10%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 INTERMEDIATE <2.5 CM	$271.80	$302.00	$130.22–$279.65	6% below	10%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 INTERMEDIATE <2.5 CM	$260.10	$289.00	$141.47–$322.34	—	10%
Lower-back epidural injection, with imaging guidance CPT 62323 STEROID INJ LUMBAR W/ IMAGING	$252.00	$280.00	$95.86–$259.28	72% below	10%
Lower-back epidural injection, with imaging guidance CPT 62323 NJX DX/THER SBST INTRLMNR LMBR	$268.20	$298.00	$95.86–$275.95	70% below	10%
Lower-back epidural injection, with imaging guidance CPT 62323 NJX DX/THER SBST INTRLMNR	$540.00	$600.00	$258.72–$555.60	39% below	10%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 STEROID INJ LUMBAR W/ IMAGING	$252.00	$280.00	$95.86–$259.28	—	10%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 NJX DX/THER SBST INTRLMNR LMBR	$268.20	$298.00	$95.86–$275.95	—	10%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 NJX DX/THER SBST INTRLMNR	$540.00	$600.00	$258.72–$555.60	—	10%
Lower-back epidural injection, without imaging guidance CPT 62322 STEROID INJ LUMBAR W/O IMAGING	$304.20	$338.00	$79.74–$312.99	58% below	10%
Lower-back epidural injection, without imaging guidance CPT 62322 NJX DX/THER SBST INTRLMNR LMBR	$381.60	$424.00	$79.74–$392.62	47% below	10%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 STEROID INJ LUMBAR W/O IMAGING	$304.20	$338.00	$79.74–$312.99	—	10%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 NJX ANES&/STRD W/IMG TFRML EDR	$259.20	$288.00	$106.86–$266.69	70% below	10%
Lumpectomy (partial mastectomy) CPT 19301 LOCAL EXC BREAST LESION	$1,467.00	$1,630.00	$657.18–$1,509.38	36% above	10%
Mastectomy (total removal of the breast) one side CPT 19303 UNILATERAL SIMPLE MASTECTOMY	$2,854.80	$3,172.00	$951.58–$2,937.27	116% above	10%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC B9 LES .5CM OR LESS TR-EXT	$150.30	$167.00	$80.72–$154.64	at median	10%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC BEN LES .5CM OR < TRK/ARM	$249.30	$277.00	$119.44–$248.72	66% above	10%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC B9 LES .5CM OR LESS T-EXT	$249.30	$277.00	$119.44–$248.72	66% above	10%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXC BEN LES .5CM OR < TRK/ARM	$249.30	$277.00	$119.44–$248.72	—	10%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXC BEN LESION .5CM OR < FACE/	$283.50	$315.00	$135.83–$282.84	17% above	10%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EX B9 LES .5CM OR LESS F/E	$283.50	$315.00	$135.83–$282.84	17% above	10%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 EXC BEN LESION .5CM OR < FACE/	$283.50	$315.00	$135.83–$282.84	—	10%
Nail removal (partial or complete), one nail CPT 11730 NAIL AVULSION SINGLE T5	$113.40	$126.00	$54.33–$116.68	4% below	10%
Nail removal (partial or complete), one nail CPT 11730 NAIL AVULSION SINGLE F5	$113.40	$126.00	$54.33–$116.68	4% below	10%
Nail removal (partial or complete), one nail CPT 11730 NAIL AVULSION SINGLE F1	$113.40	$126.00	$54.33–$116.68	4% below	10%
Nail removal (partial or complete), one nail CPT 11730 NAIL AVULSION SINGLE F8	$113.40	$126.00	$54.33–$116.68	4% below	10%
Nail removal (partial or complete), one nail CPT 11730 NAIL AVULSION SINGLE T4	$113.40	$126.00	$54.33–$116.68	4% below	10%
Nail removal (partial or complete), one nail CPT 11730 NAIL AVULSION SINGLE F6	$113.40	$126.00	$54.33–$116.68	4% below	10%
Nail removal (partial or complete), one nail CPT 11730 NAIL AVULSION SINGLE FA	$113.40	$126.00	$54.33–$116.68	4% below	10%
Nail removal (partial or complete), one nail CPT 11730 NAIL AVULSION SINGLE T3	$113.40	$126.00	$54.33–$116.68	4% below	10%
Nail removal (partial or complete), one nail CPT 11730 NAIL AVULSION SINGLE TA	$113.40	$126.00	$54.33–$116.68	4% below	10%
Nail removal (partial or complete), one nail CPT 11730 NAIL AVULSION SINGLE T2	$113.40	$126.00	$54.33–$116.68	4% below	10%
Nail removal (partial or complete), one nail CPT 11730 NAIL AVULSION SINGLE T6	$113.40	$126.00	$54.33–$116.68	4% below	10%
Nail removal (partial or complete), one nail CPT 11730 NAIL AVULSION SINGLE T1	$113.40	$126.00	$54.33–$116.68	4% below	10%
Nail removal (partial or complete), one nail CPT 11730 NAIL AVULSION SINGLE T7	$113.40	$126.00	$54.33–$116.68	4% below	10%
Nail removal (partial or complete), one nail CPT 11730 NAIL AVULSION SINGLE T8	$113.40	$126.00	$54.33–$116.68	4% below	10%
Nail removal (partial or complete), one nail CPT 11730 NAIL AVULSION SINGLE T9	$113.40	$126.00	$54.33–$116.68	4% below	10%
Nail removal (partial or complete), one nail CPT 11730 NAIL AVULSION SINGLE F2	$113.40	$126.00	$54.33–$116.68	4% below	10%
Nail removal (partial or complete), one nail CPT 11730 NAIL AVULSION SINGLE F3	$113.40	$126.00	$54.33–$116.68	4% below	10%
Nail removal (partial or complete), one nail CPT 11730 NAIL AVULSION SINGLE F4	$113.40	$126.00	$54.33–$116.68	4% below	10%
Nail removal (partial or complete), one nail CPT 11730 NAIL AVULSION SINGLE F7	$113.40	$126.00	$54.33–$116.68	4% below	10%
Nail removal (partial or complete), one nail CPT 11730 NAIL AVULSION SINGLE F9	$113.40	$126.00	$54.33–$116.68	4% below	10%
Nail removal (partial or complete), one nail CPT 11730 NAIL AVULSION SINGLE	$135.90	$151.00	$52.73–$140.97	15% above	10%
Nail removal (partial or complete), one nail CPT 11730 Avulsion nailplate part/comp	$185.40	$206.00	$88.83–$184.97	57% above	10%
Nail removal (partial or complete), one nail inpatient CPT 11730 NAIL AVULSION SINGLE T1	$113.40	$126.00	$54.33–$116.68	—	10%
Nail removal (partial or complete), one nail inpatient CPT 11730 NAIL AVULSION SINGLE F9	$113.40	$126.00	$54.33–$116.68	—	10%
Nail removal (partial or complete), one nail inpatient CPT 11730 NAIL AVULSION SINGLE F8	$113.40	$126.00	$54.33–$116.68	—	10%
Nail removal (partial or complete), one nail inpatient CPT 11730 NAIL AVULSION SINGLE F7	$113.40	$126.00	$54.33–$116.68	—	10%
Nail removal (partial or complete), one nail inpatient CPT 11730 NAIL AVULSION SINGLE F6	$113.40	$126.00	$54.33–$116.68	—	10%
Nail removal (partial or complete), one nail inpatient CPT 11730 NAIL AVULSION SINGLE F5	$113.40	$126.00	$54.33–$116.68	—	10%
Nail removal (partial or complete), one nail inpatient CPT 11730 NAIL AVULSION SINGLE F4	$113.40	$126.00	$54.33–$116.68	—	10%
Nail removal (partial or complete), one nail inpatient CPT 11730 NAIL AVULSION SINGLE F3	$113.40	$126.00	$54.33–$116.68	—	10%
Nail removal (partial or complete), one nail inpatient CPT 11730 NAIL AVULSION SINGLE F2	$113.40	$126.00	$54.33–$116.68	—	10%
