Hospital

Sabine Medical Center

Sabine Medical Center in Many, LA publishes cash prices for 209 common procedures listed here, from its own machine-readable price file updated Jun 19, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Louisiana median for 171 of 206 procedures and above it for 33. By typical cash price it ranks #1 of 28 Louisiana hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

240 HIGHLAND DRIVE,MANY,LA,71449-3767 Collected Sep 27, 2026 Source price file (318) 256-1232

Acute care hospital Emergency department CCN 190218 · 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 4 actions for a hospital named Sabine Medical Center in Many, LA:

May 4, 2023 Warning notice
Aug 17, 2023 Case closed
May 20, 2026 Warning notice
Jun 30, 2026 Case closed

Warning notice: CMS reviewed the hospital and told it that it had found possible violations of the price transparency rules. Case closed: CMS closed the case after the hospital addressed the problems.

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

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Louisiana	Off list
Ankle X-ray, complete, 3 or more views both sides CPT 73610 XR ANKLE MIN 3VW BILATERAL	$83.70	$279.00	$27.49–$610.00	—	70%
Ankle X-ray, complete, 3 or more views CPT 73610 X-RAY EXAM OF ANKLE	$45.30	$151.00	$27.49–$610.00	62% below	70%
Ankle X-ray, complete, 3 or more views one side CPT 73610 ANKLE MIN 3 VIEWS LT	$45.30	$151.00	$27.49–$610.00	62% below	70%
Ankle X-ray, complete, 3 or more views one side CPT 73610 ANKLE MIN 3 VIEWS RT	$45.30	$151.00	$27.49–$610.00	62% below	70%
Ankle X-ray, complete, 3 or more views inpatient both sides CPT 73610 XR ANKLE MIN 3VW BILATERAL	$83.70	$279.00	$27.49–$610.00	—	70%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 X-RAY EXAM OF ANKLE	$45.30	$151.00	$27.49–$610.00	—	70%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 ANKLE MIN 3 VIEWS RT	$45.30	$151.00	$27.49–$610.00	—	70%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 ANKLE MIN 3 VIEWS LT	$45.30	$151.00	$27.49–$610.00	—	70%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 UPR/L XTREMITY ART 2 LEVELS	$130.80	$436.00	$76.71–$906.00	32% below	70%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 US ABIS	$130.80	$436.00	$76.71–$906.00	32% below	70%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 ABI-ANKLE BRAHIAL INDEX	$130.80	$436.00	$76.71–$906.00	32% below	70%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 ABI-ANKLE BRAHIAL INDEX	$130.80	$436.00	$76.71–$906.00	—	70%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 US ABIS	$130.80	$436.00	$76.71–$906.00	—	70%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 UPR/L XTREMITY ART 2 LEVELS	$130.80	$436.00	$76.71–$906.00	—	70%
Breast ultrasound, complete, one breast CPT 76641 US BREAST COMP BIL	$88.80	$296.00	$74.65–$1,289.00	49% below	70%
Breast ultrasound, complete, one breast CPT 76641 ULTRASOUND BREAST COMPLETE	$88.80	$296.00	$74.65–$1,289.00	49% below	70%
Breast ultrasound, complete, one breast one side CPT 76641 US BREAST COMP RT	$84.60	$282.00	$74.65–$1,289.00	51% below	70%
Breast ultrasound, complete, one breast one side CPT 76641 US BREAST COMP LT	$178.50	$595.00	$74.65–$1,289.00	3% above	70%
Breast ultrasound, complete, one breast inpatient CPT 76641 US BREAST COMP BIL	$88.80	$296.00	$74.65–$1,289.00	—	70%
Breast ultrasound, complete, one breast inpatient CPT 76641 ULTRASOUND BREAST COMPLETE	$88.80	$296.00	$74.65–$1,289.00	—	70%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US BREAST COMP RT	$84.60	$282.00	$74.65–$1,289.00	—	70%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US BREAST COMP LT	$178.50	$595.00	$74.65–$1,289.00	—	70%
Breast ultrasound, limited (one breast or one area) CPT 76642 ULTRASOUND BREAST LIMITED	$178.50	$595.00	$56.68–$1,370.00	at median	70%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST LTD RT	$178.50	$595.00	$56.68–$1,370.00	at median	70%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST LTD LT	$178.50	$595.00	$56.68–$1,370.00	at median	70%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 ULTRASOUND BREAST LIMITED	$178.50	$595.00	$56.68–$1,370.00	—	70%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US BREAST LTD LT	$178.50	$595.00	$56.68–$1,370.00	—	70%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US BREAST LTD RT	$178.50	$595.00	$56.68–$1,370.00	—	70%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT PE ANGIO CHEST W/C	$462.00	$1,540.00	$240.00–$5,940.00	51% below	70%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA CHEST WC	$627.00	$2,090.00	$240.00–$5,940.00	34% below	70%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT ANGIO CHEST W/W/O CON	$627.00	$2,090.00	$240.00–$5,940.00	34% below	70%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT ANGIOGRAPHY CHEST	$627.00	$2,090.00	$240.00–$5,940.00	34% below	70%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT PE ANGIO CHEST W/C	$462.00	$1,540.00	$240.00–$5,940.00	—	70%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT ANGIOGRAPHY CHEST	$627.00	$2,090.00	$240.00–$5,940.00	—	70%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT ANGIO CHEST W/W/O CON	$627.00	$2,090.00	$240.00–$5,940.00	—	70%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA CHEST WC	$627.00	$2,090.00	$240.00–$5,940.00	—	70%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT RENAL STONE STUDY	$636.60	$2,122.00	$177.01–$4,519.00	49% below	70%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD&PEL WO CONTRAST	$636.60	$2,122.00	$177.01–$4,519.00	49% below	70%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT RENAL STONE STUDY	$636.60	$2,122.00	$177.01–$4,519.00	—	70%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD&PEL WO CONTRAST	$636.60	$2,122.00	$177.01–$4,519.00	—	70%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD & PELVIS W/CONTRAST	$721.80	$2,406.00	$240.00–$2,692.00	56% below	70%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD&PEL W CONTRAST	$721.80	$2,406.00	$240.00–$2,692.00	56% below	70%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD&PEL W CONTRAST	$721.80	$2,406.00	$240.00–$2,692.00	—	70%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD & PELVIS W/CONTRAST	$721.80	$2,406.00	$240.00–$2,692.00	—	70%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD&PEL WO/W CONTRAST	$806.40	$2,688.00	$240.00–$3,003.00	53% below	70%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD&PLV WO CNTR FLWD CNTR	$806.40	$2,688.00	$240.00–$3,003.00	53% below	70%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD&PEL WO/W CONTRAST	$806.40	$2,688.00	$240.00–$3,003.00	—	70%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD&PLV WO CNTR FLWD CNTR	$806.40	$2,688.00	$240.00–$3,003.00	—	70%
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W/CONTRAST	$427.50	$1,425.00	$240.00–$1,634.00	53% below	70%
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN WITH CONT	$427.50	$1,425.00	$240.00–$1,634.00	53% below	70%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN WITH CONT	$427.50	$1,425.00	$240.00–$1,634.00	—	70%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN W/CONTRAST	$427.50	$1,425.00	$240.00–$1,634.00	—	70%
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/O CONT	$368.70	$1,229.00	$131.50–$1,416.00	57% below	70%
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/O CONTRAST	$368.70	$1,229.00	$131.50–$1,416.00	57% below	70%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN W/O CONT	$368.70	$1,229.00	$131.50–$1,416.00	—	70%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN W/O CONTRAST	$368.70	$1,229.00	$131.50–$1,416.00	—	70%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILO/SINUS W/O CONT	$310.80	$1,036.00	$122.17–$1,146.00	53% below	70%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIAL W/O DYE	$310.80	$1,036.00	$122.17–$1,146.00	53% below	70%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILLOFACIAL W/O DYE	$310.80	$1,036.00	$122.17–$1,146.00	—	70%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILO/SINUS W/O CONT	$310.80	$1,036.00	$122.17–$1,146.00	—	70%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD/BRAIN W/O CONT	$368.70	$1,229.00	$101.69–$1,363.00	44% below	70%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD/BRAIN W/O CONT	$368.70	$1,229.00	$101.69–$1,363.00	—	70%
CT scan of the head with contrast CPT 70460 CT HEAD/BRAIN WITH CONT	$427.50	$1,425.00	$141.64–$1,601.00	46% below	70%
CT scan of the head with contrast inpatient CPT 70460 CT HEAD/BRAIN WITH CONT	$427.50	$1,425.00	$141.64–$1,601.00	—	70%
CT scan of the head without and with contrast CPT 70470 CT HEAD/BRAIN W/W/O CONT	$653.10	$2,177.00	$166.45–$2,378.00	31% below	70%
CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD/BRAIN W/W/O CONT	$653.10	$2,177.00	$166.45–$2,378.00	—	70%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT L-SPINE W/O CONTRAST	$391.80	$1,306.00	$123.40–$1,464.00	51% below	70%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT L-SPINE W/O CONTRAST	$391.80	$1,306.00	$123.40–$1,464.00	—	70%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT C-SPINE W/O CONTRAST	$368.70	$1,229.00	$123.99–$1,389.00	53% below	70%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT NECK SPINE W/O DYE	$368.70	$1,229.00	$123.99–$1,389.00	53% below	70%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT NECK SPINE W/O DYE	$368.70	$1,229.00	$123.99–$1,389.00	—	70%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT C-SPINE W/O CONTRAST	$368.70	$1,229.00	$123.99–$1,389.00	—	70%
CT scan of the pelvis, with contrast dye both sides CPT 72193 CT HIP BILAT WC	$350.70	$1,169.00	$219.04–$2,520.00	—	70%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS WITH CONTRAST	$350.70	$1,169.00	$219.04–$2,520.00	58% below	70%
CT scan of the pelvis, with contrast dye inpatient both sides CPT 72193 CT HIP BILAT WC	$350.70	$1,169.00	$219.04–$2,520.00	—	70%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS WITH CONTRAST	$350.70	$1,169.00	$219.04–$2,520.00	—	70%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 EXTRACRANIAL BILAT STUDY	$233.40	$778.00	$158.59–$1,595.00	—	70%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 US CAROTID DUP BILAT	$233.40	$778.00	$158.59–$1,595.00	—	70%
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 CAROTID DUPLEX DOPPLER	$233.40	$778.00	$158.59–$1,595.00	50% below	70%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 US CAROTID DUP BILAT	$233.40	$778.00	$158.59–$1,595.00	—	70%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 EXTRACRANIAL BILAT STUDY	$233.40	$778.00	$158.59–$1,595.00	—	70%
Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 CAROTID DUPLEX DOPPLER	$233.40	$778.00	$158.59–$1,595.00	—	70%
Chest X-ray, 2 views both sides CPT 71046 XR CHEST 2 LAT DECUBITUS BILAT	$59.40	$198.00	$22.99–$430.00	—	70%
Chest X-ray, 2 views CPT 71046 XR CHEST 2 VIEWS	$59.40	$198.00	$22.99–$430.00	57% below	70%
Chest X-ray, 2 views inpatient both sides CPT 71046 XR CHEST 2 LAT DECUBITUS BILAT	$59.40	$198.00	$22.99–$430.00	—	70%
Chest X-ray, 2 views inpatient CPT 71046 XR CHEST 2 VIEWS	$59.40	$198.00	$22.99–$430.00	—	70%
Chest X-ray, single view CPT 71045 XR CHEST SGL VIEW	$50.70	$169.00	$17.38–$200.62	55% below	70%
Chest X-ray, single view inpatient CPT 71045 XR CHEST SGL VIEW	$50.70	$169.00	$17.38–$200.62	—	70%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 ULTRSND RETROPERITONEAL	$178.50	$595.00	$80.64–$1,306.00	40% below	70%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RENAL/BLADDER COMPLETE	$178.50	$595.00	$80.64–$1,306.00	40% below	70%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 ULTRSND RETROPERITONEAL	$178.50	$595.00	$80.64–$1,306.00	—	70%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RENAL/BLADDER COMPLETE	$178.50	$595.00	$80.64–$1,306.00	—	70%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DXA BONE DENSITY AXIAL	$66.00	$220.00	$31.23–$281.74	61% below	70%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DXA BONE DENSITY	$66.00	$220.00	$31.23–$281.74	61% below	70%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DXA BONE DENSITY AXIAL	$66.00	$220.00	$31.23–$281.74	—	70%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DXA BONE DENSITY	$66.00	$220.00	$31.23–$281.74	—	70%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 OB US DETAILED SNGL FETUS	$144.30	$481.00	$87.54–$585.79	46% below	70%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US OB	$144.30	$481.00	$87.54–$585.79	46% below	70%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 OB US DETAILED SNGL FETUS	$144.30	$481.00	$87.54–$585.79	—	70%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US OB	$144.30	$481.00	$87.54–$585.79	—	70%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST W/O CONTRAST	$368.70	$1,229.00	$127.77–$1,400.00	52% below	70%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST W/O CONTRAST	$368.70	$1,229.00	$127.77–$1,400.00	—	70%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST WITH CONTRAST	$427.50	$1,425.00	$159.37–$1,607.00	55% below	70%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT CHEST WITH CONTRAST	$427.50	$1,425.00	$159.37–$1,607.00	—	70%
Diagnostic mammogram, both breasts both sides CPT 77066 DX MAMMO INCL CAD BI	$95.70	$319.00	$88.54–$319.00	—	70%
Diagnostic mammogram, both breasts both sides CPT 77066 3D DIAG MAMMO BILATERAL	$95.70	$319.00	$88.54–$319.00	—	70%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 3D DIAG MAMMO BILATERAL	$95.70	$319.00	$88.54–$319.00	—	70%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 DX MAMMO INCL CAD BI	$95.70	$319.00	$88.54–$319.00	—	70%
Diagnostic mammogram, one breast CPT 77065 DX MAMMO INCL CAD UNI	$33.00	$110.00	$69.00–$1,064.00	73% below	70%
Diagnostic mammogram, one breast CPT 77065 SCREEN MAMMOGRAM INCLUDING CAD UNI	$36.90	$123.00	$69.00–$1,064.00	70% below	70%
