Minden Medical Center
Minden Medical Center in Minden, LA publishes cash prices for 248 common procedures listed here, from its own machine-readable price file updated Sep 1, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Louisiana median for 139 of 245 procedures and below it for 98. By typical cash price it ranks #18 of 28 Louisiana hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.
1 MEDICAL PLAZA PL,MINDEN,LA,71055-3330 Collected Sep 27, 2026 Source price file (318) 377-2321
Acute care hospital Emergency department CMS star rating 2 of 5 CCN 190144 · CMS hospital register
CMS price transparency record
The federal Centers for Medicare & Medicaid Services (CMS) enforces the rule that makes hospitals publish their prices. Its public enforcement list shows 3 actions for a hospital named Minden Medical Center in Minden, LA:
- Apr 10, 2025 Met requirements
- Apr 14, 2026 Warning notice
- Jul 20, 2026 Corrective action plan requested
Met requirements: CMS reviewed the hospital and found it met the requirements, so no further action was taken. Warning notice: CMS reviewed the hospital and told it that it had found possible violations of the price transparency rules. Corrective action plan requested: CMS asked the hospital to submit a plan to fix the problems it found.
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 Louisiana | Off list |
|---|---|---|---|---|---|
| Ankle X-ray, complete, 3 or more views CPT 73610 X-RAY EXAM OF ANKLE | $183.30 | $611.00 | $32.18–$2,444.00 | 53% above | 70% |
| Ankle X-ray, complete, 3 or more views one side CPT 73610 HDX XR ANKLE 3+ VIEWS LEFT | $91.65 | $305.50 | $32.18–$2,444.00 | 23% below | 70% |
| Ankle X-ray, complete, 3 or more views one side CPT 73610 HDX XR ANKLE 3+ VIEWS RIGHT | $91.65 | $305.50 | $32.18–$2,444.00 | 23% below | 70% |
| Ankle X-ray, complete, 3 or more views one side CPT 73610 MFI XR ANKLE 3+ VIEWS LEFT | $91.65 | $305.50 | $32.18–$2,444.00 | 23% below | 70% |
| Ankle X-ray, complete, 3 or more views one side CPT 73610 MFI XR ANKLE 3+ VIEWS RIGHT | $91.65 | $305.50 | $32.18–$2,444.00 | 23% below | 70% |
| Ankle X-ray, complete, 3 or more views one side CPT 73610 ANKLE MIN 3 VIEWS RT | $183.30 | $611.00 | $32.18–$2,444.00 | 53% above | 70% |
| Ankle X-ray, complete, 3 or more views one side CPT 73610 ANKLE MIN 3 VIEWS LT | $183.30 | $611.00 | $32.18–$2,444.00 | 53% above | 70% |
| Ankle X-ray, complete, 3 or more views inpatient CPT 73610 X-RAY EXAM OF ANKLE | $183.30 | $611.00 | $32.18–$2,444.00 | — | 70% |
| Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 HDX XR ANKLE 3+ VIEWS LEFT | $91.65 | $305.50 | $32.18–$2,444.00 | — | 70% |
| Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 MFI XR ANKLE 3+ VIEWS LEFT | $91.65 | $305.50 | $32.18–$2,444.00 | — | 70% |
| Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 MFI XR ANKLE 3+ VIEWS RIGHT | $91.65 | $305.50 | $32.18–$2,444.00 | — | 70% |
| Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 HDX XR ANKLE 3+ VIEWS RIGHT | $91.65 | $305.50 | $32.18–$2,444.00 | — | 70% |
| Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 ANKLE MIN 3 VIEWS LT | $183.30 | $611.00 | $32.18–$2,444.00 | — | 70% |
| Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 ANKLE MIN 3 VIEWS RT | $183.30 | $611.00 | $32.18–$2,444.00 | — | 70% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 UPR/L XTREMITY ART 2 LEVELS | $99.00 | $330.00 | $55.57–$330.00 | 49% below | 70% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 ABI-ANKLEBRAHIAL INDEX | $99.00 | $330.00 | $55.57–$330.00 | 49% below | 70% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 UPR/L XTREMITY ART 2 LEVELS | $99.00 | $330.00 | $55.57–$330.00 | — | 70% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 ABI-ANKLEBRAHIAL INDEX | $99.00 | $330.00 | $55.57–$330.00 | — | 70% |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 ESOPHAGRAM | $236.85 | $789.50 | $89.74–$789.50 | at median | 70% |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 X-RAY XM ESOPHAGUS 1CNTRST | $236.85 | $789.50 | $89.74–$789.50 | at median | 70% |
| Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 ESOPHAGRAM | $236.85 | $789.50 | $89.74–$789.50 | — | 70% |
| Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 X-RAY XM ESOPHAGUS 1CNTRST | $236.85 | $789.50 | $89.74–$789.50 | — | 70% |
| Bone scan, whole body (nuclear medicine) CPT 78306 BONE/JOINT WHOLE BODY | $1,152.60 | $3,842.00 | $262.08–$3,842.00 | 90% above | 70% |
| Bone scan, whole body (nuclear medicine) CPT 78306 BONE IMAGING WHOLE BODY | $1,152.60 | $3,842.00 | $262.08–$3,842.00 | 90% above | 70% |
| Bone scan, whole body (nuclear medicine) inpatient CPT 78306 BONE/JOINT WHOLE BODY | $1,152.60 | $3,842.00 | $262.08–$3,842.00 | — | 70% |
| Bone scan, whole body (nuclear medicine) inpatient CPT 78306 BONE IMAGING WHOLE BODY | $1,152.60 | $3,842.00 | $262.08–$3,842.00 | — | 70% |
| Breast ultrasound, complete, one breast CPT 76641 ULTRASOUND BREAST COMPLETE | $505.35 | $1,684.50 | $110.68–$11,791.50 | 192% above | 70% |
| Breast ultrasound, complete, one breast CPT 76641 US BREAST COMP BIL | $505.35 | $1,684.50 | $110.68–$11,791.50 | 192% above | 70% |
| Breast ultrasound, complete, one breast one side CPT 76641 HDX US BREAST COMPLETE LEFT | $505.35 | $1,684.50 | $110.68–$11,791.50 | 192% above | 70% |
| Breast ultrasound, complete, one breast one side CPT 76641 HDX US BREAST COMPLETE RIGHT | $505.35 | $1,684.50 | $110.68–$11,791.50 | 192% above | 70% |
| Breast ultrasound, complete, one breast one side CPT 76641 MFI US BREAST COMPLETE LEFT | $505.35 | $1,684.50 | $110.68–$11,791.50 | 192% above | 70% |
| Breast ultrasound, complete, one breast one side CPT 76641 MFI US BREAST COMPLETE RIGHT | $505.35 | $1,684.50 | $110.68–$11,791.50 | 192% above | 70% |
| Breast ultrasound, complete, one breast one side CPT 76641 US BREAST COMP LT | $505.35 | $1,684.50 | $110.68–$11,791.50 | 192% above | 70% |
| Breast ultrasound, complete, one breast one side CPT 76641 US BREAST COMP RT | $505.35 | $1,684.50 | $110.68–$11,791.50 | 192% above | 70% |
| Breast ultrasound, complete, one breast inpatient CPT 76641 ULTRASOUND BREAST COMPLETE | $505.35 | $1,684.50 | $110.68–$11,791.50 | — | 70% |
| Breast ultrasound, complete, one breast inpatient CPT 76641 US BREAST COMP BIL | $505.35 | $1,684.50 | $110.68–$11,791.50 | — | 70% |
| Breast ultrasound, complete, one breast inpatient one side CPT 76641 MFI US BREAST COMPLETE LEFT | $505.35 | $1,684.50 | $110.68–$11,791.50 | — | 70% |
| Breast ultrasound, complete, one breast inpatient one side CPT 76641 US BREAST COMP LT | $505.35 | $1,684.50 | $110.68–$11,791.50 | — | 70% |
| Breast ultrasound, complete, one breast inpatient one side CPT 76641 HDX US BREAST COMPLETE LEFT | $505.35 | $1,684.50 | $110.68–$11,791.50 | — | 70% |
| Breast ultrasound, complete, one breast inpatient one side CPT 76641 US BREAST COMP RT | $505.35 | $1,684.50 | $110.68–$11,791.50 | — | 70% |
| Breast ultrasound, complete, one breast inpatient one side CPT 76641 MFI US BREAST COMPLETE RIGHT | $505.35 | $1,684.50 | $110.68–$11,791.50 | — | 70% |
| Breast ultrasound, complete, one breast inpatient one side CPT 76641 HDX US BREAST COMPLETE RIGHT | $505.35 | $1,684.50 | $110.68–$11,791.50 | — | 70% |
| Breast ultrasound, limited (one breast or one area) CPT 76642 ULTRASOUND BREAST LIMITED | $482.55 | $1,608.50 | $91.54–$9,651.00 | 171% above | 70% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 MFI US BREAST LIMITED LEFT | $482.55 | $1,608.50 | $91.54–$9,651.00 | 171% above | 70% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST LTD LT | $482.55 | $1,608.50 | $91.54–$9,651.00 | 171% above | 70% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 MFI US BREAST LIMITED RIGHT | $482.55 | $1,608.50 | $91.54–$9,651.00 | 171% above | 70% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 HDX US BREAST LIMITED LEFT | $482.55 | $1,608.50 | $91.54–$9,651.00 | 171% above | 70% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST LTD RT | $482.55 | $1,608.50 | $91.54–$9,651.00 | 171% above | 70% |
| Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 ULTRASOUND BREAST LIMITED | $482.55 | $1,608.50 | $91.54–$9,651.00 | — | 70% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 HDX US BREAST LIMITED LEFT | $482.55 | $1,608.50 | $91.54–$9,651.00 | — | 70% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US BREAST LTD LT | $482.55 | $1,608.50 | $91.54–$9,651.00 | — | 70% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 MFI US BREAST LIMITED RIGHT | $482.55 | $1,608.50 | $91.54–$9,651.00 | — | 70% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 MFI US BREAST LIMITED LEFT | $482.55 | $1,608.50 | $91.54–$9,651.00 | — | 70% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US BREAST LTD RT | $482.55 | $1,608.50 | $91.54–$9,651.00 | — | 70% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT ANGIO CHEST W/W/O CON | $1,403.85 | $4,679.50 | $306.55–$14,038.50 | 48% above | 70% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT ANGIOGRAPHY CHEST | $1,403.85 | $4,679.50 | $306.55–$14,038.50 | 48% above | 70% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA CHEST WC | $1,403.85 | $4,679.50 | $306.55–$14,038.50 | 48% above | 70% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT PE ANGIO CHEST W/C | $1,403.85 | $4,679.50 | $306.55–$14,038.50 | 48% above | 70% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT PE ANGIO CHEST W/C | $1,403.85 | $4,679.50 | $306.55–$14,038.50 | — | 70% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT ANGIO CHEST W/W/O CON | $1,403.85 | $4,679.50 | $306.55–$14,038.50 | — | 70% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA CHEST WC | $1,403.85 | $4,679.50 | $306.55–$14,038.50 | — | 70% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT ANGIOGRAPHY CHEST | $1,403.85 | $4,679.50 | $306.55–$14,038.50 | — | 70% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD & PELVIS W/O CONTRAST | $1,219.05 | $4,063.50 | $208.02–$9,954.00 | 2% below | 70% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD&PEL WO CONTRAST | $1,219.05 | $4,063.50 | $208.02–$9,954.00 | 2% below | 70% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT RENAL STONE STUDY | $1,767.15 | $5,890.50 | $208.02–$9,954.00 | 42% above | 70% |
| CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD & PELVIS W/O CONTRAST | $1,219.05 | $4,063.50 | $208.02–$9,954.00 | — | 70% |
| CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD&PEL WO CONTRAST | $1,219.05 | $4,063.50 | $208.02–$9,954.00 | — | 70% |
| CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT RENAL STONE STUDY | $1,767.15 | $5,890.50 | $208.02–$9,954.00 | — | 70% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD & PELVIS W/CONTRAST | $2,117.55 | $7,058.50 | $317.28–$7,058.50 | 30% above | 70% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD&PEL W CONTRAST | $2,117.55 | $7,058.50 | $317.28–$7,058.50 | 30% above | 70% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD & PELVIS W/CONTRAST | $2,117.55 | $7,058.50 | $317.28–$7,058.50 | — | 70% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD&PEL W CONTRAST | $2,117.55 | $7,058.50 | $317.28–$7,058.50 | — | 70% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD&PEL WO/W CONTRAST | $2,289.75 | $7,632.50 | $344.00–$7,632.50 | 35% above | 70% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD&PLV WO CNTR FLWD CNTR | $2,289.75 | $7,632.50 | $344.00–$7,632.50 | 35% above | 70% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD&PEL WO/W CONTRAST | $2,289.75 | $7,632.50 | $344.00–$7,632.50 | — | 70% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD&PLV WO CNTR FLWD CNTR | $2,289.75 | $7,632.50 | $344.00–$7,632.50 | — | 70% |
| CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W/CONTRAST | $1,219.05 | $4,063.50 | $234.97–$4,063.50 | 35% above | 70% |
| CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN WITH CONT | $1,219.05 | $4,063.50 | $234.97–$4,063.50 | 35% above | 70% |
| CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN W/CONTRAST | $1,219.05 | $4,063.50 | $234.97–$4,063.50 | — | 70% |
| CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN WITH CONT | $1,219.05 | $4,063.50 | $234.97–$4,063.50 | — | 70% |
| CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/O CONT | $1,219.05 | $4,063.50 | $154.43–$4,063.50 | 43% above | 70% |
| CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/O CONTRAST | $1,219.05 | $4,063.50 | $154.43–$4,063.50 | 43% above | 70% |
| CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN W/O CONT | $1,219.05 | $4,063.50 | $154.43–$4,063.50 | — | 70% |
| CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN W/O CONTRAST | $1,219.05 | $4,063.50 | $154.43–$4,063.50 | — | 70% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIAL W/O DYE | $1,219.05 | $4,063.50 | $142.15–$4,063.50 | 83% above | 70% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILO/SINUS W/O CONT | $1,219.05 | $4,063.50 | $142.15–$4,063.50 | 83% above | 70% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILO/SINUS W/O CONT | $1,219.05 | $4,063.50 | $142.15–$4,063.50 | — | 70% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILLOFACIAL W/O DYE | $1,219.05 | $4,063.50 | $142.15–$4,063.50 | — | 70% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD/BRAIN W/O CONT | $1,125.75 | $3,752.50 | $119.39–$3,752.50 | 72% above | 70% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD/BRAIN W/O DYE | $1,125.75 | $3,752.50 | $119.39–$3,752.50 | 72% above | 70% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD/BRAIN W/O DYE | $1,125.75 | $3,752.50 | $119.39–$3,752.50 | — | 70% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD/BRAIN W/O CONT | $1,125.75 | $3,752.50 | $119.39–$3,752.50 | — | 70% |
| CT scan of the head with contrast CPT 70460 CT HEAD/BRAIN WITH CONT | $1,521.60 | $5,072.00 | $166.29–$5,072.00 | 91% above | 70% |
| CT scan of the head with contrast CPT 70460 CT HEAD/BRAIN W/DYE | $1,521.60 | $5,072.00 | $166.29–$5,072.00 | 91% above | 70% |
| CT scan of the head with contrast inpatient CPT 70460 CT HEAD/BRAIN W/DYE | $1,521.60 | $5,072.00 | $166.29–$5,072.00 | — | 70% |
| CT scan of the head with contrast inpatient CPT 70460 CT HEAD/BRAIN WITH CONT | $1,521.60 | $5,072.00 | $166.29–$5,072.00 | — | 70% |
| CT scan of the head without and with contrast CPT 70470 CT HEAD/BRAIN W/W/O CONT | $1,971.90 | $6,573.00 | $196.45–$6,573.00 | 108% above | 70% |
| CT scan of the head without and with contrast CPT 70470 CT HEAD/BRAIN W/O & W/DYE | $1,971.90 | $6,573.00 | $196.45–$6,573.00 | 108% above | 70% |
| CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD/BRAIN W/W/O CONT | $1,971.90 | $6,573.00 | $196.45–$6,573.00 | — | 70% |
| CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD/BRAIN W/O & W/DYE | $1,971.90 | $6,573.00 | $196.45–$6,573.00 | — | 70% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMBAR SPINE W/O DYE | $1,219.05 | $4,063.50 | $165.35–$4,063.50 | 54% above | 70% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT L-SPINE W/O CONTRAST | $1,219.05 | $4,063.50 | $165.35–$4,063.50 | 54% above | 70% |
| CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT L-SPINE W/O CONTRAST | $1,219.05 | $4,063.50 | $165.35–$4,063.50 | — | 70% |
| CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT LUMBAR SPINE W/O DYE | $1,219.05 | $4,063.50 | $165.35–$4,063.50 | — | 70% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT C-SPINE W/O CONTRAST | $1,219.05 | $4,063.50 | $169.17–$4,063.50 | 55% above | 70% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT NECK SPINE W/O DYE | $1,219.05 | $4,063.50 | $169.17–$4,063.50 | 55% above | 70% |
| CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT C-SPINE W/O CONTRAST | $1,219.05 | $4,063.50 | $169.17–$4,063.50 | — | 70% |
| CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT NECK SPINE W/O DYE | $1,219.05 | $4,063.50 | $169.17–$4,063.50 | — | 70% |
| CT scan of the pelvis, with contrast dye both sides CPT 72193 CT HIP BILAT WC | $1,389.45 | $4,631.50 | $229.57–$9,263.00 | — | 70% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/DYE | $1,389.45 | $4,631.50 | $229.57–$9,263.00 | 68% above | 70% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS WITH CONTRAST | $1,389.45 | $4,631.50 | $229.57–$9,263.00 | 68% above | 70% |
| CT scan of the pelvis, with contrast dye inpatient both sides CPT 72193 CT HIP BILAT WC | $1,389.45 | $4,631.50 | $229.57–$9,263.00 | — | 70% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/DYE | $1,389.45 | $4,631.50 | $229.57–$9,263.00 | — | 70% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS WITH CONTRAST | $1,389.45 | $4,631.50 | $229.57–$9,263.00 | — | 70% |
| Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 EXTRACRANIAL BILAT STUDY | $847.35 | $2,824.50 | $471.67–$5,648.50 | — | 70% |
| Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 US CAROTID DUP BILAT | $847.35 | $2,824.50 | $471.67–$5,648.50 | — | 70% |
| Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 MFI US CAROTID DOPPLER | $423.60 | $1,412.00 | $471.67–$5,648.50 | 9% below | 70% |
| Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 HDX US CAROTID DOPPLER | $423.60 | $1,412.00 | $471.67–$5,648.50 | 9% below | 70% |
| Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 EXTRACRANIAL BILAT STUDY | $847.35 | $2,824.50 | $471.67–$5,648.50 | — | 70% |
| Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 US CAROTID DUP BILAT | $847.35 | $2,824.50 | $471.67–$5,648.50 | — | 70% |
| Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 HDX US CAROTID DOPPLER | $423.60 | $1,412.00 | $471.67–$5,648.50 | — | 70% |
| Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 MFI US CAROTID DOPPLER | $423.60 | $1,412.00 | $471.67–$5,648.50 | — | 70% |
| Chest X-ray, 2 views both sides CPT 71046 XR CHEST 2 LAT DECUBITUS BILAT | $273.15 | $910.50 | $28.49–$2,787.00 | — | 70% |
| Chest X-ray, 2 views CPT 71046 MFI XR CHEST PA & LATERAL | $136.65 | $455.50 | $28.49–$2,787.00 | at median | 70% |
| Chest X-ray, 2 views CPT 71046 HDX XR CHEST PA & LATERAL | $136.65 | $455.50 | $28.49–$2,787.00 | at median | 70% |
| Chest X-ray, 2 views CPT 71046 X-RAY EXAM CHEST 2 VIEWS | $273.15 | $910.50 | $28.49–$2,787.00 | 100% above | 70% |
| Chest X-ray, 2 views CPT 71046 XR CHEST 2 VIEWS | $273.15 | $910.50 | $28.49–$2,787.00 | 100% above | 70% |
| Chest X-ray, 2 views inpatient both sides CPT 71046 XR CHEST 2 LAT DECUBITUS BILAT | $273.15 | $910.50 | $28.49–$2,787.00 | — | 70% |
| Chest X-ray, 2 views inpatient CPT 71046 HDX XR CHEST PA & LATERAL | $136.65 | $455.50 | $28.49–$2,787.00 | — | 70% |
| Chest X-ray, 2 views inpatient CPT 71046 MFI XR CHEST PA & LATERAL | $136.65 | $455.50 | $28.49–$2,787.00 | — | 70% |
| Chest X-ray, 2 views inpatient CPT 71046 XR CHEST 2 VIEWS | $273.15 | $910.50 | $28.49–$2,787.00 | — | 70% |
| Chest X-ray, 2 views inpatient CPT 71046 X-RAY EXAM CHEST 2 VIEWS | $273.15 | $910.50 | $28.49–$2,787.00 | — | 70% |
| Chest X-ray, single view CPT 71045 CHEST 1 VIEW | $94.95 | $316.50 | $20.56–$949.50 | 15% below | 70% |
| Chest X-ray, single view CPT 71045 XR CHEST SGL VIEW | $189.90 | $633.00 | $20.56–$949.50 | 70% above | 70% |
| Chest X-ray, single view CPT 71045 X-RAY EXAM CHEST 1 VIEW | $189.90 | $633.00 | $20.56–$949.50 | 70% above | 70% |
| Chest X-ray, single view inpatient CPT 71045 CHEST 1 VIEW | $94.95 | $316.50 | $20.56–$949.50 | — | 70% |
| Chest X-ray, single view inpatient CPT 71045 X-RAY EXAM CHEST 1 VIEW | $189.90 | $633.00 | $20.56–$949.50 | — | 70% |
| Chest X-ray, single view inpatient CPT 71045 XR CHEST SGL VIEW | $189.90 | $633.00 | $20.56–$949.50 | — | 70% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US EXAM ABDO BACK WALL COMP | $561.60 | $1,872.00 | $116.68–$7,488.00 | 89% above | 70% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HDX US RENAL/BLADDER COMPLETE | $561.60 | $1,872.00 | $116.68–$7,488.00 | 89% above | 70% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 MFI US RENAL/BLADDER COMPLETE | $561.60 | $1,872.00 | $116.68–$7,488.00 | 89% above | 70% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 ULTRSND RETROPERITONEAL | $561.60 | $1,872.00 | $116.68–$7,488.00 | 89% above | 70% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RENAL/BLADDER COMPLETE | $561.60 | $1,872.00 | $116.68–$7,488.00 | 89% above | 70% |
| Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 HDX US RENAL/BLADDER COMPLETE | $561.60 | $1,872.00 | $116.68–$7,488.00 | — | 70% |
| Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US EXAM ABDO BACK WALL COMP | $561.60 | $1,872.00 | $116.68–$7,488.00 | — | 70% |
| Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RENAL/BLADDER COMPLETE | $561.60 | $1,872.00 | $116.68–$7,488.00 | — | 70% |
| Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 ULTRSND RETROPERITONEAL | $561.60 | $1,872.00 | $116.68–$7,488.00 | — | 70% |
| Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 MFI US RENAL/BLADDER COMPLETE | $561.60 | $1,872.00 | $116.68–$7,488.00 | — | 70% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 DXA BONE DENSITY AXIAL | $145.20 | $484.00 | $41.76–$968.00 | 13% below | 70% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 MFI DXA BONE DENSITY | $145.20 | $484.00 | $41.76–$968.00 | 13% below | 70% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 DXA BONE DENSITY | $145.20 | $484.00 | $41.76–$968.00 | 13% below | 70% |
| DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DXA BONE DENSITY | $145.20 | $484.00 | $41.76–$968.00 | — | 70% |
| DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 MFI DXA BONE DENSITY | $145.20 | $484.00 | $41.76–$968.00 | — | 70% |
| DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DXA BONE DENSITY AXIAL | $145.20 | $484.00 | $41.76–$968.00 | — | 70% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 MFI NM DEXA RADIUS | $135.60 | $452.00 | $28.90–$904.00 | 81% above | 70% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 NM DEXA RADIUS | $135.60 | $452.00 | $28.90–$904.00 | 81% above | 70% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 DXA BONE DENSITY APPENDICULR | $135.60 | $452.00 | $28.90–$904.00 | 81% above | 70% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 DXA BONE DENSITY APPENDICULR | $135.60 | $452.00 | $28.90–$904.00 | — | 70% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 NM DEXA RADIUS | $135.60 | $452.00 | $28.90–$904.00 | — | 70% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 MFI NM DEXA RADIUS | $135.60 | $452.00 | $28.90–$904.00 | — | 70% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT THORAX DX C- | $1,219.05 | $4,063.50 | $166.50–$4,063.50 | 57% above | 70% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST W/O CONTRAST | $1,219.05 | $4,063.50 | $166.50–$4,063.50 | 57% above | 70% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST W/O CONTRAST | $1,219.05 | $4,063.50 | $166.50–$4,063.50 | — | 70% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT THORAX DX C- | $1,219.05 | $4,063.50 | $166.50–$4,063.50 | — | 70% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT THORAX DX C+ | $1,219.05 | $4,063.50 | $233.43–$4,063.50 | 29% above | 70% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST WITH CONTRAST | $1,219.05 | $4,063.50 | $233.43–$4,063.50 | 29% above | 70% |
| Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT THORAX DX C+ | $1,219.05 | $4,063.50 | $233.43–$4,063.50 | — | 70% |
| Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT CHEST WITH CONTRAST | $1,219.05 | $4,063.50 | $233.43–$4,063.50 | — | 70% |
| Diagnostic mammogram, both breasts both sides CPT 77066 DX MAMMO INCL CAD BI | $165.00 | $550.00 | $98.38–$2,690.50 | — | 70% |
| Diagnostic mammogram, both breasts both sides CPT 77066 DIAG MAMMO W CAD BILAT | $165.00 | $550.00 | $98.38–$2,690.50 | — | 70% |
| Diagnostic mammogram, both breasts both sides CPT 77066 MFI MA MAMMOGRAM DIAGNOSTIC BILAT | $165.00 | $550.00 | $98.38–$2,690.50 | — | 70% |
| Diagnostic mammogram, both breasts both sides CPT 77066 3D DIAG MAMMO BILATERAL | $165.00 | $550.00 | $98.38–$2,690.50 | — | 70% |
| Diagnostic mammogram, both breasts both sides CPT 77066 HDX MA MAMMOGRAM DIAGNOSTIC BILAT | $165.00 | $550.00 | $98.38–$2,690.50 | — | 70% |
| Diagnostic mammogram, both breasts CPT 77066 SCREENING - 3D TOMO MAMMOGRAPHY | $147.15 | $490.50 | $98.38–$2,690.50 | 7% above | 70% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 3D DIAG MAMMO BILATERAL | $165.00 | $550.00 | $98.38–$2,690.50 | — | 70% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MFI MA MAMMOGRAM DIAGNOSTIC BILAT | $165.00 | $550.00 | $98.38–$2,690.50 | — | 70% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 DX MAMMO INCL CAD BI | $165.00 | $550.00 | $98.38–$2,690.50 | — | 70% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HDX MA MAMMOGRAM DIAGNOSTIC BILAT | $165.00 | $550.00 | $98.38–$2,690.50 | — | 70% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 DIAG MAMMO W CAD BILAT | $165.00 | $550.00 | $98.38–$2,690.50 | — | 70% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 SCREENING - 3D TOMO MAMMOGRAPHY | $147.15 | $490.50 | $98.38–$2,690.50 | — | 70% |