Nail removal (partial or complete), one nail inpatient CPT 11730 NAIL AVULSION SINGLE T9	$113.40	$126.00	$54.33–$116.68	—	10%
Nail removal (partial or complete), one nail inpatient CPT 11730 NAIL AVULSION SINGLE T8	$113.40	$126.00	$54.33–$116.68	—	10%
Nail removal (partial or complete), one nail inpatient CPT 11730 NAIL AVULSION SINGLE T7	$113.40	$126.00	$54.33–$116.68	—	10%
Nail removal (partial or complete), one nail inpatient CPT 11730 NAIL AVULSION SINGLE T6	$113.40	$126.00	$54.33–$116.68	—	10%
Nail removal (partial or complete), one nail inpatient CPT 11730 NAIL AVULSION SINGLE T5	$113.40	$126.00	$54.33–$116.68	—	10%
Nail removal (partial or complete), one nail inpatient CPT 11730 NAIL AVULSION SINGLE T4	$113.40	$126.00	$54.33–$116.68	—	10%
Nail removal (partial or complete), one nail inpatient CPT 11730 NAIL AVULSION SINGLE FA	$113.40	$126.00	$54.33–$116.68	—	10%
Nail removal (partial or complete), one nail inpatient CPT 11730 NAIL AVULSION SINGLE F1	$113.40	$126.00	$54.33–$116.68	—	10%
Nail removal (partial or complete), one nail inpatient CPT 11730 NAIL AVULSION SINGLE T3	$113.40	$126.00	$54.33–$116.68	—	10%
Nail removal (partial or complete), one nail inpatient CPT 11730 NAIL AVULSION SINGLE TA	$113.40	$126.00	$54.33–$116.68	—	10%
Nail removal (partial or complete), one nail inpatient CPT 11730 NAIL AVULSION SINGLE T2	$113.40	$126.00	$54.33–$116.68	—	10%
Nail removal (partial or complete), one nail inpatient CPT 11730 NAIL AVULSION SINGLE	$135.90	$151.00	$52.73–$140.97	—	10%
Occipital nerve block (injection for headaches) CPT 64405 NJX AA&/STRD GRT OCCIPITAL NRV	$379.80	$422.00	$48.21–$390.77	64% above	10%
Occipital nerve block (injection for headaches) CPT 64405 NJX AA&STRD GRT OCCIP NRV RHC	$638.10	$709.00	$305.72–$636.61	176% above	10%
Occipital nerve block (injection for headaches) inpatient CPT 64405 NJX AA&/STRD GRT OCCIPITAL NRV	$379.80	$422.00	$48.21–$390.77	—	10%
Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS WITH IMAGING	$302.40	$336.00	$99.79–$311.14	61% below	10%
Paracentesis with imaging guidance CPT 49083 PARACENTESIS PHYS w/ Imaging	$302.40	$336.00	$99.79–$353.26	61% below	10%
Paracentesis with imaging guidance CPT 49083 PARACENTESIS W/IMAGING	$687.60	$764.00	$329.44–$707.46	10% below	10%
Paracentesis with imaging guidance inpatient CPT 49083 PARACENTESIS W/IMAGING	$687.60	$764.00	$329.44–$707.46	—	10%
Partial knee replacement (one compartment) CPT 27446 ARTHROPLASTY KNEE MED OR LAT	$4,365.00	$4,850.00	$1,096.73–$4,491.10	75% above	10%
Partial knee replacement (one compartment) inpatient CPT 27446 ARTHROPLASTY KNEE MED OR LAT	$4,365.00	$4,850.00	$1,096.73–$4,491.10	—	10%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION OF NAIL T1	$236.70	$263.00	$100.73–$243.54	16% below	10%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXC NAIL MATRIX PERMANENT RMVL	$265.50	$295.00	$100.73–$273.17	5% below	10%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION OF NAIL FA	$397.80	$442.00	$190.59–$409.29	42% above	10%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION OF NAIL F6	$397.80	$442.00	$190.59–$409.29	42% above	10%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION OF NAIL T3	$397.80	$442.00	$190.59–$409.29	42% above	10%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION OF NAIL T5	$397.80	$442.00	$190.59–$409.29	42% above	10%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION OF NAIL F2	$397.80	$442.00	$190.59–$409.29	42% above	10%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION OF NAIL T7	$397.80	$442.00	$190.59–$409.29	42% above	10%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION OF NAIL T8	$397.80	$442.00	$190.59–$409.29	42% above	10%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION OF NAIL T9	$397.80	$442.00	$190.59–$409.29	42% above	10%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION OF NAIL F5	$397.80	$442.00	$190.59–$409.29	42% above	10%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION OF NAIL F4	$397.80	$442.00	$190.59–$409.29	42% above	10%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION OF NAIL T6	$397.80	$442.00	$190.59–$409.29	42% above	10%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EX NAIL/NAIL MATRIX PART/COMP/	$397.80	$442.00	$190.59–$396.87	42% above	10%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION OF NAIL T4	$397.80	$442.00	$190.59–$409.29	42% above	10%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION OF NAIL T2	$397.80	$442.00	$190.59–$409.29	42% above	10%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION OF NAIL T1	$397.80	$442.00	$190.59–$409.29	42% above	10%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION OF NAIL TA	$397.80	$442.00	$190.59–$409.29	42% above	10%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION OF NAIL F1	$397.80	$442.00	$190.59–$409.29	42% above	10%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION OF NAIL F9	$397.80	$442.00	$190.59–$409.29	42% above	10%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION OF NAIL F8	$397.80	$442.00	$190.59–$409.29	42% above	10%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION OF NAIL F7	$397.80	$442.00	$190.59–$409.29	42% above	10%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION OF NAIL F3	$397.80	$442.00	$190.59–$409.29	42% above	10%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXCISION OF NAIL FA	$397.80	$442.00	$190.59–$409.29	—	10%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXCISION OF NAIL F9	$397.80	$442.00	$190.59–$409.29	—	10%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXCISION OF NAIL F8	$397.80	$442.00	$190.59–$409.29	—	10%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXCISION OF NAIL F7	$397.80	$442.00	$190.59–$409.29	—	10%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXCISION OF NAIL F6	$397.80	$442.00	$190.59–$409.29	—	10%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXCISION OF NAIL F5	$397.80	$442.00	$190.59–$409.29	—	10%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXCISION OF NAIL F4	$397.80	$442.00	$190.59–$409.29	—	10%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXCISION OF NAIL F3	$397.80	$442.00	$190.59–$409.29	—	10%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXCISION OF NAIL F2	$397.80	$442.00	$190.59–$409.29	—	10%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXCISION OF NAIL T9	$397.80	$442.00	$190.59–$409.29	—	10%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXCISION OF NAIL T8	$397.80	$442.00	$190.59–$409.29	—	10%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXCISION OF NAIL T7	$397.80	$442.00	$190.59–$409.29	—	10%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXCISION OF NAIL T6	$397.80	$442.00	$190.59–$409.29	—	10%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXCISION OF NAIL T5	$397.80	$442.00	$190.59–$409.29	—	10%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXCISION OF NAIL T4	$397.80	$442.00	$190.59–$409.29	—	10%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXCISION OF NAIL T3	$397.80	$442.00	$190.59–$409.29	—	10%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXCISION OF NAIL T2	$397.80	$442.00	$190.59–$409.29	—	10%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXCISION OF NAIL T1	$397.80	$442.00	$190.59–$409.29	—	10%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXCISION OF NAIL TA	$397.80	$442.00	$190.59–$409.29	—	10%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXCISION OF NAIL F1	$397.80	$442.00	$190.59–$409.29	—	10%