Diagnostic mammogram, one breast one side CPT 77065 MA MAMMOGRAM DIAGNOSTIC RT	$33.00	$110.00	$69.00–$1,064.00	73% below	70%
Diagnostic mammogram, one breast one side CPT 77065 MA MAMMOGRAM SCREENING LT	$33.00	$110.00	$69.00–$1,064.00	73% below	70%
Diagnostic mammogram, one breast one side CPT 77065 3D DIAG MAMMO RT	$95.70	$319.00	$69.00–$1,064.00	21% below	70%
Diagnostic mammogram, one breast one side CPT 77065 3D DIAG MAMMO LEFT	$95.70	$319.00	$69.00–$1,064.00	21% below	70%
Diagnostic mammogram, one breast inpatient CPT 77065 DX MAMMO INCL CAD UNI	$33.00	$110.00	$69.00–$1,064.00	—	70%
Diagnostic mammogram, one breast inpatient CPT 77065 SCREEN MAMMOGRAM INCLUDING CAD UNI	$36.90	$123.00	$69.00–$1,064.00	—	70%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA MAMMOGRAM SCREENING LT	$33.00	$110.00	$69.00–$1,064.00	—	70%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA MAMMOGRAM DIAGNOSTIC RT	$33.00	$110.00	$69.00–$1,064.00	—	70%
Diagnostic mammogram, one breast inpatient one side CPT 77065 3D DIAG MAMMO LEFT	$95.70	$319.00	$69.00–$1,064.00	—	70%
Diagnostic mammogram, one breast inpatient one side CPT 77065 3D DIAG MAMMO RT	$95.70	$319.00	$69.00–$1,064.00	—	70%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 US ARTERY LOWER EXTREMITY BI	$212.10	$707.00	$196.23–$762.00	—	70%
Duplex ultrasound of the leg arteries, both legs CPT 93925 LOWER EXTREMITY STUDY	$212.10	$707.00	$196.23–$762.00	53% below	70%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 US ARTERY LOWER EXTREMITY BI	$212.10	$707.00	$196.23–$762.00	—	70%
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 LOWER EXTREMITY STUDY	$212.10	$707.00	$196.23–$762.00	—	70%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US VEIN LOWER EXTREMITY BILAT	$212.10	$707.00	$162.26–$884.00	—	70%
Duplex ultrasound of the leg veins, both legs CPT 93970 EXTREMITY STUDY	$212.10	$707.00	$162.26–$884.00	49% below	70%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US VEIN LOWER EXTREMITY BILAT	$212.10	$707.00	$162.26–$884.00	—	70%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 EXTREMITY STUDY	$212.10	$707.00	$162.26–$884.00	—	70%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHO W/SPEC/COLOR FLOW	$718.80	$2,396.00	$144.22–$4,902.00	at median	70%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 TTE W/DOPPLER COMPLETE	$718.80	$2,396.00	$144.22–$4,902.00	at median	70%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 US ECHOCARDIOGRAM COMPLETE	$718.80	$2,396.00	$144.22–$4,902.00	at median	70%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHO W/SPEC/COLOR FLOW	$718.80	$2,396.00	$144.22–$4,902.00	—	70%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 TTE W/DOPPLER COMPLETE	$718.80	$2,396.00	$144.22–$4,902.00	—	70%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 US ECHOCARDIOGRAM COMPLETE	$718.80	$2,396.00	$144.22–$4,902.00	—	70%
Knee X-ray, 3 views both sides CPT 73562 XR KNEE 3VW BILATERAL	$90.90	$303.00	$31.23–$720.00	—	70%
Knee X-ray, 3 views one side CPT 73562 KNEE 3 VIEWS LT	$57.90	$193.00	$31.23–$720.00	59% below	70%
Knee X-ray, 3 views one side CPT 73562 KNEE 3 VIEWS RT	$57.90	$193.00	$31.23–$720.00	59% below	70%
Knee X-ray, 3 views inpatient both sides CPT 73562 XR KNEE 3VW BILATERAL	$90.90	$303.00	$31.23–$720.00	—	70%
Knee X-ray, 3 views inpatient one side CPT 73562 KNEE 3 VIEWS RT	$57.90	$193.00	$31.23–$720.00	—	70%
Knee X-ray, 3 views inpatient one side CPT 73562 KNEE 3 VIEWS LT	$57.90	$193.00	$31.23–$720.00	—	70%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ECHO EXAM OF ABDOMEN	$178.50	$595.00	$65.29–$1,349.00	40% below	70%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ULTRASOUND GALL BLADDER	$178.50	$595.00	$65.29–$1,349.00	40% below	70%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMEN LIMITED	$197.70	$659.00	$65.29–$1,349.00	34% below	70%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 ECHO EXAM OF ABDOMEN	$178.50	$595.00	$65.29–$1,349.00	—	70%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 ULTRASOUND GALL BLADDER	$178.50	$595.00	$65.29–$1,349.00	—	70%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMEN LIMITED	$197.70	$659.00	$65.29–$1,349.00	—	70%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 LDCT LUNG SCREENING PROFEE	$33.30	$111.00	$161.87–$1,761.00	69% below	70%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT THORAX LUNG CANCER SCR C-	$495.00	$1,650.00	$161.87–$1,761.00	364% above	70%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 LDCT-LUNG SCREENING	$495.00	$1,650.00	$161.87–$1,761.00	364% above	70%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 LDCT LUNG SCREENING PROFEE	$33.30	$111.00	$161.87–$1,761.00	—	70%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT THORAX LUNG CANCER SCR C-	$495.00	$1,650.00	$161.87–$1,761.00	—	70%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 LDCT-LUNG SCREENING	$495.00	$1,650.00	$161.87–$1,761.00	—	70%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIS TRNS ABD/VAG NON-OB	$90.30	$301.00	$79.52–$1,601.00	69% below	70%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 ULTRASOUND PELVIS COMP	$178.50	$595.00	$79.52–$1,601.00	38% below	70%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US BLADDER	$178.50	$595.00	$79.52–$1,601.00	38% below	70%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIS TRNS ABD/VAG NON-OB	$90.30	$301.00	$79.52–$1,601.00	—	70%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US BLADDER	$178.50	$595.00	$79.52–$1,601.00	—	70%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 ULTRASOUND PELVIS COMP	$178.50	$595.00	$79.52–$1,601.00	—	70%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 U S OB >14 WKS 1ST GEST	$178.50	$595.00	$95.24–$697.00	35% below	70%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OB US >/= 14 WKS SNGL FETUS	$178.50	$595.00	$95.24–$697.00	35% below	70%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 U S OB >14 WKS 1ST GEST	$178.50	$595.00	$95.24–$697.00	—	70%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 OB US >/= 14 WKS SNGL FETUS	$178.50	$595.00	$95.24–$697.00	—	70%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US UTER PRIOR 14 WKS	$181.50	$605.00	$76.52–$605.00	32% below	70%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 OB US < 14 WKS SINGLE FETUS	$181.50	$605.00	$76.52–$605.00	32% below	70%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 OB US < 14 WKS SINGLE FETUS	$181.50	$605.00	$76.52–$605.00	—	70%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US UTER PRIOR 14 WKS	$181.50	$605.00	$76.52–$605.00	—	70%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB LIMITED	$144.30	$481.00	$54.44–$584.00	7% above	70%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB LIMITED	$144.30	$481.00	$54.44–$584.00	—	70%
Screening mammogram, both breasts both sides CPT 77067 SCR MAMMO BI INCL CAD	$33.00	$110.00	$73.02–$748.00	—	70%
Screening mammogram, both breasts both sides CPT 77067 3D MAMMOGRAPHY SCREENING BILATERAL	$95.70	$319.00	$73.02–$748.00	—	70%
Screening mammogram, both breasts CPT 77067 SCRN MAMMO CAD BIL	$95.70	$319.00	$73.02–$748.00	21% below	70%
Screening mammogram, both breasts inpatient both sides CPT 77067 SCR MAMMO BI INCL CAD	$33.00	$110.00	$73.02–$748.00	—	70%
Screening mammogram, both breasts inpatient both sides CPT 77067 3D MAMMOGRAPHY SCREENING BILATERAL	$95.70	$319.00	$73.02–$748.00	—	70%
Screening mammogram, both breasts inpatient CPT 77067 SCRN MAMMO CAD BIL	$95.70	$319.00	$73.02–$748.00	—	70%
Shoulder X-ray, complete, 2 or more views both sides CPT 73030 XR SHOULDER 2+VWS BILATERAL	$78.30	$261.00	$24.86–$1,198.00	—	70%
Shoulder X-ray, complete, 2 or more views CPT 73030 X-RAY EXAM OF SHOULDER	$45.30	$151.00	$24.86–$1,198.00	66% below	70%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR SHOULDER 2+ VIEWS LT	$45.30	$151.00	$24.86–$1,198.00	66% below	70%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR SHOULDER AXIAL VIEW RT	$45.30	$151.00	$24.86–$1,198.00	66% below	70%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER 3 VIEWS RT	$45.30	$151.00	$24.86–$1,198.00	66% below	70%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER 3 VIEWS LT	$45.30	$151.00	$24.86–$1,198.00	66% below	70%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR SHOULDER 2+ VIEWS RT	$45.30	$151.00	$24.86–$1,198.00	66% below	70%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR SHOULDER AXIAL VIEW LT	$45.30	$151.00	$24.86–$1,198.00	66% below	70%
Shoulder X-ray, complete, 2 or more views inpatient both sides CPT 73030 XR SHOULDER 2+VWS BILATERAL	$78.30	$261.00	$24.86–$1,198.00	—	70%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 X-RAY EXAM OF SHOULDER	$45.30	$151.00	$24.86–$1,198.00	—	70%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 SHOULDER 3 VIEWS RT	$45.30	$151.00	$24.86–$1,198.00	—	70%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 SHOULDER 3 VIEWS LT	$45.30	$151.00	$24.86–$1,198.00	—	70%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR SHOULDER 2+ VIEWS LT	$45.30	$151.00	$24.86–$1,198.00	—	70%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR SHOULDER 2+ VIEWS RT	$45.30	$151.00	$24.86–$1,198.00	—	70%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR SHOULDER AXIAL VIEW LT	$45.30	$151.00	$24.86–$1,198.00	—	70%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR SHOULDER AXIAL VIEW RT	$45.30	$151.00	$24.86–$1,198.00	—	70%
Transvaginal pelvic ultrasound CPT 76830 ULTRASOUND TRANSVAGINAL	$144.30	$481.00	$93.37–$591.00	29% below	70%
Transvaginal pelvic ultrasound inpatient CPT 76830 ULTRASOUND TRANSVAGINAL	$144.30	$481.00	$93.37–$591.00	—	70%
Transvaginal ultrasound during pregnancy CPT 76817 TRANSVAGINAL US OBSTETRIC	$180.30	$601.00	$61.55–$711.00	5% above	70%
Transvaginal ultrasound during pregnancy CPT 76817 US PREGNANCY TRANSVAG	$180.30	$601.00	$61.55–$711.00	5% above	70%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US PREGNANCY TRANSVAG	$180.30	$601.00	$61.55–$711.00	—	70%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 TRANSVAGINAL US OBSTETRIC	$180.30	$601.00	$61.55–$711.00	—	70%
Ultrasound of the abdomen, complete CPT 76700 ULTRASOUND ABDOMEN	$197.70	$659.00	$86.63–$1,445.00	41% below	70%
Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN COMPLETE	$197.70	$659.00	$86.63–$1,445.00	41% below	70%
Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMEN COMPLETE	$197.70	$659.00	$86.63–$1,445.00	—	70%
Ultrasound of the abdomen, complete inpatient CPT 76700 ULTRASOUND ABDOMEN	$197.70	$659.00	$86.63–$1,445.00	—	70%
Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM/TESTICLES	$178.50	$595.00	$77.27–$696.00	21% below	70%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM/TESTICLES	$178.50	$595.00	$77.27–$696.00	—	70%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 ULTRSND SOFT TISSUE NECK	$178.50	$595.00	$92.62–$1,280.00	38% below	70%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US EXAM OF HEAD AND NECK	$178.50	$595.00	$92.62–$1,280.00	38% below	70%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US THYROID	$178.50	$595.00	$92.62–$1,280.00	38% below	70%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 ULTRSND SOFT TISSUE NECK	$178.50	$595.00	$92.62–$1,280.00	—	70%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US EXAM OF HEAD AND NECK	$178.50	$595.00	$92.62–$1,280.00	—	70%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US THYROID	$178.50	$595.00	$92.62–$1,280.00	—	70%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 UPPER GI W/SM BOWEL	$171.60	$572.00	$84.01–$572.00	37% below	70%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 X-RAY XM UPR GI TRC 1CNTRST	$171.60	$572.00	$84.01–$572.00	37% below	70%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 X-RAY XM UPR GI TRC 1CNTRST	$171.60	$572.00	$84.01–$572.00	—	70%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 UPPER GI W/SM BOWEL	$171.60	$572.00	$84.01–$572.00	—	70%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 EXTREMITY STUDY	$170.10	$567.00	$107.41–$4,379.00	50% below	70%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US VEIN LOWER EXTREMITY RT	$170.10	$567.00	$107.41–$4,379.00	50% below	70%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US VEIN LOWER EXTREMITY LT	$170.10	$567.00	$107.41–$4,379.00	50% below	70%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US VEIN UPPER EXTREMITY RT	$466.50	$1,555.00	$107.41–$4,379.00	38% above	70%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US VEIN UPPER EXTREMITY LT	$466.50	$1,555.00	$107.41–$4,379.00	38% above	70%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 EXTREMITY STUDY	$170.10	$567.00	$107.41–$4,379.00	—	70%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US VEIN LOWER EXTREMITY RT	$170.10	$567.00	$107.41–$4,379.00	—	70%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US VEIN LOWER EXTREMITY LT	$170.10	$567.00	$107.41–$4,379.00	—	70%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US VEIN UPPER EXTREMITY LT	$466.50	$1,555.00	$107.41–$4,379.00	—	70%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US VEIN UPPER EXTREMITY RT	$466.50	$1,555.00	$107.41–$4,379.00	—	70%
Wrist X-ray, complete, 3 or more views both sides CPT 73110 XR WRIST 3VW BILATERAL	$83.70	$279.00	$31.60–$609.00	—	70%
Wrist X-ray, complete, 3 or more views CPT 73110 X-RAY EXAM OF WRIST	$45.30	$151.00	$31.60–$609.00	60% below	70%
Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST 3 VIEWS RT	$45.30	$151.00	$31.60–$609.00	60% below	70%
Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST 3 VIEWS LT	$45.30	$151.00	$31.60–$609.00	60% below	70%