| Diagnostic mammogram, one breast CPT 77065 DX MAMMO INCL CAD UNI | $121.80 | $406.00 | $76.67–$3,248.00 | at median | 70% |
| Diagnostic mammogram, one breast one side CPT 77065 MFI MA MAMMOGRAM DIAGNOSTIC LEFT | $121.80 | $406.00 | $76.67–$3,248.00 | at median | 70% |
| Diagnostic mammogram, one breast one side CPT 77065 HDX MA MAMMOGRAM DIAGNOSTIC LEFT | $121.80 | $406.00 | $76.67–$3,248.00 | at median | 70% |
| Diagnostic mammogram, one breast one side CPT 77065 HDX MA MAMMOGRAM DIAGNOSTIC RIGHT | $121.80 | $406.00 | $76.67–$3,248.00 | at median | 70% |
| Diagnostic mammogram, one breast one side CPT 77065 DIAG MAMMO W CAD LT LT | $121.80 | $406.00 | $76.67–$3,248.00 | at median | 70% |
| Diagnostic mammogram, one breast one side CPT 77065 DIAG MAMMO W CAD RT RT | $121.80 | $406.00 | $76.67–$3,248.00 | at median | 70% |
| Diagnostic mammogram, one breast one side CPT 77065 3D DIAG MAMMO RT | $121.80 | $406.00 | $76.67–$3,248.00 | at median | 70% |
| Diagnostic mammogram, one breast one side CPT 77065 3D DIAG MAMMO LEFT | $121.80 | $406.00 | $76.67–$3,248.00 | at median | 70% |
| Diagnostic mammogram, one breast one side CPT 77065 MFI MA MAMMOGRAM DIAGNOSTIC RIGHT | $121.80 | $406.00 | $76.67–$3,248.00 | at median | 70% |
| Diagnostic mammogram, one breast inpatient CPT 77065 DX MAMMO INCL CAD UNI | $121.80 | $406.00 | $76.67–$3,248.00 | — | 70% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 DIAG MAMMO W CAD RT RT | $121.80 | $406.00 | $76.67–$3,248.00 | — | 70% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 DIAG MAMMO W CAD LT LT | $121.80 | $406.00 | $76.67–$3,248.00 | — | 70% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 3D DIAG MAMMO RT | $121.80 | $406.00 | $76.67–$3,248.00 | — | 70% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HDX MA MAMMOGRAM DIAGNOSTIC RIGHT | $121.80 | $406.00 | $76.67–$3,248.00 | — | 70% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 3D DIAG MAMMO LEFT | $121.80 | $406.00 | $76.67–$3,248.00 | — | 70% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MFI MA MAMMOGRAM DIAGNOSTIC LEFT | $121.80 | $406.00 | $76.67–$3,248.00 | — | 70% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HDX MA MAMMOGRAM DIAGNOSTIC LEFT | $121.80 | $406.00 | $76.67–$3,248.00 | — | 70% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MFI MA MAMMOGRAM DIAGNOSTIC RIGHT | $121.80 | $406.00 | $76.67–$3,248.00 | — | 70% |
| Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 HDX ARTERIAL DOPPLER LOWER EXT BILATERAL | $377.85 | $1,259.50 | $471.67–$4,541.00 | — | 70% |
| Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 MFI ARTERIAL DOPPLER LOWER EXT BILATERAL | $377.85 | $1,259.50 | $471.67–$4,541.00 | — | 70% |
| Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 US ARTERY LOWER EXTREMITY BI | $606.60 | $2,022.00 | $471.67–$4,541.00 | — | 70% |
| Duplex ultrasound of the leg arteries, both legs CPT 93925 LOWER EXTREMITY STUDY | $606.60 | $2,022.00 | $471.67–$4,541.00 | 34% above | 70% |
| Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 MFI ARTERIAL DOPPLER LOWER EXT BILATERAL | $377.85 | $1,259.50 | $471.67–$4,541.00 | — | 70% |
| Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 HDX ARTERIAL DOPPLER LOWER EXT BILATERAL | $377.85 | $1,259.50 | $471.67–$4,541.00 | — | 70% |
| Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 US ARTERY LOWER EXTREMITY BI | $606.60 | $2,022.00 | $471.67–$4,541.00 | — | 70% |
| Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 LOWER EXTREMITY STUDY | $606.60 | $2,022.00 | $471.67–$4,541.00 | — | 70% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HDX VENOUS DOPPLER UPPER EXT BILATERAL | $300.90 | $1,003.00 | $471.67–$9,026.00 | — | 70% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HDX VENOUS DOPPLER LOWER EXT BILAT | $300.90 | $1,003.00 | $471.67–$9,026.00 | — | 70% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 MFI VENOUS DOPPLER UPPER EXT BILATERAL | $300.90 | $1,003.00 | $471.67–$9,026.00 | — | 70% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 MFI VENOUS DOPPLER LOWER EXT BILAT | $300.90 | $1,003.00 | $471.67–$9,026.00 | — | 70% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US VEIN LOWER EXTREMITY BILAT | $601.65 | $2,005.50 | $471.67–$9,026.00 | — | 70% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US VEIN UPPER EXTREMITY BILAT | $601.65 | $2,005.50 | $471.67–$9,026.00 | — | 70% |
| Duplex ultrasound of the leg veins, both legs CPT 93970 MFI BIL VEN REFLX | $300.90 | $1,003.00 | $471.67–$9,026.00 | 28% below | 70% |
| Duplex ultrasound of the leg veins, both legs CPT 93970 EXTREMITY STUDY | $601.65 | $2,005.50 | $471.67–$9,026.00 | 44% above | 70% |
| Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 HDX VENOUS DOPPLER LOWER EXT BILAT | $300.90 | $1,003.00 | $471.67–$9,026.00 | — | 70% |
| Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 MFI VENOUS DOPPLER LOWER EXT BILAT | $300.90 | $1,003.00 | $471.67–$9,026.00 | — | 70% |
| Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 HDX VENOUS DOPPLER UPPER EXT BILATERAL | $300.90 | $1,003.00 | $471.67–$9,026.00 | — | 70% |
| Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 MFI VENOUS DOPPLER UPPER EXT BILATERAL | $300.90 | $1,003.00 | $471.67–$9,026.00 | — | 70% |
| Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US VEIN LOWER EXTREMITY BILAT | $601.65 | $2,005.50 | $471.67–$9,026.00 | — | 70% |
| Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US VEIN UPPER EXTREMITY BILAT | $601.65 | $2,005.50 | $471.67–$9,026.00 | — | 70% |
| Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 MFI BIL VEN REFLX | $300.90 | $1,003.00 | $471.67–$9,026.00 | — | 70% |
| Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 EXTREMITY STUDY | $601.65 | $2,005.50 | $471.67–$9,026.00 | — | 70% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHO W/SPEC/COLOR FLOW | $895.80 | $2,986.00 | $344.00–$2,986.00 | 25% above | 70% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 TTE W/DOPPLER COMPLETE | $895.80 | $2,986.00 | $344.00–$2,986.00 | 25% above | 70% |
| Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 TTE W/DOPPLER COMPLETE | $895.80 | $2,986.00 | $344.00–$2,986.00 | — | 70% |
| Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHO W/SPEC/COLOR FLOW | $895.80 | $2,986.00 | $344.00–$2,986.00 | — | 70% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM HIDA W KINEVAC | $795.30 | $2,651.00 | $343.26–$2,651.00 | 57% above | 70% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HEPATOBILIARY SYSTEM IMAGING | $795.30 | $2,651.00 | $343.26–$2,651.00 | 57% above | 70% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM HIDA W KINEVAC | $795.30 | $2,651.00 | $343.26–$2,651.00 | — | 70% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HEPATOBILIARY SYSTEM IMAGING | $795.30 | $2,651.00 | $343.26–$2,651.00 | — | 70% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 POLYSOM 6/>YRS CPAP 4/> PARM | $2,791.35 | $9,304.50 | $344.00–$9,304.50 | 140% above | 70% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 POLYSOMNOGRM CPAP SPLIT | $2,791.35 | $9,304.50 | $344.00–$9,304.50 | 140% above | 70% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 POLYSOM 6/>YRS CPAP 4/> PARM | $2,791.35 | $9,304.50 | $344.00–$9,304.50 | — | 70% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 POLYSOMNOGRM CPAP SPLIT | $2,791.35 | $9,304.50 | $344.00–$9,304.50 | — | 70% |
| Knee X-ray, 3 views CPT 73562 X-RAY EXAM OF KNEE 3 | $244.05 | $813.50 | $36.42–$3,255.00 | 73% above | 70% |
| Knee X-ray, 3 views one side CPT 73562 MFI XR KNEE 3 VIEWS LEFT | $122.10 | $407.00 | $36.42–$3,255.00 | 14% below | 70% |
| Knee X-ray, 3 views one side CPT 73562 HDX XR KNEE 3 VIEWS LEFT | $122.10 | $407.00 | $36.42–$3,255.00 | 14% below | 70% |
| Knee X-ray, 3 views one side CPT 73562 MFI XR KNEE 3 VIEWS RIGHT | $122.10 | $407.00 | $36.42–$3,255.00 | 14% below | 70% |
| Knee X-ray, 3 views one side CPT 73562 HDX XR KNEE 3 VIEWS RIGHT | $122.10 | $407.00 | $36.42–$3,255.00 | 14% below | 70% |
| Knee X-ray, 3 views one side CPT 73562 KNEE 3 VIEWS LT | $244.05 | $813.50 | $36.42–$3,255.00 | 73% above | 70% |
| Knee X-ray, 3 views one side CPT 73562 KNEE 3 VIEWS RT | $244.05 | $813.50 | $36.42–$3,255.00 | 73% above | 70% |
| Knee X-ray, 3 views inpatient CPT 73562 X-RAY EXAM OF KNEE 3 | $244.05 | $813.50 | $36.42–$3,255.00 | — | 70% |
| Knee X-ray, 3 views inpatient one side CPT 73562 MFI XR KNEE 3 VIEWS RIGHT | $122.10 | $407.00 | $36.42–$3,255.00 | — | 70% |
| Knee X-ray, 3 views inpatient one side CPT 73562 MFI XR KNEE 3 VIEWS LEFT | $122.10 | $407.00 | $36.42–$3,255.00 | — | 70% |
| Knee X-ray, 3 views inpatient one side CPT 73562 HDX XR KNEE 3 VIEWS RIGHT | $122.10 | $407.00 | $36.42–$3,255.00 | — | 70% |
| Knee X-ray, 3 views inpatient one side CPT 73562 HDX XR KNEE 3 VIEWS LEFT | $122.10 | $407.00 | $36.42–$3,255.00 | — | 70% |
| Knee X-ray, 3 views inpatient one side CPT 73562 KNEE 3 VIEWS RT | $244.05 | $813.50 | $36.42–$3,255.00 | — | 70% |
| Knee X-ray, 3 views inpatient one side CPT 73562 KNEE 3 VIEWS LT | $244.05 | $813.50 | $36.42–$3,255.00 | — | 70% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HDX US PYLORIX STENOSIS | $180.00 | $600.00 | $94.17–$9,596.50 | 40% below | 70% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 MFI US PYLORIX STENOSIS | $180.00 | $600.00 | $94.17–$9,596.50 | 40% below | 70% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HDX US ABDOMEN LIMITED | $359.85 | $1,199.50 | $94.17–$9,596.50 | 20% above | 70% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HDX US BLADDER | $359.85 | $1,199.50 | $94.17–$9,596.50 | 20% above | 70% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 MFI US ABDOMEN LIMITED | $359.85 | $1,199.50 | $94.17–$9,596.50 | 20% above | 70% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 MFI US BLADDER | $359.85 | $1,199.50 | $94.17–$9,596.50 | 20% above | 70% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ULTRASOUND GALL BLADDER | $359.85 | $1,199.50 | $94.17–$9,596.50 | 20% above | 70% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMEN LIMITED | $359.85 | $1,199.50 | $94.17–$9,596.50 | 20% above | 70% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US BLADDER | $359.85 | $1,199.50 | $94.17–$9,596.50 | 20% above | 70% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ECHO EXAM OF ABDOMEN | $359.85 | $1,199.50 | $94.17–$9,596.50 | 20% above | 70% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HDX US PYLORIX STENOSIS | $180.00 | $600.00 | $94.17–$9,596.50 | — | 70% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 MFI US PYLORIX STENOSIS | $180.00 | $600.00 | $94.17–$9,596.50 | — | 70% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 MFI US ABDOMEN LIMITED | $359.85 | $1,199.50 | $94.17–$9,596.50 | — | 70% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 ULTRASOUND GALL BLADDER | $359.85 | $1,199.50 | $94.17–$9,596.50 | — | 70% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMEN LIMITED | $359.85 | $1,199.50 | $94.17–$9,596.50 | — | 70% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HDX US BLADDER | $359.85 | $1,199.50 | $94.17–$9,596.50 | — | 70% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US BLADDER | $359.85 | $1,199.50 | $94.17–$9,596.50 | — | 70% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HDX US ABDOMEN LIMITED | $359.85 | $1,199.50 | $94.17–$9,596.50 | — | 70% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 ECHO EXAM OF ABDOMEN | $359.85 | $1,199.50 | $94.17–$9,596.50 | — | 70% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 MFI US BLADDER | $359.85 | $1,199.50 | $94.17–$9,596.50 | — | 70% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT THORAX LUNG CANCER SCR C- | $186.15 | $620.50 | $104.49–$620.50 | 74% above | 70% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 LDCT-LUNG SCREENING | $186.15 | $620.50 | $104.49–$620.50 | 74% above | 70% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 LDCT-LUNG SCREENING | $186.15 | $620.50 | $104.49–$620.50 | — | 70% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT THORAX LUNG CANCER SCR C- | $186.15 | $620.50 | $104.49–$620.50 | — | 70% |
| MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 MR KNEE BILAT WO | $1,421.55 | $4,738.50 | $241.53–$44,291.00 | — | 70% |
| MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 MR HIP BILAT WO | $1,421.55 | $4,738.50 | $241.53–$44,291.00 | — | 70% |
| MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 MR ANKLE BILAT WO | $1,493.25 | $4,977.50 | $241.53–$44,291.00 | — | 70% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI JNT OF LWR EXTRE W/O DYE | $1,493.25 | $4,977.50 | $241.53–$44,291.00 | 38% above | 70% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LOW EX JOINT WO RT | $1,316.40 | $4,388.00 | $241.53–$44,291.00 | 21% above | 70% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LOW EX JNT WO CST LT | $1,421.55 | $4,738.50 | $241.53–$44,291.00 | 31% above | 70% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP WITHOUT CONT RT | $1,493.25 | $4,977.50 | $241.53–$44,291.00 | 38% above | 70% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP WITHOUT CST LT | $1,493.25 | $4,977.50 | $241.53–$44,291.00 | 38% above | 70% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE WITHOUT CONT RT | $1,613.25 | $5,377.50 | $241.53–$44,291.00 | 49% above | 70% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE WO CONTRST LT | $1,613.25 | $5,377.50 | $241.53–$44,291.00 | 49% above | 70% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient both sides CPT 73721 MR KNEE BILAT WO | $1,421.55 | $4,738.50 | $241.53–$44,291.00 | — | 70% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient both sides CPT 73721 MR HIP BILAT WO | $1,421.55 | $4,738.50 | $241.53–$44,291.00 | — | 70% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient both sides CPT 73721 MR ANKLE BILAT WO | $1,493.25 | $4,977.50 | $241.53–$44,291.00 | — | 70% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI JNT OF LWR EXTRE W/O DYE | $1,493.25 | $4,977.50 | $241.53–$44,291.00 | — | 70% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI LOW EX JOINT WO RT | $1,316.40 | $4,388.00 | $241.53–$44,291.00 | — | 70% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI LOW EX JNT WO CST LT | $1,421.55 | $4,738.50 | $241.53–$44,291.00 | — | 70% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI HIP WITHOUT CONT RT | $1,493.25 | $4,977.50 | $241.53–$44,291.00 | — | 70% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI HIP WITHOUT CST LT | $1,493.25 | $4,977.50 | $241.53–$44,291.00 | — | 70% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI KNEE WITHOUT CONT RT | $1,613.25 | $5,377.50 | $241.53–$44,291.00 | — | 70% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI KNEE WO CONTRST LT | $1,613.25 | $5,377.50 | $241.53–$44,291.00 | — | 70% |
| MRI of knee or other lower-limb joint, without and then with contrast dye both sides CPT 73723 MR HIP BILAT WW | $1,753.50 | $5,845.00 | $476.36–$24,314.00 | — | 70% |
| MRI of knee or other lower-limb joint, without and then with contrast dye both sides CPT 73723 MR ANKLE BILAT WW | $1,893.60 | $6,312.00 | $476.36–$24,314.00 | — | 70% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI JOINT LWR EXTR W/O&W/DYE | $1,893.60 | $6,312.00 | $476.36–$24,314.00 | 40% above | 70% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LOW EX JNT W/WO RT | $1,753.50 | $5,845.00 | $476.36–$24,314.00 | 29% above | 70% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LOW EX JNT W/WO LT | $1,893.60 | $6,312.00 | $476.36–$24,314.00 | 40% above | 70% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient both sides CPT 73723 MR HIP BILAT WW | $1,753.50 | $5,845.00 | $476.36–$24,314.00 | — | 70% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient both sides CPT 73723 MR ANKLE BILAT WW | $1,893.60 | $6,312.00 | $476.36–$24,314.00 | — | 70% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI JOINT LWR EXTR W/O&W/DYE | $1,893.60 | $6,312.00 | $476.36–$24,314.00 | — | 70% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI LOW EX JNT W/WO RT | $1,753.50 | $5,845.00 | $476.36–$24,314.00 | — | 70% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI LOW EX JNT W/WO LT | $1,893.60 | $6,312.00 | $476.36–$24,314.00 | — | 70% |
| MRI of the brain, no contrast dye CPT 70551 MRI BRAIN STEM W/O DYE | $1,389.45 | $4,631.50 | $236.03–$4,631.50 | 23% above | 70% |
| MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O CONTRAST | $1,389.45 | $4,631.50 | $236.03–$4,631.50 | 23% above | 70% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN STEM W/O DYE | $1,389.45 | $4,631.50 | $236.03–$4,631.50 | — | 70% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN W/O CONTRAST | $1,389.45 | $4,631.50 | $236.03–$4,631.50 | — | 70% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN STEM W/O & W/DYE | $1,594.65 | $5,315.50 | $344.00–$5,315.50 | 10% above | 70% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI IAC WO/W | $1,594.65 | $5,315.50 | $344.00–$5,315.50 | 10% above | 70% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN STEM W/O & W/DYE | $1,594.65 | $5,315.50 | $344.00–$5,315.50 | — | 70% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI IAC WO/W | $1,594.65 | $5,315.50 | $344.00–$5,315.50 | — | 70% |
| MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR SPINE W/O DYE | $1,643.10 | $5,477.00 | $229.15–$5,477.00 | 30% above | 70% |
| MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR SPINE W/O CON | $1,643.10 | $5,477.00 | $229.15–$5,477.00 | 30% above | 70% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MRI LUMBAR SPINE W/O CON | $1,643.10 | $5,477.00 | $229.15–$5,477.00 | — | 70% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MRI LUMBAR SPINE W/O DYE | $1,643.10 | $5,477.00 | $229.15–$5,477.00 | — | 70% |
| MRI of the lower back, without and then with contrast dye CPT 72158 MRI LUMBAR SPINE WWO CON | $2,044.95 | $6,816.50 | $344.00–$6,816.50 | 47% above | 70% |
| MRI of the lower back, without and then with contrast dye CPT 72158 MRI LUMBAR SPINE W/O & W/DYE | $2,044.95 | $6,816.50 | $344.00–$6,816.50 | 47% above | 70% |
| MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI LUMBAR SPINE W/O & W/DYE | $2,044.95 | $6,816.50 | $344.00–$6,816.50 | — | 70% |
| MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI LUMBAR SPINE WWO CON | $2,044.95 | $6,816.50 | $344.00–$6,816.50 | — | 70% |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI CHEST SPINE W/O DYE | $1,612.95 | $5,376.50 | $230.20–$5,376.50 | 34% above | 70% |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI T-SPINE W/O CONTRAST | $1,612.95 | $5,376.50 | $230.20–$5,376.50 | 34% above | 70% |
| MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI T-SPINE W/O CONTRAST | $1,612.95 | $5,376.50 | $230.20–$5,376.50 | — | 70% |
| MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI CHEST SPINE W/O DYE | $1,612.95 | $5,376.50 | $230.20–$5,376.50 | — | 70% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI C-SPINE WWO CONTRST | $2,044.95 | $6,816.50 | $344.00–$6,816.50 | 24% above | 70% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI NECK SPINE W/O & W/DYE | $2,044.95 | $6,816.50 | $344.00–$6,816.50 | 24% above | 70% |
| MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI C-SPINE WWO CONTRST | $2,044.95 | $6,816.50 | $344.00–$6,816.50 | — | 70% |
| MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI NECK SPINE W/O & W/DYE | $2,044.95 | $6,816.50 | $344.00–$6,816.50 | — | 70% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI NECK SPINE W/O DYE | $1,612.95 | $5,376.50 | $229.86–$5,376.50 | 31% above | 70% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI C-SPINE W/O CONTRAST | $1,612.95 | $5,376.50 | $229.86–$5,376.50 | 31% above | 70% |
| MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI NECK SPINE W/O DYE | $1,612.95 | $5,376.50 | $229.86–$5,376.50 | — | 70% |
| MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI C-SPINE W/O CONTRAST | $1,612.95 | $5,376.50 | $229.86–$5,376.50 | — | 70% |
| MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS W/W/O CONTRST | $1,753.50 | $5,845.00 | $344.00–$5,845.00 | 37% above | 70% |
| MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS W/O & W/DYE | $1,753.50 | $5,845.00 | $344.00–$5,845.00 | 37% above | 70% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS W/W/O CONTRST | $1,753.50 | $5,845.00 | $344.00–$5,845.00 | — | 70% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS W/O & W/DYE | $1,753.50 | $5,845.00 | $344.00–$5,845.00 | — | 70% |
| MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS W/O CONTRAST | $1,493.25 | $4,977.50 | $301.07–$4,977.50 | 32% above | 70% |
| MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS W/O DYE | $1,493.25 | $4,977.50 | $301.07–$4,977.50 | 32% above | 70% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS W/O DYE | $1,493.25 | $4,977.50 | $301.07–$4,977.50 | — | 70% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS W/O CONTRAST | $1,493.25 | $4,977.50 | $301.07–$4,977.50 | — | 70% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye both sides CPT 73221 MR SHOULDER BILAT WO | $1,493.25 | $4,977.50 | $241.88–$26,084.50 | — | 70% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye both sides CPT 73221 MR ELBOW BILAT WO | $1,612.95 | $5,376.50 | $241.88–$26,084.50 | — | 70% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye both sides CPT 73221 MR WRIST BILAT WO | $1,612.95 | $5,376.50 | $241.88–$26,084.50 | — | 70% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI JOINT UPR EXTREM W/O DYE | $1,612.95 | $5,376.50 | $241.88–$26,084.50 | 49% above | 70% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI UP EX JOINT WO RT | $1,493.25 | $4,977.50 | $241.88–$26,084.50 | 38% above | 70% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI UP EX JOINT W/O LT | $1,612.95 | $5,376.50 | $241.88–$26,084.50 | 49% above | 70% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient both sides CPT 73221 MR SHOULDER BILAT WO | $1,493.25 | $4,977.50 | $241.88–$26,084.50 | — | 70% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient both sides CPT 73221 MR ELBOW BILAT WO | $1,612.95 | $5,376.50 | $241.88–$26,084.50 | — | 70% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient both sides CPT 73221 MR WRIST BILAT WO | $1,612.95 | $5,376.50 | $241.88–$26,084.50 | — | 70% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MRI JOINT UPR EXTREM W/O DYE | $1,612.95 | $5,376.50 | $241.88–$26,084.50 | — | 70% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI UP EX JOINT WO RT | $1,493.25 | $4,977.50 | $241.88–$26,084.50 | — | 70% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI UP EX JOINT W/O LT | $1,612.95 | $5,376.50 | $241.88–$26,084.50 | — | 70% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HT MUS IMAGE SPECT MULTI | $2,046.90 | $6,823.00 | $344.00–$6,823.00 | 64% above | 70% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HT MUSCLE IMAGE SPECT MULT | $2,046.90 | $6,823.00 | $344.00–$6,823.00 | 64% above | 70% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HT MUSCLE IMAGE SPECT MULT | $2,046.90 | $6,823.00 | $344.00–$6,823.00 | — | 70% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HT MUS IMAGE SPECT MULTI | $2,046.90 | $6,823.00 | $344.00–$6,823.00 | — | 70% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HDX US PELVID LIMITED | $112.05 | $373.50 | $50.70–$1,868.00 | 37% below | 70% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 TWCUS TRANSABD PELVIC LIMITED | $112.05 | $373.50 | $50.70–$1,868.00 | 37% below | 70% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 MFI US TRANSABDOMINAL PELVIC LIMITED | $112.05 | $373.50 | $50.70–$1,868.00 | 37% below | 70% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US EXAM PELVIC LIMITED | $224.25 | $747.50 | $50.70–$1,868.00 | 26% above | 70% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 ULTRASOUND PELVIS LMTD | $224.25 | $747.50 | $50.70–$1,868.00 | 26% above | 70% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HDX US PELVID LIMITED | $112.05 | $373.50 | $50.70–$1,868.00 | — | 70% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 MFI US TRANSABDOMINAL PELVIC LIMITED | $112.05 | $373.50 | $50.70–$1,868.00 | — | 70% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 TWCUS TRANSABD PELVIC LIMITED | $112.05 | $373.50 | $50.70–$1,868.00 | — | 70% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 ULTRASOUND PELVIS LMTD | $224.25 | $747.50 | $50.70–$1,868.00 | — | 70% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US EXAM PELVIC LIMITED | $224.25 | $747.50 | $50.70–$1,868.00 | — | 70% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIS TRNS ABD/VAG NON-OB | $260.70 | $869.00 | $113.65–$4,345.00 | 9% below | 70% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US EXAM PELVIC COMPLETE | $260.70 | $869.00 | $113.65–$4,345.00 | 9% below | 70% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 MFI US PELVIS NON-OB COMPLETE | $260.70 | $869.00 | $113.65–$4,345.00 | 9% below | 70% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 TWCUS PELVIS NON-OB COMPLETE | $260.70 | $869.00 | $113.65–$4,345.00 | 9% below | 70% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HDX US PELVIS NON-OB COMPLETE | $260.70 | $869.00 | $113.65–$4,345.00 | 9% below | 70% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 ULTRASOUND PELVIS COMP | $260.70 | $869.00 | $113.65–$4,345.00 | 9% below | 70% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 TWCUS PELVIS NON-OB COMPLETE | $260.70 | $869.00 | $113.65–$4,345.00 | — | 70% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 ULTRASOUND PELVIS COMP | $260.70 | $869.00 | $113.65–$4,345.00 | — | 70% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US EXAM PELVIC COMPLETE | $260.70 | $869.00 | $113.65–$4,345.00 | — | 70% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 MFI US PELVIS NON-OB COMPLETE | $260.70 | $869.00 | $113.65–$4,345.00 | — | 70% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIS TRNS ABD/VAG NON-OB | $260.70 | $869.00 | $113.65–$4,345.00 | — | 70% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 HDX US PELVIS NON-OB COMPLETE | $260.70 | $869.00 | $113.65–$4,345.00 | — | 70% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 TWXUS OB COMP > 14 WEEKS | $261.30 | $871.00 | $147.58–$5,371.00 | 5% below | 70% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OB US >/= 14 WKS SNGL FETUS | $675.00 | $2,250.00 | $147.58–$5,371.00 | 144% above | 70% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 MFI US OB COMP > 14 WKS | $675.00 | $2,250.00 | $147.58–$5,371.00 | 144% above | 70% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 U S OB >14 WKS 1ST GEST | $675.00 | $2,250.00 | $147.58–$5,371.00 | 144% above | 70% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 TWXUS OB COMP > 14 WEEKS | $261.30 | $871.00 | $147.58–$5,371.00 | — | 70% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 U S OB >14 WKS 1ST GEST | $675.00 | $2,250.00 | $147.58–$5,371.00 | — | 70% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 MFI US OB COMP > 14 WKS | $675.00 | $2,250.00 | $147.58–$5,371.00 | — | 70% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 OB US >/= 14 WKS SNGL FETUS | $675.00 | $2,250.00 | $147.58–$5,371.00 | — | 70% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 MFI US TRANSVAGINAL OB | $261.30 | $871.00 | $128.55–$6,374.00 | 2% below | 70% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 TWCUS OB COMP<14 WKS | $261.30 | $871.00 | $128.55–$6,374.00 | 2% below | 70% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 MFI US OB COMP < 14 WKS | $578.40 | $1,928.00 | $128.55–$6,374.00 | 117% above | 70% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 OB US < 14 WKS SINGLE FETUS | $578.40 | $1,928.00 | $128.55–$6,374.00 | 117% above | 70% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 HDX US OB COMP < 14 WEEKS | $578.40 | $1,928.00 | $128.55–$6,374.00 | 117% above | 70% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 MFI US TRANSVAGINAL OB | $261.30 | $871.00 | $128.55–$6,374.00 | — | 70% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 TWCUS OB COMP<14 WKS | $261.30 | $871.00 | $128.55–$6,374.00 | — | 70% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 OB US < 14 WKS SINGLE FETUS | $578.40 | $1,928.00 | $128.55–$6,374.00 | — | 70% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 MFI US OB COMP < 14 WKS | $578.40 | $1,928.00 | $128.55–$6,374.00 | — | 70% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 HDX US OB COMP < 14 WEEKS | $578.40 | $1,928.00 | $128.55–$6,374.00 | — | 70% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 U/S UTERINE | $173.10 | $577.00 | $88.26–$3,913.00 | 28% above | 70% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 TWCUS OB LIMITED | $250.20 | $834.00 | $88.26–$3,913.00 | 85% above | 70% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 MFI US OB LIMITED | $250.20 | $834.00 | $88.26–$3,913.00 | 85% above | 70% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 ULTRSND PREGNANCY LMTD | $250.20 | $834.00 | $88.26–$3,913.00 | 85% above | 70% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB LIMITED | $250.20 | $834.00 | $88.26–$3,913.00 | 85% above | 70% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 OB US LIMITED FETUS(S) | $250.20 | $834.00 | $88.26–$3,913.00 | 85% above | 70% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 U/S UTERINE | $173.10 | $577.00 | $88.26–$3,913.00 | — | 70% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB LIMITED | $250.20 | $834.00 | $88.26–$3,913.00 | — | 70% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 ULTRSND PREGNANCY LMTD | $250.20 | $834.00 | $88.26–$3,913.00 | — | 70% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 MFI US OB LIMITED | $250.20 | $834.00 | $88.26–$3,913.00 | — | 70% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 TWCUS OB LIMITED | $250.20 | $834.00 | $88.26–$3,913.00 | — | 70% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 OB US LIMITED FETUS(S) | $250.20 | $834.00 | $88.26–$3,913.00 | — | 70% |
| Screening mammogram, both breasts both sides CPT 77067 SCR MAMMO BI INCL CAD | $151.35 | $504.50 | $81.13–$3,027.00 | — | 70% |
| Screening mammogram, both breasts both sides CPT 77067 MAMMOGRAM SCREEN IMPLANT BILAT | $151.35 | $504.50 | $81.13–$3,027.00 | — | 70% |
| Screening mammogram, both breasts both sides CPT 77067 3D MAMMOGRAPHY SCREENING BILATERAL | $151.35 | $504.50 | $81.13–$3,027.00 | — | 70% |
| Screening mammogram, both breasts CPT 77067 HDX MA MAMMOGRAM SCREENING | $151.35 | $504.50 | $81.13–$3,027.00 | 26% above | 70% |
| Screening mammogram, both breasts CPT 77067 MFI MA MAMMOGRAM SCREENING | $151.35 | $504.50 | $81.13–$3,027.00 | 26% above | 70% |
| Screening mammogram, both breasts one side CPT 77067 3D MAMMO SCREEN LEFT | $151.35 | $504.50 | $81.13–$3,027.00 | 26% above | 70% |
| Screening mammogram, both breasts one side CPT 77067 3D MAMMOGRAPHY SCREENING RT | $151.35 | $504.50 | $81.13–$3,027.00 | 26% above | 70% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 SCR MAMMO BI INCL CAD | $151.35 | $504.50 | $81.13–$3,027.00 | — | 70% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 MAMMOGRAM SCREEN IMPLANT BILAT | $151.35 | $504.50 | $81.13–$3,027.00 | — | 70% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 3D MAMMOGRAPHY SCREENING BILATERAL | $151.35 | $504.50 | $81.13–$3,027.00 | — | 70% |
| Screening mammogram, both breasts inpatient CPT 77067 HDX MA MAMMOGRAM SCREENING | $151.35 | $504.50 | $81.13–$3,027.00 | — | 70% |
| Screening mammogram, both breasts inpatient CPT 77067 MFI MA MAMMOGRAM SCREENING | $151.35 | $504.50 | $81.13–$3,027.00 | — | 70% |
| Screening mammogram, both breasts inpatient one side CPT 77067 3D MAMMO SCREEN LEFT | $151.35 | $504.50 | $81.13–$3,027.00 | — | 70% |
| Screening mammogram, both breasts inpatient one side CPT 77067 3D MAMMOGRAPHY SCREENING RT | $151.35 | $504.50 | $81.13–$3,027.00 | — | 70% |
| Shoulder X-ray, complete, 2 or more views CPT 73030 X-RAY EXAM OF SHOULDER | $261.75 | $872.50 | $29.77–$6,231.00 | 99% above | 70% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 MFI XR SHOULDER 2+ VIEWS RIGHT | $112.20 | $374.00 | $29.77–$6,231.00 | 15% below | 70% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 HDX XR SHOULDER 2+ VIEWS LEFT | $112.20 | $374.00 | $29.77–$6,231.00 | 15% below | 70% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 MFI XR SHOULDER 2+ VIEWS LEFT | $112.20 | $374.00 | $29.77–$6,231.00 | 15% below | 70% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 HDX XR SHOULDER 2+ VIEWS RIGHT | $112.20 | $374.00 | $29.77–$6,231.00 | 15% below | 70% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR SHOULDER AXIAL VIEW LT | $224.25 | $747.50 | $29.77–$6,231.00 | 70% above | 70% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR SHOULDER 2+ VIEWS RT | $224.25 | $747.50 | $29.77–$6,231.00 | 70% above | 70% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR SHOULDER 2+ VIEWS LT | $224.25 | $747.50 | $29.77–$6,231.00 | 70% above | 70% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR SHOULDER AXIAL VIEW RT | $224.25 | $747.50 | $29.77–$6,231.00 | 70% above | 70% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER 3 VIEWS LT | $261.75 | $872.50 | $29.77–$6,231.00 | 99% above | 70% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER 3 VIEWS RT | $261.75 | $872.50 | $29.77–$6,231.00 | 99% above | 70% |
| Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 X-RAY EXAM OF SHOULDER | $261.75 | $872.50 | $29.77–$6,231.00 | — | 70% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 HDX XR SHOULDER 2+ VIEWS RIGHT | $112.20 | $374.00 | $29.77–$6,231.00 | — | 70% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 HDX XR SHOULDER 2+ VIEWS LEFT | $112.20 | $374.00 | $29.77–$6,231.00 | — | 70% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 MFI XR SHOULDER 2+ VIEWS LEFT | $112.20 | $374.00 | $29.77–$6,231.00 | — | 70% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 MFI XR SHOULDER 2+ VIEWS RIGHT | $112.20 | $374.00 | $29.77–$6,231.00 | — | 70% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR SHOULDER AXIAL VIEW LT | $224.25 | $747.50 | $29.77–$6,231.00 | — | 70% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR SHOULDER 2+ VIEWS RT | $224.25 | $747.50 | $29.77–$6,231.00 | — | 70% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR SHOULDER 2+ VIEWS LT | $224.25 | $747.50 | $29.77–$6,231.00 | — | 70% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR SHOULDER AXIAL VIEW RT | $224.25 | $747.50 | $29.77–$6,231.00 | — | 70% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 SHOULDER 3 VIEWS LT | $261.75 | $872.50 | $29.77–$6,231.00 | — | 70% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 SHOULDER 3 VIEWS RT | $261.75 | $872.50 | $29.77–$6,231.00 | — | 70% |
| Sleep study in a lab (polysomnography) CPT 95810 POLYSOM 6/> YRS 4/> PARAM | $2,442.30 | $8,141.00 | $344.00–$8,141.00 | 82% above | 70% |
| Sleep study in a lab (polysomnography) CPT 95810 POLYSOMNOGRAPHY | $2,442.30 | $8,141.00 | $344.00–$8,141.00 | 82% above | 70% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 POLYSOM 6/> YRS 4/> PARAM | $2,442.30 | $8,141.00 | $344.00–$8,141.00 | — | 70% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 POLYSOMNOGRAPHY | $2,442.30 | $8,141.00 | $344.00–$8,141.00 | — | 70% |
| Swallow study (modified barium swallow, video X-ray) CPT 74230 X-RAY XM SWLNG FUNCJ C+ | $223.50 | $745.00 | $125.45–$745.00 | 8% below | 70% |
| Swallow study (modified barium swallow, video X-ray) CPT 74230 MODIFIED BARIUM SWALLOW | $223.50 | $745.00 | $125.45–$745.00 | 8% below | 70% |
| Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 X-RAY XM SWLNG FUNCJ C+ | $223.50 | $745.00 | $125.45–$745.00 | — | 70% |
| Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 MODIFIED BARIUM SWALLOW | $223.50 | $745.00 | $125.45–$745.00 | — | 70% |
| Transvaginal pelvic ultrasound CPT 76830 TWCUS TRANSVAGINAL NON OB | $260.70 | $869.00 | $125.55–$2,607.00 | 28% above | 70% |
| Transvaginal pelvic ultrasound CPT 76830 MFI US TRANSVAGINAL NON OB | $260.70 | $869.00 | $125.55–$2,607.00 | 28% above | 70% |
| Transvaginal pelvic ultrasound CPT 76830 TRANSVAGINAL US NON-OB | $260.70 | $869.00 | $125.55–$2,607.00 | 28% above | 70% |
| Transvaginal pelvic ultrasound CPT 76830 ULTRASOUND TRANSVAGINAL | $260.70 | $869.00 | $125.55–$2,607.00 | 28% above | 70% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 TRANSVAGINAL US NON-OB | $260.70 | $869.00 | $125.55–$2,607.00 | — | 70% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 ULTRASOUND TRANSVAGINAL | $260.70 | $869.00 | $125.55–$2,607.00 | — | 70% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 MFI US TRANSVAGINAL NON OB | $260.70 | $869.00 | $125.55–$2,607.00 | — | 70% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 TWCUS TRANSVAGINAL NON OB | $260.70 | $869.00 | $125.55–$2,607.00 | — | 70% |
| Transvaginal ultrasound during pregnancy CPT 76817 TRANSVAGINAL US OBSTETRIC | $261.30 | $871.00 | $101.44–$2,613.00 | 52% above | 70% |
| Transvaginal ultrasound during pregnancy CPT 76817 US PREGNANCY TRANSVAG | $261.30 | $871.00 | $101.44–$2,613.00 | 52% above | 70% |
| Transvaginal ultrasound during pregnancy CPT 76817 MRI TRANSVAGINAL OB | $261.30 | $871.00 | $101.44–$2,613.00 | 52% above | 70% |
| Transvaginal ultrasound during pregnancy CPT 76817 TWCUS TRANSVAGINAL OB | $261.30 | $871.00 | $101.44–$2,613.00 | 52% above | 70% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 US PREGNANCY TRANSVAG | $261.30 | $871.00 | $101.44–$2,613.00 | — | 70% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 TWCUS TRANSVAGINAL OB | $261.30 | $871.00 | $101.44–$2,613.00 | — | 70% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 MRI TRANSVAGINAL OB | $261.30 | $871.00 | $101.44–$2,613.00 | — | 70% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 TRANSVAGINAL US OBSTETRIC | $261.30 | $871.00 | $101.44–$2,613.00 | — | 70% |
| Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN COMPLETE | $862.65 | $2,875.50 | $126.09–$11,502.00 | 157% above | 70% |
| Ultrasound of the abdomen, complete CPT 76700 MFI US ABD COMPLETE | $862.65 | $2,875.50 | $126.09–$11,502.00 | 157% above | 70% |
| Ultrasound of the abdomen, complete CPT 76700 US EXAM ABDOM COMPLETE | $862.65 | $2,875.50 | $126.09–$11,502.00 | 157% above | 70% |
| Ultrasound of the abdomen, complete CPT 76700 ULTRASOUND ABDOMEN | $862.65 | $2,875.50 | $126.09–$11,502.00 | 157% above | 70% |
| Ultrasound of the abdomen, complete CPT 76700 HDX US ABD COMPLETE | $862.65 | $2,875.50 | $126.09–$11,502.00 | 157% above | 70% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US EXAM ABDOM COMPLETE | $862.65 | $2,875.50 | $126.09–$11,502.00 | — | 70% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMEN COMPLETE | $862.65 | $2,875.50 | $126.09–$11,502.00 | — | 70% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 HDX US ABD COMPLETE | $862.65 | $2,875.50 | $126.09–$11,502.00 | — | 70% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 MFI US ABD COMPLETE | $862.65 | $2,875.50 | $126.09–$11,502.00 | — | 70% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 ULTRASOUND ABDOMEN | $862.65 | $2,875.50 | $126.09–$11,502.00 | — | 70% |
| Ultrasound of the scrotum and testicles CPT 76870 US EXAM SCROTUM | $450.45 | $1,501.50 | $71.41–$4,504.50 | 99% above | 70% |
| Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM/TESTICLES | $450.45 | $1,501.50 | $71.41–$4,504.50 | 99% above | 70% |
| Ultrasound of the scrotum and testicles CPT 76870 HDX US TESTICLES | $450.45 | $1,501.50 | $71.41–$4,504.50 | 99% above | 70% |
| Ultrasound of the scrotum and testicles CPT 76870 MFI US TESTICLES | $450.45 | $1,501.50 | $71.41–$4,504.50 | 99% above | 70% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 MFI US TESTICLES | $450.45 | $1,501.50 | $71.41–$4,504.50 | — | 70% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 US EXAM SCROTUM | $450.45 | $1,501.50 | $71.41–$4,504.50 | — | 70% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM/TESTICLES | $450.45 | $1,501.50 | $71.41–$4,504.50 | — | 70% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 HDX US TESTICLES | $450.45 | $1,501.50 | $71.41–$4,504.50 | — | 70% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HDX US FACIAL | $128.10 | $427.00 | $118.90–$6,835.50 | 55% below | 70% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 MFI US FACIAL | $128.10 | $427.00 | $118.90–$6,835.50 | 55% below | 70% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US EXAM OF HEAD AND NECK | $256.35 | $854.50 | $118.90–$6,835.50 | 11% below | 70% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 MFI US THYROID | $256.35 | $854.50 | $118.90–$6,835.50 | 11% below | 70% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 ULTRSND SOFT TISSUE NECK | $256.35 | $854.50 | $118.90–$6,835.50 | 11% below | 70% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US THYROID | $256.35 | $854.50 | $118.90–$6,835.50 | 11% below | 70% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HDX US NECK | $256.35 | $854.50 | $118.90–$6,835.50 | 11% below | 70% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HDX US THYROID | $256.35 | $854.50 | $118.90–$6,835.50 | 11% below | 70% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 MFI US NECK | $256.35 | $854.50 | $118.90–$6,835.50 | 11% below | 70% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HDX US FACIAL | $128.10 | $427.00 | $118.90–$6,835.50 | — | 70% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 MFI US FACIAL | $128.10 | $427.00 | $118.90–$6,835.50 | — | 70% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HDX US THYROID | $256.35 | $854.50 | $118.90–$6,835.50 | — | 70% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US EXAM OF HEAD AND NECK | $256.35 | $854.50 | $118.90–$6,835.50 | — | 70% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 MFI US THYROID | $256.35 | $854.50 | $118.90–$6,835.50 | — | 70% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US THYROID | $256.35 | $854.50 | $118.90–$6,835.50 | — | 70% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HDX US NECK | $256.35 | $854.50 | $118.90–$6,835.50 | — | 70% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 MFI US NECK | $256.35 | $854.50 | $118.90–$6,835.50 | — | 70% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 ULTRSND SOFT TISSUE NECK | $256.35 | $854.50 | $118.90–$6,835.50 | — | 70% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 UPPER GI W/SM BOWEL | $155.25 | $517.50 | $115.05–$2,295.50 | 43% below | 70% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 XR UPPER GI WO/KUB | $198.00 | $660.00 | $115.05–$2,295.50 | 27% below | 70% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 X-RAY XM UPR GI TRC 1CNTRST | $198.00 | $660.00 | $115.05–$2,295.50 | 27% below | 70% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 UPPER GI WITH KUB | $335.40 | $1,118.00 | $115.05–$2,295.50 | 23% above | 70% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 UPPER GI W/SM BOWEL | $155.25 | $517.50 | $115.05–$2,295.50 | — | 70% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 X-RAY XM UPR GI TRC 1CNTRST | $198.00 | $660.00 | $115.05–$2,295.50 | — | 70% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 XR UPPER GI WO/KUB | $198.00 | $660.00 | $115.05–$2,295.50 | — | 70% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 UPPER GI WITH KUB | $335.40 | $1,118.00 | $115.05–$2,295.50 | — | 70% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 EXTREMITY STUDY | $425.25 | $1,417.50 | $226.85–$12,424.00 | 26% above | 70% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 MFI RT VENOUS REFLUX | $202.50 | $675.00 | $226.85–$12,424.00 | 40% below | 70% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 MFI LT VENOUS REFLUX LE | $202.50 | $675.00 | $226.85–$12,424.00 | 40% below | 70% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 MFI VENOUS DOPPLER UPPER EXT RIGHT | $202.65 | $675.50 | $226.85–$12,424.00 | 40% below | 70% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 HDX VENOUS DOPPLER LOWER EXT RIGHT | $202.65 | $675.50 | $226.85–$12,424.00 | 40% below | 70% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 HDX VENOUS DOPPLER LOWER EXT LEFT | $202.65 | $675.50 | $226.85–$12,424.00 | 40% below | 70% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 HDX VENOUS DOPPLER UPPER EXT LEFT | $202.65 | $675.50 | $226.85–$12,424.00 | 40% below | 70% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 HDX VENOUS DOPPLER UPPER EXT RIGHT | $202.65 | $675.50 | $226.85–$12,424.00 | 40% below | 70% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 MFI VENOUS DOPPLER UPPER EXT LEFT | $202.65 | $675.50 | $226.85–$12,424.00 | 40% below | 70% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 MFI VENOUS DOPPLER LOWER EXT LEFT | $202.65 | $675.50 | $226.85–$12,424.00 | 40% below | 70% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 MFI VENOUS DOPPLER LOWER EXT RIGHT | $202.65 | $675.50 | $226.85–$12,424.00 | 40% below | 70% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US VEIN UPPER EXTREMITY RT | $425.25 | $1,417.50 | $226.85–$12,424.00 | 26% above | 70% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US VEIN LOWER EXTREMITY LT | $425.25 | $1,417.50 | $226.85–$12,424.00 | 26% above | 70% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US VEIN UPPER EXTREMITY LT | $425.25 | $1,417.50 | $226.85–$12,424.00 | 26% above | 70% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US VEIN LOWER EXTREMITY RT | $425.25 | $1,417.50 | $226.85–$12,424.00 | 26% above | 70% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 EXTREMITY STUDY | $425.25 | $1,417.50 | $226.85–$12,424.00 | — | 70% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 MFI RT VENOUS REFLUX | $202.50 | $675.00 | $226.85–$12,424.00 | — | 70% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 MFI LT VENOUS REFLUX LE | $202.50 | $675.00 | $226.85–$12,424.00 | — | 70% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 HDX VENOUS DOPPLER LOWER EXT LEFT | $202.65 | $675.50 | $226.85–$12,424.00 | — | 70% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 HDX VENOUS DOPPLER UPPER EXT RIGHT | $202.65 | $675.50 | $226.85–$12,424.00 | — | 70% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 MFI VENOUS DOPPLER LOWER EXT LEFT | $202.65 | $675.50 | $226.85–$12,424.00 | — | 70% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 HDX VENOUS DOPPLER LOWER EXT RIGHT | $202.65 | $675.50 | $226.85–$12,424.00 | — | 70% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 MFI VENOUS DOPPLER LOWER EXT RIGHT | $202.65 | $675.50 | $226.85–$12,424.00 | — | 70% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 HDX VENOUS DOPPLER UPPER EXT LEFT | $202.65 | $675.50 | $226.85–$12,424.00 | — | 70% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 MFI VENOUS DOPPLER UPPER EXT RIGHT | $202.65 | $675.50 | $226.85–$12,424.00 | — | 70% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 MFI VENOUS DOPPLER UPPER EXT LEFT | $202.65 | $675.50 | $226.85–$12,424.00 | — | 70% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US VEIN UPPER EXTREMITY LT | $425.25 | $1,417.50 | $226.85–$12,424.00 | — | 70% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US VEIN UPPER EXTREMITY RT | $425.25 | $1,417.50 | $226.85–$12,424.00 | — | 70% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US VEIN LOWER EXTREMITY RT | $425.25 | $1,417.50 | $226.85–$12,424.00 | — | 70% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US VEIN LOWER EXTREMITY LT | $425.25 | $1,417.50 | $226.85–$12,424.00 | — | 70% |
| Wrist X-ray, complete, 3 or more views CPT 73110 X-RAY EXAM OF WRIST | $220.05 | $733.50 | $36.03–$2,933.00 | 95% above | 70% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 MFI XR WRIST 3+ VIEWS LEFT | $109.95 | $366.50 | $36.03–$2,933.00 | 2% below | 70% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 MFI XR WRIST 3+ VIEWS RIGHT | $109.95 | $366.50 | $36.03–$2,933.00 | 2% below | 70% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 HDX XR WRIST 3+ VIEWS LEFT | $109.95 | $366.50 | $36.03–$2,933.00 | 2% below | 70% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 HDX XR WRIST 3+ VIEWS RIGHT | $109.95 | $366.50 | $36.03–$2,933.00 | 2% below | 70% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST 3 VIEWS RT | $220.05 | $733.50 | $36.03–$2,933.00 | 95% above | 70% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST 3 VIEWS LT | $220.05 | $733.50 | $36.03–$2,933.00 | 95% above | 70% |
| Wrist X-ray, complete, 3 or more views inpatient CPT 73110 X-RAY EXAM OF WRIST | $220.05 | $733.50 | $36.03–$2,933.00 | — | 70% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 HDX XR WRIST 3+ VIEWS RIGHT | $109.95 | $366.50 | $36.03–$2,933.00 | — | 70% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 MFI XR WRIST 3+ VIEWS LEFT | $109.95 | $366.50 | $36.03–$2,933.00 | — | 70% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 HDX XR WRIST 3+ VIEWS LEFT | $109.95 | $366.50 | $36.03–$2,933.00 | — | 70% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 MFI XR WRIST 3+ VIEWS RIGHT | $109.95 | $366.50 | $36.03–$2,933.00 | — | 70% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 WRIST 3 VIEWS LT | $220.05 | $733.50 | $36.03–$2,933.00 | — | 70% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 WRIST 3 VIEWS RT | $220.05 | $733.50 | $36.03–$2,933.00 | — | 70% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 X-RAY EXAM HIP UNI 2-3 VIEWS | $203.55 | $678.50 | $42.20–$2,715.00 | 43% above | 70% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HDX XR HIP 2 VIEWS RIGHT W/PELVIS | $101.85 | $339.50 | $42.20–$2,715.00 | 28% below | 70% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 MFI XR HIP 2 VIEWS RIGHT W/PELVIS | $101.85 | $339.50 | $42.20–$2,715.00 | 28% below | 70% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 MFI XR HIP 2 VIEWS LEFT W/PELVIS | $101.85 | $339.50 | $42.20–$2,715.00 | 28% below | 70% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HDX XR HIP 2 VIEWS LEFT W/PELVIS | $101.85 | $339.50 | $42.20–$2,715.00 | 28% below | 70% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XRAY HIP 2/3 VW LT | $203.55 | $678.50 | $42.20–$2,715.00 | 43% above | 70% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XRAY HIP 2/3 VW RT | $203.55 | $678.50 | $42.20–$2,715.00 | 43% above | 70% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 X-RAY EXAM HIP UNI 2-3 VIEWS | $203.55 | $678.50 | $42.20–$2,715.00 | — | 70% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HDX XR HIP 2 VIEWS LEFT W/PELVIS | $101.85 | $339.50 | $42.20–$2,715.00 | — | 70% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HDX XR HIP 2 VIEWS RIGHT W/PELVIS | $101.85 | $339.50 | $42.20–$2,715.00 | — | 70% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 MFI XR HIP 2 VIEWS RIGHT W/PELVIS | $101.85 | $339.50 | $42.20–$2,715.00 | — | 70% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 MFI XR HIP 2 VIEWS LEFT W/PELVIS | $101.85 | $339.50 | $42.20–$2,715.00 | — | 70% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XRAY HIP 2/3 VW RT | $203.55 | $678.50 | $42.20–$2,715.00 | — | 70% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XRAY HIP 2/3 VW LT | $203.55 | $678.50 | $42.20–$2,715.00 | — | 70% |