Prostate biopsy CPT 55700 US Prostate Biopsy	$1,350.00	$1,500.00	$646.80–$1,389.00	84% above	10%
Prostate biopsy CPT 55700 BX PROSTATE NEEDLE OR PUNCH	$1,485.00	$1,650.00	$133.61–$1,527.90	102% above	10%
Prostate biopsy inpatient CPT 55700 US Prostate Biopsy	$1,350.00	$1,500.00	$646.80–$1,389.00	—	10%
Prostate biopsy inpatient CPT 55700 BX PROSTATE NEEDLE OR PUNCH	$1,485.00	$1,650.00	$133.61–$1,527.90	—	10%
Removal of a breast lump, open surgery CPT 19120 EXC BREAST MASS/DUCT LESION	$1,267.20	$1,408.00	$423.96–$1,303.81	5% above	10%
Removal of a foreign object under the skin, simple CPT 10120 FB REMOVAL SUB-Q TISSUE SIMPLE	$153.00	$170.00	$73.30–$157.42	13% below	10%
Removal of a foreign object under the skin, simple CPT 10120 FB RMVL SUB-Q TISSUE SIMPLE	$228.60	$254.00	$107.99–$235.20	30% above	10%
Removal of a foreign object under the skin, simple CPT 10120 REMOVAL OF FB SIMPLE	$381.60	$424.00	$182.83–$380.71	117% above	10%
Removal of a foreign object under the skin, simple CPT 10120 REMOVAL OF FB SIMPLE	$381.60	$424.00	$182.83–$380.71	117% above	10%
Removal of a foreign object under the skin, simple inpatient CPT 10120 REMOVAL OF FB SIMPLE	$381.60	$424.00	$182.83–$380.71	—	10%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 COLORECT SCRN-NOT HI RISK	$893.70	$993.00	$175.95–$919.52	2% below	10%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 COLORECT SCREEN- HI RISK	$893.70	$993.00	$175.71–$919.52	6% below	10%
Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 LITHOTRIPSY	$2,495.70	$2,773.00	$555.15–$2,567.80	2% above	10%
Shock-wave lithotripsy to break up kidney stones (from outside the body) inpatient CPT 50590 LITHOTRIPSY	$2,495.70	$2,773.00	$555.15–$2,567.80	—	10%
Short arm splint (forearm and hand) both sides CPT 29125 SPLINT DISTAL BILAT RT UE	$133.20	$148.00	$43.06–$137.05	—	10%
Short arm splint (forearm and hand) CPT 29125 SPLINT DISTAL UPPER EXTREMITY	$85.50	$95.00	$40.96–$87.97	16% below	10%
Short arm splint (forearm and hand) CPT 29125 SPLINT DISTAL UPPER EXTREM BIL	$85.50	$95.00	$40.96–$87.97	16% below	10%
Short arm splint (forearm and hand) CPT 29125 SPLINT DISTAL UE	$89.10	$99.00	$43.06–$91.67	12% below	10%
Short arm splint (forearm and hand) CPT 29125 SPLINT DISTAL UPPER EXTREMITY-	$89.10	$99.00	$43.06–$91.67	12% below	10%
Short arm splint (forearm and hand) CPT 29125 APPLICATION SHORT ARM SPLINT	$147.60	$164.00	$70.72–$147.26	45% above	10%
Short arm splint (forearm and hand) one side CPT 29125 SPLINT DISTAL UPPER EXTREM RT	$85.50	$95.00	$40.96–$87.97	16% below	10%
Short arm splint (forearm and hand) one side CPT 29125 SPLINT DISTAL UPPER EXTREM LT	$85.50	$95.00	$40.96–$87.97	16% below	10%
Short arm splint (forearm and hand) one side CPT 29125 SPLINT DISTAL RT UE	$89.10	$99.00	$43.06–$91.67	12% below	10%
Short arm splint (forearm and hand) one side CPT 29125 SPLINT DISTAL LT UE	$89.10	$99.00	$43.06–$91.67	12% below	10%
Short arm splint (forearm and hand) inpatient both sides CPT 29125 SPLINT DISTAL BILAT RT UE	$133.20	$148.00	$43.06–$137.05	—	10%
Short arm splint (forearm and hand) inpatient CPT 29125 SPLINT DISTAL UPPER EXTREM BIL	$85.50	$95.00	$40.96–$87.97	—	10%
Short arm splint (forearm and hand) inpatient one side CPT 29125 SPLINT DISTAL UPPER EXTREM RT	$85.50	$95.00	$40.96–$87.97	—	10%
Short arm splint (forearm and hand) inpatient one side CPT 29125 SPLINT DISTAL UPPER EXTREM LT	$85.50	$95.00	$40.96–$87.97	—	10%
Short arm splint (forearm and hand) inpatient one side CPT 29125 SPLINT DISTAL LT UE	$89.10	$99.00	$43.06–$91.67	—	10%
Short arm splint (forearm and hand) inpatient one side CPT 29125 SPLINT DISTAL RT UE	$89.10	$99.00	$43.06–$91.67	—	10%
Short leg cast (below the knee) CPT 29405 SHORT LEG CAST	$145.80	$162.00	$69.85–$145.46	17% below	10%
Short leg cast (below the knee) inpatient CPT 29405 SHORT LEG CAST	$145.80	$162.00	$69.85–$145.46	—	10%
Short leg splint (calf to foot) both sides CPT 29515 SHORT LEG SPLINT BILATERAL	$68.40	$76.00	$32.77–$70.38	—	10%
Short leg splint (calf to foot) CPT 29515 SHORT LEG SPLINT	$85.50	$95.00	$40.96–$87.97	15% below	10%
Short leg splint (calf to foot) CPT 29515 SHORT LEG SPLINT	$188.10	$209.00	$90.12–$187.66	87% above	10%
Short leg splint (calf to foot) one side CPT 29515 SHORT LEG SPLINT RIGHT	$45.90	$51.00	$21.99–$47.23	54% below	10%
Short leg splint (calf to foot) one side CPT 29515 SHORT LEG SPLINT LEFT	$45.90	$51.00	$21.99–$47.23	54% below	10%
Short leg splint (calf to foot) inpatient both sides CPT 29515 SHORT LEG SPLINT BILATERAL	$68.40	$76.00	$32.77–$70.38	—	10%
Short leg splint (calf to foot) inpatient CPT 29515 SHORT LEG SPLINT	$188.10	$209.00	$90.12–$187.66	—	10%
Short leg splint (calf to foot) inpatient one side CPT 29515 SHORT LEG SPLINT RIGHT	$45.90	$51.00	$21.99–$47.23	—	10%
Short leg splint (calf to foot) inpatient one side CPT 29515 SHORT LEG SPLINT LEFT	$45.90	$51.00	$21.99–$47.23	—	10%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 ASSIST ARTHROSCOPY DISTAL CLAV	$414.90	$461.00	$410.29–$682.79	69% below	10%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 ARTHROSCOPY DISTAL CLAV	$2,073.60	$2,304.00	$669.13–$2,133.50	57% above	10%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) inpatient CPT 29824 ASSIST ARTHROSCOPY DISTAL CLAV	$414.90	$461.00	$410.29–$682.79	—	10%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) inpatient CPT 29824 ARTHROSCOPY DISTAL CLAV	$2,073.60	$2,304.00	$669.13–$2,133.50	—	10%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 ASSIST DECOMPRESS SUBACROMIAL	$593.10	$659.00	$155.39–$610.23	at median	10%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 DECOMPRESS SUBACROMIAL SPACE	$2,962.80	$3,292.00	$155.39–$3,048.39	400% above	10%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 ASSIST