Wrist X-ray, complete, 3 or more views inpatient both sides CPT 73110 XR WRIST 3VW BILATERAL	$83.70	$279.00	$31.60–$609.00	—	70%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 X-RAY EXAM OF WRIST	$45.30	$151.00	$31.60–$609.00	—	70%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 WRIST 3 VIEWS RT	$45.30	$151.00	$31.60–$609.00	—	70%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 WRIST 3 VIEWS LT	$45.30	$151.00	$31.60–$609.00	—	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	$44.70	$149.00	$35.72–$333.00	69% 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	$44.70	$149.00	$35.72–$333.00	69% below	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	$44.70	$149.00	$35.72–$333.00	—	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	$44.70	$149.00	$35.72–$333.00	—	70%
X-ray of the abdomen, 1 view CPT 74018 XR ABDOMEN 1 VIEW	$102.00	$340.00	$21.12–$369.00	10% below	70%
X-ray of the abdomen, 1 view CPT 74018 RADEX ABDOMEN 1 VIEW	$102.00	$340.00	$21.12–$369.00	10% below	70%
X-ray of the abdomen, 1 view inpatient CPT 74018 XR ABDOMEN 1 VIEW	$102.00	$340.00	$21.12–$369.00	—	70%
X-ray of the abdomen, 1 view inpatient CPT 74018 RADEX ABDOMEN 1 VIEW	$102.00	$340.00	$21.12–$369.00	—	70%
X-ray of the ankle, 2 views both sides CPT 73600 XR ANKLE 2VW BILATERAL	$78.30	$261.00	$24.49–$628.00	—	70%
X-ray of the ankle, 2 views CPT 73600 X-RAY EXAM OF ANKLE	$50.70	$169.00	$24.49–$628.00	53% below	70%
X-ray of the ankle, 2 views one side CPT 73600 XR ANKLE 2 VIEWS LT	$50.70	$169.00	$24.49–$628.00	53% below	70%
X-ray of the ankle, 2 views one side CPT 73600 XR ANKLE 2 VIEWS RT	$50.70	$169.00	$24.49–$628.00	53% below	70%
X-ray of the ankle, 2 views inpatient both sides CPT 73600 XR ANKLE 2VW BILATERAL	$78.30	$261.00	$24.49–$628.00	—	70%
X-ray of the ankle, 2 views inpatient CPT 73600 X-RAY EXAM OF ANKLE	$50.70	$169.00	$24.49–$628.00	—	70%
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR ANKLE 2 VIEWS RT	$50.70	$169.00	$24.49–$628.00	—	70%
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR ANKLE 2 VIEWS LT	$50.70	$169.00	$24.49–$628.00	—	70%
X-ray of the finger(s), 2 or more views both sides CPT 73140 XR FINGER 2+VW BILATERAL	$78.30	$261.00	$30.11–$1,189.00	—	70%
X-ray of the finger(s), 2 or more views CPT 73140 X-RAY EXAM OF FINGER(S)	$45.30	$151.00	$30.11–$1,189.00	54% below	70%
X-ray of the finger(s), 2 or more views one side CPT 73140 FINGER(S) MIN 2 VIEWS RT	$45.30	$151.00	$30.11–$1,189.00	54% below	70%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER RT THUMB	$45.30	$151.00	$30.11–$1,189.00	54% below	70%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER RT	$45.30	$151.00	$30.11–$1,189.00	54% below	70%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER LT THUMB	$45.30	$151.00	$30.11–$1,189.00	54% below	70%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER LT	$45.30	$151.00	$30.11–$1,189.00	54% below	70%
X-ray of the finger(s), 2 or more views one side CPT 73140 FINGER(S) MIN 2 VIEWS LT	$45.30	$151.00	$30.11–$1,189.00	54% below	70%
X-ray of the finger(s), 2 or more views inpatient both sides CPT 73140 XR FINGER 2+VW BILATERAL	$78.30	$261.00	$30.11–$1,189.00	—	70%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 X-RAY EXAM OF FINGER(S)	$45.30	$151.00	$30.11–$1,189.00	—	70%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGER LT THUMB	$45.30	$151.00	$30.11–$1,189.00	—	70%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGER LT	$45.30	$151.00	$30.11–$1,189.00	—	70%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 FINGER(S) MIN 2 VIEWS RT	$45.30	$151.00	$30.11–$1,189.00	—	70%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 FINGER(S) MIN 2 VIEWS LT	$45.30	$151.00	$30.11–$1,189.00	—	70%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGER RT THUMB	$45.30	$151.00	$30.11–$1,189.00	—	70%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGER RT	$45.30	$151.00	$30.11–$1,189.00	—	70%
X-ray of the foot, 2 views both sides CPT 73620 XR FOOT 2VW BILATERAL	$78.30	$261.00	$21.12–$625.00	—	70%
X-ray of the foot, 2 views CPT 73620 X-RAY EXAM OF FOOT	$50.70	$169.00	$21.12–$625.00	53% below	70%
X-ray of the foot, 2 views one side CPT 73620 XR FOOT 2 VIEWS LT	$50.70	$169.00	$21.12–$625.00	53% below	70%
X-ray of the foot, 2 views one side CPT 73620 XR FOOT 2 VIEWS RT	$50.70	$169.00	$21.12–$625.00	53% below	70%
X-ray of the foot, 2 views inpatient both sides CPT 73620 XR FOOT 2VW BILATERAL	$78.30	$261.00	$21.12–$625.00	—	70%
X-ray of the foot, 2 views inpatient CPT 73620 X-RAY EXAM OF FOOT	$50.70	$169.00	$21.12–$625.00	—	70%
X-ray of the foot, 2 views inpatient one side CPT 73620 XR FOOT 2 VIEWS LT	$50.70	$169.00	$21.12–$625.00	—	70%
X-ray of the foot, 2 views inpatient one side CPT 73620 XR FOOT 2 VIEWS RT	$50.70	$169.00	$21.12–$625.00	—	70%
X-ray of the foot, complete, 3 or more views both sides CPT 73630 XR FOOT MIN 3V2 BILATERAL	$83.70	$279.00	$25.61–$609.00	—	70%
X-ray of the foot, complete, 3 or more views CPT 73630 X-RAY EXAM OF FOOT	$45.30	$151.00	$25.61–$609.00	63% below	70%
X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT MIN 3 VIEWS LT	$45.30	$151.00	$25.61–$609.00	63% below	70%
X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT MIN 3 VIEWS RT	$45.30	$151.00	$25.61–$609.00	63% below	70%
X-ray of the foot, complete, 3 or more views inpatient both sides CPT 73630 XR FOOT MIN 3V2 BILATERAL	$83.70	$279.00	$25.61–$609.00	—	70%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 X-RAY EXAM OF FOOT	$45.30	$151.00	$25.61–$609.00	—	70%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 FOOT MIN 3 VIEWS RT	$45.30	$151.00	$25.61–$609.00	—	70%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 FOOT MIN 3 VIEWS LT	$45.30	$151.00	$25.61–$609.00	—	70%
X-ray of the hand, 3 or more views both sides CPT 73130 XR HAND 3VW BILATERAL	$83.70	$279.00	$27.49–$645.00	—	70%
X-ray of the hand, 3 or more views CPT 73130 X-RAY EXAM OF HAND	$50.70	$169.00	$27.49–$645.00	60% below	70%
X-ray of the hand, 3 or more views one side CPT 73130 HAND MIN 3 VIEWS RT	$50.70	$169.00	$27.49–$645.00	60% below	70%
X-ray of the hand, 3 or more views one side CPT 73130 HAND MIN 3 VIEWS LT	$50.70	$169.00	$27.49–$645.00	60% below	70%
X-ray of the hand, 3 or more views inpatient both sides CPT 73130 XR HAND 3VW BILATERAL	$83.70	$279.00	$27.49–$645.00	—	70%
X-ray of the hand, 3 or more views inpatient CPT 73130 X-RAY EXAM OF HAND	$50.70	$169.00	$27.49–$645.00	—	70%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 HAND MIN 3 VIEWS LT	$50.70	$169.00	$27.49–$645.00	—	70%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 HAND MIN 3 VIEWS RT	$50.70	$169.00	$27.49–$645.00	—	70%
X-ray of the knee, 1 or 2 views both sides CPT 73560 XR KNEE 1-2 VIEWS BILAT	$45.30	$151.00	$26.36–$701.00	—	70%
X-ray of the knee, 1 or 2 views CPT 73560 X-RAY EXAM OF KNEE 1 OR 2	$33.00	$110.00	$26.36–$701.00	70% below	70%
X-ray of the knee, 1 or 2 views CPT 73560 XR PATELLA	$45.30	$151.00	$26.36–$701.00	59% below	70%
X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE 1-2 VIEWS RT	$33.00	$110.00	$26.36–$701.00	70% below	70%
X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE 1-2 VIEWS LT	$33.00	$110.00	$26.36–$701.00	70% below	70%
X-ray of the knee, 1 or 2 views one side CPT 73560 XR PATELLA RT	$45.30	$151.00	$26.36–$701.00	59% below	70%
X-ray of the knee, 1 or 2 views inpatient both sides CPT 73560 XR KNEE 1-2 VIEWS BILAT	$45.30	$151.00	$26.36–$701.00	—	70%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 X-RAY EXAM OF KNEE 1 OR 2	$33.00	$110.00	$26.36–$701.00	—	70%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 XR PATELLA	$45.30	$151.00	$26.36–$701.00	—	70%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 KNEE 1-2 VIEWS LT	$33.00	$110.00	$26.36–$701.00	—	70%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 KNEE 1-2 VIEWS RT	$33.00	$110.00	$26.36–$701.00	—	70%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR PATELLA RT	$45.30	$151.00	$26.36–$701.00	—	70%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 X-RAY EXAM L-S SPINE 2/3 VWS	$95.40	$318.00	$28.23–$353.00	37% below	70%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 LUMBOSACRAL 2-3 VIEWS	$95.40	$318.00	$28.23–$353.00	37% below	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	$95.40	$318.00	$28.23–$353.00	—	70%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 LUMBOSACRAL 2-3 VIEWS	$95.40	$318.00	$28.23–$353.00	—	70%
X-ray of the lower back, 4 or more views CPT 72110 X-RAY EXAM L-2 SPINE 4/>VWS	$95.40	$318.00	$37.22–$360.00	59% below	70%
X-ray of the lower back, 4 or more views CPT 72110 LUMBOSACRAL MIN 4 VIEW	$95.40	$318.00	$37.22–$360.00	59% below	70%
X-ray of the lower back, 4 or more views inpatient CPT 72110 LUMBOSACRAL MIN 4 VIEW	$95.40	$318.00	$37.22–$360.00	—	70%
X-ray of the lower back, 4 or more views inpatient CPT 72110 X-RAY EXAM L-2 SPINE 4/>VWS	$95.40	$318.00	$37.22–$360.00	—	70%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 THORACIC SPINE 2 VIEWS	$46.80	$156.00	$22.62–$281.74	74% below	70%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 THORACIC SPINE 2 VIEWS	$46.80	$156.00	$22.62–$281.74	—	70%
X-ray of the nasal bones, 3 or more views CPT 70160 NASAL BONE MIN 3 VIEWS	$63.60	$212.00	$28.98–$240.00	47% below	70%
X-ray of the nasal bones, 3 or more views CPT 70160 X-RAY EXAM OF NASAL BONES	$63.60	$212.00	$28.98–$240.00	47% below	70%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 NASAL BONE MIN 3 VIEWS	$63.60	$212.00	$28.98–$240.00	—	70%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 X-RAY EXAM OF NASAL BONES	$63.60	$212.00	$28.98–$240.00	—	70%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 CERVICAL SPINE 2-3 VIEWS	$106.20	$354.00	$28.23–$393.00	26% below	70%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 X-RAY EXAM NECK SPINE 2-3 VW	$106.20	$354.00	$28.23–$393.00	26% below	70%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 CERVICAL SPINE 2-3 VIEWS	$106.20	$354.00	$28.23–$393.00	—	70%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 X-RAY EXAM NECK SPINE 2-3 VW	$106.20	$354.00	$28.23–$393.00	—	70%
X-ray of the pelvis, 1 or 2 views CPT 72170 X-RAY EXAM OF PELVIS	$63.60	$212.00	$20.75–$281.74	56% below	70%
X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS 1-2 VIEWS	$63.60	$212.00	$20.75–$281.74	56% below	70%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PELVIS 1-2 VIEWS	$63.60	$212.00	$20.75–$281.74	—	70%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 X-RAY EXAM OF PELVIS	$63.60	$212.00	$20.75–$281.74	—	70%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 SACRUM &COCCYX MIN 2 VW	$66.00	$220.00	$23.74–$248.00	53% below	70%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 X-RAY EXAM SACRUM TAILBONE	$66.00	$220.00	$23.74–$248.00	53% below	70%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 X-RAY EXAM SACRUM TAILBONE	$66.00	$220.00	$23.74–$248.00	—	70%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 SACRUM &COCCYX MIN 2 VW	$66.00	$220.00	$23.74–$248.00	—	70%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Louisiana	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALT (SGPT)	$16.80	$56.00	$4.44–$56.00	46% below	70%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALANINE AMINO (ALT) (SGPT)	$16.80	$56.00	$4.44–$56.00	46% below	70%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALANINE AMINO (ALT) (SGPT)	$16.80	$56.00	$4.44–$56.00	—	70%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALT (SGPT)	$16.80	$56.00	$4.44–$56.00	—	70%
AST (aspartate aminotransferase) enzyme test CPT 84450 TRANSFERASE (AST) (SGOT)	$33.30	$111.00	$4.33–$111.00	1% above	70%
AST (aspartate aminotransferase) enzyme test CPT 84450 AST (SGOT)	$33.30	$111.00	$4.33–$111.00	1% above	70%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 AST (SGOT)	$33.30	$111.00	$4.33–$111.00	—	70%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 TRANSFERASE (AST) (SGOT)	$33.30	$111.00	$4.33–$111.00	—	70%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE EACH	$16.50	$55.00	$4.38–$55.00	64% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLG SPEC IGE CRUDE XTRC EA	$16.50	$55.00	$4.38–$55.00	64% above	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLG SPEC IGE CRUDE XTRC EA	$16.50	$55.00	$4.38–$55.00	—	70%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE EACH	$16.50	$55.00	$4.38–$55.00	—	70%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP AB	$33.90	$113.00	$10.85–$113.00	29% below	70%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP ANTIBODY	$33.90	$113.00	$10.85–$113.00	29% below	70%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CCP AB	$33.90	$113.00	$10.85–$113.00	—	70%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CCP ANTIBODY	$33.90	$113.00	$10.85–$113.00	—	70%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA W/REFLEX	$66.60	$222.00	$10.13–$552.00	27% above	70%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODIES	$99.00	$330.00	$10.13–$552.00	89% above	70%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA QUAL SCREEN	$99.00	$330.00	$10.13–$552.00	89% above	70%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA W/REFLEX	$66.60	$222.00	$10.13–$552.00	—	70%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA QUAL SCREEN	$99.00	$330.00	$10.13–$552.00	—	70%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR ANTIBODIES	$99.00	$330.00	$10.13–$552.00	—	70%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 ASSAY OF NATRIURETIC PEPTIDE	$33.00	$110.00	$28.46–$110.00	58% below	70%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NATRIURETIC PEPTIDE	$33.00	$110.00	$28.46–$110.00	58% below	70%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NATRIURETIC PEPTIDE	$33.00	$110.00	$28.46–$110.00	—	70%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 ASSAY OF NATRIURETIC PEPTIDE	$33.00	$110.00	$28.46–$110.00	—	70%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PNL TOTAL CA	$28.80	$96.00	$7.10–$96.00	53% below	70%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL	$28.80	$96.00	$7.10–$96.00	53% below	70%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PNL TOTAL CA	$28.80	$96.00	$7.10–$96.00	—	70%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL	$28.80	$96.00	$7.10–$96.00	—	70%