| X-ray of the abdomen, 1 view CPT 74018 MFI XR ABDOMEN (KUB) 1 VIEW | $105.45 | $351.50 | $27.94–$1,406.00 | 7% below | 70% |
| X-ray of the abdomen, 1 view CPT 74018 HDX XR ABDOMEN (KUB) 1 VIEW | $105.45 | $351.50 | $27.94–$1,406.00 | 7% below | 70% |
| X-ray of the abdomen, 1 view CPT 74018 XR ABDOMEN 1 VIEW | $210.90 | $703.00 | $27.94–$1,406.00 | 86% above | 70% |
| X-ray of the abdomen, 1 view CPT 74018 RADEX ABDOMEN 1 VIEW | $210.90 | $703.00 | $27.94–$1,406.00 | 86% above | 70% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 HDX XR ABDOMEN (KUB) 1 VIEW | $105.45 | $351.50 | $27.94–$1,406.00 | — | 70% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 MFI XR ABDOMEN (KUB) 1 VIEW | $105.45 | $351.50 | $27.94–$1,406.00 | — | 70% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 XR ABDOMEN 1 VIEW | $210.90 | $703.00 | $27.94–$1,406.00 | — | 70% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 RADEX ABDOMEN 1 VIEW | $210.90 | $703.00 | $27.94–$1,406.00 | — | 70% |
| X-ray of the ankle, 2 views CPT 73600 X-RAY EXAM OF ANKLE | $112.65 | $375.50 | $30.37–$1,503.00 | 5% above | 70% |
| X-ray of the ankle, 2 views one side CPT 73600 HDX XR ANKLE 2 VIEWS RIGHT | $56.40 | $188.00 | $30.37–$1,503.00 | 48% below | 70% |
| X-ray of the ankle, 2 views one side CPT 73600 MFI XR ANKLE 2 VIEWS LEFT | $56.40 | $188.00 | $30.37–$1,503.00 | 48% below | 70% |
| X-ray of the ankle, 2 views one side CPT 73600 MFI XR ANKLE 2 VIEWS RIGHT | $56.40 | $188.00 | $30.37–$1,503.00 | 48% below | 70% |
| X-ray of the ankle, 2 views one side CPT 73600 HDX XR ANKLE 2 VIEWS LEFT | $56.40 | $188.00 | $30.37–$1,503.00 | 48% below | 70% |
| X-ray of the ankle, 2 views one side CPT 73600 XR ANKLE 2 VIEWS RT | $112.65 | $375.50 | $30.37–$1,503.00 | 5% above | 70% |
| X-ray of the ankle, 2 views one side CPT 73600 XR ANKLE 2 VIEWS LT | $112.65 | $375.50 | $30.37–$1,503.00 | 5% above | 70% |
| X-ray of the ankle, 2 views inpatient CPT 73600 X-RAY EXAM OF ANKLE | $112.65 | $375.50 | $30.37–$1,503.00 | — | 70% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 HDX XR ANKLE 2 VIEWS RIGHT | $56.40 | $188.00 | $30.37–$1,503.00 | — | 70% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 MFI XR ANKLE 2 VIEWS RIGHT | $56.40 | $188.00 | $30.37–$1,503.00 | — | 70% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 HDX XR ANKLE 2 VIEWS LEFT | $56.40 | $188.00 | $30.37–$1,503.00 | — | 70% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 MFI XR ANKLE 2 VIEWS LEFT | $56.40 | $188.00 | $30.37–$1,503.00 | — | 70% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 XR ANKLE 2 VIEWS LT | $112.65 | $375.50 | $30.37–$1,503.00 | — | 70% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 XR ANKLE 2 VIEWS RT | $112.65 | $375.50 | $30.37–$1,503.00 | — | 70% |
| X-ray of the finger(s), 2 or more views CPT 73140 X-RAY EXAM OF FINGER(S) | $76.35 | $254.50 | $31.99–$2,674.50 | 22% below | 70% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 HDX XR FINGER LEFT 3 VIEWS | $38.25 | $127.50 | $31.99–$2,674.50 | 61% below | 70% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 MFI XR FINGER RIGHT 3 VIEWS | $38.25 | $127.50 | $31.99–$2,674.50 | 61% below | 70% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 MFI XR FINGER LEFT THUMB | $38.25 | $127.50 | $31.99–$2,674.50 | 61% below | 70% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 MFI XR FINGER LEFT 3 VIEWS | $38.25 | $127.50 | $31.99–$2,674.50 | 61% below | 70% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 MFI XR FINGER LEFT 1 VIEW | $38.25 | $127.50 | $31.99–$2,674.50 | 61% below | 70% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 HDX XR FINGER RIGHT THUMB | $38.25 | $127.50 | $31.99–$2,674.50 | 61% below | 70% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 HDX XR FINGER RIGHT 3 VIEWS | $38.25 | $127.50 | $31.99–$2,674.50 | 61% below | 70% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 HDX XR FINGER LEFT THUMB | $38.25 | $127.50 | $31.99–$2,674.50 | 61% below | 70% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 MFI XR FINGER RIGHT THUMB | $38.25 | $127.50 | $31.99–$2,674.50 | 61% below | 70% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER LT | $76.35 | $254.50 | $31.99–$2,674.50 | 22% below | 70% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER RT | $76.35 | $254.50 | $31.99–$2,674.50 | 22% below | 70% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER LT THUMB | $76.35 | $254.50 | $31.99–$2,674.50 | 22% below | 70% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER RT THUMB | $76.35 | $254.50 | $31.99–$2,674.50 | 22% below | 70% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 FINGER(S) MIN 2 VIEWS RT | $76.35 | $254.50 | $31.99–$2,674.50 | 22% below | 70% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 FINGER(S) MIN 2 VIEWS LT | $76.35 | $254.50 | $31.99–$2,674.50 | 22% below | 70% |
| X-ray of the finger(s), 2 or more views inpatient CPT 73140 X-RAY EXAM OF FINGER(S) | $76.35 | $254.50 | $31.99–$2,674.50 | — | 70% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 MFI XR FINGER LEFT 1 VIEW | $38.25 | $127.50 | $31.99–$2,674.50 | — | 70% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 HDX XR FINGER LEFT 3 VIEWS | $38.25 | $127.50 | $31.99–$2,674.50 | — | 70% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 HDX XR FINGER LEFT THUMB | $38.25 | $127.50 | $31.99–$2,674.50 | — | 70% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 HDX XR FINGER RIGHT 3 VIEWS | $38.25 | $127.50 | $31.99–$2,674.50 | — | 70% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 HDX XR FINGER RIGHT THUMB | $38.25 | $127.50 | $31.99–$2,674.50 | — | 70% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 MFI XR FINGER LEFT 3 VIEWS | $38.25 | $127.50 | $31.99–$2,674.50 | — | 70% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 MFI XR FINGER LEFT THUMB | $38.25 | $127.50 | $31.99–$2,674.50 | — | 70% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 MFI XR FINGER RIGHT 3 VIEWS | $38.25 | $127.50 | $31.99–$2,674.50 | — | 70% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 MFI XR FINGER RIGHT THUMB | $38.25 | $127.50 | $31.99–$2,674.50 | — | 70% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 FINGER(S) MIN 2 VIEWS LT | $76.35 | $254.50 | $31.99–$2,674.50 | — | 70% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGER RT | $76.35 | $254.50 | $31.99–$2,674.50 | — | 70% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGER LT THUMB | $76.35 | $254.50 | $31.99–$2,674.50 | — | 70% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGER LT | $76.35 | $254.50 | $31.99–$2,674.50 | — | 70% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGER RT THUMB | $76.35 | $254.50 | $31.99–$2,674.50 | — | 70% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 FINGER(S) MIN 2 VIEWS RT | $76.35 | $254.50 | $31.99–$2,674.50 | — | 70% |
| X-ray of the foot, 2 views CPT 73620 X-RAY EXAM OF FOOT | $115.80 | $386.00 | $26.52–$1,544.00 | 8% above | 70% |
| X-ray of the foot, 2 views one side CPT 73620 HDX XR FOOT 2 VIEWS LEFT | $57.90 | $193.00 | $26.52–$1,544.00 | 46% below | 70% |
| X-ray of the foot, 2 views one side CPT 73620 MFI XR FOOT 2 VIEWS RIGHT | $57.90 | $193.00 | $26.52–$1,544.00 | 46% below | 70% |
| X-ray of the foot, 2 views one side CPT 73620 MFI XR FOOT 2 VIEWS LEFT | $57.90 | $193.00 | $26.52–$1,544.00 | 46% below | 70% |
| X-ray of the foot, 2 views one side CPT 73620 HDX XR FOOT 2 VIEWS RIGHT | $57.90 | $193.00 | $26.52–$1,544.00 | 46% below | 70% |
| X-ray of the foot, 2 views one side CPT 73620 XR FOOT 2 VIEWS RT | $115.80 | $386.00 | $26.52–$1,544.00 | 8% above | 70% |
| X-ray of the foot, 2 views one side CPT 73620 XR FOOT 2 VIEWS LT | $115.80 | $386.00 | $26.52–$1,544.00 | 8% above | 70% |
| X-ray of the foot, 2 views inpatient CPT 73620 X-RAY EXAM OF FOOT | $115.80 | $386.00 | $26.52–$1,544.00 | — | 70% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 MFI XR FOOT 2 VIEWS LEFT | $57.90 | $193.00 | $26.52–$1,544.00 | — | 70% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 HDX XR FOOT 2 VIEWS RIGHT | $57.90 | $193.00 | $26.52–$1,544.00 | — | 70% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 HDX XR FOOT 2 VIEWS LEFT | $57.90 | $193.00 | $26.52–$1,544.00 | — | 70% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 MFI XR FOOT 2 VIEWS RIGHT | $57.90 | $193.00 | $26.52–$1,544.00 | — | 70% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 XR FOOT 2 VIEWS LT | $115.80 | $386.00 | $26.52–$1,544.00 | — | 70% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 XR FOOT 2 VIEWS RT | $115.80 | $386.00 | $26.52–$1,544.00 | — | 70% |
| X-ray of the foot, complete, 3 or more views CPT 73630 MFI XR FOOT 3+ VIEWS BIL | $155.84 | $519.48 | $29.72–$4,491.44 | 27% above | 70% |
| X-ray of the foot, complete, 3 or more views CPT 73630 XR FOOT MIN 3 VIEWS BIL | $155.84 | $519.48 | $29.72–$4,491.44 | 27% above | 70% |
| X-ray of the foot, complete, 3 or more views CPT 73630 HDX XR FOOT 3+ VIEWS BIL | $155.84 | $519.48 | $29.72–$4,491.44 | 27% above | 70% |
| X-ray of the foot, complete, 3 or more views CPT 73630 X-RAY EXAM OF FOOT | $220.05 | $733.50 | $29.72–$4,491.44 | 80% above | 70% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 HDX XR FOOT 3+ VIEWS RIGHT | $109.95 | $366.50 | $29.72–$4,491.44 | 10% below | 70% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 HDX XR FOOT 3+ VIEWS LEFT | $109.95 | $366.50 | $29.72–$4,491.44 | 10% below | 70% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 MFI XR FOOT 3+ VIEWS LEFT | $109.95 | $366.50 | $29.72–$4,491.44 | 10% below | 70% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 MFI XR FOOT 3+ VIEWS RIGHT | $109.95 | $366.50 | $29.72–$4,491.44 | 10% below | 70% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT MIN 3 VIEWS RT | $220.05 | $733.50 | $29.72–$4,491.44 | 80% above | 70% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT MIN 3 VIEWS LT | $220.05 | $733.50 | $29.72–$4,491.44 | 80% above | 70% |
| X-ray of the foot, complete, 3 or more views inpatient CPT 73630 HDX XR FOOT 3+ VIEWS BIL | $155.84 | $519.48 | $29.72–$4,491.44 | — | 70% |
| X-ray of the foot, complete, 3 or more views inpatient CPT 73630 XR FOOT MIN 3 VIEWS BIL | $155.84 | $519.48 | $29.72–$4,491.44 | — | 70% |
| X-ray of the foot, complete, 3 or more views inpatient CPT 73630 MFI XR FOOT 3+ VIEWS BIL | $155.84 | $519.48 | $29.72–$4,491.44 | — | 70% |
| X-ray of the foot, complete, 3 or more views inpatient CPT 73630 X-RAY EXAM OF FOOT | $220.05 | $733.50 | $29.72–$4,491.44 | — | 70% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 MFI XR FOOT 3+ VIEWS RIGHT | $109.95 | $366.50 | $29.72–$4,491.44 | — | 70% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 MFI XR FOOT 3+ VIEWS LEFT | $109.95 | $366.50 | $29.72–$4,491.44 | — | 70% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 HDX XR FOOT 3+ VIEWS RIGHT | $109.95 | $366.50 | $29.72–$4,491.44 | — | 70% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 HDX XR FOOT 3+ VIEWS LEFT | $109.95 | $366.50 | $29.72–$4,491.44 | — | 70% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 FOOT MIN 3 VIEWS LT | $220.05 | $733.50 | $29.72–$4,491.44 | — | 70% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 FOOT MIN 3 VIEWS RT | $220.05 | $733.50 | $29.72–$4,491.44 | — | 70% |
| X-ray of the hand, 3 or more views CPT 73130 X-RAY EXAM OF HAND | $218.85 | $729.50 | $31.47–$2,919.00 | 73% above | 70% |
| X-ray of the hand, 3 or more views one side CPT 73130 HDX XR HAND 3+ VIEWS RIGHT | $109.50 | $365.00 | $31.47–$2,919.00 | 14% below | 70% |
| X-ray of the hand, 3 or more views one side CPT 73130 HDX XR HAND 3+ VIEWS LEFT | $109.50 | $365.00 | $31.47–$2,919.00 | 14% below | 70% |
| X-ray of the hand, 3 or more views one side CPT 73130 MFI XR HAND 3+ VIEWS RIGHT | $109.50 | $365.00 | $31.47–$2,919.00 | 14% below | 70% |
| X-ray of the hand, 3 or more views one side CPT 73130 MFI XR HAND 3+ VIEWS LEFT | $109.50 | $365.00 | $31.47–$2,919.00 | 14% below | 70% |
| X-ray of the hand, 3 or more views one side CPT 73130 HAND MIN 3 VIEWS RT | $218.85 | $729.50 | $31.47–$2,919.00 | 73% above | 70% |
| X-ray of the hand, 3 or more views one side CPT 73130 HAND MIN 3 VIEWS LT | $218.85 | $729.50 | $31.47–$2,919.00 | 73% above | 70% |
| X-ray of the hand, 3 or more views inpatient CPT 73130 X-RAY EXAM OF HAND | $218.85 | $729.50 | $31.47–$2,919.00 | — | 70% |
| X-ray of the hand, 3 or more views inpatient one side CPT 73130 HDX XR HAND 3+ VIEWS RIGHT | $109.50 | $365.00 | $31.47–$2,919.00 | — | 70% |
| X-ray of the hand, 3 or more views inpatient one side CPT 73130 MFI XR HAND 3+ VIEWS LEFT | $109.50 | $365.00 | $31.47–$2,919.00 | — | 70% |
| X-ray of the hand, 3 or more views inpatient one side CPT 73130 HDX XR HAND 3+ VIEWS LEFT | $109.50 | $365.00 | $31.47–$2,919.00 | — | 70% |
| X-ray of the hand, 3 or more views inpatient one side CPT 73130 MFI XR HAND 3+ VIEWS RIGHT | $109.50 | $365.00 | $31.47–$2,919.00 | — | 70% |
| X-ray of the hand, 3 or more views inpatient one side CPT 73130 HAND MIN 3 VIEWS LT | $218.85 | $729.50 | $31.47–$2,919.00 | — | 70% |
| X-ray of the hand, 3 or more views inpatient one side CPT 73130 HAND MIN 3 VIEWS RT | $218.85 | $729.50 | $31.47–$2,919.00 | — | 70% |
| X-ray of the knee, 1 or 2 views both sides CPT 73560 XR KNEE 1-2 VIEWS BILAT | $286.95 | $956.50 | $31.43–$4,623.00 | — | 70% |
| X-ray of the knee, 1 or 2 views CPT 73560 X-RAY EXAM OF KNEE 1 OR 2 | $220.05 | $733.50 | $31.43–$4,623.00 | 100% above | 70% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 MFI XR KNEE 1-2 VIEWS RIGHT | $109.95 | $366.50 | $31.43–$4,623.00 | at median | 70% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 MFI XR KNEE 1-2 VIEWS LEFT | $109.95 | $366.50 | $31.43–$4,623.00 | at median | 70% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 HDX XR KNEE 1-2 VIEWS LEFT | $109.95 | $366.50 | $31.43–$4,623.00 | at median | 70% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 HDX XR KNEE 1-2 VIEWS RIGHT | $109.95 | $366.50 | $31.43–$4,623.00 | at median | 70% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 XR PATELLA RT | $220.05 | $733.50 | $31.43–$4,623.00 | 100% above | 70% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE 1-2 VIEWS RT | $220.05 | $733.50 | $31.43–$4,623.00 | 100% above | 70% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE 1-2 VIEWS LT | $220.05 | $733.50 | $31.43–$4,623.00 | 100% above | 70% |
| X-ray of the knee, 1 or 2 views inpatient both sides CPT 73560 XR KNEE 1-2 VIEWS BILAT | $286.95 | $956.50 | $31.43–$4,623.00 | — | 70% |
| X-ray of the knee, 1 or 2 views inpatient CPT 73560 X-RAY EXAM OF KNEE 1 OR 2 | $220.05 | $733.50 | $31.43–$4,623.00 | — | 70% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 HDX XR KNEE 1-2 VIEWS LEFT | $109.95 | $366.50 | $31.43–$4,623.00 | — | 70% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 MFI XR KNEE 1-2 VIEWS RIGHT | $109.95 | $366.50 | $31.43–$4,623.00 | — | 70% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 MFI XR KNEE 1-2 VIEWS LEFT | $109.95 | $366.50 | $31.43–$4,623.00 | — | 70% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 HDX XR KNEE 1-2 VIEWS RIGHT | $109.95 | $366.50 | $31.43–$4,623.00 | — | 70% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 KNEE 1-2 VIEWS LT | $220.05 | $733.50 | $31.43–$4,623.00 | — | 70% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 KNEE 1-2 VIEWS RT | $220.05 | $733.50 | $31.43–$4,623.00 | — | 70% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR PATELLA RT | $220.05 | $733.50 | $31.43–$4,623.00 | — | 70% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HDX XR LUMBAR SPINE 3 VIEWS | $150.45 | $501.50 | $35.89–$2,006.50 | 1% below | 70% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 MFI XR LUMBAR SPINE 3 VIEWS | $150.45 | $501.50 | $35.89–$2,006.50 | 1% below | 70% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 LUMBOSACRAL 2-3 VIEWS | $301.05 | $1,003.50 | $35.89–$2,006.50 | 99% above | 70% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 X-RAY EXAM L-S SPINE 2/3 VWS | $301.05 | $1,003.50 | $35.89–$2,006.50 | 99% above | 70% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 MFI XR LUMBAR SPINE 3 VIEWS | $150.45 | $501.50 | $35.89–$2,006.50 | — | 70% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 HDX XR LUMBAR SPINE 3 VIEWS | $150.45 | $501.50 | $35.89–$2,006.50 | — | 70% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 X-RAY EXAM L-S SPINE 2/3 VWS | $301.05 | $1,003.50 | $35.89–$2,006.50 | — | 70% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 LUMBOSACRAL 2-3 VIEWS | $301.05 | $1,003.50 | $35.89–$2,006.50 | — | 70% |
| X-ray of the lower back, 4 or more views CPT 72110 MFI XR LUMBAR SPINE MIN 4 VIEWS | $264.00 | $880.00 | $50.08–$3,520.00 | 15% above | 70% |
| X-ray of the lower back, 4 or more views CPT 72110 HDX XR LUMBAR SPINE MIN 4 VIEWS | $264.00 | $880.00 | $50.08–$3,520.00 | 15% above | 70% |
| X-ray of the lower back, 4 or more views CPT 72110 X-RAY EXAM L-2 SPINE 4/>VWS | $528.00 | $1,760.00 | $50.08–$3,520.00 | 129% above | 70% |
| X-ray of the lower back, 4 or more views CPT 72110 LUMBOSACRAL MIN 4 VIEW | $528.00 | $1,760.00 | $50.08–$3,520.00 | 129% above | 70% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 MFI XR LUMBAR SPINE MIN 4 VIEWS | $264.00 | $880.00 | $50.08–$3,520.00 | — | 70% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 HDX XR LUMBAR SPINE MIN 4 VIEWS | $264.00 | $880.00 | $50.08–$3,520.00 | — | 70% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 X-RAY EXAM L-2 SPINE 4/>VWS | $528.00 | $1,760.00 | $50.08–$3,520.00 | — | 70% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 LUMBOSACRAL MIN 4 VIEW | $528.00 | $1,760.00 | $50.08–$3,520.00 | — | 70% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 HDX XR THORACIC SPINE 2 VIEWS | $176.85 | $589.50 | $34.85–$2,358.00 | at median | 70% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 MFI XR THORACIC SPINE 2 VIEWS | $176.85 | $589.50 | $34.85–$2,358.00 | at median | 70% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 X-RAY EXAM THORAC SPINE 2VWS | $353.70 | $1,179.00 | $34.85–$2,358.00 | 100% above | 70% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 THORACIC SPINE 2 VIEWS | $353.70 | $1,179.00 | $34.85–$2,358.00 | 100% above | 70% |
| X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 HDX XR THORACIC SPINE 2 VIEWS | $176.85 | $589.50 | $34.85–$2,358.00 | — | 70% |
| X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 MFI XR THORACIC SPINE 2 VIEWS | $176.85 | $589.50 | $34.85–$2,358.00 | — | 70% |
| X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 X-RAY EXAM THORAC SPINE 2VWS | $353.70 | $1,179.00 | $34.85–$2,358.00 | — | 70% |
| X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 THORACIC SPINE 2 VIEWS | $353.70 | $1,179.00 | $34.85–$2,358.00 | — | 70% |
| X-ray of the nasal bones, 3 or more views CPT 70160 MFI XR NASAL BONES | $107.55 | $358.50 | $33.22–$1,434.00 | 11% below | 70% |
| X-ray of the nasal bones, 3 or more views CPT 70160 HDX XR NASAL BONES | $107.55 | $358.50 | $33.22–$1,434.00 | 11% below | 70% |
| X-ray of the nasal bones, 3 or more views CPT 70160 NASAL BONE MIN 3 VIEWS | $215.10 | $717.00 | $33.22–$1,434.00 | 78% above | 70% |
| X-ray of the nasal bones, 3 or more views CPT 70160 X-RAY EXAM OF NASAL BONES | $215.10 | $717.00 | $33.22–$1,434.00 | 78% above | 70% |
| X-ray of the nasal bones, 3 or more views inpatient CPT 70160 HDX XR NASAL BONES | $107.55 | $358.50 | $33.22–$1,434.00 | — | 70% |
| X-ray of the nasal bones, 3 or more views inpatient CPT 70160 MFI XR NASAL BONES | $107.55 | $358.50 | $33.22–$1,434.00 | — | 70% |
| X-ray of the nasal bones, 3 or more views inpatient CPT 70160 NASAL BONE MIN 3 VIEWS | $215.10 | $717.00 | $33.22–$1,434.00 | — | 70% |
| X-ray of the nasal bones, 3 or more views inpatient CPT 70160 X-RAY EXAM OF NASAL BONES | $215.10 | $717.00 | $33.22–$1,434.00 | — | 70% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 HDX XR C-SPINE 2-3 VIEWS | $199.95 | $666.50 | $33.79–$2,666.00 | 39% above | 70% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 MFI XR C-SPINE 2-3 VIEWS | $199.95 | $666.50 | $33.79–$2,666.00 | 39% above | 70% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 X-RAY EXAM NECK SPINE 2-3 VW | $399.90 | $1,333.00 | $33.79–$2,666.00 | 178% above | 70% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 CERVICAL SPINE 2-3 VIEWS | $399.90 | $1,333.00 | $33.79–$2,666.00 | 178% above | 70% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 HDX XR C-SPINE 2-3 VIEWS | $199.95 | $666.50 | $33.79–$2,666.00 | — | 70% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 MFI XR C-SPINE 2-3 VIEWS | $199.95 | $666.50 | $33.79–$2,666.00 | — | 70% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 CERVICAL SPINE 2-3 VIEWS | $399.90 | $1,333.00 | $33.79–$2,666.00 | — | 70% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 X-RAY EXAM NECK SPINE 2-3 VW | $399.90 | $1,333.00 | $33.79–$2,666.00 | — | 70% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 HDX XR PELVIS 1-2 VIEWS | $78.30 | $261.00 | $32.53–$1,044.00 | 46% below | 70% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 MFI XR PELVIS 1-2 VIEWS | $78.30 | $261.00 | $32.53–$1,044.00 | 46% below | 70% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS 1-2 VIEWS | $156.60 | $522.00 | $32.53–$1,044.00 | 9% above | 70% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 X-RAY EXAM OF PELVIS | $156.60 | $522.00 | $32.53–$1,044.00 | 9% above | 70% |
| X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 MFI XR PELVIS 1-2 VIEWS | $78.30 | $261.00 | $32.53–$1,044.00 | — | 70% |
| X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 HDX XR PELVIS 1-2 VIEWS | $78.30 | $261.00 | $32.53–$1,044.00 | — | 70% |
| X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 X-RAY EXAM OF PELVIS | $156.60 | $522.00 | $32.53–$1,044.00 | — | 70% |
| X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PELVIS 1-2 VIEWS | $156.60 | $522.00 | $32.53–$1,044.00 | — | 70% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 HDX XR SACRUM/COCCYX | $145.50 | $485.00 | $28.67–$1,940.50 | 3% above | 70% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 MFI XR SACRUM/COCCYX | $145.50 | $485.00 | $28.67–$1,940.50 | 3% above | 70% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 SACRUM &COCCYX MIN 2 VW | $291.15 | $970.50 | $28.67–$1,940.50 | 106% above | 70% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 X-RAY EXAM SACRUM TAILBONE | $291.15 | $970.50 | $28.67–$1,940.50 | 106% above | 70% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 MFI XR SACRUM/COCCYX | $145.50 | $485.00 | $28.67–$1,940.50 | — | 70% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 HDX XR SACRUM/COCCYX | $145.50 | $485.00 | $28.67–$1,940.50 | — | 70% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 SACRUM &COCCYX MIN 2 VW | $291.15 | $970.50 | $28.67–$1,940.50 | — | 70% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 X-RAY EXAM SACRUM TAILBONE | $291.15 | $970.50 | $28.67–$1,940.50 | — | 70% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Louisiana | Off list |
|---|---|---|---|---|---|
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALANINE AMINO (ALT) (SGPT) | $18.30 | $61.00 | $5.30–$61.00 | 41% below | 70% |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALT (SGPT) | $18.30 | $61.00 | $5.30–$61.00 | 41% below | 70% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALT (SGPT) | $18.30 | $61.00 | $5.30–$61.00 | — | 70% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALANINE AMINO (ALT) (SGPT) | $18.30 | $61.00 | $5.30–$61.00 | — | 70% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 TRANSFERASE (AST) (SGOT) | $18.30 | $61.00 | $5.18–$61.00 | 45% below | 70% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 AST (SGOT) | $18.30 | $61.00 | $5.18–$61.00 | 45% below | 70% |
| AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 AST (SGOT) | $18.30 | $61.00 | $5.18–$61.00 | — | 70% |
| AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 TRANSFERASE (AST) (SGOT) | $18.30 | $61.00 | $5.18–$61.00 | — | 70% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HEPATITIS PROFILE (A,B,C) | $73.80 | $246.00 | $47.63–$1,341.00 | 36% below | 70% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE HEPATITIS PANEL | $328.50 | $1,095.00 | $47.63–$1,341.00 | 184% above | 70% |
| Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HEPATITIS PROFILE (A,B,C) | $73.80 | $246.00 | $47.63–$1,341.00 | — | 70% |
| Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 ACUTE HEPATITIS PANEL | $328.50 | $1,095.00 | $47.63–$1,341.00 | — | 70% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MILK IGE | $2.93 | $9.78 | $5.06–$1,356.56 | 71% below | 70% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLG SPEC IGE CRUDE XTRC EA | $198.53 | $661.78 | $5.06–$1,356.56 | 1873% above | 70% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE EACH | $198.53 | $661.78 | $5.06–$1,356.56 | 1873% above | 70% |
| Allergy blood test, specific IgE, per allergen CPT 86003 RAST ADULT FOOD PNL | $205.50 | $685.00 | $5.06–$1,356.56 | 1943% above | 70% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MILK IGE | $2.93 | $9.78 | $5.06–$1,356.56 | — | 70% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLG SPEC IGE CRUDE XTRC EA | $198.53 | $661.78 | $5.06–$1,356.56 | — | 70% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE EACH | $198.53 | $661.78 | $5.06–$1,356.56 | — | 70% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RAST ADULT FOOD PNL | $205.50 | $685.00 | $5.06–$1,356.56 | — | 70% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP AB | $165.75 | $552.50 | $12.95–$552.50 | 248% above | 70% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP ANTIBODY | $165.75 | $552.50 | $12.95–$552.50 | 248% above | 70% |
| Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CCP AB | $165.75 | $552.50 | $12.95–$552.50 | — | 70% |
| Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CCP ANTIBODY | $165.75 | $552.50 | $12.95–$552.50 | — | 70% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA QUAL SCREEN | $66.45 | $221.50 | $12.09–$886.00 | 27% above | 70% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODIES | $66.45 | $221.50 | $12.09–$886.00 | 27% above | 70% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA NON-REFLEX TO TITER | $66.45 | $221.50 | $12.09–$886.00 | 27% above | 70% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA W/REFLEX | $66.45 | $221.50 | $12.09–$886.00 | 27% above | 70% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA REFLEX AUTOIMM AB PROFILE | $66.45 | $221.50 | $12.09–$886.00 | 27% above | 70% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA QUAL SCREEN | $66.45 | $221.50 | $12.09–$886.00 | — | 70% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR ANTIBODIES | $66.45 | $221.50 | $12.09–$886.00 | — | 70% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA W/REFLEX | $66.45 | $221.50 | $12.09–$886.00 | — | 70% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA REFLEX AUTOIMM AB PROFILE | $66.45 | $221.50 | $12.09–$886.00 | — | 70% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA NON-REFLEX TO TITER | $66.45 | $221.50 | $12.09–$886.00 | — | 70% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NATRIURETIC PEPTIDE | $144.00 | $480.00 | $39.26–$480.00 | 83% above | 70% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 ASSAY OF NATRIURETIC PEPTIDE | $144.00 | $480.00 | $39.26–$480.00 | 83% above | 70% |
| BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NATRIURETIC PEPTIDE | $144.00 | $480.00 | $39.26–$480.00 | — | 70% |
| BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 ASSAY OF NATRIURETIC PEPTIDE | $144.00 | $480.00 | $39.26–$480.00 | — | 70% |
| Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL | $95.85 | $319.50 | $8.46–$319.50 | 57% above | 70% |
| Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PNL TOTAL CA | $95.85 | $319.50 | $8.46–$319.50 | 57% above | 70% |
| Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL | $95.85 | $319.50 | $8.46–$319.50 | — | 70% |
| Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PNL TOTAL CA | $95.85 | $319.50 | $8.46–$319.50 | — | 70% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 LEVEL IV SURG PATH GROSS & MICRO | $62.70 | $209.00 | $33.13–$209.00 | 14% below | 70% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 TISSUE EXAM BY PATHOLOGIST | $62.70 | $209.00 | $33.13–$209.00 | 14% below | 70% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 TISSUE EXAM BY PATHOLOGIST | $62.70 | $209.00 | $33.13–$209.00 | — | 70% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 LEVEL IV SURG PATH GROSS & MICRO | $62.70 | $209.00 | $33.13–$209.00 | — | 70% |
| Blood culture for bacteria CPT 87040 BLOOD CULTURE FOR BACTERIA | $88.20 | $294.00 | $10.32–$294.00 | 21% above | 70% |
| Blood culture for bacteria CPT 87040 CULTURE BLOOD | $88.20 | $294.00 | $10.32–$294.00 | 21% above | 70% |
| Blood culture for bacteria inpatient CPT 87040 CULTURE BLOOD | $88.20 | $294.00 | $10.32–$294.00 | — | 70% |
| Blood culture for bacteria inpatient CPT 87040 BLOOD CULTURE FOR BACTERIA | $88.20 | $294.00 | $10.32–$294.00 | — | 70% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE COLLECTION OF VENOUS BLOOD | $2.85 | $9.50 | $2.70–$51.50 | 67% below | 70% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLL VENOUS BLD VENIPUNCTURE | $12.60 | $42.00 | $2.70–$51.50 | 47% above | 70% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE | $12.60 | $42.00 | $2.70–$51.50 | 47% above | 70% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE COLLECTION OF VENOUS BLOOD | $2.85 | $9.50 | $2.70–$51.50 | — | 70% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 COLL VENOUS BLD VENIPUNCTURE | $12.60 | $42.00 | $2.70–$51.50 | — | 70% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE | $12.60 | $42.00 | $2.70–$51.50 | — | 70% |
| Blood glucose (sugar) test CPT 82947 CSF GLUCOSE | $13.05 | $43.50 | $3.93–$87.00 | 25% below | 70% |
| Blood glucose (sugar) test CPT 82947 ASSAY GLUCOSE BLOOD QUANT | $13.05 | $43.50 | $3.93–$87.00 | 25% below | 70% |
| Blood glucose (sugar) test CPT 82947 GLUCOSE BLD QN | $13.05 | $43.50 | $3.93–$87.00 | 25% below | 70% |
| Blood glucose (sugar) test inpatient CPT 82947 ASSAY GLUCOSE BLOOD QUANT | $13.05 | $43.50 | $3.93–$87.00 | — | 70% |
| Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE BLD QN | $13.05 | $43.50 | $3.93–$87.00 | — | 70% |
| Blood glucose (sugar) test inpatient CPT 82947 CSF GLUCOSE | $13.05 | $43.50 | $3.93–$87.00 | — | 70% |
| Blood lead test CPT 83655 ASSAY OF LEAD | $81.75 | $272.50 | $12.11–$817.50 | 163% above | 70% |
| Blood lead test CPT 83655 LEAD, BLOOD, CAPILLARY | $81.75 | $272.50 | $12.11–$817.50 | 163% above | 70% |
| Blood lead test CPT 83655 LEAD, BLOOD, VENIPUNCTURE | $81.75 | $272.50 | $12.11–$817.50 | 163% above | 70% |
| Blood lead test CPT 83655 LEAD BLOOD | $81.75 | $272.50 | $12.11–$817.50 | 163% above | 70% |
| Blood lead test inpatient CPT 83655 LEAD BLOOD | $81.75 | $272.50 | $12.11–$817.50 | — | 70% |
| Blood lead test inpatient CPT 83655 ASSAY OF LEAD | $81.75 | $272.50 | $12.11–$817.50 | — | 70% |
| Blood lead test inpatient CPT 83655 LEAD, BLOOD, CAPILLARY | $81.75 | $272.50 | $12.11–$817.50 | — | 70% |
| Blood lead test inpatient CPT 83655 LEAD, BLOOD, VENIPUNCTURE | $81.75 | $272.50 | $12.11–$817.50 | — | 70% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 CHORIONIC GONADOTROPIN ASSAY | $8.25 | $27.50 | $4.63–$27.50 | 85% below | 70% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HCG SERUM | $8.25 | $27.50 | $4.63–$27.50 | 85% below | 70% |
| Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 CHORIONIC GONADOTROPIN ASSAY | $8.25 | $27.50 | $4.63–$27.50 | — | 70% |
| Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HCG SERUM | $8.25 | $27.50 | $4.63–$27.50 | — | 70% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO TYPE | $72.66 | $242.20 | $2.99–$242.20 | 54% above | 70% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPING SEROLOGIC ABO | $72.66 | $242.20 | $2.99–$242.20 | 54% above | 70% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO TYPE | $72.66 | $242.20 | $2.99–$242.20 | — | 70% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BLOOD TYPING SEROLOGIC ABO | $72.66 | $242.20 | $2.99–$242.20 | — | 70% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN | $55.05 | $183.50 | $5.18–$367.00 | 62% above | 70% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN | $55.05 | $183.50 | $5.18–$367.00 | — | 70% |
| C. difficile toxin gene test (stool PCR) CPT 87493 C DIFFICILE TOXIN | $214.27 | $714.25 | $37.27–$714.25 | 211% above | 70% |
| C. difficile toxin gene test (stool PCR) CPT 87493 C DIFF AMPLIFIED PROBE | $214.27 | $714.25 | $37.27–$714.25 | 211% above | 70% |
| C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C DIFF AMPLIFIED PROBE | $214.27 | $714.25 | $37.27–$714.25 | — | 70% |
| C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C DIFFICILE TOXIN | $214.27 | $714.25 | $37.27–$714.25 | — | 70% |
| CA 19-9 blood test (tumor marker) CPT 86301 IMMUNOASSAY TUMOR CA 19-9 | $16.50 | $55.00 | $9.26–$62.43 | 66% below | 70% |
| CA 19-9 blood test (tumor marker) CPT 86301 CANCER ANTIGEN 19-9 | $16.50 | $55.00 | $9.26–$62.43 | 66% below | 70% |
| CA 19-9 blood test (tumor marker) inpatient CPT 86301 IMMUNOASSAY TUMOR CA 19-9 | $16.50 | $55.00 | $9.26–$62.43 | — | 70% |
| CA 19-9 blood test (tumor marker) inpatient CPT 86301 CANCER ANTIGEN 19-9 | $16.50 | $55.00 | $9.26–$62.43 | — | 70% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 CA 125 | $49.65 | $165.50 | $20.81–$331.00 | 26% below | 70% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 CANCER ANTIGEN 125 | $49.65 | $165.50 | $20.81–$331.00 | 26% below | 70% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 IMMUNOASSAY TUMOR CA 125 | $49.65 | $165.50 | $20.81–$331.00 | 26% below | 70% |
| CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 IMMUNOASSAY TUMOR CA 125 | $49.65 | $165.50 | $20.81–$331.00 | — | 70% |
| CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CANCER ANTIGEN 125 | $49.65 | $165.50 | $20.81–$331.00 | — | 70% |
| CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA 125 | $49.65 | $165.50 | $20.81–$331.00 | — | 70% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-COV-2 COVID-19 AMP PRB | $88.05 | $293.50 | $38.48–$293.50 | 56% above | 70% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID 19 TESTING | $88.05 | $293.50 | $38.48–$293.50 | 56% above | 70% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-COV-2 COVID-19 AMP PRB | $88.05 | $293.50 | $38.48–$293.50 | — | 70% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COVID 19 TESTING | $88.05 | $293.50 | $38.48–$293.50 | — | 70% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 C. TRACHO RECTAL/PHARYNGEAL | $79.80 | $266.00 | $35.09–$1,330.00 | 42% above | 70% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA, TMA, SWAB | $79.80 | $266.00 | $35.09–$1,330.00 | 42% above | 70% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA T AMP PROBE | $79.80 | $266.00 | $35.09–$1,330.00 | 42% above | 70% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA, TMA, URINE | $79.80 | $266.00 | $35.09–$1,330.00 | 42% above | 70% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 THIN PREP/SURE PATH CHLAMYDIA DNA | $79.80 | $266.00 | $35.09–$1,330.00 | 42% above | 70% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLMYD TRACH DNA AMP PROBE | $79.80 | $266.00 | $35.09–$1,330.00 | 42% above | 70% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA, TMA, URINE | $79.80 | $266.00 | $35.09–$1,330.00 | — | 70% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 C. TRACHO RECTAL/PHARYNGEAL | $79.80 | $266.00 | $35.09–$1,330.00 | — | 70% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 THIN PREP/SURE PATH CHLAMYDIA DNA | $79.80 | $266.00 | $35.09–$1,330.00 | — | 70% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLMYD TRACH DNA AMP PROBE | $79.80 | $266.00 | $35.09–$1,330.00 | — | 70% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA, TMA, SWAB | $79.80 | $266.00 | $35.09–$1,330.00 | — | 70% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA T AMP PROBE | $79.80 | $266.00 | $35.09–$1,330.00 | — | 70% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL | $72.60 | $242.00 | $13.39–$242.00 | 3% above | 70% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL | $72.60 | $242.00 | $13.39–$242.00 | — | 70% |
| Complete blood count (CBC) with differential CPT 85025 COMPLETE CBC W/AUTO DIFF WBC | $81.00 | $270.00 | $7.77–$270.00 | 113% above | 70% |
| Complete blood count (CBC) with differential CPT 85025 CBC AUTO DIFF | $81.00 | $270.00 | $7.77–$270.00 | 113% above | 70% |
| Complete blood count (CBC) with differential inpatient CPT 85025 COMPLETE CBC W/AUTO DIFF WBC | $81.00 | $270.00 | $7.77–$270.00 | — | 70% |
| Complete blood count (CBC) with differential inpatient CPT 85025 CBC AUTO DIFF | $81.00 | $270.00 | $7.77–$270.00 | — | 70% |
| Complete blood count (CBC), no differential CPT 85027 COMPLETE CBC AUTOMATED | $72.60 | $242.00 | $6.47–$242.00 | 65% above | 70% |
| Complete blood count (CBC), no differential CPT 85027 CBC HEMOGRAM | $72.60 | $242.00 | $6.47–$242.00 | 65% above | 70% |
| Complete blood count (CBC), no differential inpatient CPT 85027 CBC HEMOGRAM | $72.60 | $242.00 | $6.47–$242.00 | — | 70% |
| Complete blood count (CBC), no differential inpatient CPT 85027 COMPLETE CBC AUTOMATED | $72.60 | $242.00 | $6.47–$242.00 | — | 70% |
| Comprehensive metabolic panel (blood test) CPT 80053 COMP METABOLIC PANEL | $199.80 | $666.00 | $10.56–$666.00 | 76% above | 70% |
| Comprehensive metabolic panel (blood test) CPT 80053 COMPREHEN METABOLIC PANEL | $199.80 | $666.00 | $10.56–$666.00 | 76% above | 70% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHEN METABOLIC PANEL | $199.80 | $666.00 | $10.56–$666.00 | — | 70% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMP METABOLIC PANEL | $199.80 | $666.00 | $10.56–$666.00 | — | 70% |
| D-dimer blood test (blood clot marker) CPT 85379 D-DIMER QUANT | $115.35 | $384.50 | $10.18–$384.50 | 60% above | 70% |
| D-dimer blood test (blood clot marker) CPT 85379 FIBRIN DEGRADATION QUANT | $115.35 | $384.50 | $10.18–$384.50 | 60% above | 70% |
| D-dimer blood test (blood clot marker) inpatient CPT 85379 FIBRIN DEGRADATION QUANT | $115.35 | $384.50 | $10.18–$384.50 | — | 70% |
| D-dimer blood test (blood clot marker) inpatient CPT 85379 D-DIMER QUANT | $115.35 | $384.50 | $10.18–$384.50 | — | 70% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA-S | $13.35 | $44.50 | $14.98–$89.00 | 78% below | 70% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 DEHYDROEPIANDROSTERONE | $13.35 | $44.50 | $14.98–$89.00 | 78% below | 70% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA SULFATE | $13.35 | $44.50 | $14.98–$89.00 | 78% below | 70% |
| DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA-S | $13.35 | $44.50 | $14.98–$89.00 | — | 70% |
| DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DEHYDROEPIANDROSTERONE | $13.35 | $44.50 | $14.98–$89.00 | — | 70% |
| DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA SULFATE | $13.35 | $44.50 | $14.98–$89.00 | — | 70% |
| Estradiol blood test CPT 82670 ASSAY OF TOTAL ESTRADIOL | $168.90 | $563.00 | $27.94–$1,126.00 | 115% above | 70% |
| Estradiol blood test CPT 82670 ESTRADIOL | $168.90 | $563.00 | $27.94–$1,126.00 | 115% above | 70% |
| Estradiol blood test inpatient CPT 82670 ASSAY OF TOTAL ESTRADIOL | $168.90 | $563.00 | $27.94–$1,126.00 | — | 70% |
| Estradiol blood test inpatient CPT 82670 ESTRADIOL | $168.90 | $563.00 | $27.94–$1,126.00 | — | 70% |
| FSH (follicle-stimulating hormone) test CPT 83001 ASSAY OF GONADOTROPIN (FSH) | $186.75 | $622.50 | $18.58–$1,245.00 | 196% above | 70% |
| FSH (follicle-stimulating hormone) test CPT 83001 FSH | $186.75 | $622.50 | $18.58–$1,245.00 | 196% above | 70% |
| FSH (follicle-stimulating hormone) test CPT 83001 FOLLICLE STIM HORMONE | $186.75 | $622.50 | $18.58–$1,245.00 | 196% above | 70% |
| FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH | $186.75 | $622.50 | $18.58–$1,245.00 | — | 70% |
| FSH (follicle-stimulating hormone) test inpatient CPT 83001 ASSAY OF GONADOTROPIN (FSH) | $186.75 | $622.50 | $18.58–$1,245.00 | — | 70% |
| FSH (follicle-stimulating hormone) test inpatient CPT 83001 FOLLICLE STIM HORMONE | $186.75 | $622.50 | $18.58–$1,245.00 | — | 70% |
| Fecal calprotectin (stool inflammation test) CPT 83993 ASSAY FOR CALPROTECTIN FECAL | $150.90 | $503.00 | $19.63–$503.00 | 14% above | 70% |
| Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN FECAL | $150.90 | $503.00 | $19.63–$503.00 | 14% above | 70% |
| Fecal calprotectin (stool inflammation test) inpatient CPT 83993 ASSAY FOR CALPROTECTIN FECAL | $150.90 | $503.00 | $19.63–$503.00 | — | 70% |
| Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CALPROTECTIN FECAL | $150.90 | $503.00 | $19.63–$503.00 | — | 70% |
| Ferritin blood test (iron stores) CPT 82728 ASSAY OF FERRITIN | $58.80 | $196.00 | $13.63–$196.00 | 7% above | 70% |
| Ferritin blood test (iron stores) CPT 82728 FERRITIN | $58.80 | $196.00 | $13.63–$196.00 | 7% above | 70% |
| Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN | $58.80 | $196.00 | $13.63–$196.00 | — | 70% |
| Ferritin blood test (iron stores) inpatient CPT 82728 ASSAY OF FERRITIN | $58.80 | $196.00 | $13.63–$196.00 | — | 70% |
| Folate (folic acid) blood test CPT 82746 FOLIC ACID | $61.05 | $203.50 | $14.70–$203.50 | 30% above | 70% |
| Folate (folic acid) blood test CPT 82746 ASSAY OF FOLIC ACID SERUM | $61.05 | $203.50 | $14.70–$203.50 | 30% above | 70% |
| Folate (folic acid) blood test inpatient CPT 82746 FOLIC ACID | $61.05 | $203.50 | $14.70–$203.50 | — | 70% |
| Folate (folic acid) blood test inpatient CPT 82746 ASSAY OF FOLIC ACID SERUM | $61.05 | $203.50 | $14.70–$203.50 | — | 70% |
| Free T3 thyroid hormone test CPT 84481 FREE T3 | $33.30 | $111.00 | $11.50–$222.00 | 40% below | 70% |
| Free T3 thyroid hormone test CPT 84481 T3 FREE | $33.30 | $111.00 | $11.50–$222.00 | 40% below | 70% |
| Free T3 thyroid hormone test CPT 84481 FREE ASSAY (FT-3) | $33.30 | $111.00 | $11.50–$222.00 | 40% below | 70% |
| Free T3 thyroid hormone test inpatient CPT 84481 FREE T3 | $33.30 | $111.00 | $11.50–$222.00 | — | 70% |
| Free T3 thyroid hormone test inpatient CPT 84481 T3 FREE | $33.30 | $111.00 | $11.50–$222.00 | — | 70% |
| Free T3 thyroid hormone test inpatient CPT 84481 FREE ASSAY (FT-3) | $33.30 | $111.00 | $11.50–$222.00 | — | 70% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 ASSAY OF FREE THYROXINE | $33.30 | $111.00 | $9.02–$111.00 | 42% below | 70% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 T4 FREE | $33.30 | $111.00 | $9.02–$111.00 | 42% below | 70% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4 FREE | $33.30 | $111.00 | $9.02–$111.00 | — | 70% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 ASSAY OF FREE THYROXINE | $33.30 | $111.00 | $9.02–$111.00 | — | 70% |
| Free testosterone test CPT 84402 TESTOSTERONE FREE | $85.95 | $286.50 | $25.47–$286.50 | 18% above | 70% |
| Free testosterone test CPT 84402 ASSAY OF FREE TESTOSTERONE | $85.95 | $286.50 | $25.47–$286.50 | 18% above | 70% |
| Free testosterone test inpatient CPT 84402 TESTOSTERONE FREE | $85.95 | $286.50 | $25.47–$286.50 | — | 70% |
| Free testosterone test inpatient CPT 84402 ASSAY OF FREE TESTOSTERONE | $85.95 | $286.50 | $25.47–$286.50 | — | 70% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE TEST | $13.05 | $43.50 | $4.75–$43.50 | 19% below | 70% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE 2 HR POSTRANDIAL | $13.05 | $43.50 | $4.75–$43.50 | 19% below | 70% |
| Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE TEST | $13.05 | $43.50 | $4.75–$43.50 | — | 70% |
| Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE 2 HR POSTRANDIAL | $13.05 | $43.50 | $4.75–$43.50 | — | 70% |
| Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE TEST (GTT) | $13.20 | $44.00 | $7.40–$44.00 | 71% below | 70% |
| Glucose tolerance test, 3 samples CPT 82951 GTT 1ST 3 SPECIMENS | $13.20 | $44.00 | $7.40–$44.00 | 71% below | 70% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 GTT 1ST 3 SPECIMENS | $13.20 | $44.00 | $7.40–$44.00 | — | 70% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOLERANCE TEST (GTT) | $13.20 | $44.00 | $7.40–$44.00 | — | 70% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GC AMP PROBE | $52.80 | $176.00 | $35.09–$880.00 | at median | 70% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 N. GONORRHO RECTAL/PHARYNGEAL | $52.80 | $176.00 | $35.09–$880.00 | at median | 70% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 N.GONORRHOEAE DNA AMP PROB | $52.80 | $176.00 | $35.09–$880.00 | at median | 70% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 THIN PREP/SURE PATH GC | $52.80 | $176.00 | $35.09–$880.00 | at median | 70% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GONORRHEA, TMA, URINE | $52.80 | $176.00 | $35.09–$880.00 | at median | 70% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GONORRHEA, TMA, SIMPLESWAB | $52.80 | $176.00 | $35.09–$880.00 | at median | 70% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 GONORRHEA, TMA, SIMPLESWAB | $52.80 | $176.00 | $35.09–$880.00 | — | 70% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 GC AMP PROBE | $52.80 | $176.00 | $35.09–$880.00 | — | 70% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 N. GONORRHO RECTAL/PHARYNGEAL | $52.80 | $176.00 | $35.09–$880.00 | — | 70% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 GONORRHEA, TMA, URINE | $52.80 | $176.00 | $35.09–$880.00 | — | 70% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 N.GONORRHOEAE DNA AMP PROB | $52.80 | $176.00 | $35.09–$880.00 | — | 70% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 THIN PREP/SURE PATH GC | $52.80 | $176.00 | $35.09–$880.00 | — | 70% |
| H. pylori antibody blood test CPT 86677 HELICOBACTER PYLORI ANTIBODY | $144.75 | $482.50 | $13.56–$482.50 | 87% above | 70% |
| H. pylori antibody blood test CPT 86677 H PYLORI AB QUAL | $144.75 | $482.50 | $13.56–$482.50 | 87% above | 70% |
| H. pylori antibody blood test inpatient CPT 86677 H PYLORI AB QUAL | $144.75 | $482.50 | $13.56–$482.50 | — | 70% |
| H. pylori antibody blood test inpatient CPT 86677 HELICOBACTER PYLORI ANTIBODY | $144.75 | $482.50 | $13.56–$482.50 | — | 70% |
| H. pylori stool antigen test CPT 87338 H. PYLORI STOOL ANTIGEN | $16.80 | $56.00 | $5.41–$56.00 | 75% below | 70% |
| H. pylori stool antigen test CPT 87338 HPYLORI STOOL AG IA | $16.80 | $56.00 | $5.41–$56.00 | 75% below | 70% |
| H. pylori stool antigen test inpatient CPT 87338 H. PYLORI STOOL ANTIGEN | $16.80 | $56.00 | $5.41–$56.00 | — | 70% |
| H. pylori stool antigen test inpatient CPT 87338 HPYLORI STOOL AG IA | $16.80 | $56.00 | $5.41–$56.00 | — | 70% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV 1 RNA QUANT | $79.50 | $265.00 | $84.91–$1,063.50 | 59% below | 70% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 QUANT&REVRSE TRNSCRPJ | $79.50 | $265.00 | $84.91–$1,063.50 | 59% below | 70% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV VIRAL LOAD | $239.55 | $798.50 | $84.91–$1,063.50 | 25% above | 70% |
| HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV-1 QUANT&REVRSE TRNSCRPJ | $79.50 | $265.00 | $84.91–$1,063.50 | — | 70% |
| HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV 1 RNA QUANT | $79.50 | $265.00 | $84.91–$1,063.50 | — | 70% |
| HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV VIRAL LOAD | $239.55 | $798.50 | $84.91–$1,063.50 | — | 70% |
| HIV-1 and HIV-2 antibody test CPT 86703 HIV-1/HIV-2 1 RESULT ANTBDY | $88.65 | $295.50 | $12.31–$295.50 | 74% above | 70% |
| HIV-1 and HIV-2 antibody test CPT 86703 HIV 1&2 AB QUAL | $88.65 | $295.50 | $12.31–$295.50 | 74% above | 70% |
| HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV-1/HIV-2 1 RESULT ANTBDY | $88.65 | $295.50 | $12.31–$295.50 | — | 70% |
| HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV 1&2 AB QUAL | $88.65 | $295.50 | $12.31–$295.50 | — | 70% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV-1 AG W/HIV-1&-2 AB AG IA | $90.75 | $302.50 | $24.08–$302.50 | 83% above | 70% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV 1/2 4TH GEN, RFLX CONF | $90.75 | $302.50 | $24.08–$302.50 | 83% above | 70% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV-1 AG W/HIV-1&-2 AB AG IA | $90.75 | $302.50 | $24.08–$302.50 | — | 70% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV 1/2 4TH GEN, RFLX CONF | $90.75 | $302.50 | $24.08–$302.50 | — | 70% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN GLYCOSYLATED A1C | $87.90 | $293.00 | $9.71–$293.00 | 78% above | 70% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN A1C | $87.90 | $293.00 | $9.71–$293.00 | 78% above | 70% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HEMOGLOBIN A1C | $87.90 | $293.00 | $9.71–$293.00 | — | 70% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HEMOGLOBIN GLYCOSYLATED A1C | $87.90 | $293.00 | $9.71–$293.00 | — | 70% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS BS AB QUANT | $126.90 | $423.00 | $10.74–$1,269.00 | 215% above | 70% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEP B SURFACE ANTIBODY | $126.90 | $423.00 | $10.74–$1,269.00 | 215% above | 70% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HB S AB QUAL | $126.90 | $423.00 | $10.74–$1,269.00 | 215% above | 70% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURFACE AB | $126.90 | $423.00 | $10.74–$1,269.00 | 215% above | 70% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B SURFACE AB | $126.90 | $423.00 | $10.74–$1,269.00 | — | 70% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS BS AB QUANT | $126.90 | $423.00 | $10.74–$1,269.00 | — | 70% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEP B SURFACE ANTIBODY | $126.90 | $423.00 | $10.74–$1,269.00 | — | 70% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HB S AB QUAL | $126.90 | $423.00 | $10.74–$1,269.00 | — | 70% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURF AG | $58.80 | $196.00 | $10.33–$392.00 | 36% above | 70% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURFACE AG IA | $58.80 | $196.00 | $10.33–$392.00 | 36% above | 70% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 HEP B S AG EIA | $58.80 | $196.00 | $10.33–$392.00 | 36% above | 70% |
| Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS B SURF AG | $58.80 | $196.00 | $10.33–$392.00 | — | 70% |
| Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEP B S AG EIA | $58.80 | $196.00 | $10.33–$392.00 | — | 70% |
| Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS B SURFACE AG IA | $58.80 | $196.00 | $10.33–$392.00 | — | 70% |
| Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C PANEL | $26.10 | $87.00 | $14.27–$1,210.50 | 49% below | 70% |
| Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C AB TEST | $112.35 | $374.50 | $14.27–$1,210.50 | 120% above | 70% |
| Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C REFLEX QNT | $112.35 | $374.50 | $14.27–$1,210.50 | 120% above | 70% |
| Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ANTIBODY | $112.35 | $374.50 | $14.27–$1,210.50 | 120% above | 70% |
| Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C AB QUAL | $112.35 | $374.50 | $14.27–$1,210.50 | 120% above | 70% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C PANEL | $26.10 | $87.00 | $14.27–$1,210.50 | — | 70% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C ANTIBODY | $112.35 | $374.50 | $14.27–$1,210.50 | — | 70% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C REFLEX QNT | $112.35 | $374.50 | $14.27–$1,210.50 | — | 70% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C AB TEST | $112.35 | $374.50 | $14.27–$1,210.50 | — | 70% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C AB QUAL | $112.35 | $374.50 | $14.27–$1,210.50 | — | 70% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 HEP C RNA QUANT | $234.15 | $780.50 | $42.84–$1,561.00 | 41% above | 70% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 HCV RNA, PCR QUAL/QUANT | $234.15 | $780.50 | $42.84–$1,561.00 | 41% above | 70% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 HEPATITIS C REVRS TRNSCRPJ | $234.15 | $780.50 | $42.84–$1,561.00 | 41% above | 70% |
| Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEPATITIS C REVRS TRNSCRPJ | $234.15 | $780.50 | $42.84–$1,561.00 | — | 70% |
| Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEP C RNA QUANT | $234.15 | $780.50 | $42.84–$1,561.00 | — | 70% |
| Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HCV RNA, PCR QUAL/QUANT | $234.15 | $780.50 | $42.84–$1,561.00 | — | 70% |
| Herpes blood test, HSV-1 antibody CPT 86695 HERPES SIMPLEX TYPE 1 TEST | $18.75 | $62.50 | $10.52–$62.50 | 48% below | 70% |
| Herpes blood test, HSV-1 antibody CPT 86695 HERPES SIMP1 AB QUAL | $18.75 | $62.50 | $10.52–$62.50 | 48% below | 70% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 HERPES SIMPLEX TYPE 1 TEST | $18.75 | $62.50 | $10.52–$62.50 | — | 70% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 HERPES SIMP1 AB QUAL | $18.75 | $62.50 | $10.52–$62.50 | — | 70% |
| Herpes blood test, HSV-2 antibody CPT 86696 HERPES SIMPLEX TYPE 2 TEST | $35.10 | $117.00 | $19.35–$117.00 | 22% below | 70% |
| Herpes blood test, HSV-2 antibody CPT 86696 HERPES SIMPLEX 2 AB IGG | $35.10 | $117.00 | $19.35–$117.00 | 22% below | 70% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 HERPES SIMPLEX TYPE 2 TEST | $35.10 | $117.00 | $19.35–$117.00 | — | 70% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 HERPES SIMPLEX 2 AB IGG | $35.10 | $117.00 | $19.35–$117.00 | — | 70% |
| Homocysteine blood test CPT 83090 HOMOCYSTEINE | $336.15 | $1,120.50 | $17.92–$2,241.00 | 490% above | 70% |
| Homocysteine blood test CPT 83090 ASSAY OF HOMOCYSTEINE | $336.15 | $1,120.50 | $17.92–$2,241.00 | 490% above | 70% |
| Homocysteine blood test CPT 83090 HOMOCYSTEINE QN | $336.15 | $1,120.50 | $17.92–$2,241.00 | 490% above | 70% |
| Homocysteine blood test inpatient CPT 83090 ASSAY OF HOMOCYSTEINE | $336.15 | $1,120.50 | $17.92–$2,241.00 | — | 70% |
| Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINE | $336.15 | $1,120.50 | $17.92–$2,241.00 | — | 70% |
| Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINE QN | $336.15 | $1,120.50 | $17.92–$2,241.00 | — | 70% |
| Insulin blood test CPT 83525 INSULIN | $71.85 | $239.50 | $11.43–$479.00 | 71% above | 70% |
| Insulin blood test CPT 83525 INSULIN TOTAL | $71.85 | $239.50 | $11.43–$479.00 | 71% above | 70% |
| Insulin blood test CPT 83525 ASSAY OF INSULIN | $71.85 | $239.50 | $11.43–$479.00 | 71% above | 70% |
| Insulin blood test inpatient CPT 83525 INSULIN | $71.85 | $239.50 | $11.43–$479.00 | — | 70% |
| Insulin blood test inpatient CPT 83525 INSULIN TOTAL | $71.85 | $239.50 | $11.43–$479.00 | — | 70% |
| Insulin blood test inpatient CPT 83525 ASSAY OF INSULIN | $71.85 | $239.50 | $11.43–$479.00 | — | 70% |
| Iron blood test (serum iron) CPT 83540 ASSAY OF IRON | $34.20 | $114.00 | $6.26–$114.00 | 1% below | 70% |
| Iron blood test (serum iron) CPT 83540 IRON | $34.20 | $114.00 | $6.26–$114.00 | 1% below | 70% |
| Iron blood test (serum iron) inpatient CPT 83540 ASSAY OF IRON | $34.20 | $114.00 | $6.26–$114.00 | — | 70% |
| Iron blood test (serum iron) inpatient CPT 83540 IRON | $34.20 | $114.00 | $6.26–$114.00 | — | 70% |
| Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING TEST | $58.05 | $193.50 | $8.74–$387.00 | 31% above | 70% |
| Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING (TIBC) | $58.05 | $193.50 | $8.74–$387.00 | 31% above | 70% |
| Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING CAPACITY | $58.05 | $193.50 | $8.74–$387.00 | 31% above | 70% |
| Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BINDING TEST | $58.05 | $193.50 | $8.74–$387.00 | — | 70% |
| Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BINDING CAPACITY | $58.05 | $193.50 | $8.74–$387.00 | — | 70% |
| Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BINDING (TIBC) | $58.05 | $193.50 | $8.74–$387.00 | — | 70% |
| Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL | $69.60 | $232.00 | $8.68–$232.00 | 15% below | 70% |
| Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL | $69.60 | $232.00 | $8.68–$232.00 | — | 70% |
| LH (luteinizing hormone) test CPT 83002 LH | $160.80 | $536.00 | $18.52–$1,072.00 | 164% above | 70% |
| LH (luteinizing hormone) test CPT 83002 LUTEINIZING HORMONE | $160.80 | $536.00 | $18.52–$1,072.00 | 164% above | 70% |
| LH (luteinizing hormone) test CPT 83002 ASSAY OF GONADOTROPIN (LH) | $160.80 | $536.00 | $18.52–$1,072.00 | 164% above | 70% |
| LH (luteinizing hormone) test inpatient CPT 83002 ASSAY OF GONADOTROPIN (LH) | $160.80 | $536.00 | $18.52–$1,072.00 | — | 70% |
| LH (luteinizing hormone) test inpatient CPT 83002 LUTEINIZING HORMONE | $160.80 | $536.00 | $18.52–$1,072.00 | — | 70% |
| LH (luteinizing hormone) test inpatient CPT 83002 LH | $160.80 | $536.00 | $18.52–$1,072.00 | — | 70% |
| Lipase blood test (pancreas enzyme) CPT 83690 LIPASE | $71.40 | $238.00 | $6.89–$476.00 | 70% above | 70% |
| Lipase blood test (pancreas enzyme) CPT 83690 LIPASE, BODY FLUID | $71.40 | $238.00 | $6.89–$476.00 | 70% above | 70% |
| Lipase blood test (pancreas enzyme) CPT 83690 ASSAY OF LIPASE | $71.40 | $238.00 | $6.89–$476.00 | 70% above | 70% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 ASSAY OF LIPASE | $71.40 | $238.00 | $6.89–$476.00 | — | 70% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE | $71.40 | $238.00 | $6.89–$476.00 | — | 70% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE, BODY FLUID | $71.40 | $238.00 | $6.89–$476.00 | — | 70% |
| Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL | $232.65 | $775.50 | $8.17–$775.50 | 175% above | 70% |
| Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL | $232.65 | $775.50 | $8.17–$775.50 | — | 70% |
| Lyme disease antibody test CPT 86618 LYME TOTAL ANTIBODY | $163.05 | $543.50 | $17.03–$1,630.50 | 222% above | 70% |
| Lyme disease antibody test CPT 86618 LYME DISEASE AB QL | $163.05 | $543.50 | $17.03–$1,630.50 | 222% above | 70% |
| Lyme disease antibody test CPT 86618 LYME AB REFLEX IB | $163.05 | $543.50 | $17.03–$1,630.50 | 222% above | 70% |
| Lyme disease antibody test CPT 86618 LYME DISEASE ANTIBODY | $163.05 | $543.50 | $17.03–$1,630.50 | 222% above | 70% |
| Lyme disease antibody test inpatient CPT 86618 LYME DISEASE AB QL | $163.05 | $543.50 | $17.03–$1,630.50 | — | 70% |
| Lyme disease antibody test inpatient CPT 86618 LYME DISEASE ANTIBODY | $163.05 | $543.50 | $17.03–$1,630.50 | — | 70% |
| Lyme disease antibody test inpatient CPT 86618 LYME AB REFLEX IB | $163.05 | $543.50 | $17.03–$1,630.50 | — | 70% |
| Lyme disease antibody test inpatient CPT 86618 LYME TOTAL ANTIBODY | $163.05 | $543.50 | $17.03–$1,630.50 | — | 70% |
| Magnesium blood test CPT 83735 MAGNESIUM BLD | $55.35 | $184.50 | $6.70–$184.50 | 102% above | 70% |
| Magnesium blood test CPT 83735 ASSAY OF MAGNESIUM | $55.35 | $184.50 | $6.70–$184.50 | 102% above | 70% |
| Magnesium blood test inpatient CPT 83735 MAGNESIUM BLD | $55.35 | $184.50 | $6.70–$184.50 | — | 70% |
| Magnesium blood test inpatient CPT 83735 ASSAY OF MAGNESIUM | $55.35 | $184.50 | $6.70–$184.50 | — | 70% |
| Measles (rubeola) antibody test CPT 86765 RUBEOLA IGM ANTIBODY | $13.35 | $44.50 | $12.88–$211.50 | 64% below | 70% |
| Measles (rubeola) antibody test CPT 86765 RUBEOLA IGG/IGM ANTIBODIES | $16.05 | $53.50 | $12.88–$211.50 | 57% below | 70% |
| Measles (rubeola) antibody test CPT 86765 RUBEOLA ANTIBODY | $16.05 | $53.50 | $12.88–$211.50 | 57% below | 70% |
| Measles (rubeola) antibody test CPT 86765 RUBEOLA AB QUAL | $16.05 | $53.50 | $12.88–$211.50 | 57% below | 70% |
| Measles (rubeola) antibody test CPT 86765 RUBEOLA IGG ANTIBODY | $18.00 | $60.00 | $12.88–$211.50 | 52% below | 70% |
| Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA IGM ANTIBODY | $13.35 | $44.50 | $12.88–$211.50 | — | 70% |
| Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA ANTIBODY | $16.05 | $53.50 | $12.88–$211.50 | — | 70% |
| Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA IGG/IGM ANTIBODIES | $16.05 | $53.50 | $12.88–$211.50 | — | 70% |
| Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA AB QUAL | $16.05 | $53.50 | $12.88–$211.50 | — | 70% |
| Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA IGG ANTIBODY | $18.00 | $60.00 | $12.88–$211.50 | — | 70% |
| Mono test (heterophile antibody, Monospot) CPT 86308 MONO SCR (HETEROPHILE) | $103.20 | $344.00 | $5.18–$344.00 | 182% above | 70% |
| Mono test (heterophile antibody, Monospot) CPT 86308 HETEROPHILE ANTIBODY SCREEN | $103.20 | $344.00 | $5.18–$344.00 | 182% above | 70% |
| Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HETEROPHILE ANTIBODY SCREEN | $103.20 | $344.00 | $5.18–$344.00 | — | 70% |
| Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONO SCR (HETEROPHILE) | $103.20 | $344.00 | $5.18–$344.00 | — | 70% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PROS SPEC AG FREE | $67.65 | $225.50 | $18.39–$225.50 | 17% above | 70% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 ASSAY OF PSA FREE | $67.65 | $225.50 | $18.39–$225.50 | 17% above | 70% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 ASSAY OF PSA FREE | $67.65 | $225.50 | $18.39–$225.50 | — | 70% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PROS SPEC AG FREE | $67.65 | $225.50 | $18.39–$225.50 | — | 70% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA DIAGNOSTIC | $16.50 | $55.00 | $18.39–$457.50 | 71% below | 70% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 ASSAY OF PSA TOTAL | $120.75 | $402.50 | $18.39–$457.50 | 113% above | 70% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA, ULTRASENSITIVE | $120.75 | $402.50 | $18.39–$457.50 | 113% above | 70% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA DIAGNOSTIC | $16.50 | $55.00 | $18.39–$457.50 | — | 70% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 ASSAY OF PSA TOTAL | $120.75 | $402.50 | $18.39–$457.50 | — | 70% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA, ULTRASENSITIVE | $120.75 | $402.50 | $18.39–$457.50 | — | 70% |
| Parathyroid hormone (PTH) blood test CPT 83970 PTH INTACT | $414.15 | $1,380.50 | $41.28–$2,761.00 | 280% above | 70% |
| Parathyroid hormone (PTH) blood test CPT 83970 INTACT PTH | $414.15 | $1,380.50 | $41.28–$2,761.00 | 280% above | 70% |
| Parathyroid hormone (PTH) blood test CPT 83970 ASSAY OF PARATHORMONE | $414.15 | $1,380.50 | $41.28–$2,761.00 | 280% above | 70% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 ASSAY OF PARATHORMONE | $414.15 | $1,380.50 | $41.28–$2,761.00 | — | 70% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 INTACT PTH | $414.15 | $1,380.50 | $41.28–$2,761.00 | — | 70% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH INTACT | $414.15 | $1,380.50 | $41.28–$2,761.00 | — | 70% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PARTIAL | $73.35 | $244.50 | $6.01–$244.50 | 122% above | 70% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PTT | $73.35 | $244.50 | $6.01–$244.50 | 122% above | 70% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME PARTIAL | $73.35 | $244.50 | $6.01–$244.50 | — | 70% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT | $73.35 | $244.50 | $6.01–$244.50 | — | 70% |
| Progesterone blood test CPT 84144 ASSAY OF PROGESTERONE | $192.60 | $642.00 | $20.86–$1,284.00 | 168% above | 70% |
| Progesterone blood test CPT 84144 PROGESTERONE | $192.60 | $642.00 | $20.86–$1,284.00 | 168% above | 70% |
| Progesterone blood test inpatient CPT 84144 ASSAY OF PROGESTERONE | $192.60 | $642.00 | $20.86–$1,284.00 | — | 70% |
| Progesterone blood test inpatient CPT 84144 PROGESTERONE | $192.60 | $642.00 | $20.86–$1,284.00 | — | 70% |
| Prolactin blood test CPT 84146 ASSAY OF PROLACTIN | $113.85 | $379.50 | $19.38–$759.00 | 49% above | 70% |
| Prolactin blood test CPT 84146 PROLACTIN | $113.85 | $379.50 | $19.38–$759.00 | 49% above | 70% |
| Prolactin blood test inpatient CPT 84146 ASSAY OF PROLACTIN | $113.85 | $379.50 | $19.38–$759.00 | — | 70% |
| Prolactin blood test inpatient CPT 84146 PROLACTIN | $113.85 | $379.50 | $19.38–$759.00 | — | 70% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME | $73.35 | $244.50 | $4.29–$244.50 | 255% above | 70% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTIME | $73.35 | $244.50 | $4.29–$244.50 | 255% above | 70% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTIME | $73.35 | $244.50 | $4.29–$244.50 | — | 70% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME | $73.35 | $244.50 | $4.29–$244.50 | — | 70% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 RADIP DRUG SCREEN | $13.50 | $45.00 | $7.57–$45.00 | 41% below | 70% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 DRUG TEST PRSMV DIR OPT OBS | $13.50 | $45.00 | $7.57–$45.00 | 41% below | 70% |
| Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 RADIP DRUG SCREEN | $13.50 | $45.00 | $7.57–$45.00 | — | 70% |
| Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 DRUG TEST PRSMV DIR OPT OBS | $13.50 | $45.00 | $7.57–$45.00 | — | 70% |
| Rapid flu test (influenza antigen) CPT 87804 INFLUENZA VIRUS A AG OIA | $36.60 | $122.00 | $13.97–$122.00 | 2% above | 70% |
| Rapid flu test (influenza antigen) CPT 87804 INFLUENZA ASSAY W/OPTIC | $36.60 | $122.00 | $13.97–$122.00 | 2% above | 70% |
| Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA VIRUS A AG OIA | $36.60 | $122.00 | $13.97–$122.00 | — | 70% |
| Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA ASSAY W/OPTIC | $36.60 | $122.00 | $13.97–$122.00 | — | 70% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREP A OPTICAL IA | $39.30 | $131.00 | $13.97–$131.00 | 42% above | 70% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREP A ASSAY W/OPTIC | $39.30 | $131.00 | $13.97–$131.00 | 42% above | 70% |
| Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 STREP A ASSAY W/OPTIC | $39.30 | $131.00 | $13.97–$131.00 | — | 70% |
| Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 STREP A OPTICAL IA | $39.30 | $131.00 | $13.97–$131.00 | — | 70% |
| Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANT | $84.45 | $281.50 | $5.67–$563.00 | 209% above | 70% |
| Rheumatoid factor (RF) test CPT 86431 RA QN | $84.45 | $281.50 | $5.67–$563.00 | 209% above | 70% |
| Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR, QUANT | $84.45 | $281.50 | $5.67–$563.00 | 209% above | 70% |
| Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR, QUANT | $84.45 | $281.50 | $5.67–$563.00 | — | 70% |
| Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR QUANT | $84.45 | $281.50 | $5.67–$563.00 | — | 70% |
| Rheumatoid factor (RF) test inpatient CPT 86431 RA QN | $84.45 | $281.50 | $5.67–$563.00 | — | 70% |
| Rubella antibody test (immunity check) CPT 86762 RUBELLA IGM ANTIBODY | $13.35 | $44.50 | $14.39–$104.50 | 65% below | 70% |
| Rubella antibody test (immunity check) CPT 86762 RUBELLA ANTIBODY | $18.00 | $60.00 | $14.39–$104.50 | 53% below | 70% |
| Rubella antibody test (immunity check) CPT 86762 RUBELLA IGG | $18.00 | $60.00 | $14.39–$104.50 | 53% below | 70% |
| Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA IGM ANTIBODY | $13.35 | $44.50 | $14.39–$104.50 | — | 70% |
| Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA ANTIBODY | $18.00 | $60.00 | $14.39–$104.50 | — | 70% |
| Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA IGG | $18.00 | $60.00 | $14.39–$104.50 | — | 70% |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 SED RATE AUTO | $83.70 | $279.00 | $2.70–$279.00 | 167% above | 70% |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 RBC SED RATE AUTOMATED | $83.70 | $279.00 | $2.70–$279.00 | 167% above | 70% |
| Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 RBC SED RATE AUTOMATED | $83.70 | $279.00 | $2.70–$279.00 | — | 70% |
| Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 SED RATE AUTO | $83.70 | $279.00 | $2.70–$279.00 | — | 70% |
| Stool ova and parasites exam CPT 87177 O&P SMEAR CONC ID | $94.35 | $314.50 | $8.90–$314.50 | 156% above | 70% |
| Stool ova and parasites exam CPT 87177 OVA AND PARASITES SMEARS | $94.35 | $314.50 | $8.90–$314.50 | 156% above | 70% |
| Stool ova and parasites exam inpatient CPT 87177 OVA AND PARASITES SMEARS | $94.35 | $314.50 | $8.90–$314.50 | — | 70% |
| Stool ova and parasites exam inpatient CPT 87177 O&P SMEAR CONC ID | $94.35 | $314.50 | $8.90–$314.50 | — | 70% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR QUAL | $25.20 | $84.00 | $4.27–$587.00 | 27% above | 70% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR REFLEX TO T. PALLIDUM - PA | $25.20 | $84.00 | $4.27–$587.00 | 27% above | 70% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 VDRL CSF QUAL | $32.85 | $109.50 | $4.27–$587.00 | 65% above | 70% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 SYPHILIS TEST NON-TREP QUAL | $92.85 | $309.50 | $4.27–$587.00 | 366% above | 70% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 FTA AB CSF | $92.85 | $309.50 | $4.27–$587.00 | 366% above | 70% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR REFLEX TO T. PALLIDUM - PA | $25.20 | $84.00 | $4.27–$587.00 | — | 70% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR QUAL | $25.20 | $84.00 | $4.27–$587.00 | — | 70% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 VDRL CSF QUAL | $32.85 | $109.50 | $4.27–$587.00 | — | 70% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 FTA AB CSF | $92.85 | $309.50 | $4.27–$587.00 | — | 70% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 SYPHILIS TEST NON-TREP QUAL | $92.85 | $309.50 | $4.27–$587.00 | — | 70% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB TEST CELL IMMUN MEASURE | $138.00 | $460.00 | $61.98–$460.00 | 20% above | 70% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QUANTIFERON TB GOLD | $138.00 | $460.00 | $61.98–$460.00 | 20% above | 70% |
| TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 QUANTIFERON TB GOLD | $138.00 | $460.00 | $61.98–$460.00 | — | 70% |
| TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 TB TEST CELL IMMUN MEASURE | $138.00 | $460.00 | $61.98–$460.00 | — | 70% |
| Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE, FEM/CHILD, ULTRA | $302.10 | $1,007.00 | $25.81–$3,021.00 | 337% above | 70% |
| Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE | $302.10 | $1,007.00 | $25.81–$3,021.00 | 337% above | 70% |
| Testosterone blood test, total (not free testosterone) CPT 84403 ASSAY OF TOTAL TESTOSTERONE | $302.10 | $1,007.00 | $25.81–$3,021.00 | 337% above | 70% |
| Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TOTAL | $302.10 | $1,007.00 | $25.81–$3,021.00 | 337% above | 70% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 ASSAY OF TOTAL TESTOSTERONE | $302.10 | $1,007.00 | $25.81–$3,021.00 | — | 70% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE, FEM/CHILD, ULTRA | $302.10 | $1,007.00 | $25.81–$3,021.00 | — | 70% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE | $302.10 | $1,007.00 | $25.81–$3,021.00 | — | 70% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE TOTAL | $302.10 | $1,007.00 | $25.81–$3,021.00 | — | 70% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 ANTI MICROSOMAL AB | $42.75 | $142.50 | $14.55–$285.00 | 4% below | 70% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 THYROID PEROXIDASE AB | $42.75 | $142.50 | $14.55–$285.00 | 4% below | 70% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 MICROSOMAL ANTIBODY EACH | $42.75 | $142.50 | $14.55–$285.00 | 4% below | 70% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 THYROID PEROXIDASE AB | $42.75 | $142.50 | $14.55–$285.00 | — | 70% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 MICROSOMAL ANTIBODY EACH | $42.75 | $142.50 | $14.55–$285.00 | — | 70% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 ANTI MICROSOMAL AB | $42.75 | $142.50 | $14.55–$285.00 | — | 70% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH | $88.20 | $294.00 | $16.80–$294.00 | 84% above | 70% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 ASSAY THYROID STIM HORMONE | $88.20 | $294.00 | $16.80–$294.00 | 84% above | 70% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH | $88.20 | $294.00 | $16.80–$294.00 | — | 70% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 ASSAY THYROID STIM HORMONE | $88.20 | $294.00 | $16.80–$294.00 | — | 70% |
| Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS AMPLIF | $46.65 | $155.50 | $35.09–$466.50 | 21% below | 70% |
| Trichomonas test (NAAT) CPT 87661 TRICHOMONAS, VAG SWAB, AMP | $46.65 | $155.50 | $35.09–$466.50 | 21% below | 70% |
| Trichomonas test (NAAT) CPT 87661 TRICHOMONAS, URINE, AMP | $46.65 | $155.50 | $35.09–$466.50 | 21% below | 70% |
| Trichomonas test (NAAT) CPT 87661 TRICHOMONAS, SWAB, AMP | $46.65 | $155.50 | $35.09–$466.50 | 21% below | 70% |
| Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS VAGINALIS AMPLIF | $46.65 | $155.50 | $35.09–$466.50 | — | 70% |
| Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS, SWAB, AMP | $46.65 | $155.50 | $35.09–$466.50 | — | 70% |
| Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS, URINE, AMP | $46.65 | $155.50 | $35.09–$466.50 | — | 70% |
| Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS, VAG SWAB, AMP | $46.65 | $155.50 | $35.09–$466.50 | — | 70% |
| Uric acid blood test CPT 84550 ASSAY OF BLOOD/URIC ACID | $55.80 | $186.00 | $4.52–$186.00 | 111% above | 70% |
| Uric acid blood test CPT 84550 URIC ACID BLD | $55.80 | $186.00 | $4.52–$186.00 | 111% above | 70% |
| Uric acid blood test inpatient CPT 84550 ASSAY OF BLOOD/URIC ACID | $55.80 | $186.00 | $4.52–$186.00 | — | 70% |
| Uric acid blood test inpatient CPT 84550 URIC ACID BLD | $55.80 | $186.00 | $4.52–$186.00 | — | 70% |
| Urinalysis with microscope exam, automated CPT 81001 URINALYSIS AUTO W/SCOPE | $59.55 | $198.50 | $3.17–$198.50 | 23% above | 70% |
| Urinalysis with microscope exam, automated CPT 81001 UA W MICROSCOPIC AUTO | $59.55 | $198.50 | $3.17–$198.50 | 23% above | 70% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS AUTO W/SCOPE | $59.55 | $198.50 | $3.17–$198.50 | — | 70% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 UA W MICROSCOPIC AUTO | $59.55 | $198.50 | $3.17–$198.50 | — | 70% |
| Urinalysis without microscope exam, automated CPT 81003 RAPID UA | $3.00 | $10.00 | $2.25–$395.50 | 70% below | 70% |
| Urinalysis without microscope exam, automated CPT 81003 PH UR AUTO | $5.70 | $19.00 | $2.25–$395.50 | 42% below | 70% |