DECOMPRESS SUBACROMIAL	$593.10	$659.00	$155.39–$610.23	—	10%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 DECOMPRESS SUBACROMIAL SPACE	$2,962.80	$3,292.00	$155.39–$3,048.39	—	10%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 SIMPLE <2.5CM	$166.50	$185.00	$46.16–$171.31	27% above	10%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 SIMPLE REP SCLP/NCK/AX/GENIT/T	$166.50	$185.00	$46.16–$171.31	27% above	10%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 SIMPLE <2.5CM PHYS	$166.50	$185.00	$46.16–$171.31	27% above	10%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Simple repair <2.5cm scalp/nec	$415.80	$462.00	$199.21–$414.83	216% above	10%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 SIMPLE <2.5 CM	$415.80	$462.00	$199.21–$427.81	216% above	10%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 SIMPLE REP SCLP/NCK/AX/GENIT/T	$166.50	$185.00	$46.16–$171.31	—	10%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BX SINGLE SKIN LESION	$252.90	$281.00	$40.92–$260.21	15% above	10%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BIOPSY OF SKIN LESION	$252.90	$281.00	$121.17–$260.21	15% above	10%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BX OF SKIN SINGLE LESION	$422.10	$469.00	$202.23–$421.12	93% above	10%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BX OF SKIN SINGLE LESION	$422.10	$469.00	$202.23–$421.12	93% above	10%
Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BX OF SKIN SINGLE LESION	$422.10	$469.00	$202.23–$421.12	—	10%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 EX MAL LES .5CM OR < TR/A/LEG	$286.20	$318.00	$137.12–$285.53	7% below	10%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 EX MAL LES .5CM OR < TR/A/LEG	$286.20	$318.00	$137.12–$285.53	—	10%
Skin tag removal, up to 15 tags CPT 11200 EXCISION SKIN TAGS	$132.30	$147.00	$63.39–$136.12	14% above	10%
Skin tag removal, up to 15 tags CPT 11200 EXC SKIN LESIONS UP TO 15	$169.20	$188.00	$81.07–$168.81	46% above	10%
Skin tag removal, up to 15 tags CPT 11200 EXCISION SKIN LESIONS UP TO 15	$169.20	$188.00	$81.07–$168.81	46% above	10%
Skin tag removal, up to 15 tags inpatient CPT 11200 EXC SKIN LESIONS UP TO 15	$169.20	$188.00	$81.07–$168.81	—	10%
Spinal tap (lumbar puncture), diagnostic CPT 62270 LUMBAR PUNCTURE	$404.10	$449.00	$193.61–$415.77	10% below	10%
Spinal tap (lumbar puncture), diagnostic CPT 62270 LUMBAR PUNCTURE	$404.10	$449.00	$61.29–$415.77	10% below	10%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 LUMBAR PUNCTURE	$404.10	$449.00	$193.61–$415.77	—	10%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 SIMPLE 2.6 TO 7.5 CM PHYS	$221.40	$246.00	$60.21–$227.80	34% above	10%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 SIMPLE REP 2.6-7.5CM SCLP/N	$369.90	$411.00	$177.22–$369.04	124% above	10%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 SIMPLE 2.6 TO 7.5 CM	$369.90	$411.00	$177.22–$380.59	124% above	10%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 SIMPLE 0-2.5 CM PHYS	$189.00	$210.00	$57.01–$194.46	24% above	10%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 SIMPLE REP 2.5CM OR LESS FACE/	$189.00	$210.00	$57.01–$194.46	24% above	10%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 SIMPLE 0-2.5 CM	$471.60	$524.00	$225.95–$485.22	208% above	10%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Simple repair <2.5cm face/ear	$471.60	$524.00	$225.95–$470.50	208% above	10%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 SIMPLE REP 2.5CM OR LESS FACE/	$189.00	$210.00	$57.01–$194.46	—	10%
TURP (transurethral resection of the prostate) CPT 52601 PROSTATECTOMY (TURP)	$2,518.20	$2,798.00	$560.67–$2,590.95	34% above	10%
TURP (transurethral resection of the prostate) inpatient CPT 52601 PROSTATECTOMY (TURP)	$2,518.20	$2,798.00	$560.67–$2,590.95	—	10%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGENTIAL BX SKIN SINGLE LES	$188.10	$209.00	$90.12–$187.66	10% above	10%
Thoracentesis with imaging guidance CPT 32555 ASPIRATE PLEURA W IMAGING	$672.30	$747.00	$101.50–$691.72	4% above	10%
Thoracentesis with imaging guidance CPT 32555 THORACENTESIS, NEEDLE/CATH, AS	$672.30	$747.00	$322.11–$691.72	4% above	10%
Thoracentesis with imaging guidance CPT 32555 THORACENTESIS, NEEDLE OR CATH,	$672.30	$747.00	$101.50–$691.72	4% above	10%
Thoracentesis with imaging guidance CPT 32555 US GUIDANCE THOROCENTESIS	$1,796.40	$1,996.00	$860.68–$1,848.30	178% above	10%
Thoracentesis with imaging guidance inpatient CPT 32555 US GUIDANCE THOROCENTESIS	$1,796.40	$1,996.00	$860.68–$1,848.30	—	10%
Total hip replacement CPT 27130 ASSIST ARTHROPLASTY ACETAB/PRO	$1,185.30	$1,317.00	$1,172.13–$1,241.78	53% below	10%
Total hip replacement CPT 27130 TOTAL HIP ARTHROPLASTY	$3,104.10	$3,449.00	$1,216.94–$3,193.77	23% above	10%
Total hip replacement inpatient CPT 27130 ASSIST ARTHROPLASTY ACETAB/PRO	$1,185.30	$1,317.00	$1,172.13–$1,241.78	—	10%
Total hip replacement inpatient CPT 27130 TOTAL HIP ARTHROPLASTY	$3,104.10	$3,449.00	$1,216.94–$3,193.77	—	10%
Total knee replacement CPT 27447 ASSIST ARTHROPLASTY KNEE CONDY	$2,425.50	$2,695.00	$1,214.51–$2,495.57	24% below	10%
Total knee replacement CPT 27447 ARTHROPLASTY KNEE MED & LAT	$5,333.40	$5,926.00	$1,214.51–$5,487.48	67% above	10%
Total knee replacement inpatient CPT 27447 ASSIST ARTHROPLASTY KNEE CONDY	$2,425.50	$2,695.00	$1,214.51–$2,495.57	—	10%
Total knee replacement inpatient CPT 27447 ARTHROPLASTY KNEE MED & LAT	$5,333.40	$5,926.00	$1,214.51–$5,487.48	—	10%
Total shoulder replacement CPT 23472 TOTAL SHOULDER REPLACEMENT	$2,745.90	$3,051.00	$1,364.28–$2,825.23	9% above	10%
Total shoulder replacement inpatient CPT 23472 TOTAL SHOULDER REPLACEMENT	$2,745.90	$3,051.00	$1,364.28–$2,825.23	—	10%
Trigger finger release surgery CPT 26055 TENDON SHEATH INCISION	$1,066.50	$1,185.00	$300.80–$1,097.31	10% above	10%
Trigger finger release surgery inpatient CPT 26055 TENDON SHEATH INCISION	$1,066.50	$1,185.00	$300.80–$1,097.31	—	10%
Trigger point injections, 1 or 2 muscles CPT 20552 INJX SINGLE/MLT TRIGGER POIN	$107.10	$119.00	$38.19–$110.19	21% below	10%
Trigger point injections, 1 or 2 muscles CPT 20552 INJECTION TRIGGER POINT	$306.00	$340.00	$146.61–$314.84	125% above	10%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINT, 1/2 MUSCL	$379.80	$422.00	$181.97–$378.91	179% above	10%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ TRIGGER POINT, 1/2 MUSCL	$379.80	$422.00	$181.97–$378.91	—	10%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 BX BREAST NEEDLE W/PLACEMENT	$444.60	$494.00	$140.70–$457.44	73% below	10%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 EGD W/BALLOON	$728.10	$809.00	$145.76–$749.13	33% below	10%