Blood culture for bacteria CPT 87040 BLOOD CULTURE FOR BACTERIA	$29.10	$97.00	$8.65–$97.00	60% below	70%
Blood culture for bacteria CPT 87040 CULTURE BLOOD	$29.10	$97.00	$8.65–$97.00	60% below	70%
Blood culture for bacteria inpatient CPT 87040 CULTURE BLOOD	$29.10	$97.00	$8.65–$97.00	—	70%
Blood culture for bacteria inpatient CPT 87040 BLOOD CULTURE FOR BACTERIA	$29.10	$97.00	$8.65–$97.00	—	70%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLL VENOUS BLD VENIPUNCTURE	$3.00	$10.00	$1.80–$20.00	65% below	70%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE	$3.00	$10.00	$1.80–$20.00	65% below	70%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENI-PUNCTURE SPECIMEN	$3.00	$10.00	$1.80–$20.00	65% below	70%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENI-PUNCTURE SPECIMEN	$3.00	$10.00	$1.80–$20.00	—	70%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE	$3.00	$10.00	$1.80–$20.00	—	70%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 COLL VENOUS BLD VENIPUNCTURE	$3.00	$10.00	$1.80–$20.00	—	70%
Blood glucose (sugar) test CPT 82947 GLUCOSE BLD QN	$19.80	$66.00	$3.29–$66.00	14% above	70%
Blood glucose (sugar) test CPT 82947 ASSAY GLUCOSE BLOOD QUANT	$19.80	$66.00	$3.29–$66.00	14% above	70%
Blood glucose (sugar) test inpatient CPT 82947 ASSAY GLUCOSE BLOOD QUANT	$19.80	$66.00	$3.29–$66.00	—	70%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE BLD QN	$19.80	$66.00	$3.29–$66.00	—	70%
Blood lead test CPT 83655 LEAD BLOOD	$21.60	$72.00	$10.15–$72.00	31% below	70%
Blood lead test CPT 83655 ASSAY OF LEAD	$21.60	$72.00	$10.15–$72.00	31% below	70%
Blood lead test inpatient CPT 83655 LEAD BLOOD	$21.60	$72.00	$10.15–$72.00	—	70%
Blood lead test inpatient CPT 83655 ASSAY OF LEAD	$21.60	$72.00	$10.15–$72.00	—	70%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HCG SERUM	$16.50	$55.00	$6.29–$55.00	70% below	70%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 CHORIONIC GONADOTROPIN ASSAY	$16.50	$55.00	$6.29–$55.00	70% below	70%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HCG SERUM	$16.50	$55.00	$6.29–$55.00	—	70%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 CHORIONIC GONADOTROPIN ASSAY	$16.50	$55.00	$6.29–$55.00	—	70%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABORH	$22.20	$74.00	$2.50–$74.00	53% below	70%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPING SEROLOGIC ABO	$22.20	$74.00	$2.50–$74.00	53% below	70%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABORH	$22.20	$74.00	$2.50–$74.00	—	70%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BLOOD TYPING SEROLOGIC ABO	$22.20	$74.00	$2.50–$74.00	—	70%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN	$41.70	$139.00	$4.34–$139.00	23% above	70%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN	$41.70	$139.00	$4.34–$139.00	—	70%
CA-125 blood test (ovarian cancer marker) CPT 86304 IMMUNOASSAY TUMOR CA 125	$72.30	$241.00	$17.44–$241.00	8% above	70%
CA-125 blood test (ovarian cancer marker) CPT 86304 CA 125	$72.30	$241.00	$17.44–$241.00	8% above	70%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 IMMUNOASSAY TUMOR CA 125	$72.30	$241.00	$17.44–$241.00	—	70%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA 125	$72.30	$241.00	$17.44–$241.00	—	70%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA, TMA, SWAB	$44.10	$147.00	$29.42–$294.00	21% below	70%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLMYD TRACH DNA AMP PROBE	$44.10	$147.00	$29.42–$294.00	21% below	70%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA T AMP PROBE	$44.10	$147.00	$29.42–$294.00	21% below	70%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLMYD TRACH DNA AMP PROBE	$44.10	$147.00	$29.42–$294.00	—	70%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA, TMA, SWAB	$44.10	$147.00	$29.42–$294.00	—	70%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA T AMP PROBE	$44.10	$147.00	$29.42–$294.00	—	70%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL	$27.00	$90.00	$11.23–$90.00	62% below	70%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL	$27.00	$90.00	$11.23–$90.00	—	70%
Complete blood count (CBC) with differential CPT 85025 COMPLETE CBC W/AUTO DIFF WBC	$16.50	$55.00	$6.52–$143.00	57% below	70%
Complete blood count (CBC) with differential CPT 85025 CBC AUTO DIFF	$16.50	$55.00	$6.52–$143.00	57% below	70%
Complete blood count (CBC) with differential CPT 85025 CBC WITH MAN DIFF	$26.40	$88.00	$6.52–$143.00	31% below	70%
Complete blood count (CBC) with differential inpatient CPT 85025 COMPLETE CBC W/AUTO DIFF WBC	$16.50	$55.00	$6.52–$143.00	—	70%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC AUTO DIFF	$16.50	$55.00	$6.52–$143.00	—	70%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC WITH MAN DIFF	$26.40	$88.00	$6.52–$143.00	—	70%
Comprehensive metabolic panel (blood test) CPT 80053 COMPREHEN METABOLIC PANEL	$34.20	$114.00	$8.86–$114.00	70% below	70%
Comprehensive metabolic panel (blood test) CPT 80053 COMP METABOLIC PANEL	$34.20	$114.00	$8.86–$114.00	70% below	70%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHEN METABOLIC PANEL	$34.20	$114.00	$8.86–$114.00	—	70%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMP METABOLIC PANEL	$34.20	$114.00	$8.86–$114.00	—	70%
D-dimer blood test (blood clot marker) CPT 85379 FIBRIN DEGRADATION QUANT	$21.00	$70.00	$8.53–$70.00	71% below	70%
D-dimer blood test (blood clot marker) CPT 85379 D-DIMER QUANT	$21.00	$70.00	$8.53–$70.00	71% below	70%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-DIMER QUANT	$21.00	$70.00	$8.53–$70.00	—	70%
D-dimer blood test (blood clot marker) inpatient CPT 85379 FIBRIN DEGRADATION QUANT	$21.00	$70.00	$8.53–$70.00	—	70%
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA SULFATE	$24.90	$83.00	$18.64–$83.00	60% below	70%
DHEA sulfate (DHEA-S) blood test CPT 82627 DEHYDROEPIANDROSTERONE	$24.90	$83.00	$18.64–$83.00	60% below	70%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA SULFATE	$24.90	$83.00	$18.64–$83.00	—	70%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DEHYDROEPIANDROSTERONE	$24.90	$83.00	$18.64–$83.00	—	70%
Estradiol blood test CPT 82670 ESTRADIOL	$67.80	$226.00	$23.42–$226.00	14% below	70%
Estradiol blood test CPT 82670 ASSAY OF TOTAL ESTRADIOL	$67.80	$226.00	$23.42–$226.00	14% below	70%
Estradiol blood test inpatient CPT 82670 ASSAY OF TOTAL ESTRADIOL	$67.80	$226.00	$23.42–$226.00	—	70%
Estradiol blood test inpatient CPT 82670 ESTRADIOL	$67.80	$226.00	$23.42–$226.00	—	70%
FSH (follicle-stimulating hormone) test CPT 83001 ASSAY OF GONADOTROPIN (FSH)	$31.50	$105.00	$15.58–$105.00	50% below	70%
FSH (follicle-stimulating hormone) test CPT 83001 FSH	$31.50	$105.00	$15.58–$105.00	50% below	70%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 ASSAY OF GONADOTROPIN (FSH)	$31.50	$105.00	$15.58–$105.00	—	70%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH	$31.50	$105.00	$15.58–$105.00	—	70%
Fecal calprotectin (stool inflammation test) CPT 83993 ASSAY FOR CALPROTECTIN FECAL	$171.60	$572.00	$16.45–$572.00	30% above	70%
Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN FECAL	$171.60	$572.00	$16.45–$572.00	30% above	70%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 ASSAY FOR CALPROTECTIN FECAL	$171.60	$572.00	$16.45–$572.00	—	70%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CALPROTECTIN FECAL	$171.60	$572.00	$16.45–$572.00	—	70%
Ferritin blood test (iron stores) CPT 82728 FERRITIN	$26.40	$88.00	$11.42–$88.00	52% below	70%
Ferritin blood test (iron stores) CPT 82728 ASSAY OF FERRITIN	$26.40	$88.00	$11.42–$88.00	52% below	70%
Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN	$26.40	$88.00	$11.42–$88.00	—	70%
Ferritin blood test (iron stores) inpatient CPT 82728 ASSAY OF FERRITIN	$26.40	$88.00	$11.42–$88.00	—	70%
Folate (folic acid) blood test CPT 82746 FOLIC ACID	$26.40	$88.00	$12.32–$88.00	44% below	70%
Folate (folic acid) blood test CPT 82746 ASSAY OF FOLIC ACID SERUM	$26.40	$88.00	$12.32–$88.00	44% below	70%
Folate (folic acid) blood test inpatient CPT 82746 ASSAY OF FOLIC ACID SERUM	$26.40	$88.00	$12.32–$88.00	—	70%
Folate (folic acid) blood test inpatient CPT 82746 FOLIC ACID	$26.40	$88.00	$12.32–$88.00	—	70%
Free T3 thyroid hormone test CPT 84481 T3 FREE	$29.40	$98.00	$13.43–$98.00	47% below	70%
Free T3 thyroid hormone test CPT 84481 FREE ASSAY (FT-3)	$29.40	$98.00	$13.43–$98.00	47% below	70%
Free T3 thyroid hormone test inpatient CPT 84481 FREE ASSAY (FT-3)	$29.40	$98.00	$13.43–$98.00	—	70%
Free T3 thyroid hormone test inpatient CPT 84481 T3 FREE	$29.40	$98.00	$13.43–$98.00	—	70%
Free T4 (free thyroxine) thyroid blood test CPT 84439 T4 FREE	$36.60	$122.00	$7.56–$122.00	37% below	70%
Free T4 (free thyroxine) thyroid blood test CPT 84439 ASSAY OF FREE THYROXINE	$36.60	$122.00	$7.56–$122.00	37% below	70%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4 FREE	$36.60	$122.00	$7.56–$122.00	—	70%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 ASSAY OF FREE THYROXINE	$36.60	$122.00	$7.56–$122.00	—	70%
Free testosterone test CPT 84402 ASSAY OF FREE TESTOSTERONE	$31.50	$105.00	$21.34–$105.00	57% below	70%
Free testosterone test CPT 84402 TESTOSTERONE FREE	$31.50	$105.00	$21.34–$105.00	57% below	70%
Free testosterone test inpatient CPT 84402 ASSAY OF FREE TESTOSTERONE	$31.50	$105.00	$21.34–$105.00	—	70%
Free testosterone test inpatient CPT 84402 TESTOSTERONE FREE	$31.50	$105.00	$21.34–$105.00	—	70%
Glucose tolerance test, 3 samples CPT 82951 GTT 1ST 3 SPECIMENS	$31.50	$105.00	$10.79–$105.00	32% below	70%
Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE TEST (GTT)	$31.50	$105.00	$10.79–$105.00	32% below	70%
Glucose tolerance test, 3 samples inpatient CPT 82951 GTT 1ST 3 SPECIMENS	$31.50	$105.00	$10.79–$105.00	—	70%
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOLERANCE TEST (GTT)	$31.50	$105.00	$10.79–$105.00	—	70%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GONORRHEA, TMA, SIMPLESWAB	$45.00	$150.00	$29.42–$373.00	15% below	70%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 N.GONORRHOEAE DNA AMP PROB	$66.90	$223.00	$29.42–$373.00	27% above	70%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GC AMP PROBE	$66.90	$223.00	$29.42–$373.00	27% above	70%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 GONORRHEA, TMA, SIMPLESWAB	$45.00	$150.00	$29.42–$373.00	—	70%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 GC AMP PROBE	$66.90	$223.00	$29.42–$373.00	—	70%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 N.GONORRHOEAE DNA AMP PROB	$66.90	$223.00	$29.42–$373.00	—	70%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV 1/2 4TH GEN, RFLX CONF	$49.50	$165.00	$20.47–$165.00	at median	70%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV-1 AG W/HIV-1&-2 AB AG IA	$49.50	$165.00	$20.47–$165.00	at median	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	$49.50	$165.00	$20.47–$165.00	—	70%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV 1/2 4TH GEN, RFLX CONF	$49.50	$165.00	$20.47–$165.00	—	70%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN GLYCOSYLATED A1C	$28.50	$95.00	$8.14–$95.00	42% below	70%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN A1C	$28.50	$95.00	$8.14–$95.00	42% below	70%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HEMOGLOBIN A1C	$28.50	$95.00	$8.14–$95.00	—	70%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HEMOGLOBIN GLYCOSYLATED A1C	$28.50	$95.00	$8.14–$95.00	—	70%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HB S AB QUAL	$45.90	$153.00	$9.01–$306.00	14% above	70%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURFACE AB	$45.90	$153.00	$9.01–$306.00	14% above	70%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEP B SURFACE ANTIBODY	$45.90	$153.00	$9.01–$306.00	14% above	70%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEP B SURFACE ANTIBODY	$45.90	$153.00	$9.01–$306.00	—	70%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B SURFACE AB	$45.90	$153.00	$9.01–$306.00	—	70%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HB S AB QUAL	$45.90	$153.00	$9.01–$306.00	—	70%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURFACE AG IA	$45.90	$153.00	$8.66–$153.00	6% above	70%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEP B S AG EIA	$45.90	$153.00	$8.66–$153.00	6% above	70%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS B SURFACE AG IA	$45.90	$153.00	$8.66–$153.00	—	70%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEP B S AG EIA	$45.90	$153.00	$8.66–$153.00	—	70%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C REFLEX QNT	$99.90	$333.00	$11.96–$666.00	95% above	70%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C AB TEST	$99.90	$333.00	$11.96–$666.00	95% above	70%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C AB QUAL	$99.90	$333.00	$11.96–$666.00	95% above	70%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C AB TEST	$99.90	$333.00	$11.96–$666.00	—	70%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C REFLEX QNT	$99.90	$333.00	$11.96–$666.00	—	70%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C AB QUAL	$99.90	$333.00	$11.96–$666.00	—	70%
Hepatitis C viral load (HCV RNA) test CPT 87522 HEPATITIS C REVRS TRNSCRPJ	$97.80	$326.00	$35.91–$326.00	41% below	70%
Hepatitis C viral load (HCV RNA) test CPT 87522 HCV RNA, PCR QUAL/QUANT	$97.80	$326.00	$35.91–$326.00	41% below	70%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HCV RNA, PCR QUAL/QUANT	$97.80	$326.00	$35.91–$326.00	—	70%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEPATITIS C REVRS TRNSCRPJ	$97.80	$326.00	$35.91–$326.00	—	70%