| Urinalysis without microscope exam, automated CPT 81003 URINALYSIS AUTO W/O SCOPE | $53.85 | $179.50 | $2.25–$395.50 | 444% above | 70% |
| Urinalysis without microscope exam, automated CPT 81003 KETONES UR AUTO | $53.85 | $179.50 | $2.25–$395.50 | 444% above | 70% |
| Urinalysis without microscope exam, automated CPT 81003 UA W O MICRO AUTO | $56.10 | $187.00 | $2.25–$395.50 | 467% above | 70% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 RAPID UA | $3.00 | $10.00 | $2.25–$395.50 | — | 70% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 PH UR AUTO | $5.70 | $19.00 | $2.25–$395.50 | — | 70% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 KETONES UR AUTO | $53.85 | $179.50 | $2.25–$395.50 | — | 70% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS AUTO W/O SCOPE | $53.85 | $179.50 | $2.25–$395.50 | — | 70% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 UA W O MICRO AUTO | $56.10 | $187.00 | $2.25–$395.50 | — | 70% |
| Urinalysis without microscope exam, manual CPT 81002 UA W MICRO MANUAL | $6.90 | $23.00 | $2.98–$49.50 | 7% below | 70% |
| Urinalysis without microscope exam, manual CPT 81002 UA W O MICRO MANUAL | $7.95 | $26.50 | $2.98–$49.50 | 7% above | 70% |
| Urinalysis without microscope exam, manual CPT 81002 URINALYSIS NONAUTO W/O SCOPE | $7.95 | $26.50 | $2.98–$49.50 | 7% above | 70% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 UA W MICRO MANUAL | $6.90 | $23.00 | $2.98–$49.50 | — | 70% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 UA W O MICRO MANUAL | $7.95 | $26.50 | $2.98–$49.50 | — | 70% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 URINALYSIS NONAUTO W/O SCOPE | $7.95 | $26.50 | $2.98–$49.50 | — | 70% |
| Urine culture for bacteria, with colony count CPT 87086 URINE CULTURE/COLONY COUNT | $119.25 | $397.50 | $8.07–$397.50 | 123% above | 70% |
| Urine culture for bacteria, with colony count CPT 87086 CULT COLONY COUNT UR | $119.25 | $397.50 | $8.07–$397.50 | 123% above | 70% |
| Urine culture for bacteria, with colony count inpatient CPT 87086 URINE CULTURE/COLONY COUNT | $119.25 | $397.50 | $8.07–$397.50 | — | 70% |
| Urine culture for bacteria, with colony count inpatient CPT 87086 CULT COLONY COUNT UR | $119.25 | $397.50 | $8.07–$397.50 | — | 70% |
| Urine pregnancy test, read by color change CPT 81025 PREG URINE QUAL | $35.55 | $118.50 | $7.37–$118.50 | 65% above | 70% |
| Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY TEST | $35.55 | $118.50 | $7.37–$118.50 | 65% above | 70% |
| Urine pregnancy test, read by color change inpatient CPT 81025 URINE PREGNANCY TEST | $35.55 | $118.50 | $7.37–$118.50 | — | 70% |
| Urine pregnancy test, read by color change inpatient CPT 81025 PREG URINE QUAL | $35.55 | $118.50 | $7.37–$118.50 | — | 70% |
| Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B12 | $48.90 | $163.00 | $15.08–$163.00 | 11% below | 70% |
| Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B-12 | $48.90 | $163.00 | $15.08–$163.00 | 11% below | 70% |
| Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B12 | $48.90 | $163.00 | $15.08–$163.00 | — | 70% |
| Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B-12 | $48.90 | $163.00 | $15.08–$163.00 | — | 70% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25 HYDROXY | $70.35 | $234.50 | $29.60–$234.50 | 32% below | 70% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D3 25-OH | $70.35 | $234.50 | $29.60–$234.50 | 32% below | 70% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D3 25-OH | $70.35 | $234.50 | $29.60–$234.50 | — | 70% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D 25 HYDROXY | $70.35 | $234.50 | $29.60–$234.50 | — | 70% |
| Zinc blood test CPT 84630 ZINC BLOOD | $78.30 | $261.00 | $11.39–$261.00 | 90% above | 70% |
| Zinc blood test CPT 84630 ASSAY OF ZINC | $78.30 | $261.00 | $11.39–$261.00 | 90% above | 70% |
| Zinc blood test inpatient CPT 84630 ASSAY OF ZINC | $78.30 | $261.00 | $11.39–$261.00 | — | 70% |
| Zinc blood test inpatient CPT 84630 ZINC BLOOD | $78.30 | $261.00 | $11.39–$261.00 | — | 70% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 CHORIONIC GONADOTROPIN TEST | $137.85 | $459.50 | $15.05–$459.50 | 101% above | 70% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG BETA QUANTITATIVE | $137.85 | $459.50 | $15.05–$459.50 | 101% above | 70% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCG BETA QUANTITATIVE | $137.85 | $459.50 | $15.05–$459.50 | — | 70% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 CHORIONIC GONADOTROPIN TEST | $137.85 | $459.50 | $15.05–$459.50 | — | 70% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Louisiana | Off list |
|---|---|---|---|---|---|
| Cardiac catheterization with coronary angiogram CPT 93458 L HRT ARTERY/VENTRICLE ANGIO | $9,246.00 | $30,820.00 | $4,050.00–$6,276.00 | 97% above | 70% |
| Cardiac catheterization with coronary angiogram inpatient CPT 93458 L HRT ARTERY/VENTRICLE ANGIO | $9,246.00 | $30,820.00 | $4,050.00–$6,276.00 | — | 70% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 DEFIBRILLATION | $602.10 | $2,007.00 | $688.00–$5,701.00 | 12% above | 70% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION | $1,108.20 | $3,694.00 | $688.00–$5,701.00 | 105% above | 70% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ELECTRIC EXT | $1,108.20 | $3,694.00 | $688.00–$5,701.00 | 105% above | 70% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 DEFIBRILLATION | $602.10 | $2,007.00 | $688.00–$5,701.00 | — | 70% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION | $1,108.20 | $3,694.00 | $688.00–$5,701.00 | — | 70% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION ELECTRIC EXT | $1,108.20 | $3,694.00 | $688.00–$5,701.00 | — | 70% |
| Carpal tunnel release, open surgery CPT 64721 CARPAL TUNNEL SURGERY | $1,329.45 | $4,431.50 | $468.30–$2,653.00 | 25% below | 70% |
| Carpal tunnel release, open surgery inpatient CPT 64721 CARPAL TUNNEL SURGERY | $1,329.45 | $4,431.50 | $468.30–$2,653.00 | — | 70% |
| Cataract surgery with lens implant CPT 66984 XCAPSL CTRC RMVL W/O ECP | $1,660.95 | $5,536.50 | $864.15–$4,600.00 | 4% above | 70% |
| Cataract surgery with lens implant inpatient CPT 66984 XCAPSL CTRC RMVL W/O ECP | $1,660.95 | $5,536.50 | $864.15–$4,600.00 | — | 70% |
| Colonoscopy with polyp removal CPT 45385 COLONOSCOPY W/LESION REMOVAL | $456.90 | $1,523.00 | $468.30–$1,629.00 | 53% below | 70% |
| Colonoscopy with polyp removal inpatient CPT 45385 COLONOSCOPY W/LESION REMOVAL | $456.90 | $1,523.00 | $468.30–$1,629.00 | — | 70% |
| Colonoscopy with tissue sample CPT 45380 COLONOSCOPY AND BIOPSY | $456.90 | $1,523.00 | $468.30–$1,629.00 | 50% below | 70% |
| Colonoscopy with tissue sample inpatient CPT 45380 COLONOSCOPY AND BIOPSY | $456.90 | $1,523.00 | $468.30–$1,629.00 | — | 70% |
| Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 CREATE EARDRUM OPENING | $172.65 | $575.50 | $535.50–$1,850.00 | 77% below | 70% |
| Ear tube placement (tympanostomy) under general anesthesia, one ear inpatient CPT 69436 CREATE EARDRUM OPENING | $172.65 | $575.50 | $535.50–$1,850.00 | — | 70% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVE IMPACTED EAR WAX UNI | $18.90 | $63.00 | $10.60–$1,300.00 | 66% below | 70% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 CERUMEN REMOVAL SYRINGEIRRIGATION/LAVAGE | $18.90 | $63.00 | $10.60–$1,300.00 | 66% below | 70% |
| Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 REMOVE IMPACTED EAR WAX UNI | $18.90 | $63.00 | $10.60–$1,300.00 | — | 70% |
| Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 CERUMEN REMOVAL SYRINGEIRRIGATION/LAVAGE | $18.90 | $63.00 | $10.60–$1,300.00 | — | 70% |
| Earwax removal with instruments, one ear CPT 69210 CERUMEN REMOVAL | $18.90 | $63.00 | $49.66–$1,300.00 | 69% below | 70% |
| Earwax removal with instruments, one ear CPT 69210 REMOVE IMPACTED EAR WAX UNI | $69.60 | $232.00 | $49.66–$1,300.00 | 15% above | 70% |
| Earwax removal with instruments, one ear CPT 69210 REMOVAL OF IMPACTED WAX FAC | $69.60 | $232.00 | $49.66–$1,300.00 | 15% above | 70% |
| Earwax removal with instruments, one ear inpatient CPT 69210 CERUMEN REMOVAL | $18.90 | $63.00 | $49.66–$1,300.00 | — | 70% |
| Earwax removal with instruments, one ear inpatient CPT 69210 REMOVAL OF IMPACTED WAX FAC | $69.60 | $232.00 | $49.66–$1,300.00 | — | 70% |
| Earwax removal with instruments, one ear inpatient CPT 69210 REMOVE IMPACTED EAR WAX UNI | $69.60 | $232.00 | $49.66–$1,300.00 | — | 70% |
| Gallbladder removal, laparoscopic CPT 47562 LAPAROSCOPIC CHOLECYSTECTOMY | $1,778.25 | $5,927.50 | $535.50–$7,441.00 | at median | 70% |
| Gallbladder removal, laparoscopic inpatient CPT 47562 LAPAROSCOPIC CHOLECYSTECTOMY | $1,778.25 | $5,927.50 | $535.50–$7,441.00 | — | 70% |
| Hysterectomy through an abdominal incision (total) CPT 58150 TOTAL HYSTERECTOMY | $1,778.25 | $5,927.50 | $99.69–$6,699.00 | — | 70% |
| Hysterectomy through an abdominal incision (total) inpatient CPT 58150 TOTAL HYSTERECTOMY | $1,778.25 | $5,927.50 | $99.69–$6,699.00 | — | 70% |
| Incision and drainage of a simple or single skin abscess CPT 10060 INCISION AND DRAINAGE | $59.55 | $198.50 | $33.42–$1,300.00 | 68% below | 70% |
| Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS SIMPLE/SINGLE | $59.55 | $198.50 | $33.42–$1,300.00 | 68% below | 70% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D ABSCESS SIMPLE/SINGLE | $59.55 | $198.50 | $33.42–$1,300.00 | — | 70% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 INCISION AND DRAINAGE | $59.55 | $198.50 | $33.42–$1,300.00 | — | 70% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 PRP I/HERN INIT REDUC >5 YR | $1,660.95 | $5,536.50 | $661.50–$3,602.00 | 13% below | 70% |
| Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 PRP I/HERN INIT REDUC >5 YR | $1,660.95 | $5,536.50 | $661.50–$3,602.00 | — | 70% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHRO INTERMEDIATE JOINT/STERILE INJECT | $89.70 | $299.00 | $50.35–$1,300.00 | 61% below | 70% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAIN/INJ JOINT/BURSA W/O US | $89.70 | $299.00 | $50.35–$1,300.00 | 61% below | 70% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 DRAIN/INJ JOINT/BURSA W/O US | $89.70 | $299.00 | $50.35–$1,300.00 | — | 70% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHRO INTERMEDIATE JOINT/STERILE INJECT | $89.70 | $299.00 | $50.35–$1,300.00 | — | 70% |
| Knee arthroscopy with meniscus trim CPT 29881 ARTHRS KNE SRG MNISECTMY M/L | $1,778.25 | $5,927.50 | $661.50–$3,602.00 | 31% below | 70% |
| Knee arthroscopy with meniscus trim inpatient CPT 29881 ARTHRS KNE SRG MNISECTMY M/L | $1,778.25 | $5,927.50 | $661.50–$3,602.00 | — | 70% |
| Laser treatment of clouding after cataract surgery (YAG) CPT 66821 AFTER CATARACT LASER SURGERY | $346.80 | $1,156.00 | $468.30–$1,520.00 | 25% below | 70% |
| Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 AFTER CATARACT LASER SURGERY | $346.80 | $1,156.00 | $468.30–$1,520.00 | — | 70% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 WOUND REPAIR SCALP TRUNK 2.5CM OR LESS | $123.15 | $410.50 | $69.12–$1,300.00 | 59% below | 70% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 INTMD RPR S/A/T/EXT 2.5 CM/< | $123.15 | $410.50 | $69.12–$1,300.00 | 59% below | 70% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 INTMD RPR S/A/T/EXT 2.5 CM/< | $123.15 | $410.50 | $69.12–$1,300.00 | — | 70% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 WOUND REPAIR SCALP TRUNK 2.5CM OR LESS | $123.15 | $410.50 | $69.12–$1,300.00 | — | 70% |
| Nail removal (partial or complete), one nail CPT 11730 AVULSION OF NAIL PLATE | $59.55 | $198.50 | $33.42–$1,300.00 | 60% below | 70% |
| Nail removal (partial or complete), one nail CPT 11730 AVULSION NAIL PLATE SIMPLE 1 | $59.55 | $198.50 | $33.42–$1,300.00 | 60% below | 70% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSION NAIL PLATE SIMPLE 1 | $59.55 | $198.50 | $33.42–$1,300.00 | — | 70% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSION OF NAIL PLATE | $59.55 | $198.50 | $33.42–$1,300.00 | — | 70% |
| Removal of a foreign object under the skin, simple CPT 10120 FOREIGN BODY REMOVAL SUBQ | $105.00 | $350.00 | $212.34–$1,300.00 | 57% below | 70% |
| Removal of a foreign object under the skin, simple CPT 10120 SOFT TISSUE FB REMOVAL- SUBCQ SIMPLE | $123.15 | $410.50 | $212.34–$1,300.00 | 50% below | 70% |
| Removal of a foreign object under the skin, simple CPT 10120 INC&RMVL FB SUBQ TISS SMPL | $123.15 | $410.50 | $212.34–$1,300.00 | 50% below | 70% |
| Removal of a foreign object under the skin, simple CPT 10120 REMOVAL F.B.W/INCISION-FAC | $150.15 | $500.50 | $212.34–$1,300.00 | 39% below | 70% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 FOREIGN BODY REMOVAL SUBQ | $105.00 | $350.00 | $212.34–$1,300.00 | — | 70% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 INC&RMVL FB SUBQ TISS SMPL | $123.15 | $410.50 | $212.34–$1,300.00 | — | 70% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 SOFT TISSUE FB REMOVAL- SUBCQ SIMPLE | $123.15 | $410.50 | $212.34–$1,300.00 | — | 70% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 REMOVAL F.B.W/INCISION-FAC | $150.15 | $500.50 | $212.34–$1,300.00 | — | 70% |
| Septoplasty to straighten the nasal septum CPT 30520 REPAIR OF NASAL SEPTUM | $1,660.95 | $5,536.50 | $661.50–$3,005.00 | — | 70% |
| Septoplasty to straighten the nasal septum inpatient CPT 30520 REPAIR OF NASAL SEPTUM | $1,660.95 | $5,536.50 | $661.50–$3,005.00 | — | 70% |
| Short arm splint (forearm and hand) CPT 29125 SPLINT-SHORT ARM | $38.25 | $127.50 | $213.77–$1,269.50 | 66% below | 70% |
| Short arm splint (forearm and hand) CPT 29125 APPL SHORT ARM SPLINT STATIC | $38.25 | $127.50 | $213.77–$1,269.50 | 66% below | 70% |
| Short arm splint (forearm and hand) CPT 29125 APPL FOREARM SPLINT | $110.55 | $368.50 | $213.77–$1,269.50 | 3% below | 70% |
| Short arm splint (forearm and hand) CPT 29125 APP FOREARM SPLNT SP | $121.50 | $405.00 | $213.77–$1,269.50 | 7% above | 70% |
| Short arm splint (forearm and hand) inpatient CPT 29125 SPLINT-SHORT ARM | $38.25 | $127.50 | $213.77–$1,269.50 | — | 70% |
| Short arm splint (forearm and hand) inpatient CPT 29125 APPL SHORT ARM SPLINT STATIC | $38.25 | $127.50 | $213.77–$1,269.50 | — | 70% |
| Short arm splint (forearm and hand) inpatient CPT 29125 APPL FOREARM SPLINT | $110.55 | $368.50 | $213.77–$1,269.50 | — | 70% |
| Short arm splint (forearm and hand) inpatient CPT 29125 APP FOREARM SPLNT SP | $121.50 | $405.00 | $213.77–$1,269.50 | — | 70% |
| Short leg splint (calf to foot) CPT 29515 SPLINT - SHORT LEG | $48.15 | $160.50 | $166.62–$1,211.00 | 64% below | 70% |
| Short leg splint (calf to foot) CPT 29515 APPL LOWER LEG SPLINT | $121.50 | $405.00 | $166.62–$1,211.00 | 10% below | 70% |
| Short leg splint (calf to foot) CPT 29515 APPLICATION SHORT LEG SPLINT | $127.20 | $424.00 | $166.62–$1,211.00 | 5% below | 70% |
| Short leg splint (calf to foot) CPT 29515 APPL OF SHORT LEG SPLINT FAC | $127.20 | $424.00 | $166.62–$1,211.00 | 5% below | 70% |
| Short leg splint (calf to foot) inpatient CPT 29515 SPLINT - SHORT LEG | $48.15 | $160.50 | $166.62–$1,211.00 | — | 70% |
| Short leg splint (calf to foot) inpatient CPT 29515 APPL LOWER LEG SPLINT | $121.50 | $405.00 | $166.62–$1,211.00 | — | 70% |
| Short leg splint (calf to foot) inpatient CPT 29515 APPLICATION SHORT LEG SPLINT | $127.20 | $424.00 | $166.62–$1,211.00 | — | 70% |
| Short leg splint (calf to foot) inpatient CPT 29515 APPL OF SHORT LEG SPLINT FAC | $127.20 | $424.00 | $166.62–$1,211.00 | — | 70% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 SHO ARTHRS SRG DECOMPRESSION | $1,778.25 | $5,927.50 | $535.50–$1,850.00 | 16% below | 70% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 SHO ARTHRS SRG DECOMPRESSION | $1,778.25 | $5,927.50 | $535.50–$1,850.00 | — | 70% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 RPR S/N/AX/GEN/TRNK 2.5CM/< | $59.55 | $198.50 | $33.42–$1,300.00 | 67% below | 70% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 WOUND REPAIR 2.5CM OR LESS | $59.55 | $198.50 | $33.42–$1,300.00 | 67% below | 70% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 RPR S/N/AX/GEN/TRNK 2.5CM/< | $59.55 | $198.50 | $33.42–$1,300.00 | — | 70% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 WOUND REPAIR 2.5CM OR LESS | $59.55 | $198.50 | $33.42–$1,300.00 | — | 70% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 DX LMBR SPI PNXR | $574.05 | $1,913.50 | $322.23–$1,913.50 | 16% above | 70% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL TAP FACILITY | $574.05 | $1,913.50 | $322.23–$1,913.50 | 16% above | 70% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL TAP FACILITY | $574.05 | $1,913.50 | $322.23–$1,913.50 | — | 70% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 DX LMBR SPI PNXR | $574.05 | $1,913.50 | $322.23–$1,913.50 | — | 70% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 RPR S/N/AX/GEN/TRNK2.6-7.5CM | $59.55 | $198.50 | $33.42–$1,211.00 | 67% below | 70% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 WOUND REPAIR 2.6 TO 7.5CM | $59.55 | $198.50 | $33.42–$1,211.00 | 67% below | 70% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 WOUND REPAIR 2.6 TO 7.5CM | $59.55 | $198.50 | $33.42–$1,211.00 | — | 70% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 RPR S/N/AX/GEN/TRNK2.6-7.5CM | $59.55 | $198.50 | $33.42–$1,211.00 | — | 70% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 RPR F/E/E/N/L/M 2.5 CM/< | $59.55 | $198.50 | $33.42–$1,211.00 | 67% below | 70% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 WOUND REPAIR FACE 2.5CM OR LESS | $59.55 | $198.50 | $33.42–$1,211.00 | 67% below | 70% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 WOUND REPAIR FACE 2.5CM OR LESS | $59.55 | $198.50 | $33.42–$1,211.00 | — | 70% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 RPR F/E/E/N/L/M 2.5 CM/< | $59.55 | $198.50 | $33.42–$1,211.00 | — | 70% |
| Thoracentesis with imaging guidance CPT 32555 ASPIRATE PLEURA W/ IMAGING | $535.35 | $1,784.50 | $300.50–$1,784.50 | 15% below | 70% |
| Thoracentesis with imaging guidance CPT 32555 ASPIRATE PLRA W/IMAG | $535.35 | $1,784.50 | $300.50–$1,784.50 | 15% below | 70% |
| Thoracentesis with imaging guidance inpatient CPT 32555 ASPIRATE PLRA W/IMAG | $535.35 | $1,784.50 | $300.50–$1,784.50 | — | 70% |
| Thoracentesis with imaging guidance inpatient CPT 32555 ASPIRATE PLEURA W/ IMAGING | $535.35 | $1,784.50 | $300.50–$1,784.50 | — | 70% |
| Total hip replacement CPT 27130 TOTAL HIP ARTHROPLASTY | $2,075.10 | $6,917.00 | $108.11–$10,355.00 | — | 70% |
| Total hip replacement inpatient CPT 27130 TOTAL HIP ARTHROPLASTY | $2,075.10 | $6,917.00 | $108.11–$10,355.00 | — | 70% |
| Trigger point injections, 1 or 2 muscles CPT 20552 NJX 1/MLT TRIGGER POINT 1/2 | $89.70 | $299.00 | $50.35–$1,300.00 | 33% below | 70% |
| Trigger point injections, 1 or 2 muscles CPT 20552 TRIGGER POINT INJ-1 OR 2 MUSCLES | $89.70 | $299.00 | $50.35–$1,300.00 | 33% below | 70% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 NJX 1/MLT TRIGGER POINT 1/2 | $89.70 | $299.00 | $50.35–$1,300.00 | — | 70% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 TRIGGER POINT INJ-1 OR 2 MUSCLES | $89.70 | $299.00 | $50.35–$1,300.00 | — | 70% |
| Upper endoscopy (EGD) with biopsy CPT 43239 EGD BIOPSY SINGLE/MULTIPLE | $1,827.15 | $6,090.50 | $468.30–$1,629.00 | 127% above | 70% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 EGD BIOPSY SINGLE/MULTIPLE | $1,827.15 | $6,090.50 | $468.30–$1,629.00 | — | 70% |
| Upper endoscopy (EGD), diagnostic CPT 43235 EGD DIAGNOSTIC BRUSH WASH | $1,827.15 | $6,090.50 | $349.65–$1,629.00 | 121% above | 70% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 EGD DIAGNOSTIC BRUSH WASH | $1,827.15 | $6,090.50 | $349.65–$1,629.00 | — | 70% |
| Vein ablation, radiofrequency, first vein CPT 36475 ERFA-ENDOLUMINAL READRIOFREQUENCY ALAT | $3,600.00 | $12,000.00 | $0.01–$12,000.00 | 168% above | 70% |
| Vein ablation, radiofrequency, first vein CPT 36475 ENDOVENOUS RF 1ST VEIN | $3,600.00 | $12,000.00 | $0.01–$12,000.00 | 168% above | 70% |
| Vein ablation, radiofrequency, first vein inpatient CPT 36475 ERFA-ENDOLUMINAL READRIOFREQUENCY ALAT | $3,600.00 | $12,000.00 | $0.01–$12,000.00 | — | 70% |
| Vein ablation, radiofrequency, first vein inpatient CPT 36475 ENDOVENOUS RF 1ST VEIN | $3,600.00 | $12,000.00 | $0.01–$12,000.00 | — | 70% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDEMENT - SUBCUTANEOUS TISSUE<20 CM | $123.15 | $410.50 | $69.12–$1,520.00 | 67% below | 70% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DBRDMT SUBQ TIS 1ST 20SQCM/< | $123.15 | $410.50 | $69.12–$1,520.00 | 67% below | 70% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DBRDMT SUBQ TIS 1ST 20SQCM/< | $123.15 | $410.50 | $69.12–$1,520.00 | — | 70% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDEMENT - SUBCUTANEOUS TISSUE<20 CM | $123.15 | $410.50 | $69.12–$1,520.00 | — | 70% |
Doctor visits and therapy
| Procedure | Cash price | List price | Insurers pay | vs Louisiana | Off list |
|---|---|---|---|---|---|
| Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSE BLOOD/BLD PROD EA UNIT | $690.30 | $2,301.00 | $785.39–$9,204.00 | 46% above | 70% |
| Blood transfusion (giving blood or blood components) CPT 36430 BLOOD INFUSION UP TO 4 HOURS | $690.30 | $2,301.00 | $785.39–$9,204.00 | 46% above | 70% |
| Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION BLD/BLD COMPNT | $690.30 | $2,301.00 | $785.39–$9,204.00 | 46% above | 70% |
| Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION | $690.30 | $2,301.00 | $785.39–$9,204.00 | 46% above | 70% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSION BLD/BLD COMPNT | $690.30 | $2,301.00 | $785.39–$9,204.00 | — | 70% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSION | $690.30 | $2,301.00 | $785.39–$9,204.00 | — | 70% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD INFUSION UP TO 4 HOURS | $690.30 | $2,301.00 | $785.39–$9,204.00 | — | 70% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSE BLOOD/BLD PROD EA UNIT | $690.30 | $2,301.00 | $785.39–$9,204.00 | — | 70% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RESPIRATORY THERAPY INHALATION | $63.15 | $210.50 | $369.68–$2,195.50 | 33% below | 70% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 INHALATION TREATMENT INITIAL | $85.20 | $284.00 | $369.68–$2,195.50 | 9% below | 70% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HAND HELD NEBULIZER-1ST TX | $85.20 | $284.00 | $369.68–$2,195.50 | 9% below | 70% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 METERED DOSE INHALER INITIAL | $85.20 | $284.00 | $369.68–$2,195.50 | 9% below | 70% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AIRWAY INHALATION TREATMENT | $169.95 | $566.50 | $369.68–$2,195.50 | 81% above | 70% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HAND HELD NEB SUBQ | $169.95 | $566.50 | $369.68–$2,195.50 | 81% above | 70% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 METERED DOSE INHALER SUBSEQ | $169.95 | $566.50 | $369.68–$2,195.50 | 81% above | 70% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RESPIRATORY THERAPY INHALATION | $63.15 | $210.50 | $369.68–$2,195.50 | — | 70% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 INHALATION TREATMENT INITIAL | $85.20 | $284.00 | $369.68–$2,195.50 | — | 70% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HAND HELD NEBULIZER-1ST TX | $85.20 | $284.00 | $369.68–$2,195.50 | — | 70% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 METERED DOSE INHALER INITIAL | $85.20 | $284.00 | $369.68–$2,195.50 | — | 70% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HAND HELD NEB SUBQ | $169.95 | $566.50 | $369.68–$2,195.50 | — | 70% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 METERED DOSE INHALER SUBSEQ | $169.95 | $566.50 | $369.68–$2,195.50 | — | 70% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AIRWAY INHALATION TREATMENT | $169.95 | $566.50 | $369.68–$2,195.50 | — | 70% |
| Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE FAC | $751.05 | $2,503.50 | $344.00–$2,503.50 | at median | 70% |
| Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE FIRST HOUR | $751.05 | $2,503.50 | $344.00–$2,503.50 | at median | 70% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 CRITICAL CARE FAC | $751.05 | $2,503.50 | $344.00–$2,503.50 | — | 70% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 CRITICAL CARE FIRST HOUR | $751.05 | $2,503.50 | $344.00–$2,503.50 | — | 70% |
| EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG AWAKE AND DROWSY | $345.00 | $1,150.00 | $193.66–$1,150.00 | 11% above | 70% |
| EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 EEG AWAKE AND DROWSY | $345.00 | $1,150.00 | $193.66–$1,150.00 | — | 70% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG W/AT LEAST 12 LEADS;TRACING ONLY W/O | $18.90 | $63.00 | $111.34–$1,124.50 | 77% below | 70% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG | $159.30 | $531.00 | $111.34–$1,124.50 | 94% above | 70% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ELECTROCARDIOGRAM TRACING | $159.30 | $531.00 | $111.34–$1,124.50 | 94% above | 70% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG W/AT LEAST 12 LEADS;TRACING ONLY W/O | $18.90 | $63.00 | $111.34–$1,124.50 | — | 70% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG | $159.30 | $531.00 | $111.34–$1,124.50 | — | 70% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ELECTROCARDIOGRAM TRACING | $159.30 | $531.00 | $111.34–$1,124.50 | — | 70% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 TRIAGE ONLY | $33.00 | $110.00 | $129.66–$770.00 | 44% below | 70% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER LEVEL 1 | $198.00 | $660.00 | $129.66–$770.00 | 238% above | 70% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 EMR DPT VST MAYX REQ PHY/QHP | $198.00 | $660.00 | $129.66–$770.00 | 238% above | 70% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 TRIAGE ONLY | $33.00 | $110.00 | $129.66–$770.00 | — | 70% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 EMR DPT VST MAYX REQ PHY/QHP | $198.00 | $660.00 | $129.66–$770.00 | — | 70% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ER LEVEL 1 | $198.00 | $660.00 | $129.66–$770.00 | — | 70% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ER LEVEL 2 | $214.50 | $715.00 | $120.40–$715.00 | 46% above | 70% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 EMERGENCY DEPT VISIT SF MDM | $214.50 | $715.00 | $120.40–$715.00 | 46% above | 70% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 EMERGENCY DEPT VISIT SF MDM | $214.50 | $715.00 | $120.40–$715.00 | — | 70% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ER LEVEL 2 | $214.50 | $715.00 | $120.40–$715.00 | — | 70% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 EMERGENCY DEPT VISIT LOW MDM | $240.00 | $800.00 | $134.72–$800.00 | 4% above | 70% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ER LEVEL 3 | $240.00 | $800.00 | $134.72–$800.00 | 4% above | 70% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 EMERGENCY DEPT VISIT LOW MDM | $240.00 | $800.00 | $134.72–$800.00 | — | 70% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ER LEVEL 3 | $240.00 | $800.00 | $134.72–$800.00 | — | 70% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 EMERGENCY DEPT VISIT MOD MDM | $387.00 | $1,290.00 | $217.23–$1,290.00 | 2% above | 70% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ER LEVEL 4 | $387.00 | $1,290.00 | $217.23–$1,290.00 | 2% above | 70% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 EMERGENCY DEPT VISIT MOD MDM | $387.00 | $1,290.00 | $217.23–$1,290.00 | — | 70% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ER LEVEL 4 | $387.00 | $1,290.00 | $217.23–$1,290.00 | — | 70% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ER LEVEL 5(TRANSFER) | $525.00 | $1,750.00 | $294.70–$1,750.00 | 1% above | 70% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 EMERGENCY DEPT VISIT HI MDM | $525.00 | $1,750.00 | $294.70–$1,750.00 | 1% above | 70% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ER LEVEL 5(TRANSFER) | $525.00 | $1,750.00 | $294.70–$1,750.00 | — | 70% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 EMERGENCY DEPT VISIT HI MDM | $525.00 | $1,750.00 | $294.70–$1,750.00 | — | 70% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 STRESS TEST | $583.65 | $1,945.50 | $512.27–$4,145.50 | 66% above | 70% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 CV STRESS TEST TRACING ONLY | $583.65 | $1,945.50 | $512.27–$4,145.50 | 66% above | 70% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 STRESS TEST W/PHARMACEUTICAL | $660.00 | $2,200.00 | $512.27–$4,145.50 | 88% above | 70% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 STRESS TEST | $583.65 | $1,945.50 | $512.27–$4,145.50 | — | 70% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CV STRESS TEST TRACING ONLY | $583.65 | $1,945.50 | $512.27–$4,145.50 | — | 70% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 STRESS TEST W/PHARMACEUTICAL | $660.00 | $2,200.00 | $512.27–$4,145.50 | — | 70% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRATION INITIAL | $68.10 | $227.00 | $371.89–$3,193.00 | 60% below | 70% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV INFUSION HYDRATION,INITIAL | $117.45 | $391.50 | $371.89–$3,193.00 | 31% below | 70% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRATION 1ST HR | $127.65 | $425.50 | $371.89–$3,193.00 | 25% below | 70% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRATION 1ST HOUR | $127.65 | $425.50 | $371.89–$3,193.00 | 25% below | 70% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRATION IV INFUSION INIT | $134.10 | $447.00 | $371.89–$3,193.00 | 21% below | 70% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRATION 1 HR | $134.10 | $447.00 | $371.89–$3,193.00 | 21% below | 70% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HYDRATION INITIAL | $68.10 | $227.00 | $371.89–$3,193.00 | — | 70% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV INFUSION HYDRATION,INITIAL | $117.45 | $391.50 | $371.89–$3,193.00 | — | 70% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV HYDRATION 1ST HR | $127.65 | $425.50 | $371.89–$3,193.00 | — | 70% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV HYDRATION 1ST HOUR | $127.65 | $425.50 | $371.89–$3,193.00 | — | 70% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HYDRATION IV INFUSION INIT | $134.10 | $447.00 | $371.89–$3,193.00 | — | 70% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV HYDRATION 1 HR | $134.10 | $447.00 | $371.89–$3,193.00 | — | 70% |
| IV infusion of a medicine, first hour CPT 96365 DRIP/IVPB INITIAL | $68.10 | $227.00 | $371.89–$4,764.50 | 63% below | 70% |
| IV infusion of a medicine, first hour CPT 96365 IV HYDRATION ADDL HR | $184.95 | $616.50 | $371.89–$4,764.50 | 1% below | 70% |
| IV infusion of a medicine, first hour CPT 96365 INFUSION THERAP/DIAG 1ST | $196.05 | $653.50 | $371.89–$4,764.50 | 5% above | 70% |
| IV infusion of a medicine, first hour CPT 96365 IVPB THER INITIAL HOUR | $196.05 | $653.50 | $371.89–$4,764.50 | 5% above | 70% |
| IV infusion of a medicine, first hour CPT 96365 THER/PROPH/DIAG IV INF INIT | $196.05 | $653.50 | $371.89–$4,764.50 | 5% above | 70% |
| IV infusion of a medicine, first hour CPT 96365 IV THERAPY DX 1 HR | $196.05 | $653.50 | $371.89–$4,764.50 | 5% above | 70% |
| IV infusion of a medicine, first hour inpatient CPT 96365 DRIP/IVPB INITIAL | $68.10 | $227.00 | $371.89–$4,764.50 | — | 70% |
| IV infusion of a medicine, first hour inpatient CPT 96365 IV HYDRATION ADDL HR | $184.95 | $616.50 | $371.89–$4,764.50 | — | 70% |
| IV infusion of a medicine, first hour inpatient CPT 96365 IV THERAPY DX 1 HR | $196.05 | $653.50 | $371.89–$4,764.50 | — | 70% |
| IV infusion of a medicine, first hour inpatient CPT 96365 INFUSION THERAP/DIAG 1ST | $196.05 | $653.50 | $371.89–$4,764.50 | — | 70% |
| IV infusion of a medicine, first hour inpatient CPT 96365 IVPB THER INITIAL HOUR | $196.05 | $653.50 | $371.89–$4,764.50 | — | 70% |
| IV infusion of a medicine, first hour inpatient CPT 96365 THER/PROPH/DIAG IV INF INIT | $196.05 | $653.50 | $371.89–$4,764.50 | — | 70% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 INTRAMUSCULAR/SUBCUTANEOUS INJ | $22.20 | $74.00 | $122.39–$1,628.00 | 57% below | 70% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 IM/SQ INJECTION | $56.55 | $188.50 | $122.39–$1,628.00 | 8% above | 70% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 IM\SQ INJECTION | $56.55 | $188.50 | $122.39–$1,628.00 | 8% above | 70% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 THERAPEUTC DX SQ/IM | $65.40 | $218.00 | $122.39–$1,628.00 | 25% above | 70% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DIAG INJ SC/IM | $65.40 | $218.00 | $122.39–$1,628.00 | 25% above | 70% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INTRAMUSCULAR/SUBCUTANEOUS INJ | $22.20 | $74.00 | $122.39–$1,628.00 | — | 70% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 IM/SQ INJECTION | $56.55 | $188.50 | $122.39–$1,628.00 | — | 70% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 IM\SQ INJECTION | $56.55 | $188.50 | $122.39–$1,628.00 | — | 70% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THERAPEUTC DX SQ/IM | $65.40 | $218.00 | $122.39–$1,628.00 | — | 70% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THER/PROPH/DIAG INJ SC/IM | $65.40 | $218.00 | $122.39–$1,628.00 | — | 70% |
| Neuromuscular re-education, 15 minutes CPT 97112 OT NEUROMUSC RE-ED 15M | $62.70 | $209.00 | $31.07–$964.00 | 69% above | 70% |
| Neuromuscular re-education, 15 minutes CPT 97112 NEURO REED | $66.00 | $220.00 | $31.07–$964.00 | 78% above | 70% |
| Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSCULAR RE-EDUC | $80.25 | $267.50 | $31.07–$964.00 | 116% above | 70% |
| Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSCULAR REEDUCATION | $80.25 | $267.50 | $31.07–$964.00 | 116% above | 70% |
| Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSCULAR RE-ED PTA | $80.25 | $267.50 | $31.07–$964.00 | 116% above | 70% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 OT NEUROMUSC RE-ED 15M | $62.70 | $209.00 | $31.07–$964.00 | — | 70% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEURO REED | $66.00 | $220.00 | $31.07–$964.00 | — | 70% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEUROMUSCULAR RE-ED PTA | $80.25 | $267.50 | $31.07–$964.00 | — | 70% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEUROMUSCULAR RE-EDUC | $80.25 | $267.50 | $31.07–$964.00 | — | 70% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEUROMUSCULAR REEDUCATION | $80.25 | $267.50 | $31.07–$964.00 | — | 70% |
| New patient office visit, about 45 minutes CPT 99204 OFFICE O/P NEW MOD 45 MIN | $90.00 | $300.00 | $56.77–$700.00 | at median | 70% |
| New patient office visit, about 45 minutes CPT 99204 WORK FIT VISIT | $90.00 | $300.00 | $56.77–$700.00 | at median | 70% |
| New patient office visit, about 45 minutes CPT 99204 WORK FIT VISIT TECH | $120.00 | $400.00 | $56.77–$700.00 | 33% above | 70% |
| New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE O/P NEW MOD 45 MIN | $90.00 | $300.00 | $56.77–$700.00 | — | 70% |
| New patient office visit, about 45 minutes inpatient CPT 99204 WORK FIT VISIT | $90.00 | $300.00 | $56.77–$700.00 | — | 70% |
| New patient office visit, about 45 minutes inpatient CPT 99204 WORK FIT VISIT TECH | $120.00 | $400.00 | $56.77–$700.00 | — | 70% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MEDICAL NUTRITION INDIV IN | $26.55 | $88.50 | $14.90–$88.50 | 8% below | 70% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MED NUTRITONAL TX 15 MIN INT | $26.55 | $88.50 | $14.90–$88.50 | 8% below | 70% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MEDICAL NUTRITION INDIV IN | $26.55 | $88.50 | $14.90–$88.50 | — | 70% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MED NUTRITONAL TX 15 MIN INT | $26.55 | $88.50 | $14.90–$88.50 | — | 70% |
| Occupational therapy evaluation, low complexity CPT 97165 OT EVALUATION INITIAL - LOW | $169.80 | $566.00 | $57.26–$566.00 | 56% above | 70% |
| Occupational therapy evaluation, low complexity CPT 97165 OT EVAL LOW COMPLEX 30 MIN | $169.80 | $566.00 | $57.26–$566.00 | 56% above | 70% |
| Occupational therapy evaluation, low complexity inpatient CPT 97165 OT EVALUATION INITIAL - LOW | $169.80 | $566.00 | $57.26–$566.00 | — | 70% |
| Occupational therapy evaluation, low complexity inpatient CPT 97165 OT EVAL LOW COMPLEX 30 MIN | $169.80 | $566.00 | $57.26–$566.00 | — | 70% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT EVALUATION INITIAL - HIGH | $156.00 | $520.00 | $58.94–$1,040.00 | 44% above | 70% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT EVAL HIGH 45 MIN | $156.00 | $520.00 | $58.94–$1,040.00 | 44% above | 70% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT EVAL HIGH COMPLEX 45 MIN | $156.00 | $520.00 | $58.94–$1,040.00 | 44% above | 70% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT EVALUATION INITIAL - HIGH | $156.00 | $520.00 | $58.94–$1,040.00 | — | 70% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT EVAL HIGH COMPLEX 45 MIN | $156.00 | $520.00 | $58.94–$1,040.00 | — | 70% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT EVAL HIGH 45 MIN | $156.00 | $520.00 | $58.94–$1,040.00 | — | 70% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT EVALUATION INITIAL - LOW | $156.00 | $520.00 | $58.94–$1,040.00 | 65% above | 70% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT EVAL LOW COMPLEX 20 MIN | $156.00 | $520.00 | $58.94–$1,040.00 | 65% above | 70% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT EVAL LOW 20 MIN | $156.00 | $520.00 | $58.94–$1,040.00 | 65% above | 70% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT EVALUATION INITIAL - LOW | $156.00 | $520.00 | $58.94–$1,040.00 | — | 70% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT EVAL LOW 20 MIN | $156.00 | $520.00 | $58.94–$1,040.00 | — | 70% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT EVAL LOW COMPLEX 20 MIN | $156.00 | $520.00 | $58.94–$1,040.00 | — | 70% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT EVALUATION INITIAL - MOD | $156.00 | $520.00 | $58.94–$1,040.00 | 62% above | 70% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT EVAL MOD COMPLEX 30 MIN | $156.00 | $520.00 | $58.94–$1,040.00 | 62% above | 70% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT EVAL MOD 30 MIN | $156.00 | $520.00 | $58.94–$1,040.00 | 62% above | 70% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT EVAL MOD 30 MIN | $156.00 | $520.00 | $58.94–$1,040.00 | — | 70% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT EVALUATION INITIAL - MOD | $156.00 | $520.00 | $58.94–$1,040.00 | — | 70% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT EVAL MOD COMPLEX 30 MIN | $156.00 | $520.00 | $58.94–$1,040.00 | — | 70% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THERAPY OTA | $74.55 | $248.50 | $26.34–$1,590.00 | 69% above | 70% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 OT MANUAL THERAPY 15 MIN | $74.55 | $248.50 | $26.34–$1,590.00 | 69% above | 70% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THERAPY 1/> REGIONS | $84.45 | $281.50 | $26.34–$1,590.00 | 91% above | 70% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THERAPY | $84.45 | $281.50 | $26.34–$1,590.00 | 91% above | 70% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THERAPY PTA | $84.45 | $281.50 | $26.34–$1,590.00 | 91% above | 70% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 OT MANUAL THERAPY 15 MIN | $74.55 | $248.50 | $26.34–$1,590.00 | — | 70% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MANUAL THERAPY OTA | $74.55 | $248.50 | $26.34–$1,590.00 | — | 70% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MANUAL THERAPY | $84.45 | $281.50 | $26.34–$1,590.00 | — | 70% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MANUAL THERAPY PTA | $84.45 | $281.50 | $26.34–$1,590.00 | — | 70% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MANUAL THERAPY 1/> REGIONS | $84.45 | $281.50 | $26.34–$1,590.00 | — | 70% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISE | $89.70 | $299.00 | $10.96–$1,442.50 | 136% above | 70% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISE PTA | $89.70 | $299.00 | $10.96–$1,442.50 | 136% above | 70% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISE OTA | $89.70 | $299.00 | $10.96–$1,442.50 | 136% above | 70% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISES | $89.70 | $299.00 | $10.96–$1,442.50 | 136% above | 70% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC EXERCISE | $89.70 | $299.00 | $10.96–$1,442.50 | — | 70% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC EXERCISE OTA | $89.70 | $299.00 | $10.96–$1,442.50 | — | 70% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC EXERCISE PTA | $89.70 | $299.00 | $10.96–$1,442.50 | — | 70% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC EXERCISES | $89.70 | $299.00 | $10.96–$1,442.50 | — | 70% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 SMOKING CESSATION | $47.61 | $158.72 | $55.30–$476.24 | 64% above | 70% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 BEHAV CHNG SMOKING 3-10 MIN | $47.62 | $158.76 | $55.30–$476.24 | 64% above | 70% |
| Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 SMOKING CESSATION | $47.61 | $158.72 | $55.30–$476.24 | — | 70% |
| Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 BEHAV CHNG SMOKING 3-10 MIN | $47.62 | $158.76 | $55.30–$476.24 | — | 70% |
| Speech and language evaluation CPT 92523 SPEECH SOUND LANG COMPREHEN | $256.35 | $854.50 | $66.74–$854.50 | 68% above | 70% |
| Speech and language evaluation CPT 92523 ST EVAL SPEECH/LANGUAGE | $256.35 | $854.50 | $66.74–$854.50 | 68% above | 70% |
| Speech and language evaluation inpatient CPT 92523 ST EVAL SPEECH/LANGUAGE | $256.35 | $854.50 | $66.74–$854.50 | — | 70% |
| Speech and language evaluation inpatient CPT 92523 SPEECH SOUND LANG COMPREHEN | $256.35 | $854.50 | $66.74–$854.50 | — | 70% |
| Speech therapy session, individual CPT 92507 TX SP LANG VOICE COMM INDIV | $201.00 | $670.00 | $32.79–$670.00 | 148% above | 70% |
| Speech therapy session, individual CPT 92507 ST SPEECH TREATMENT | $201.00 | $670.00 | $32.79–$670.00 | 148% above | 70% |
| Speech therapy session, individual inpatient CPT 92507 ST SPEECH TREATMENT | $201.00 | $670.00 | $32.79–$670.00 | — | 70% |
| Speech therapy session, individual inpatient CPT 92507 TX SP LANG VOICE COMM INDIV | $201.00 | $670.00 | $32.79–$670.00 | — | 70% |
| Spirometry (breathing test) CPT 94010 PULMONARY FUNCTION TEST | $103.50 | $345.00 | $66.51–$395.00 | 27% below | 70% |
| Spirometry (breathing test) CPT 94010 BREATHING CAPACITY TEST | $103.50 | $345.00 | $66.51–$395.00 | 27% below | 70% |
| Spirometry (breathing test) inpatient CPT 94010 BREATHING CAPACITY TEST | $103.50 | $345.00 | $66.51–$395.00 | — | 70% |
| Spirometry (breathing test) inpatient CPT 94010 PULMONARY FUNCTION TEST | $103.50 | $345.00 | $66.51–$395.00 | — | 70% |
| Spirometry before and after a bronchodilator CPT 94060 COMPLETE PFT | $330.00 | $1,100.00 | $185.24–$1,100.00 | 5% above | 70% |
| Spirometry before and after a bronchodilator CPT 94060 EVALUATION OF WHEEZING | $330.00 | $1,100.00 | $185.24–$1,100.00 | 5% above | 70% |
| Spirometry before and after a bronchodilator inpatient CPT 94060 COMPLETE PFT | $330.00 | $1,100.00 | $185.24–$1,100.00 | — | 70% |
| Spirometry before and after a bronchodilator inpatient CPT 94060 EVALUATION OF WHEEZING | $330.00 | $1,100.00 | $185.24–$1,100.00 | — | 70% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 THERAPEUTIC ACTIVITIES | $80.25 | $267.50 | $8.76–$1,039.50 | 113% above | 70% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 THERAPEUTIC ACTIVITIES PTA | $80.25 | $267.50 | $8.76–$1,039.50 | 113% above | 70% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 THERAPEUTIC ACTIVITI | $80.25 | $267.50 | $8.76–$1,039.50 | 113% above | 70% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THERAPEUTIC ACTIVITIES | $80.25 | $267.50 | $8.76–$1,039.50 | — | 70% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THERAPEUTIC ACTIVITI | $80.25 | $267.50 | $8.76–$1,039.50 | — | 70% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THERAPEUTIC ACTIVITIES PTA | $80.25 | $267.50 | $8.76–$1,039.50 | — | 70% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 THERAPEUTIC PHLEB | $134.40 | $448.00 | $75.44–$448.00 | 31% above | 70% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY | $134.40 | $448.00 | $75.44–$448.00 | 31% above | 70% |
| Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 THERAPEUTIC PHLEB | $134.40 | $448.00 | $75.44–$448.00 | — | 70% |
| Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY | $134.40 | $448.00 | $75.44–$448.00 | — | 70% |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs Louisiana | Off list |
|---|---|---|---|---|---|
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLU VV SPLT 3YR> IM | $44.70 | $149.00 | $23.22–$149.00 | 93% above | 70% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 IIV3 VACC NO PRSV 0.5 ML IM | $44.70 | $149.00 | $23.22–$149.00 | 93% above | 70% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLU VV SPLT 3YR> IM | $44.70 | $149.00 | $23.22–$149.00 | — | 70% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 IIV3 VACC NO PRSV 0.5 ML IM | $44.70 | $149.00 | $23.22–$149.00 | — | 70% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 IIV NO PRSV INCREASED AG IM | $120.75 | $402.50 | $67.78–$402.50 | 205% above | 70% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 FLUZONE HIGH DOSE | $120.75 | $402.50 | $67.78–$402.50 | 205% above | 70% |
| High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 FLUZONE HIGH DOSE | $120.75 | $402.50 | $67.78–$402.50 | — | 70% |
| High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 IIV NO PRSV INCREASED AG IM | $120.75 | $402.50 | $67.78–$402.50 | — | 70% |
| MMR vaccine (measles, mumps and rubella), live CPT 90707 MMR VACCINE SC | $63.60 | $212.00 | $35.70–$212.00 | 13% below | 70% |
| MMR vaccine (measles, mumps and rubella), live CPT 90707 MMR INJ | $63.60 | $212.00 | $35.70–$212.00 | 13% below | 70% |
| MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MMR VACCINE SC | $63.60 | $212.00 | $35.70–$212.00 | — | 70% |
| MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MMR INJ | $63.60 | $212.00 | $35.70–$212.00 | — | 70% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PREVNAR 20 | $525.30 | $1,751.00 | $294.86–$1,751.00 | 244% above | 70% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PCV20 VACCINE IM | $525.30 | $1,751.00 | $294.86–$1,751.00 | 244% above | 70% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PREVNAR 20 | $525.30 | $1,751.00 | $294.86–$1,751.00 | — | 70% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PCV20 VACCINE IM | $525.30 | $1,751.00 | $294.86–$1,751.00 | — | 70% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PPSV23 VACC 2 YRS+ SUBQ/IM | $75.30 | $251.00 | $20.33–$251.00 | 24% above | 70% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMO 23 VAC ADLT J | $75.30 | $251.00 | $20.33–$251.00 | 24% above | 70% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PPSV23 VACC 2 YRS+ SUBQ/IM | $75.30 | $251.00 | $20.33–$251.00 | — | 70% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMO 23 VAC ADLT J | $75.30 | $251.00 | $20.33–$251.00 | — | 70% |
| Rabies vaccine, one dose CPT 90675 RABIES VACCINE IM | $723.90 | $2,413.00 | $313.68–$2,413.00 | 17% below | 70% |
| Rabies vaccine, one dose CPT 90675 RABIES VAC 2.5UNITS UD J | $723.90 | $2,413.00 | $313.68–$2,413.00 | 17% below | 70% |
| Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE IM | $723.90 | $2,413.00 | $313.68–$2,413.00 | — | 70% |
| Rabies vaccine, one dose inpatient CPT 90675 RABIES VAC 2.5UNITS UD J | $723.90 | $2,413.00 | $313.68–$2,413.00 | — | 70% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TENIVAC 5-2LFU 10X0.5ML ADULT | $31.20 | $104.00 | $17.51–$104.00 | at median | 70% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TD VACC NO PRESV 7 YRS+ IM | $31.20 | $104.00 | $17.51–$104.00 | at median | 70% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TD VACC NO PRESV 7 YRS+ IM | $31.20 | $104.00 | $17.51–$104.00 | — | 70% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TENIVAC 5-2LFU 10X0.5ML ADULT | $31.20 | $104.00 | $17.51–$104.00 | — | 70% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TET\DIPHTOXOID PF J | $24.75 | $82.50 | $42.60–$295.50 | 47% below | 70% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDAP VACCINE 7 YRS/> IM | $63.90 | $213.00 | $42.60–$295.50 | 37% above | 70% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDAP VACC 7YRS>IM | $63.90 | $213.00 | $42.60–$295.50 | 37% above | 70% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TET\DIPHTOXOID PF J | $24.75 | $82.50 | $42.60–$295.50 | — | 70% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TDAP VACC 7YRS>IM | $63.90 | $213.00 | $42.60–$295.50 | — | 70% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TDAP VACCINE 7 YRS/> IM | $63.90 | $213.00 | $42.60–$295.50 | — | 70% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 VACCINE ADMINISTRATION (1) | $22.20 | $74.00 | $66.93–$397.50 | 45% below | 70% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 VACCINE ADMINISTRATION | $40.50 | $135.00 | $66.93–$397.50 | 1% above | 70% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMM ADM 1ST VACCINE | $56.55 | $188.50 | $66.93–$397.50 | 40% above | 70% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 VACCINE ADMINISTRATION (1) | $22.20 | $74.00 | $66.93–$397.50 | — | 70% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 VACCINE ADMINISTRATION | $40.50 | $135.00 | $66.93–$397.50 | — | 70% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMM ADM 1ST VACCINE | $56.55 | $188.50 | $66.93–$397.50 | — | 70% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 VACCINE EACH ADDITIONAL | $56.55 | $188.50 | $63.48–$377.00 | 112% above | 70% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMM ADM EA ADD VACC | $56.55 | $188.50 | $63.48–$377.00 | 112% above | 70% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMM ADM EA ADD VACC | $56.55 | $188.50 | $63.48–$377.00 | — | 70% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 VACCINE EACH ADDITIONAL | $56.55 | $188.50 | $63.48–$377.00 | — | 70% |
Source file: https://mindenmedicalcenter.com/824625698_MINDEN-MEDICAL-CENTER_standardcharges.csv