Upper endoscopy (EGD) with biopsy CPT 43239 UPPER GI ENDO W/BX	$726.30	$807.00	$132.13–$747.28	17% below	10%
Upper endoscopy (EGD) with biopsy CPT 43239 UPPER GI ENDO W/BX	$726.30	$807.00	$132.13–$747.28	17% below	10%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 UPPER GI ENDO W/BX	$726.30	$807.00	$132.13–$747.28	—	10%
Upper endoscopy (EGD) with injection into the lining CPT 43236 UPPER GI SCOPE SUBMUCOSAL INJ	$891.90	$991.00	$132.13–$917.67	4% below	10%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 EGD W/REM TUMOR,POLYP SNARE	$839.70	$933.00	$185.20–$863.96	8% above	10%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 EGD INSERT GUIDE WIRE DILATOR	$475.20	$528.00	$158.15–$488.93	at median	10%
Upper endoscopy (EGD), diagnostic CPT 43235 UPPER GASTROINTENSTINAL ENDOSC	$642.60	$714.00	$118.08–$661.16	14% below	10%
Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 CYSTO W/LITHOTRIPSY	$1,776.60	$1,974.00	$367.94–$1,827.92	91% above	10%
Ureteroscopy with laser stone breaking (lithotripsy) inpatient CPT 52353 CYSTO W/LITHOTRIPSY	$1,776.60	$1,974.00	$367.94–$1,827.92	—	10%
Ureteroscopy with laser stone breaking and stent placement CPT 52356 CYSTO W/URETEROSCOPY AND/OR PY	$1,234.80	$1,372.00	$390.57–$1,270.47	13% above	10%
Ureteroscopy with laser stone breaking and stent placement inpatient CPT 52356 CYSTO W/URETEROSCOPY AND/OR PY	$1,234.80	$1,372.00	$390.57–$1,270.47	—	10%
Vasectomy, one or both sides, including follow-up semen testing CPT 55250 VASECTOMY	$1,984.50	$2,205.00	$231.34–$2,041.83	291% above	10%
Vasectomy, one or both sides, including follow-up semen testing CPT 55250 VASECTOMY	$1,984.50	$2,205.00	$231.34–$2,041.83	291% above	10%
Vasectomy, one or both sides, including follow-up semen testing inpatient CPT 55250 VASECTOMY	$1,984.50	$2,205.00	$231.34–$2,041.83	—	10%
Wart removal, up to 14 warts CPT 17110 Destruction Wart up to14 les	$121.50	$135.00	$66.02–$125.01	1% above	10%
Wart removal, up to 14 warts CPT 17110 WART(S) - REMOVAL	$121.50	$135.00	$66.02–$140.15	1% above	10%
Wart removal, up to 14 warts CPT 17110 DESTRUCTION WARTS UP TO 14 LES	$203.40	$226.00	$97.45–$202.93	69% above	10%
Wart removal, up to 14 warts CPT 17110 WART(S) REMOVAL	$203.40	$226.00	$97.45–$209.28	69% above	10%
Wart removal, up to 14 warts CPT 17110 DESTRUCTION WARTS UP TO 14 LES	$203.40	$226.00	$97.45–$202.93	69% above	10%
Wart removal, up to 14 warts inpatient CPT 17110 Destruction Wart up to14 les	$121.50	$135.00	$66.02–$125.01	—	10%
Wart removal, up to 14 warts inpatient CPT 17110 DESTRUCTION WARTS UP TO 14 LES	$203.40	$226.00	$97.45–$202.93	—	10%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEB SKIN & SUBCUTANEOUS TISSUE	$157.50	$175.00	$59.33–$162.05	14% below	10%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEB SUBQ TISSUE 20 SQ CM/<	$157.50	$175.00	$59.33–$162.05	14% below	10%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDE SKIN AND SUBCU TISSUE	$189.00	$210.00	$90.55–$194.46	3% above	10%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDEMENT SKIN & SUBCU TISSU	$262.80	$292.00	$125.91–$262.19	44% above	10%
Wrist fracture surgery (plate and screws), distal radius CPT 25607 ASSIST TREAT FX RAD EXTRA-ARTI	$932.40	$1,036.00	$730.08–$959.34	41% below	10%
Wrist fracture surgery (plate and screws), distal radius CPT 25607 TREAT FX RAD EXTRA-ARTICUL	$1,829.70	$2,033.00	$730.08–$1,882.56	16% above	10%
Wrist fracture surgery (plate and screws), distal radius inpatient CPT 25607 ASSIST TREAT FX RAD EXTRA-ARTI	$932.40	$1,036.00	$730.08–$959.34	—	10%
Wrist fracture surgery (plate and screws), distal radius inpatient CPT 25607 TREAT FX RAD EXTRA-ARTICUL	$1,829.70	$2,033.00	$730.08–$1,882.56	—	10%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Maine	Off list
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMIN (2 UNITS)	$490.50	$545.00	$235.00–$504.67	at median	10%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMIN (1 UNIT)	$490.50	$545.00	$235.00–$504.67	at median	10%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMIN (2 UNITS)	$490.50	$545.00	$235.00–$504.67	at median	10%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMIN (3+ UNITS)	$490.50	$545.00	$235.00–$504.67	at median	10%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMIN (1 UNIT)	$490.50	$545.00	$235.00–$504.67	at median	10%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMIN (3+ UNITS)	$490.50	$545.00	$235.00–$504.67	at median	10%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMIN (1 UNIT)	$490.50	$545.00	$235.00–$504.67	—	10%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMIN (2 UNITS)	$490.50	$545.00	$235.00–$504.67	—	10%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMIN (3+ UNITS)	$490.50	$545.00	$235.00–$504.67	—	10%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Nebulizer Treatment (RHC)	$71.10	$79.00	$34.06–$73.15	62% below	10%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NEB TX ER	$296.10	$329.00	$141.86–$304.65	57% above	10%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AEROSOL TX	$296.10	$329.00	$141.86–$304.65	57% above	10%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AEROSOL TX	$296.10	$329.00	$141.86–$304.65	—	10%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 NEB TX ER	$296.10	$329.00	$141.86–$304.65	—	10%
Chemotherapy IV infusion, first hour CPT 96413 CHEMO ADMIN IV INIT UP TO 1 HR	$723.60	$804.00	$346.68–$744.50	72% above	10%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE FIRST HOUR	$558.00	$620.00	$214.80–$574.12	43% below	10%
Critical care, first 30 to 74 minutes CPT 99291 PF CRITICAL CARE FIRST 30-74 M	$641.70	$713.00	$214.80–$660.24	34% below	10%
Critical care, first 30 to 74 minutes CPT 99291 PF CRITICAL CARE 1ST 30-74	$641.70	$713.00	$214.80–$660.24	34% below	10%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE	$1,427.40	$1,586.00	$683.88–$1,468.64	46% above	10%
Critical care, first 30 to 74 minutes inpatient CPT 99291 CRITICAL CARE FIRST HOUR	$558.00	$620.00	$214.80–$574.12	—	10%
Critical care, first 30 to 74 minutes inpatient CPT 99291 PF CRITICAL CARE FIRST 30-74 M	$641.70	$713.00	$214.80–$660.24	—	10%