Herpes blood test, HSV-2 antibody CPT 86696 HERPES SIMPLEX 2 AB IGG	$72.30	$241.00	$16.23–$241.00	61% above	70%
Herpes blood test, HSV-2 antibody CPT 86696 HERPES SIMPLEX TYPE 2 TEST	$72.30	$241.00	$16.23–$241.00	61% above	70%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HERPES SIMPLEX TYPE 2 TEST	$72.30	$241.00	$16.23–$241.00	—	70%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HERPES SIMPLEX 2 AB IGG	$72.30	$241.00	$16.23–$241.00	—	70%
High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROTEIN HS	$41.70	$139.00	$10.85–$139.00	6% below	70%
High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROTEIN(CRP)HIGH SENSITIVITY	$41.70	$139.00	$10.85–$139.00	6% below	70%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-REACTIVE PROTEIN HS	$41.70	$139.00	$10.85–$139.00	—	70%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-REACTIVE PROTEIN(CRP)HIGH SENSITIVITY	$41.70	$139.00	$10.85–$139.00	—	70%
Homocysteine blood test CPT 83090 HOMOCYSTEINE QN	$102.00	$340.00	$14.14–$340.00	79% above	70%
Homocysteine blood test CPT 83090 ASSAY OF HOMOCYSTEINE	$102.00	$340.00	$14.14–$340.00	79% above	70%
Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINE QN	$102.00	$340.00	$14.14–$340.00	—	70%
Homocysteine blood test inpatient CPT 83090 ASSAY OF HOMOCYSTEINE	$102.00	$340.00	$14.14–$340.00	—	70%
Insulin blood test CPT 83525 INSULIN	$23.40	$78.00	$9.59–$156.00	44% below	70%
Insulin blood test CPT 83525 INSULIN TOTAL	$23.40	$78.00	$9.59–$156.00	44% below	70%
Insulin blood test CPT 83525 ASSAY OF INSULIN	$23.40	$78.00	$9.59–$156.00	44% below	70%
Insulin blood test inpatient CPT 83525 ASSAY OF INSULIN	$23.40	$78.00	$9.59–$156.00	—	70%
Insulin blood test inpatient CPT 83525 INSULIN	$23.40	$78.00	$9.59–$156.00	—	70%
Insulin blood test inpatient CPT 83525 INSULIN TOTAL	$23.40	$78.00	$9.59–$156.00	—	70%
Iron blood test (serum iron) CPT 83540 IRON	$39.00	$130.00	$5.43–$130.00	13% above	70%
Iron blood test (serum iron) CPT 83540 ASSAY OF IRON	$39.00	$130.00	$5.43–$130.00	13% above	70%
Iron blood test (serum iron) inpatient CPT 83540 ASSAY OF IRON	$39.00	$130.00	$5.43–$130.00	—	70%
Iron blood test (serum iron) inpatient CPT 83540 IRON	$39.00	$130.00	$5.43–$130.00	—	70%
Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING TEST	$19.80	$66.00	$7.33–$226.00	55% below	70%
Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING (TIBC)	$19.80	$66.00	$7.33–$226.00	55% below	70%
Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING CAPACITY	$48.00	$160.00	$7.33–$226.00	8% above	70%
Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BINDING TEST	$19.80	$66.00	$7.33–$226.00	—	70%
Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BINDING (TIBC)	$19.80	$66.00	$7.33–$226.00	—	70%
Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BINDING CAPACITY	$48.00	$160.00	$7.33–$226.00	—	70%
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL	$31.80	$106.00	$7.28–$106.00	61% below	70%
Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL	$31.80	$106.00	$7.28–$106.00	—	70%
LH (luteinizing hormone) test CPT 83002 ASSAY OF GONADOTROPIN (LH)	$31.50	$105.00	$15.53–$105.00	48% below	70%
LH (luteinizing hormone) test CPT 83002 LH	$31.50	$105.00	$15.53–$105.00	48% below	70%
LH (luteinizing hormone) test inpatient CPT 83002 ASSAY OF GONADOTROPIN (LH)	$31.50	$105.00	$15.53–$105.00	—	70%
LH (luteinizing hormone) test inpatient CPT 83002 LH	$31.50	$105.00	$15.53–$105.00	—	70%
Lipase blood test (pancreas enzyme) CPT 83690 ASSAY OF LIPASE	$43.50	$145.00	$5.77–$145.00	4% above	70%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE	$43.50	$145.00	$5.77–$145.00	4% above	70%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE	$43.50	$145.00	$5.77–$145.00	—	70%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 ASSAY OF LIPASE	$43.50	$145.00	$5.77–$145.00	—	70%
Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL	$35.40	$118.00	$6.85–$118.00	58% below	70%
Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL	$35.40	$118.00	$6.85–$118.00	—	70%
Lyme disease antibody test CPT 86618 LYME DISEASE ANTIBODY	$16.50	$55.00	$14.28–$55.00	67% below	70%
Lyme disease antibody test CPT 86618 LYME AB REFLEX IB	$16.50	$55.00	$14.28–$55.00	67% below	70%
Lyme disease antibody test inpatient CPT 86618 LYME AB REFLEX IB	$16.50	$55.00	$14.28–$55.00	—	70%
Lyme disease antibody test inpatient CPT 86618 LYME DISEASE ANTIBODY	$16.50	$55.00	$14.28–$55.00	—	70%
Magnesium blood test CPT 83735 MAGNESIUM BLD	$15.90	$53.00	$5.62–$53.00	42% below	70%
Magnesium blood test CPT 83735 ASSAY OF MAGNESIUM	$15.90	$53.00	$5.62–$53.00	42% below	70%
Magnesium blood test inpatient CPT 83735 ASSAY OF MAGNESIUM	$15.90	$53.00	$5.62–$53.00	—	70%
Magnesium blood test inpatient CPT 83735 MAGNESIUM BLD	$15.90	$53.00	$5.62–$53.00	—	70%
Measles (rubeola) antibody test CPT 86765 RUBEOLA ANTIBODY	$43.20	$144.00	$10.80–$144.00	16% above	70%
Measles (rubeola) antibody test CPT 86765 RUBEOLA IGM ANTIBODY	$43.20	$144.00	$10.80–$144.00	16% above	70%
Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA ANTIBODY	$43.20	$144.00	$10.80–$144.00	—	70%
Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA IGM ANTIBODY	$43.20	$144.00	$10.80–$144.00	—	70%
Mono test (heterophile antibody, Monospot) CPT 86308 MONO SCR (HETEROPHILE)	$18.60	$62.00	$4.34–$62.00	49% below	70%
Mono test (heterophile antibody, Monospot) CPT 86308 HETEROPHILE ANTIBODY SCREEN	$18.60	$62.00	$4.34–$62.00	49% below	70%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HETEROPHILE ANTIBODY SCREEN	$18.60	$62.00	$4.34–$62.00	—	70%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONO SCR (HETEROPHILE)	$18.60	$62.00	$4.34–$62.00	—	70%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA TOTAL AND FREE	$71.10	$237.00	$15.42–$237.00	23% above	70%
PSA (prostate-specific antigen) blood test, free CPT 84154 ASSAY OF PSA FREE	$71.10	$237.00	$15.42–$237.00	23% above	70%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 ASSAY OF PSA FREE	$71.10	$237.00	$15.42–$237.00	—	70%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA TOTAL AND FREE	$71.10	$237.00	$15.42–$237.00	—	70%
PSA (prostate-specific antigen) blood test, total CPT 84153 PROS SPEC AG (PSA)	$34.80	$116.00	$15.42–$116.00	39% below	70%
PSA (prostate-specific antigen) blood test, total CPT 84153 ASSAY OF PSA TOTAL	$34.80	$116.00	$15.42–$116.00	39% below	70%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROS SPEC AG (PSA)	$34.80	$116.00	$15.42–$116.00	—	70%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 ASSAY OF PSA TOTAL	$34.80	$116.00	$15.42–$116.00	—	70%
Parathyroid hormone (PTH) blood test CPT 83970 PTH INTACT	$33.00	$110.00	$33.00–$110.00	70% below	70%
Parathyroid hormone (PTH) blood test CPT 83970 ASSAY OF PARATHORMONE	$33.00	$110.00	$33.00–$110.00	70% below	70%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 ASSAY OF PARATHORMONE	$33.00	$110.00	$33.00–$110.00	—	70%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH INTACT	$33.00	$110.00	$33.00–$110.00	—	70%
Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PARTIAL	$31.50	$105.00	$5.03–$105.00	5% below	70%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT	$31.50	$105.00	$5.03–$105.00	5% below	70%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME PARTIAL	$31.50	$105.00	$5.03–$105.00	—	70%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT	$31.50	$105.00	$5.03–$105.00	—	70%
Progesterone blood test CPT 84144 ASSAY OF PROGESTERONE	$66.30	$221.00	$17.49–$221.00	8% below	70%
Progesterone blood test CPT 84144 PROGESTERONE	$66.30	$221.00	$17.49–$221.00	8% below	70%
Progesterone blood test inpatient CPT 84144 ASSAY OF PROGESTERONE	$66.30	$221.00	$17.49–$221.00	—	70%
Progesterone blood test inpatient CPT 84144 PROGESTERONE	$66.30	$221.00	$17.49–$221.00	—	70%
Prolactin blood test CPT 84146 ASSAY OF PROLACTIN	$89.40	$298.00	$16.25–$298.00	17% above	70%
Prolactin blood test CPT 84146 PROLACTIN	$89.40	$298.00	$16.25–$298.00	17% above	70%
Prolactin blood test inpatient CPT 84146 ASSAY OF PROLACTIN	$89.40	$298.00	$16.25–$298.00	—	70%
Prolactin blood test inpatient CPT 84146 PROLACTIN	$89.40	$298.00	$16.25–$298.00	—	70%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME	$19.80	$66.00	$3.29–$66.00	4% below	70%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTIME	$19.80	$66.00	$3.29–$66.00	4% below	70%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME	$19.80	$66.00	$3.29–$66.00	—	70%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTIME	$19.80	$66.00	$3.29–$66.00	—	70%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA ASSAY W/OPTIC	$81.90	$273.00	$10.06–$273.00	129% above	70%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA VIRUS A AG OIA	$81.90	$273.00	$10.06–$273.00	129% above	70%
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA VIRUS A AG OIA	$81.90	$273.00	$10.06–$273.00	—	70%
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA ASSAY W/OPTIC	$81.90	$273.00	$10.06–$273.00	—	70%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREP A OPTICAL IA	$21.60	$72.00	$10.06–$72.00	22% below	70%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREP A ASSAY W/OPTIC	$21.60	$72.00	$10.06–$72.00	22% below	70%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 STREP A OPTICAL IA	$21.60	$72.00	$10.06–$72.00	—	70%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 STREP A ASSAY W/OPTIC	$21.60	$72.00	$10.06–$72.00	—	70%
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANT	$22.80	$76.00	$4.76–$76.00	16% below	70%
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR, QUANT	$22.80	$76.00	$4.76–$76.00	16% below	70%
Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR, QUANT	$22.80	$76.00	$4.76–$76.00	—	70%
Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR QUANT	$22.80	$76.00	$4.76–$76.00	—	70%
Rubella antibody test (immunity check) CPT 86762 RUBELLA IGG	$43.20	$144.00	$12.07–$288.00	14% above	70%
Rubella antibody test (immunity check) CPT 86762 RUBELLA ANTIBODY	$43.20	$144.00	$12.07–$288.00	14% above	70%
Rubella antibody test (immunity check) CPT 86762 RUBELLA IGM ANTIBODY	$43.20	$144.00	$12.07–$288.00	14% above	70%
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA IGM ANTIBODY	$43.20	$144.00	$12.07–$288.00	—	70%
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA ANTIBODY	$43.20	$144.00	$12.07–$288.00	—	70%
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA IGG	$43.20	$144.00	$12.07–$288.00	—	70%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 SYPHILIS TEST NON-TREP QUAL	$19.80	$66.00	$3.58–$176.00	1% below	70%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR QUAL	$19.80	$66.00	$3.58–$176.00	1% below	70%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR REFLEX TO T. PALLIDUM - PA	$33.00	$110.00	$3.58–$176.00	66% above	70%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR QUAL	$19.80	$66.00	$3.58–$176.00	—	70%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 SYPHILIS TEST NON-TREP QUAL	$19.80	$66.00	$3.58–$176.00	—	70%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR REFLEX TO T. PALLIDUM - PA	$33.00	$110.00	$3.58–$176.00	—	70%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB TEST CELL IMMUN MEASURE	$33.00	$110.00	$33.00–$155.80	71% below	70%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QUANTIFERON TB GOLD	$33.00	$110.00	$33.00–$155.80	71% below	70%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 TB TEST CELL IMMUN MEASURE	$33.00	$110.00	$33.00–$155.80	—	70%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 QUANTIFERON TB GOLD	$33.00	$110.00	$33.00–$155.80	—	70%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE	$33.00	$110.00	$21.65–$220.00	52% below	70%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TOTAL	$33.00	$110.00	$21.65–$220.00	52% below	70%
Testosterone blood test, total (not free testosterone) CPT 84403 ASSAY OF TOTAL TESTOSTERONE	$33.00	$110.00	$21.65–$220.00	52% below	70%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE TOTAL	$33.00	$110.00	$21.65–$220.00	—	70%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 ASSAY OF TOTAL TESTOSTERONE	$33.00	$110.00	$21.65–$220.00	—	70%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE	$33.00	$110.00	$21.65–$220.00	—	70%
Thyroid peroxidase (TPO) antibody test CPT 86376 MICROSOMAL ANTIBODY EACH	$36.00	$120.00	$12.20–$276.00	19% below	70%
Thyroid peroxidase (TPO) antibody test CPT 86376 LKM MICROSOME AB	$36.00	$120.00	$12.20–$276.00	19% below	70%
Thyroid peroxidase (TPO) antibody test CPT 86376 THYROID PEROXIDASE AB	$46.80	$156.00	$12.20–$276.00	5% above	70%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 MICROSOMAL ANTIBODY EACH	$36.00	$120.00	$12.20–$276.00	—	70%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 LKM MICROSOME AB	$36.00	$120.00	$12.20–$276.00	—	70%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 THYROID PEROXIDASE AB	$46.80	$156.00	$12.20–$276.00	—	70%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH	$27.60	$92.00	$14.08–$92.00	42% below	70%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 ASSAY THYROID STIM HORMONE	$27.60	$92.00	$14.08–$92.00	42% below	70%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 ASSAY THYROID STIM HORMONE	$27.60	$92.00	$14.08–$92.00	—	70%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH	$27.60	$92.00	$14.08–$92.00	—	70%
Trichomonas test (NAAT) CPT 87661 TRICHOMONAS, SWAB, AMP	$16.50	$55.00	$28.72–$349.00	72% below	70%
Trichomonas test (NAAT) CPT 87661 TRICHOMONAS, VAG SWAB, AMP	$44.10	$147.00	$28.72–$349.00	25% below	70%
Trichomonas test (NAAT) CPT 87661 TRICHOMONAS, URINE, AMP	$44.10	$147.00	$28.72–$349.00	25% below	70%
Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS AMPLIF	$44.10	$147.00	$28.72–$349.00	25% below	70%
Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS, SWAB, AMP	$16.50	$55.00	$28.72–$349.00	—	70%
Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS, VAG SWAB, AMP	$44.10	$147.00	$28.72–$349.00	—	70%
Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS, URINE, AMP	$44.10	$147.00	$28.72–$349.00	—	70%
Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS VAGINALIS AMPLIF	$44.10	$147.00	$28.72–$349.00	—	70%
Uric acid blood test CPT 84550 ASSAY OF BLOOD/URIC ACID	$9.00	$30.00	$3.79–$30.00	66% below	70%
Uric acid blood test CPT 84550 URIC ACID BLD	$9.00	$30.00	$3.79–$30.00	66% below	70%
Uric acid blood test inpatient CPT 84550 ASSAY OF BLOOD/URIC ACID	$9.00	$30.00	$3.79–$30.00	—	70%
Uric acid blood test inpatient CPT 84550 URIC ACID BLD	$9.00	$30.00	$3.79–$30.00	—	70%
Urinalysis with microscope exam, automated CPT 81001 UA W MICROSCOPIC AUTO	$9.90	$33.00	$2.66–$33.00	80% below	70%
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS AUTO W/SCOPE	$9.90	$33.00	$2.66–$33.00	80% below	70%
Urinalysis with microscope exam, automated inpatient CPT 81001 UA W MICROSCOPIC AUTO	$9.90	$33.00	$2.66–$33.00	—	70%
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS AUTO W/SCOPE	$9.90	$33.00	$2.66–$33.00	—	70%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS AUTO W/O SCOPE	$9.90	$33.00	$1.88–$66.00	at median	70%
Urinalysis without microscope exam, automated CPT 81003 PH UR AUTO	$9.90	$33.00	$1.88–$66.00	at median	70%
Urinalysis without microscope exam, automated CPT 81003 UA W O MICRO AUTO	$9.90	$33.00	$1.88–$66.00	at median	70%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS AUTO W/O SCOPE	$9.90	$33.00	$1.88–$66.00	—	70%
Urinalysis without microscope exam, automated inpatient CPT 81003 UA W O MICRO AUTO	$9.90	$33.00	$1.88–$66.00	—	70%
Urinalysis without microscope exam, automated inpatient CPT 81003 PH UR AUTO	$9.90	$33.00	$1.88–$66.00	—	70%
Urinalysis without microscope exam, manual CPT 81002 UA W O MICRO MANUAL	$13.20	$44.00	$2.14–$44.00	78% above	70%
Urinalysis without microscope exam, manual CPT 81002 URINALYSIS NONAUTO W/O SCOPE	$13.20	$44.00	$2.14–$44.00	78% above	70%
Urinalysis without microscope exam, manual inpatient CPT 81002 URINALYSIS NONAUTO W/O SCOPE	$13.20	$44.00	$2.14–$44.00	—	70%
Urinalysis without microscope exam, manual inpatient CPT 81002 UA W O MICRO MANUAL	$13.20	$44.00	$2.14–$44.00	—	70%
Urine culture for bacteria, with colony count CPT 87086 CULT COLONY COUNT UR	$19.80	$66.00	$6.77–$66.00	63% below	70%
Urine culture for bacteria, with colony count CPT 87086 URINE CULTURE/COLONY COUNT	$19.80	$66.00	$6.77–$66.00	63% below	70%
Urine culture for bacteria, with colony count inpatient CPT 87086 CULT COLONY COUNT UR	$19.80	$66.00	$6.77–$66.00	—	70%
Urine culture for bacteria, with colony count inpatient CPT 87086 URINE CULTURE/COLONY COUNT	$19.80	$66.00	$6.77–$66.00	—	70%
Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY TEST	$16.50	$55.00	$5.30–$55.00	24% below	70%
Urine pregnancy test, read by color change CPT 81025 PREG URINE QUAL	$16.50	$55.00	$5.30–$55.00	24% below	70%
Urine pregnancy test, read by color change inpatient CPT 81025 PREG URINE QUAL	$16.50	$55.00	$5.30–$55.00	—	70%
Urine pregnancy test, read by color change inpatient CPT 81025 URINE PREGNANCY TEST	$16.50	$55.00	$5.30–$55.00	—	70%
Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B12	$33.60	$112.00	$12.64–$112.00	39% below	70%
Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B-12	$33.60	$112.00	$12.64–$112.00	39% below	70%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B12	$33.60	$112.00	$12.64–$112.00	—	70%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B-12	$33.60	$112.00	$12.64–$112.00	—	70%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25 HYDROXY	$32.70	$109.00	$24.82–$109.00	68% below	70%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D3 25-OH	$32.70	$109.00	$24.82–$109.00	68% below	70%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D 25 HYDROXY	$32.70	$109.00	$24.82–$109.00	—	70%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D3 25-OH	$32.70	$109.00	$24.82–$109.00	—	70%
Zinc blood test CPT 84630 ZINC BLOOD	$51.60	$172.00	$9.55–$172.00	25% above	70%
Zinc blood test CPT 84630 ASSAY OF ZINC	$51.60	$172.00	$9.55–$172.00	25% above	70%
Zinc blood test inpatient CPT 84630 ASSAY OF ZINC	$51.60	$172.00	$9.55–$172.00	—	70%
Zinc blood test inpatient CPT 84630 ZINC BLOOD	$51.60	$172.00	$9.55–$172.00	—	70%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG BETA QUANTITATIVE	$69.30	$231.00	$12.62–$231.00	1% above	70%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 CHORIONIC GONADOTROPIN TEST	$69.30	$231.00	$12.62–$231.00	1% above	70%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCG BETA QUANTITATIVE	$69.30	$231.00	$12.62–$231.00	—	70%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 CHORIONIC GONADOTROPIN TEST	$69.30	$231.00	$12.62–$231.00	—	70%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Louisiana	Off list
Appendectomy, open surgery CPT 44950 APPENDECTOMY PROFEE	$546.60	$1,822.00	$398.67–$7,815.95	65% below	70%
Appendectomy, open surgery CPT 44950 APPENDECTOMY	$546.60	$1,822.00	$398.67–$7,815.95	65% below	70%
Appendectomy, open surgery inpatient CPT 44950 APPENDECTOMY	$546.60	$1,822.00	$398.67–$7,815.95	—	70%
Appendectomy, open surgery inpatient CPT 44950 APPENDECTOMY PROFEE	$546.60	$1,822.00	$398.67–$7,815.95	—	70%
Bunion correction with a bone cut near the head of the first metatarsal CPT 28296 CORRECTION HLX VLG DSTL MTAR OSTEO	$433.95	$1,446.50	$433.95–$6,881.13	84% below	70%
Bunion correction with a bone cut near the head of the first metatarsal CPT 28296 COR HLX VLGS DSTL MTAR OSTEO	$433.95	$1,446.50	$433.95–$6,881.13	84% below	70%
Bunion correction with a bone cut near the head of the first metatarsal inpatient CPT 28296 CORRECTION HLX VLG DSTL MTAR OSTEO	$433.95	$1,446.50	$433.95–$6,881.13	—	70%
Bunion correction with a bone cut near the head of the first metatarsal inpatient CPT 28296 COR HLX VLGS DSTL MTAR OSTEO	$433.95	$1,446.50	$433.95–$6,881.13	—	70%
Bunion correction with removal of part of the big toe joint CPT 28292 COR HLX VLGS RSC PRX PHLX BS	$393.11	$1,310.37	$393.11–$6,881.13	84% below	70%
Bunion correction with removal of part of the big toe joint inpatient CPT 28292 COR HLX VLGS RSC PRX PHLX BS	$393.11	$1,310.37	$393.11–$6,881.13	—	70%
Colonoscopy with polyp removal CPT 45385 COLONOSCOPY W/LESION REMOVAL	$370.80	$1,236.00	$331.45–$2,524.31	61% below	70%
Colonoscopy with polyp removal CPT 45385 COLONOSCOPY RML LESI	$370.80	$1,236.00	$331.45–$2,524.31	61% below	70%
Colonoscopy with polyp removal inpatient CPT 45385 COLONOSCOPY RML LESI	$370.80	$1,236.00	$331.45–$2,524.31	—	70%
Colonoscopy with polyp removal inpatient CPT 45385 COLONOSCOPY W/LESION REMOVAL	$370.80	$1,236.00	$331.45–$2,524.31	—	70%
Colonoscopy with tissue sample CPT 45380 COLONOSCOPY AND BIOPSY	$351.30	$1,171.00	$293.02–$2,524.31	61% below	70%
Colonoscopy with tissue sample CPT 45380 PRO FEE COLONOSCOPY	$351.30	$1,171.00	$293.02–$2,524.31	61% below	70%
Colonoscopy with tissue sample inpatient CPT 45380 PRO FEE COLONOSCOPY	$351.30	$1,171.00	$293.02–$2,524.31	—	70%
Colonoscopy with tissue sample inpatient CPT 45380 COLONOSCOPY AND BIOPSY	$351.30	$1,171.00	$293.02–$2,524.31	—	70%
Colonoscopy, diagnostic CPT 45378 SCREENG COLONOSCOPY	$277.50	$925.00	$244.11–$1,920.17	70% below	70%
Colonoscopy, diagnostic CPT 45378 DIAGNOSTIC COLONOSCOPY	$1,161.00	$3,870.00	$244.11–$1,920.17	27% above	70%
Colonoscopy, diagnostic inpatient CPT 45378 SCREENG COLONOSCOPY	$277.50	$925.00	$244.11–$1,920.17	—	70%
Colonoscopy, diagnostic inpatient CPT 45378 DIAGNOSTIC COLONOSCOPY	$1,161.00	$3,870.00	$244.11–$1,920.17	—	70%
Earwax removal with instruments, one ear CPT 69210 REMOVAL OF IMPACTED WAX FAC	$33.00	$110.00	$33.00–$1,300.00	45% below	70%
Earwax removal with instruments, one ear CPT 69210 REMOVE IMPACTED EAR WAX UNI	$33.00	$110.00	$33.00–$1,300.00	45% below	70%
Earwax removal with instruments, one ear inpatient CPT 69210 REMOVE IMPACTED EAR WAX UNI	$33.00	$110.00	$33.00–$1,300.00	—	70%
Earwax removal with instruments, one ear inpatient CPT 69210 REMOVAL OF IMPACTED WAX FAC	$33.00	$110.00	$33.00–$1,300.00	—	70%
First repair of a front abdominal hernia larger than 10 cm CPT 49595 RPR AA HRN 1ST > 10 RDC	$654.90	$2,183.01	$654.90–$7,815.95	89% below	70%
First repair of a front abdominal hernia larger than 10 cm inpatient CPT 49595 RPR AA HRN 1ST > 10 RDC	$654.90	$2,183.01	$654.90–$7,815.95	—	70%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 REPAIR AA HERNIA 1ST <3CM RDC	$289.50	$965.00	$511.50–$7,815.95	91% below	70%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 RPR AA HRN 1ST < 3 CM RDC	$291.60	$972.00	$511.50–$7,815.95	91% below	70%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 REPAIR ANTERIOR ABD HERNIA <3 PROFEE	$291.60	$972.00	$511.50–$7,815.95	91% below	70%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm inpatient CPT 49591 REPAIR AA HERNIA 1ST <3CM RDC	$289.50	$965.00	$511.50–$7,815.95	—	70%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm inpatient CPT 49591 REPAIR ANTERIOR ABD HERNIA <3 PROFEE	$291.60	$972.00	$511.50–$7,815.95	—	70%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm inpatient CPT 49591 RPR AA HRN 1ST < 3 CM RDC	$291.60	$972.00	$511.50–$7,815.95	—	70%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 FLEX SIGMOIDOSCOPY	$148.50	$495.00	$81.87–$1,920.17	66% below	70%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 DIAGNOSTIC SIGMOIDOSCOPY	$148.50	$495.00	$81.87–$1,920.17	66% below	70%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 DIAGNOSTIC SIGMOIDOSCOPY	$148.50	$495.00	$81.87–$1,920.17	—	70%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 FLEX SIGMOIDOSCOPY	$148.50	$495.00	$81.87–$1,920.17	—	70%
Gallbladder removal, laparoscopic CPT 47562 LAP INC HERNIA REPAI	$561.90	$1,873.00	$455.38–$12,150.50	68% below	70%
Gallbladder removal, laparoscopic CPT 47562 LAPAROSCOPIC CHOLECYSTECTOMY	$561.90	$1,873.00	$455.38–$12,150.50	68% below	70%
Gallbladder removal, laparoscopic CPT 47562 LAP CHOLESYSTECTOMY	$561.90	$1,873.00	$455.38–$12,150.50	68% below	70%
Gallbladder removal, laparoscopic inpatient CPT 47562 LAP INC HERNIA REPAI	$561.90	$1,873.00	$455.38–$12,150.50	—	70%
Gallbladder removal, laparoscopic inpatient CPT 47562 LAPAROSCOPIC CHOLECYSTECTOMY	$561.90	$1,873.00	$455.38–$12,150.50	—	70%
Gallbladder removal, laparoscopic inpatient CPT 47562 LAP CHOLESYSTECTOMY	$561.90	$1,873.00	$455.38–$12,150.50	—	70%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 LAPARO CHOLECYSTECTOMY/GRAPH	$607.65	$2,025.50	$535.50–$12,150.50	64% below	70%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery inpatient CPT 47563 LAPARO CHOLECYSTECTOMY/GRAPH	$607.65	$2,025.50	$535.50–$12,150.50	—	70%
Gallbladder removal, open surgery through a larger incision CPT 47600 CHOLECYSTECTOMY	$904.21	$3,014.04	$904.21–$12,150.50	38% below	70%
Gallbladder removal, open surgery through a larger incision inpatient CPT 47600 CHOLECYSTECTOMY	$904.21	$3,014.04	$904.21–$12,150.50	—	70%
Hammertoe correction surgery CPT 28285 REPAIR HAMMERTOE	$325.95	$1,086.50	$325.95–$6,881.13	85% below	70%
Hammertoe correction surgery CPT 28285 REPAIR OF HAMMERTOE	$325.95	$1,086.50	$325.95–$6,881.13	85% below	70%
Hammertoe correction surgery inpatient CPT 28285 REPAIR OF HAMMERTOE	$325.95	$1,086.50	$325.95–$6,881.13	—	70%
Hammertoe correction surgery inpatient CPT 28285 REPAIR HAMMERTOE	$325.95	$1,086.50	$325.95–$6,881.13	—	70%
Hemorrhoidectomy (internal and external), one area CPT 46255 RMV'L INT/EXT HEMMRH	$426.60	$1,422.00	$280.67–$5,892.57	49% below	70%
Hemorrhoidectomy (internal and external), one area CPT 46255 REMOVE INT/EXT HEM 1 GROUP	$426.60	$1,422.00	$280.67–$5,892.57	49% below	70%
Hemorrhoidectomy (internal and external), one area inpatient CPT 46255 RMV'L INT/EXT HEMMRH	$426.60	$1,422.00	$280.67–$5,892.57	—	70%
Hemorrhoidectomy (internal and external), one area inpatient CPT 46255 REMOVE INT/EXT HEM 1 GROUP	$426.60	$1,422.00	$280.67–$5,892.57	—	70%
Hysterectomy through an abdominal incision (total) CPT 58150 TOTAL HYSTRECTOMY PROFEE	$864.60	$2,882.00	$647.11–$10,737.37	—	70%
Hysterectomy through an abdominal incision (total) CPT 58150 TOTAL HYSTERECTOMY	$864.60	$2,882.00	$647.11–$10,737.37	—	70%
Hysterectomy through an abdominal incision (total) inpatient CPT 58150 TOTAL HYSTERECTOMY	$864.60	$2,882.00	$647.11–$10,737.37	—	70%
Hysterectomy through an abdominal incision (total) inpatient CPT 58150 TOTAL HYSTRECTOMY PROFEE	$864.60	$2,882.00	$647.11–$10,737.37	—	70%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS,CYST SIMPLE-FAC	$33.00	$110.00	$65.58–$1,300.00	82% below	70%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS SIMPLE/SINGLE	$104.40	$348.00	$65.58–$1,300.00	43% below	70%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D SKIN ABSCESS	$104.40	$348.00	$65.58–$1,300.00	43% below	70%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D ABSCESS,CYST SIMPLE-FAC	$33.00	$110.00	$65.58–$1,300.00	—	70%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D SKIN ABSCESS	$104.40	$348.00	$65.58–$1,300.00	—	70%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D ABSCESS SIMPLE/SINGLE	$104.40	$348.00	$65.58–$1,300.00	—	70%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 PRP I/HERN INIT REDUC >5 YR	$444.90	$1,483.00	$316.87–$7,815.95	77% below	70%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 ING HERNIA REPAIR	$444.90	$1,483.00	$316.87–$7,815.95	77% below	70%
Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 PRP I/HERN INIT REDUC >5 YR	$444.90	$1,483.00	$316.87–$7,815.95	—	70%
Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 ING HERNIA REPAIR	$444.90	$1,483.00	$316.87–$7,815.95	—	70%
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 LAP APPENDECTOMY	$512.40	$1,708.00	$365.16–$12,150.50	65% below	70%
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 LAPAROSCOPY APPENDECTOMY	$512.40	$1,708.00	$365.16–$12,150.50	65% below	70%