Critical care, first 30 to 74 minutes inpatient CPT 99291 CRITICAL CARE	$1,427.40	$1,586.00	$683.88–$1,468.64	—	10%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 ECG	$200.70	$223.00	$96.16–$206.50	136% above	10%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG STANDARD	$138.60	$154.00	$66.40–$142.60	30% above	10%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG 12 LEAD	$138.60	$154.00	$66.40–$142.60	30% above	10%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG STANDARD	$138.60	$154.00	$66.40–$142.60	—	10%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG 12 LEAD	$138.60	$154.00	$66.40–$142.60	—	10%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER-SUTURE/CAST FOLLOW-UP	$30.60	$34.00	$14.66–$34.00	66% below	10%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER VISIT STRAIGHTFORWARD	$165.60	$184.00	$11.85–$170.38	82% above	10%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 F/U OTHER	$165.60	$184.00	$11.85–$170.38	82% above	10%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 PA MINIMAL-LEVEL 1	$165.60	$184.00	$11.85–$170.38	82% above	10%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER LEVEL I	$223.20	$248.00	$106.94–$248.00	145% above	10%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ER-SUTURE/CAST FOLLOW-UP	$30.60	$34.00	$14.66–$34.00	—	10%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ER LEVEL I	$223.20	$248.00	$106.94–$248.00	—	10%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 PA MINIMAL-LEVEL 2	$250.20	$278.00	$43.47–$257.43	41% above	10%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ER VISIT PROBLEM FOCUSED	$250.20	$278.00	$43.47–$257.43	41% above	10%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ER LEVEL II	$481.50	$535.00	$230.69–$535.00	172% above	10%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ER LEVEL II	$481.50	$535.00	$230.69–$535.00	—	10%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ER VISIT MODERATE COMPLEXITY	$327.60	$364.00	$74.61–$337.06	2% below	10%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 PA LIMITED-LEVEL3	$327.60	$364.00	$74.61–$337.06	2% below	10%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ER LEVEL III	$661.50	$735.00	$316.93–$735.00	97% above	10%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ER LEVEL III	$661.50	$735.00	$316.93–$735.00	—	10%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ER VISIT DETAILED	$407.70	$453.00	$126.92–$419.48	33% below	10%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 PA INTERMEDIATE-LEVEL 4	$407.70	$453.00	$126.92–$419.48	33% below	10%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ER LEVEL IV	$1,128.60	$1,254.00	$540.72–$1,254.00	86% above	10%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ER LEVEL IV	$1,128.60	$1,254.00	$540.72–$1,254.00	—	10%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ER VISIT COMPREHENSIVE	$486.90	$541.00	$184.32–$500.97	51% below	10%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 PA EXTENDED-LEVEL 5	$486.90	$541.00	$184.32–$500.97	51% below	10%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ER LEVEL V	$1,312.20	$1,458.00	$628.69–$1,458.00	33% above	10%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ER LEVEL V	$1,312.20	$1,458.00	$628.69–$1,458.00	—	10%
Exercise stress test, tracing only, the hospital charge CPT 93017 LEXISCAN SESTAMIBI STRESS TEST	$563.40	$626.00	$269.93–$579.68	at median	10%
Exercise stress test, tracing only, the hospital charge CPT 93017 TREADMILL	$563.40	$626.00	$269.93–$579.68	at median	10%
Exercise stress test, tracing only, the hospital charge CPT 93017 SESTAMIBI TREADMILL	$563.40	$626.00	$269.93–$579.68	at median	10%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 LEXISCAN SESTAMIBI STRESS TEST	$563.40	$626.00	$269.93–$579.68	—	10%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 SESTAMIBI TREADMILL	$563.40	$626.00	$269.93–$579.68	—	10%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 TREADMILL	$563.40	$626.00	$269.93–$579.68	—	10%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRATE INITIAL 31-60 MIN	$288.00	$320.00	$137.98–$287.33	40% above	10%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HYDRATE INITIAL 31-60 MIN	$288.00	$320.00	$137.98–$287.33	—	10%
IV infusion of a medicine, first hour CPT 96365 INFUSION INITIAL UP TO 1 HOUR	$431.10	$479.00	$206.54–$430.09	34% above	10%
IV infusion of a medicine, first hour inpatient CPT 96365 INFUSION INITIAL UP TO 1 HOUR	$431.10	$479.00	$206.54–$430.09	—	10%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION IM/SQ *OBS	$71.10	$79.00	$34.06–$73.15	6% above	10%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION IM/SQ	$71.10	$79.00	$34.06–$73.15	6% above	10%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION IM/SQ *ER	$71.10	$79.00	$34.06–$73.15	6% above	10%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJ. SC/IM BY PA-C	$71.10	$79.00	$16.33–$73.15	6% above	10%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION ASU	$71.10	$79.00	$34.06–$73.15	6% above	10%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THERAPEUTIC INJ-SUBQ (RHC)	$71.10	$79.00	$34.06–$70.93	6% above	10%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJECTION IM/SQ *OBS	$71.10	$79.00	$34.06–$73.15	—	10%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJECTION ASU	$71.10	$79.00	$34.06–$73.15	—	10%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJECTION IM/SQ *ER	$71.10	$79.00	$34.06–$73.15	—	10%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 NERVE CONDUCTION STUDY 7-8 STU	$214.20	$238.00	$102.63–$220.39	21% below	10%
Neuromuscular re-education, 15 minutes CPT 97112 NEUROMSCLR RE-EDU EA 15 MIN	$112.50	$125.00	$53.90–$115.75	16% above	10%
Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSCULAR FACIL EA 15 MIN	$131.40	$146.00	$62.96–$135.20	35% above	10%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEUROMSCLR RE-EDU EA 15 MIN	$112.50	$125.00	$53.90–$115.75	—	10%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEUROMUSCULAR FACIL EA 15 MIN	$131.40	$146.00	$62.96–$135.20	—	10%
New patient office visit, about 30 minutes CPT 99203 OFFICE VISIT-NEW DETAILED	$251.10	$279.00	$120.30–$250.51	134% above	10%
New patient office visit, about 30 minutes CPT 99203 OFF/OP CONSLT NEW/EST PT LOW	$293.40	$326.00	$140.57–$292.72	173% above	10%
New patient office visit, about 45 minutes CPT 99204 DRESSING CHANGE NEW PT COMPLEX	$130.50	$145.00	$62.52–$134.27	20% below	10%
New patient office visit, about 45 minutes CPT 99204 OFFICE VISIT-NEW COMPREHENSIVE	$325.80	$362.00	$156.09–$325.04	100% above	10%
New patient office visit, about 45 minutes CPT 99204 OFF/OP CONSLT NEW/EST PT MOD	$402.30	$447.00	$192.75–$401.36	147% above	10%
New patient office visit, about 60 minutes CPT 99205 TELEHLTH OV-NEW HIGH	$374.40	$416.00	$172.73–$385.22	53% above	10%
New patient office visit, about 60 minutes CPT 99205 OFFICE VISIT-NEW HIGH	$406.80	$452.00	$194.90–$405.85	66% above	10%