Laparoscopic appendectomy (appendix removal through small cuts) inpatient CPT 44970 LAP APPENDECTOMY	$512.40	$1,708.00	$365.16–$12,150.50	—	70%
Laparoscopic appendectomy (appendix removal through small cuts) inpatient CPT 44970 LAPAROSCOPY APPENDECTOMY	$512.40	$1,708.00	$365.16–$12,150.50	—	70%
Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 PRO FEE LAP ING HERN	$367.80	$1,226.00	$260.98–$12,150.50	89% below	70%
Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 LAP ING HERNIA REPAIR INIT	$367.80	$1,226.00	$260.98–$12,150.50	89% below	70%
Laparoscopic inguinal (groin) hernia repair, first repair on that side inpatient CPT 49650 LAP ING HERNIA REPAIR INIT	$367.80	$1,226.00	$260.98–$12,150.50	—	70%
Laparoscopic inguinal (groin) hernia repair, first repair on that side inpatient CPT 49650 PRO FEE LAP ING HERN	$367.80	$1,226.00	$260.98–$12,150.50	—	70%
Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 LAPAROSCOPY REMOVAL ADNEXAL STRUCTURES	$548.40	$1,828.00	$548.40–$12,150.50	—	70%
Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 LAPAROSCOPY REMOVE ADNEXA	$548.40	$1,828.00	$548.40–$12,150.50	—	70%
Laparoscopic removal of fallopian tubes and/or ovaries inpatient CPT 58661 LAPAROSCOPY REMOVE ADNEXA	$548.40	$1,828.00	$548.40–$12,150.50	—	70%
Laparoscopic removal of fallopian tubes and/or ovaries inpatient CPT 58661 LAPAROSCOPY REMOVAL ADNEXAL STRUCTURES	$548.40	$1,828.00	$548.40–$12,150.50	—	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/<	$72.60	$242.00	$72.60–$1,300.00	76% below	70%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 LAC/LAYER2.5ORLESS/SCALP,TRUNK	$72.60	$242.00	$72.60–$1,300.00	76% 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/<	$72.60	$242.00	$72.60–$1,300.00	—	70%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 LAC/LAYER2.5ORLESS/SCALP,TRUNK	$72.60	$242.00	$72.60–$1,300.00	—	70%
Mastectomy (total removal of the breast) CPT 19303 MASTECTOMY SIMPLE	$813.90	$2,713.00	$584.09–$13,164.98	79% below	70%
Mastectomy (total removal of the breast) CPT 19303 MAST SIMPLE COMPLETE	$813.90	$2,713.00	$584.09–$13,164.98	79% below	70%
Mastectomy (total removal of the breast) inpatient CPT 19303 MASTECTOMY SIMPLE	$813.90	$2,713.00	$584.09–$13,164.98	—	70%
Mastectomy (total removal of the breast) inpatient CPT 19303 MAST SIMPLE COMPLETE	$813.90	$2,713.00	$584.09–$13,164.98	—	70%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC TR-EXT B9+MARG 0.5 CM<	$104.10	$347.00	$67.27–$1,533.38	50% below	70%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC BENIGN LESION	$104.10	$347.00	$67.27–$1,533.38	50% below	70%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXC BENIGN LESION	$104.10	$347.00	$67.27–$1,533.38	—	70%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXC TR-EXT B9+MARG 0.5 CM<	$104.10	$347.00	$67.27–$1,533.38	—	70%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXC FACILA LESION	$116.70	$389.00	$74.79–$1,533.38	62% below	70%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXC FACE-MM B9+MARG 0.5 CM/<	$116.70	$389.00	$74.79–$1,533.38	62% below	70%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 EXC FACE-MM B9+MARG 0.5 CM/<	$116.70	$389.00	$74.79–$1,533.38	—	70%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 EXC FACILA LESION	$116.70	$389.00	$74.79–$1,533.38	—	70%
Nail removal (partial or complete), one nail CPT 11730 AVULSION NAIL PLATE/FAC	$66.00	$220.00	$55.60–$1,300.00	56% below	70%
Nail removal (partial or complete), one nail CPT 11730 AVULSION NAIL PLATE SIMPLE 1	$66.00	$220.00	$55.60–$1,300.00	56% below	70%
Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSION NAIL PLATE SIMPLE 1	$66.00	$220.00	$55.60–$1,300.00	—	70%
Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSION NAIL PLATE/FAC	$66.00	$220.00	$55.60–$1,300.00	—	70%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION NAIL&NAIL MATRIX	$115.50	$385.00	$100.83–$1,300.00	55% below	70%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 NAIL EXCISION PARTIAL OR COMPL	$115.50	$385.00	$100.83–$1,300.00	55% below	70%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 NAIL EXCISION PARTIAL OR COMPL	$115.50	$385.00	$100.83–$1,300.00	—	70%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXCISION NAIL&NAIL MATRIX	$115.50	$385.00	$100.83–$1,300.00	—	70%
Removal of a foreign object under the skin, simple CPT 10120 REMOVAL F.B.W/INCISION-FAC	$49.50	$165.00	$124.43–$1,300.00	80% below	70%
Removal of a foreign object under the skin, simple CPT 10120 INC&RMVL FB SUBQ TISS SMPL	$121.36	$404.55	$124.43–$1,300.00	51% below	70%
Removal of a foreign object under the skin, simple CPT 10120 INC & RMVL FB SUBQ TISS SMPL	$121.36	$404.55	$124.43–$1,300.00	51% below	70%
Removal of a foreign object under the skin, simple inpatient CPT 10120 REMOVAL F.B.W/INCISION-FAC	$49.50	$165.00	$124.43–$1,300.00	—	70%
Removal of a foreign object under the skin, simple inpatient CPT 10120 INC&RMVL FB SUBQ TISS SMPL	$121.36	$404.55	$124.43–$1,300.00	—	70%
Removal of a foreign object under the skin, simple inpatient CPT 10120 INC & RMVL FB SUBQ TISS SMPL	$121.36	$404.55	$124.43–$1,300.00	—	70%
Short arm splint (forearm and hand) CPT 29125 APPL SHORT ARM SPLINT STATIC	$99.00	$330.00	$63.97–$330.00	13% below	70%
Short arm splint (forearm and hand) CPT 29125 APPL.SHORT ARM SPLINT FAC	$99.00	$330.00	$63.97–$330.00	13% below	70%
Short arm splint (forearm and hand) inpatient CPT 29125 APPL SHORT ARM SPLINT STATIC	$99.00	$330.00	$63.97–$330.00	—	70%
Short arm splint (forearm and hand) inpatient CPT 29125 APPL.SHORT ARM SPLINT FAC	$99.00	$330.00	$63.97–$330.00	—	70%
Short leg splint (calf to foot) CPT 29515 APPLICATION SHORT LEG SPLINT	$66.00	$220.00	$66.00–$336.18	51% below	70%
Short leg splint (calf to foot) CPT 29515 APPL OF SHORT LEG SPLINT FAC	$66.00	$220.00	$66.00–$336.18	51% below	70%
Short leg splint (calf to foot) inpatient CPT 29515 APPL OF SHORT LEG SPLINT FAC	$66.00	$220.00	$66.00–$336.18	—	70%
Short leg splint (calf to foot) inpatient CPT 29515 APPLICATION SHORT LEG SPLINT	$66.00	$220.00	$66.00–$336.18	—	70%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 LAC-SIM/2.5ORLESS/SCP,TRNK,EXT	$57.00	$190.00	$57.00–$1,300.00	69% below	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/<	$57.00	$190.00	$57.00–$1,300.00	69% below	70%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 LAC-SIM/2.5ORLESS/SCP,TRNK,EXT	$57.00	$190.00	$57.00–$1,300.00	—	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/<	$57.00	$190.00	$57.00–$1,300.00	—	70%
Skin tag removal, up to 15 tags CPT 11200 RMVL SKIN TAGS UP TO&INC 15	$58.01	$193.38	$58.01–$1,300.00	56% below	70%
Skin tag removal, up to 15 tags inpatient CPT 11200 RMVL SKIN TAGS UP TO&INC 15	$58.01	$193.38	$58.01–$1,300.00	—	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	$38.10	$127.00	$77.91–$439.22	79% 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 LAC SIM/2.6-7.5/SCALP/TRNK/FAC	$38.10	$127.00	$77.91–$439.22	79% 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 REPAIR S/N/AX/GEN/TRNK 2.6-7.5CM	$51.45	$171.50	$77.91–$439.22	72% 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 RPR S/N/AX/GEN/TRNK2.6-7.5CM	$38.10	$127.00	$77.91–$439.22	—	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 LAC SIM/2.6-7.5/SCALP/TRNK/FAC	$38.10	$127.00	$77.91–$439.22	—	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 REPAIR S/N/AX/GEN/TRNK 2.6-7.5CM	$51.45	$171.50	$77.91–$439.22	—	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/<	$47.46	$158.22	$73.43–$515.13	74% below	70%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 LAC SIM/2.5ORLESS/EARS/NOSEFAC	$49.50	$165.00	$73.43–$515.13	73% below	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/<	$47.46	$158.22	$73.43–$515.13	—	70%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 LAC SIM/2.5ORLESS/EARS/NOSEFAC	$49.50	$165.00	$73.43–$515.13	—	70%
Upper endoscopy (EGD) with biopsy CPT 43239 EGD W/COLD BIOPSY	$302.40	$1,008.00	$211.18–$1,975.57	62% below	70%
Upper endoscopy (EGD) with biopsy CPT 43239 EGD BIOPSY SINGLE/MULTIPLE	$302.40	$1,008.00	$211.18–$1,975.57	62% below	70%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 EGD BIOPSY SINGLE/MULTIPLE	$302.40	$1,008.00	$211.18–$1,975.57	—	70%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 EGD W/COLD BIOPSY	$302.40	$1,008.00	$211.18–$1,975.57	—	70%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 EGD REMOVAL LESIONS BY SNARE	$397.50	$1,325.00	$300.15–$3,914.84	52% below	70%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 EGD REMOVE LESION SNARE	$397.50	$1,325.00	$300.15–$3,914.84	52% below	70%
Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 EGD REMOVE LESION SNARE	$397.50	$1,325.00	$300.15–$3,914.84	—	70%
Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 EGD REMOVAL LESIONS BY SNARE	$397.50	$1,325.00	$300.15–$3,914.84	—	70%
Upper endoscopy (EGD), diagnostic CPT 43235 EGD	$232.20	$774.00	$187.40–$1,975.57	72% below	70%
Upper endoscopy (EGD), diagnostic CPT 43235 EGD DIAGNOSTIC BRUSH WASH	$232.20	$774.00	$187.40–$1,975.57	72% below	70%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 EGD DIAGNOSTIC BRUSH WASH	$232.20	$774.00	$187.40–$1,975.57	—	70%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 EGD	$232.20	$774.00	$187.40–$1,975.57	—	70%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRID SUB Q 20 CM OR LESS	$105.30	$351.00	$45.27–$1,520.00	72% below	70%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DBRDMT SUBQ TIS 1ST 20SQCM/<	$105.30	$351.00	$45.27–$1,520.00	72% below	70%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DBRDMT SUBQ TIS 1ST 20SQCM/<	$105.30	$351.00	$45.27–$1,520.00	—	70%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRID SUB Q 20 CM OR LESS	$105.30	$351.00	$45.27–$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 OP BLOOD TRNS 2 4 HRS	$132.00	$440.00	$47.51–$6,761.00	72% below	70%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD INFUSION UP TO 4 HOURS	$177.00	$590.00	$47.51–$6,761.00	62% below	70%
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSE BLOOD/BLD PROD EA UNIT	$177.00	$590.00	$47.51–$6,761.00	62% below	70%
Blood transfusion (giving blood or blood components) CPT 36430 OP BLOOD TRNS 4 6 HOURS	$198.00	$660.00	$47.51–$6,761.00	58% below	70%
Blood transfusion (giving blood or blood components) CPT 36430 OP BLOOD TRNS 6 8 HOURS	$264.00	$880.00	$47.51–$6,761.00	44% below	70%
Blood transfusion (giving blood or blood components) CPT 36430 OP BLOOD TRNS 8 10 HOURS	$330.00	$1,100.00	$47.51–$6,761.00	30% below	70%
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION	$690.30	$2,301.00	$47.51–$6,761.00	46% above	70%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 OP BLOOD TRNS 2 4 HRS	$132.00	$440.00	$47.51–$6,761.00	—	70%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD INFUSION UP TO 4 HOURS	$177.00	$590.00	$47.51–$6,761.00	—	70%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSE BLOOD/BLD PROD EA UNIT	$177.00	$590.00	$47.51–$6,761.00	—	70%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 OP BLOOD TRNS 4 6 HOURS	$198.00	$660.00	$47.51–$6,761.00	—	70%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 OP BLOOD TRNS 6 8 HOURS	$264.00	$880.00	$47.51–$6,761.00	—	70%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 OP BLOOD TRNS 8 10 HOURS	$330.00	$1,100.00	$47.51–$6,761.00	—	70%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSION	$690.30	$2,301.00	$47.51–$6,761.00	—	70%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 METERED DOSE INHALER SUBSEQ	$66.00	$220.00	$21.12–$1,071.00	30% below	70%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 METERED DOSE INHALER INITIAL	$66.00	$220.00	$21.12–$1,071.00	30% below	70%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AIRWAY INHALATION TREATMENT	$74.40	$248.00	$21.12–$1,071.00	21% below	70%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HAND HELD NEB SUBQ	$74.40	$248.00	$21.12–$1,071.00	21% below	70%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 SPUTUM INDUCTION	$99.00	$330.00	$21.12–$1,071.00	5% above	70%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 METERED DOSE INHALER SUBSEQ	$66.00	$220.00	$21.12–$1,071.00	—	70%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 METERED DOSE INHALER INITIAL	$66.00	$220.00	$21.12–$1,071.00	—	70%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AIRWAY INHALATION TREATMENT	$74.40	$248.00	$21.12–$1,071.00	—	70%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HAND HELD NEB SUBQ	$74.40	$248.00	$21.12–$1,071.00	—	70%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 SPUTUM INDUCTION	$99.00	$330.00	$21.12–$1,071.00	—	70%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE FIRST HOUR	$792.00	$2,640.00	$237.72–$2,640.00	5% above	70%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE FAC	$792.00	$2,640.00	$237.72–$2,640.00	5% above	70%
Critical care, first 30 to 74 minutes inpatient CPT 99291 CRITICAL CARE FIRST HOUR	$792.00	$2,640.00	$237.72–$2,640.00	—	70%
Critical care, first 30 to 74 minutes inpatient CPT 99291 CRITICAL CARE FAC	$792.00	$2,640.00	$237.72–$2,640.00	—	70%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ELECTROCARDIOGRAM TRACING	$82.20	$274.00	$9.30–$822.00	at median	70%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG TRACING 12 LEAD	$82.20	$274.00	$9.30–$822.00	at median	70%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG	$82.20	$274.00	$9.30–$822.00	at median	70%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ELECTROCARDIOGRAM TRACING	$82.20	$274.00	$9.30–$822.00	—	70%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG	$82.20	$274.00	$9.30–$822.00	—	70%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG TRACING 12 LEAD	$82.20	$274.00	$9.30–$822.00	—	70%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 TRIAGE ONLY	$33.00	$110.00	$24.46–$385.00	44% below	70%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER LEVEL 1	$82.50	$275.00	$24.46–$385.00	41% 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	$82.50	$275.00	$24.46–$385.00	41% 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	$24.46–$385.00	—	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	$82.50	$275.00	$24.46–$385.00	—	70%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ER LEVEL 1	$82.50	$275.00	$24.46–$385.00	—	70%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 EMERGENCY DEPT VISIT SF MDM	$165.00	$550.00	$46.95–$550.00	12% above	70%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ER LEVEL 2	$165.00	$550.00	$46.95–$550.00	12% above	70%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ER LEVEL 2	$165.00	$550.00	$46.95–$550.00	—	70%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 EMERGENCY DEPT VISIT SF MDM	$165.00	$550.00	$46.95–$550.00	—	70%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 EMERGENCY DEPT VISIT LOW MDM	$264.00	$880.00	$70.30–$880.00	14% above	70%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ER LEVEL 3	$264.00	$880.00	$70.30–$880.00	14% above	70%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ER LEVEL 3	$264.00	$880.00	$70.30–$880.00	—	70%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 EMERGENCY DEPT VISIT LOW MDM	$264.00	$880.00	$70.30–$880.00	—	70%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 EMERGENCY DEPT VISIT MOD MDM	$412.50	$1,375.00	$129.55–$1,375.00	9% above	70%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ER LEVEL 4	$412.50	$1,375.00	$129.55–$1,375.00	9% above	70%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 EMERGENCY DEPT VISIT MOD MDM	$412.50	$1,375.00	$129.55–$1,375.00	—	70%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ER LEVEL 4	$412.50	$1,375.00	$129.55–$1,375.00	—	70%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ER LEVEL 5(TRANSFER)	$561.00	$1,870.00	$188.42–$1,870.00	8% above	70%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 EMERGENCY DEPT VISIT HI MDM	$561.00	$1,870.00	$188.42–$1,870.00	8% above	70%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ER LEVEL 5(TRANSFER)	$561.00	$1,870.00	$188.42–$1,870.00	—	70%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 EMERGENCY DEPT VISIT HI MDM	$561.00	$1,870.00	$188.42–$1,870.00	—	70%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV INFUSION HYDRATION,INITIAL	$52.80	$176.00	$41.54–$563.47	69% below	70%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 OP IV HYDRATION INITIAL	$52.80	$176.00	$41.54–$563.47	69% below	70%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRATION IV INFUSION INIT	$52.80	$176.00	$41.54–$563.47	69% below	70%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HYDRATION IV INFUSION INIT	$52.80	$176.00	$41.54–$563.47	—	70%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 OP IV HYDRATION INITIAL	$52.80	$176.00	$41.54–$563.47	—	70%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV INFUSION HYDRATION,INITIAL	$52.80	$176.00	$41.54–$563.47	—	70%
IV infusion of a medicine, first hour CPT 96365 IVPB THER INITIAL HOUR	$52.80	$176.00	$85.85–$563.47	72% below	70%
IV infusion of a medicine, first hour CPT 96365 THER/PROPH/DIAG IV INF INIT	$95.40	$318.00	$85.85–$563.47	49% below	70%
IV infusion of a medicine, first hour CPT 96365 OP IV THERAPY INITIAL	$95.40	$318.00	$85.85–$563.47	49% below	70%
IV infusion of a medicine, first hour inpatient CPT 96365 IVPB THER INITIAL HOUR	$52.80	$176.00	$85.85–$563.47	—	70%
IV infusion of a medicine, first hour inpatient CPT 96365 THER/PROPH/DIAG IV INF INIT	$95.40	$318.00	$85.85–$563.47	—	70%
IV infusion of a medicine, first hour inpatient CPT 96365 OP IV THERAPY INITIAL	$95.40	$318.00	$85.85–$563.47	—	70%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 EVAL/ASSESS IN PSYCH	$66.00	$220.00	$66.00–$330.20	37% below	70%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 PSYCH DIAGNOSTIC EVALUATION	$66.00	$220.00	$66.00–$330.20	37% below	70%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 EVAL/ASSESS IN PSYCH	$66.00	$220.00	$66.00–$330.20	—	70%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 PSYCH DIAGNOSTIC EVALUATION	$66.00	$220.00	$66.00–$330.20	—	70%
Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSCULAR RE-EDUC	$33.00	$110.00	$27.96–$110.00	11% below	70%
Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSCULAR REEDUCATION	$33.00	$110.00	$27.96–$110.00	11% below	70%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEUROMUSCULAR REEDUCATION	$33.00	$110.00	$27.96–$110.00	—	70%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEUROMUSCULAR RE-EDUC	$33.00	$110.00	$27.96–$110.00	—	70%
New patient office visit, about 30 minutes CPT 99203 LEVEL 3 NP	$46.29	$154.30	$38.00–$465.30	16% below	70%
New patient office visit, about 30 minutes CPT 99203 �O/P NEW LOW 30-44 MIN PROFEE	$93.30	$311.00	$38.00–$465.30	69% above	70%
New patient office visit, about 30 minutes CPT 99203 OFFICE O/P NEW LOW 30 MIN	$93.30	$311.00	$38.00–$465.30	69% above	70%
New patient office visit, about 30 minutes inpatient CPT 99203 LEVEL 3 NP	$46.29	$154.30	$38.00–$465.30	—	70%
New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE O/P NEW LOW 30 MIN	$93.30	$311.00	$38.00–$465.30	—	70%
New patient office visit, about 30 minutes inpatient CPT 99203 �O/P NEW LOW 30-44 MIN PROFEE	$93.30	$311.00	$38.00–$465.30	—	70%
New patient office visit, about 60 minutes CPT 99205 LEVEL 5 NP	$102.30	$341.00	$57.00–$341.00	26% below	70%
New patient office visit, about 60 minutes CPT 99205 OFFICE O/P NEW HI 60 MIN	$102.30	$341.00	$57.00–$341.00	26% below	70%
New patient office visit, about 60 minutes inpatient CPT 99205 OFFICE O/P NEW HI 60 MIN	$102.30	$341.00	$57.00–$341.00	—	70%
New patient office visit, about 60 minutes inpatient CPT 99205 LEVEL 5 NP	$102.30	$341.00	$57.00–$341.00	—	70%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT EVALUATION INITIAL - HIGH	$59.40	$198.00	$58.94–$208.64	45% below	70%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT EVAL HIGH COMPLEX 45 MIN	$59.40	$198.00	$58.94–$208.64	45% below	70%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT EVAL HIGH COMPLEX 45 MIN	$59.40	$198.00	$58.94–$208.64	—	70%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT EVALUATION INITIAL - HIGH	$59.40	$198.00	$58.94–$208.64	—	70%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT EVALUATION INITIAL - LOW	$65.40	$218.00	$58.94–$218.00	31% below	70%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT EVAL LOW COMPLEX 20 MIN	$65.40	$218.00	$58.94–$218.00	31% below	70%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT EVALUATION INITIAL - LOW	$65.40	$218.00	$58.94–$218.00	—	70%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT EVAL LOW COMPLEX 20 MIN	$65.40	$218.00	$58.94–$218.00	—	70%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT EVAL MOD COMPLEX 30 MIN	$52.80	$176.00	$52.80–$208.64	45% below	70%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT EVALUATION INITIAL - MOD	$52.80	$176.00	$52.80–$208.64	45% below	70%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT EVALUATION INITIAL - MOD	$52.80	$176.00	$52.80–$208.64	—	70%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT EVAL MOD COMPLEX 30 MIN	$52.80	$176.00	$52.80–$208.64	—	70%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THERAPY 1/> REGIONS	$27.00	$90.00	$23.71–$90.00	39% below	70%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THERAPY	$27.00	$90.00	$23.71–$90.00	39% below	70%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MANUAL THERAPY	$27.00	$90.00	$23.71–$90.00	—	70%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MANUAL THERAPY 1/> REGIONS	$27.00	$90.00	$23.71–$90.00	—	70%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISES	$33.00	$110.00	$11.00–$110.00	13% below	70%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISE	$33.00	$110.00	$11.00–$110.00	13% below	70%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC EXERCISE	$33.00	$110.00	$11.00–$110.00	—	70%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC EXERCISES	$33.00	$110.00	$11.00–$110.00	—	70%
Psychotherapy session, 45 minutes CPT 90834 PSYTX W PT 45 MINUTES	$99.00	$330.00	$92.93–$330.20	24% below	70%
Psychotherapy session, 45 minutes CPT 90834 IOP GROUP THERAPY	$99.00	$330.00	$92.93–$330.20	24% below	70%
Psychotherapy session, 45 minutes inpatient CPT 90834 IOP GROUP THERAPY	$99.00	$330.00	$92.93–$330.20	—	70%
Psychotherapy session, 45 minutes inpatient CPT 90834 PSYTX W PT 45 MINUTES	$99.00	$330.00	$92.93–$330.20	—	70%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 SMOKING CESSATION	$33.00	$110.00	$13.79–$110.00	14% above	70%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 BEHAV CHNG SMOKING 3-10 MIN	$33.00	$110.00	$13.79–$110.00	14% above	70%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 BEHAV CHNG SMOKING 3-10 MIN	$33.00	$110.00	$13.79–$110.00	—	70%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 SMOKING CESSATION	$33.00	$110.00	$13.79–$110.00	—	70%
Specialist consultation, low complexity or 30+ minutes CPT 99243 OFF/OP CNSLTJ NEW/EST LOW 30	$78.00	$260.00	$59.83–$260.00	36% below	70%
Specialist consultation, low complexity or 30+ minutes CPT 99243 CONSULT DETAILED	$78.00	$260.00	$59.83–$260.00	36% below	70%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 CONSULT DETAILED	$78.00	$260.00	$59.83–$260.00	—	70%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 OFF/OP CNSLTJ NEW/EST LOW 30	$78.00	$260.00	$59.83–$260.00	—	70%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 OFF/OP CNSLTJ NEW/EST MOD 40	$115.80	$386.00	$65.38–$386.00	17% below	70%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 CONSULT COMP/MOD	$115.80	$386.00	$65.38–$386.00	17% below	70%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 CONSULT COMP/MOD	$115.80	$386.00	$65.38–$386.00	—	70%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 OFF/OP CNSLTJ NEW/EST MOD 40	$115.80	$386.00	$65.38–$386.00	—	70%
Therapeutic activities (functional training), 15 minutes CPT 97530 THERAPEUTIC ACTIVITIES	$33.00	$110.00	$8.80–$110.00	12% below	70%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THERAPEUTIC ACTIVITIES	$33.00	$110.00	$8.80–$110.00	—	70%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Louisiana	Off list
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMO 23 VAC ADLT J	$139.80	$466.00	$133.47–$466.00	130% above	70%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PPSV23 VACC 2 YRS+ SUBQ/IM	$139.80	$466.00	$133.47–$466.00	130% above	70%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMO 23 VAC ADLT J	$139.80	$466.00	$133.47–$466.00	—	70%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PPSV23 VACC 2 YRS+ SUBQ/IM	$139.80	$466.00	$133.47–$466.00	—	70%
Rabies vaccine, one dose CPT 90675 RABIES VAC 2.5UNITS UD J	$764.40	$2,548.00	$282.31–$2,548.00	12% below	70%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE IM	$764.40	$2,548.00	$282.31–$2,548.00	12% below	70%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE IM	$764.40	$2,548.00	$282.31–$2,548.00	—	70%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VAC 2.5UNITS UD J	$764.40	$2,548.00	$282.31–$2,548.00	—	70%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TD VACC NO PRESV 7 YRS+ IM	$54.90	$183.00	$38.97–$183.00	76% above	70%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS DIPTHERIA TOXOIC 0.5 ML INJ	$54.90	$183.00	$38.97–$183.00	76% above	70%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TD VACC NO PRESV 7 YRS+ IM	$54.90	$183.00	$38.97–$183.00	—	70%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS DIPTHERIA TOXOIC 0.5 ML INJ	$54.90	$183.00	$38.97–$183.00	—	70%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDAP VACC 7YRS>IM	$30.30	$101.00	$39.69–$310.50	35% below	70%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDAP VACCINE 7 YRS/> IM	$30.30	$101.00	$39.69–$310.50	35% below	70%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TET\DIPHTOXOID PF J	$62.85	$209.50	$39.69–$310.50	35% above	70%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TDAP VACCINE 7 YRS/> IM	$30.30	$101.00	$39.69–$310.50	—	70%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TDAP VACC 7YRS>IM	$30.30	$101.00	$39.69–$310.50	—	70%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TET\DIPHTOXOID PF J	$62.85	$209.50	$39.69–$310.50	—	70%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN	$12.90	$43.00	$10.00–$86.00	68% below	70%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 OUTPATIENT VACCINE	$12.90	$43.00	$10.00–$86.00	68% below	70%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 VACCINE ADMINISTRATION	$12.90	$43.00	$10.00–$86.00	68% below	70%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 VACCINE ADMINISTRATION	$12.90	$43.00	$10.00–$86.00	—	70%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 OUTPATIENT VACCINE	$12.90	$43.00	$10.00–$86.00	—	70%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMIN	$12.90	$43.00	$10.00–$86.00	—	70%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMM ADM EA ADD VACC	$6.60	$22.00	$10.00–$44.00	75% below	70%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 VACCINE ADMIN, EACH ADD'L	$6.60	$22.00	$10.00–$44.00	75% below	70%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMIN EACH ADD	$6.60	$22.00	$10.00–$44.00	75% below	70%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 VACCINE ADMIN, EACH ADD'L	$6.60	$22.00	$10.00–$44.00	—	70%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUNIZATION ADMIN EACH ADD	$6.60	$22.00	$10.00–$44.00	—	70%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMM ADM EA ADD VACC	$6.60	$22.00	$10.00–$44.00	—	70%

Source file: https://sabinemedicalcenter.net/26-2074318_SABINE-MEDICAL-CENTER_standardcharges.csv