New patient office visit, about 60 minutes CPT 99205 OFF/OP CONSLT NEW/EST PT HIGH	$491.40	$546.00	$235.44–$490.25	101% above	10%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 OFFICE VISIT-NEW EXPANDED	$162.90	$181.00	$78.05–$162.52	149% above	10%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MNT INDIV INIT EA 15 MINS	$47.70	$53.00	$22.85–$49.08	3% above	10%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MCD PREASSESSMENT	$186.30	$207.00	$89.26–$191.68	302% above	10%
Occupational therapy evaluation, low complexity CPT 97165 OT EVALUATION LOW COMPLEXITY	$222.30	$247.00	$106.51–$228.72	at median	10%
Occupational therapy evaluation, low complexity inpatient CPT 97165 OT EVALUATION LOW COMPLEXITY	$222.30	$247.00	$106.51–$228.72	—	10%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 EVALUATION PHYS THER HIGH COMP	$321.30	$357.00	$153.94–$330.58	27% above	10%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 EVALUATION PHYS THER HIGH COMP	$321.30	$357.00	$153.94–$330.58	—	10%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 EVALUATION PHYS THER LOW COMPL	$222.30	$247.00	$106.51–$228.72	at median	10%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 EVALUATION PHYS THER LOW COMPL	$222.30	$247.00	$106.51–$228.72	—	10%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 EVALUATION PHYS THER MODERATE	$270.90	$301.00	$129.79–$278.73	3% above	10%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 EVALUATION PHYS THER MODERATE	$270.90	$301.00	$129.79–$278.73	—	10%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MYOFASCIAL RELEASE EA 15 MINS	$102.60	$114.00	$49.16–$105.56	17% above	10%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THER TECH EA 15 MINUTE	$107.10	$119.00	$51.31–$110.19	22% above	10%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MYOFASCIAL RELEASE EA 15 MINS	$102.60	$114.00	$49.16–$105.56	—	10%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MANUAL THER TECH EA 15 MINUTE	$107.10	$119.00	$51.31–$110.19	—	10%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISE EA 15 MIN	$114.30	$127.00	$54.76–$117.60	85% above	10%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THER EXERCISE EA 15 MIN	$130.50	$145.00	$62.52–$134.27	111% above	10%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC EXERCISE EA 15 MIN	$114.30	$127.00	$54.76–$117.60	—	10%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THER EXERCISE EA 15 MIN	$130.50	$145.00	$62.52–$134.27	—	10%
Preventive checkup, new patient aged 18–39 CPT 99385 NEW PV 18-39 YRS	$216.90	$241.00	$103.92–$216.39	98% above	10%
Preventive checkup, new patient aged 40–64 CPT 99386 NEW PV 40-64 YEARS	$243.00	$270.00	$116.42–$242.43	77% above	10%
Preventive checkup, returning patient aged 18–39 CPT 99395 EST PV CARE 18-39 YRS	$213.30	$237.00	$102.19–$212.80	104% above	10%
Preventive checkup, returning patient aged 40–64 CPT 99396 EST PV CARE 40-64 YRS	$230.40	$256.00	$110.39–$229.86	120% above	10%
Preventive checkup, returning patient aged 65 or older CPT 99397 EST PV CARE 65 YRS & >	$257.40	$286.00	$123.32–$256.80	130% above	10%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 SMOKING CESSATION 3-10 MINUTES	$35.10	$39.00	$16.82–$36.11	42% above	10%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 TOBACCO USE CESSATION INTERMED	$35.10	$39.00	$16.82–$35.02	42% above	10%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 SMOKING CESSATION 3-10 MINUTES	$35.10	$39.00	$16.82–$36.11	—	10%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 EST PT COMPLEX	$131.40	$146.00	$62.96–$135.20	at median	10%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 INSULIN PUMP INSULIN START	$148.50	$165.00	$71.15–$152.79	13% above	10%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE VISIT-EST HIGH	$329.40	$366.00	$157.82–$328.63	151% above	10%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Consult High	$430.20	$478.00	$136.29–$442.63	227% above	10%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 INSULIN PUMP INSULIN START	$148.50	$165.00	$71.15–$152.79	—	10%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Consult High	$430.20	$478.00	$136.29–$442.63	—	10%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 DRSSG CHANGE EST PT INTRMD W/P	$66.60	$74.00	$31.91–$68.52	at median	10%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 EST PT INTERMEDIATE	$66.60	$74.00	$31.91–$68.52	at median	10%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 TELEHLTH OV-EST DETAILED	$99.00	$110.00	$62.47–$101.86	49% above	10%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE VISIT-EST DETAILED	$165.60	$184.00	$79.34–$165.21	149% above	10%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Consult Low	$268.20	$298.00	$62.47–$275.95	303% above	10%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Consult Low	$268.20	$298.00	$62.47–$275.95	—	10%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 DRSSG CHANGE EST PT EXT W/PROC	$91.80	$102.00	$43.98–$94.45	at median	10%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 EST PT EXTENDED	$91.80	$102.00	$43.98–$94.45	at median	10%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 DRSSNG CHANGE EST PT EXTENDED	$91.80	$102.00	$43.98–$94.45	at median	10%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 INSULIN PUMP RECHECK	$138.60	$154.00	$66.40–$142.60	51% above	10%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE VISIT-EST COMPREHENSIVE	$230.40	$256.00	$110.39–$229.86	151% above	10%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 TELEHLTH OV-EST COMPREHENSIVE	$230.40	$256.00	$91.83–$237.06	151% above	10%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 REMOVAL GASTROSTOMY TUBE	$282.60	$314.00	$135.40–$290.76	208% above	10%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Consult Mod	$349.20	$388.00	$91.83–$359.29	280% above	10%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 REMOVAL GASTROSTOMY TUBE	$282.60	$314.00	$135.40–$290.76	—	10%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Consult Mod	$349.20	$388.00	$91.83–$359.29	—	10%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 DRSSG CHANGE EST PT LTD W/PROC	$50.40	$56.00	$24.15–$51.86	at median	10%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 DRESSING CHANGE EST PT LIMITED	$50.40	$56.00	$24.15–$51.86	at median	10%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 EST PT LIMITED	$50.40	$56.00	$24.15–$51.86	at median	10%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 TELEHLTH OV-EST EXP	$76.50	$85.00	$33.64–$78.71	52% above	10%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE VISIT-EST EXPANDED	$126.90	$141.00	$60.80–$126.60	152% above	10%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE/OP CONSLT NEW/EST PT SF	$195.30	$217.00	$93.57–$194.84	288% above	10%
Specialist consultation, low complexity or 30+ minutes CPT 99243 OFF/OP CONSLT NEW/EST PT LOW	$269.10	$299.00	$266.11–$276.87	159% above	10%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 OFF/OP CONSLT NEW/EST PT LOW	$269.10	$299.00	$266.11–$276.87	—	10%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 OFF/OP CONSLT NEW/EST PT MOD	$402.30	$447.00	$397.83–$413.92	204% above	10%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 OFF/OP CONSLT NEW/EST PT MOD	$402.30	$447.00	$397.83–$413.92	—	10%
Speech and language evaluation CPT 92523 SPEECH SOUND EVALUATION	$374.40	$416.00	$179.38–$385.22	22% above	10%
Speech and language evaluation inpatient CPT 92523 SPEECH SOUND EVALUATION	$374.40	$416.00	$179.38–$385.22	—	10%
Speech therapy session, individual CPT 92507 SPEECH TREATMENT	$260.10	$289.00	$124.62–$267.61	59% above	10%
Speech therapy session, individual inpatient CPT 92507 SPEECH TREATMENT	$260.10	$289.00	$124.62–$267.61	—	10%
Spirometry (breathing test) CPT 94010 PEAK FLOW I/S INSTRUCTION	$51.30	$57.00	$24.58–$52.78	66% below	10%
Spirometry (breathing test) CPT 94010 SPIROMETRY	$77.40	$86.00	$37.08–$79.64	48% below	10%
Spirometry (breathing test) inpatient CPT 94010 PEAK FLOW I/S INSTRUCTION	$51.30	$57.00	$24.58–$52.78	—	10%
Therapeutic activities (functional training), 15 minutes CPT 97530 FUNCTIONL ACTIVITIES EA 15 MIN	$117.00	$130.00	$56.06–$120.38	33% above	10%
Therapeutic activities (functional training), 15 minutes CPT 97530 THER ACTIVITIES EA 15 MINS	$136.80	$152.00	$65.54–$140.75	55% above	10%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 FUNCTIONL ACTIVITIES EA 15 MIN	$117.00	$130.00	$56.06–$120.38	—	10%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THER ACTIVITIES EA 15 MINS	$136.80	$152.00	$65.54–$140.75	—	10%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY, THERAPEUTIC	$94.50	$105.00	$45.28–$97.23	37% below	10%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY, THERAPEUTIC	$94.50	$105.00	$45.28–$97.23	—	10%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Maine	Off list
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 HEP B/HEP A 20MCG-720ELU/ML	$415.80	$462.00	$199.21–$427.81	165% above	10%
Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 HEP B/HEP A 20MCG-720ELU/ML	$415.80	$462.00	$199.21–$427.81	—	10%
Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A-ADULT 1440 ELU/ML	$285.30	$317.00	$136.69–$293.54	256% above	10%
Hepatitis A vaccine, adult dose CPT 90632 Hepatitis A Vac 1440 ELU/ML	$349.20	$388.00	$167.31–$359.29	336% above	10%
Hepatitis A vaccine, adult dose inpatient CPT 90632 Hepatitis A Vac 1440 ELU/ML	$349.20	$388.00	$167.31–$359.29	—	10%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 Hepatitis B-adult	$333.00	$370.00	$159.54–$342.62	517% above	10%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 INFLUENZA (HI-DOSE) 0.7ML SYR	$234.00	$260.00	$112.11–$240.76	104% above	10%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 INFLUENZA (HI-DOSE) 0.7ML SYR	$234.00	$260.00	$112.11–$240.76	—	10%
MMR vaccine (measles, mumps and rubella), live CPT 90707 VFC-MMR II	$19.80	$22.00	$9.49–$20.37	81% below	10%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MMR live	$198.90	$221.00	$95.30–$204.65	92% above	10%
MMR vaccine (measles, mumps and rubella), live CPT 90707 M-M-R II VACCINE	$356.40	$396.00	$170.76–$366.70	244% above	10%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 VFC-MMR II	$19.80	$22.00	$9.49–$20.37	—	10%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 M-M-R II VACCINE	$356.40	$396.00	$170.76–$366.70	—	10%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 Meningococcal Vaccine (Menveo)	$189.90	$211.00	$90.98–$195.39	84% above	10%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENACTRA VACCINE	$665.10	$739.00	$318.66–$684.31	544% above	10%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 Meningococcal Vaccine (Menveo)	$189.90	$211.00	$90.98–$195.39	—	10%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Pneumococcal plysc Adult/immun	$152.10	$169.00	$72.87–$156.49	68% above	10%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL 25mcg/0.5mL INJ	$286.20	$318.00	$137.12–$294.47	216% above	10%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL 25mcg/0.5mL INJ	$286.20	$318.00	$137.12–$294.47	—	10%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE PRE/POST EXP	$1,071.00	$1,190.00	$513.13–$1,101.94	191% above	10%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE PRE/POST EXP	$1,071.00	$1,190.00	$513.13–$1,101.94	—	10%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TD	$45.00	$50.00	$21.56–$46.30	8% above	10%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS-DIPHTH TOX 0.5ML VIAL	$99.00	$110.00	$47.43–$101.86	137% above	10%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS-DIPHTH TOX 0.5ML VIAL	$99.00	$110.00	$47.43–$101.86	—	10%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 VFC-TD/TDAP (BOOSTRIX)	$19.80	$22.00	$9.49–$20.37	53% below	10%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDAP	$199.80	$222.00	$95.73–$205.57	371% above	10%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDaP VACCINE 0.5ML INJ SYRI	$199.80	$222.00	$95.73–$205.57	371% above	10%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 VFC-TD/TDAP (BOOSTRIX)	$19.80	$22.00	$9.49–$20.37	—	10%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TDaP VACCINE 0.5ML INJ SYRI	$199.80	$222.00	$95.73–$205.57	—	10%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Admin Adult Vaccine-one vac	$42.30	$47.00	$20.27–$43.52	152% above	10%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 VACCINE ADMIN IM/SQ	$46.80	$52.00	$22.42–$48.15	179% above	10%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 VACCINE ADMIN IM/SQ	$46.80	$52.00	$22.42–$48.15	179% above	10%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 VACCINE ADMIN IM/SQ	$46.80	$52.00	$22.42–$48.15	—	10%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Admin Adult Vaccine-ea addl	$24.30	$27.00	$11.64–$25.00	30% above	10%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 VACCINE ADMIN IM/SQ EA ADDL	$46.80	$52.00	$22.42–$48.15	151% above	10%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 VACCINE IM/SQ EA ADDL	$48.60	$54.00	$23.28–$50.00	161% above	10%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 VACCINE IM/SQ EA ADDL	$48.60	$54.00	$23.28–$50.00	—	10%

Source file: https://mrhme.org/files/01-0223482_millinocket-regional-hospital_standardcharges.csv