Hospital

Sabine Medical Center

Sabine Medical Center in Many, LA publishes cash prices for 282 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 228 of 281 procedures and above it for 52. By typical cash price it ranks #8 of 67 Louisiana hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.

240 HIGHLAND DRIVE,MANY,LA,71449-3767 Collected Sep 27, 2026 Source price file Check a bill from this hospital (318) 256-1232

Acute care hospital For-profit hospital Emergency department CCN 190218 · CMS hospital register NPI 1568626273

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
Abdominal CT scan without and with contrast CPT 74170 CT ABD WO CNTRST FLWD CNTRST	$653.10	$2,177.00	$240.00–$2,287.00	36% below	70%
Abdominal CT scan without and with contrast CPT 74170 CT ABDOMEN W/W/O CONT	$653.10	$2,177.00	$240.00–$2,287.00	36% below	70%
Abdominal CT scan without and with contrast inpatient CPT 74170 CT ABD WO CNTRST FLWD CNTRST	$653.10	$2,177.00	$240.00–$2,287.00	—	70%
Abdominal CT scan without and with contrast inpatient CPT 74170 CT ABDOMEN W/W/O CONT	$653.10	$2,177.00	$240.00–$2,287.00	—	70%
Abdominal X-ray, 2 views CPT 74019 XR ABODOMEN 2 VW	$102.00	$340.00	$25.61–$379.00	41% below	70%
Abdominal X-ray, 2 views CPT 74019 RADEX ABDOMEN 2 VIEWS	$102.00	$340.00	$25.61–$379.00	41% below	70%
Abdominal X-ray, 2 views inpatient CPT 74019 XR ABODOMEN 2 VW	$102.00	$340.00	$25.61–$379.00	—	70%
Abdominal X-ray, 2 views inpatient CPT 74019 RADEX ABDOMEN 2 VIEWS	$102.00	$340.00	$25.61–$379.00	—	70%
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	64% 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	64% 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	64% 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 ABI-ANKLE BRAHIAL INDEX	$130.80	$436.00	$76.71–$906.00	25% below	70%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 US ABIS	$130.80	$436.00	$76.71–$906.00	25% below	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	25% below	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%
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%
Arm CT scan without contrast (shoulder to hand, any part) both sides CPT 73200 CT EXTREMITY UPPER BILAT WO	$368.70	$1,229.00	$153.97–$5,026.00	—	70%
Arm CT scan without contrast (shoulder to hand, any part) both sides CPT 73200 CT HAND BILAT WO	$368.70	$1,229.00	$153.97–$5,026.00	—	70%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT UP EXTREM W/O CONT RT	$368.70	$1,229.00	$153.97–$5,026.00	43% below	70%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT UP EXTREM W/O CONT LT	$368.70	$1,229.00	$153.97–$5,026.00	43% below	70%
Arm CT scan without contrast (shoulder to hand, any part) inpatient both sides CPT 73200 CT EXTREMITY UPPER BILAT WO	$368.70	$1,229.00	$153.97–$5,026.00	—	70%
Arm CT scan without contrast (shoulder to hand, any part) inpatient both sides CPT 73200 CT HAND BILAT WO	$368.70	$1,229.00	$153.97–$5,026.00	—	70%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT UP EXTREM W/O CONT LT	$368.70	$1,229.00	$153.97–$5,026.00	—	70%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT UP EXTREM W/O CONT RT	$368.70	$1,229.00	$153.97–$5,026.00	—	70%
Breast ultrasound, complete, one breast CPT 76641 ULTRASOUND BREAST COMPLETE	$88.80	$296.00	$74.65–$1,289.00	47% below	70%
Breast ultrasound, complete, one breast CPT 76641 US BREAST COMP BIL	$88.80	$296.00	$74.65–$1,289.00	47% below	70%
Breast ultrasound, complete, one breast one side CPT 76641 US BREAST COMP RT	$84.60	$282.00	$74.65–$1,289.00	50% below	70%
Breast ultrasound, complete, one breast one side CPT 76641 US BREAST COMP LT	$178.50	$595.00	$74.65–$1,289.00	6% above	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 CPT 76641 US BREAST COMP BIL	$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	7% above	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	7% above	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	7% above	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 RT	$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%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CTA ABD&PLVS W/CONTRAST	$660.00	$2,200.00	$240.00–$4,745.00	28% below	70%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CTA ABD&PEL W CONT	$660.00	$2,200.00	$240.00–$4,745.00	28% below	70%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CTA ABDOMEN & PELVIS W/WO	$660.00	$2,200.00	$240.00–$4,745.00	28% below	70%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CTA ABD&PEL W CONT	$660.00	$2,200.00	$240.00–$4,745.00	—	70%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CTA ABDOMEN & PELVIS W/WO	$660.00	$2,200.00	$240.00–$4,745.00	—	70%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CTA ABD&PLVS W/CONTRAST	$660.00	$2,200.00	$240.00–$4,745.00	—	70%
CT angiography (CTA) of the head CPT 70496 CTA HEAD WC	$660.00	$2,200.00	$240.00–$4,620.00	5% below	70%
CT angiography (CTA) of the head CPT 70496 CT ANGIO HEAD W&WO CONT	$660.00	$2,200.00	$240.00–$4,620.00	5% below	70%
CT angiography (CTA) of the head inpatient CPT 70496 CTA HEAD WC	$660.00	$2,200.00	$240.00–$4,620.00	—	70%
CT angiography (CTA) of the head inpatient CPT 70496 CT ANGIO HEAD W&WO CONT	$660.00	$2,200.00	$240.00–$4,620.00	—	70%
CT angiography (CTA) of the neck CPT 70498 CTA NECK WC	$594.00	$1,980.00	$240.00–$4,140.00	15% below	70%
CT angiography (CTA) of the neck CPT 70498 CT ANGIOGRAPHY NECK	$594.00	$1,980.00	$240.00–$4,140.00	15% below	70%
CT angiography (CTA) of the neck CPT 70498 CT ANGIO NECK W&WO CONT	$594.00	$1,980.00	$240.00–$4,140.00	15% below	70%
CT angiography (CTA) of the neck inpatient CPT 70498 CT ANGIO NECK W&WO CONT	$594.00	$1,980.00	$240.00–$4,140.00	—	70%
CT angiography (CTA) of the neck inpatient CPT 70498 CT ANGIOGRAPHY NECK	$594.00	$1,980.00	$240.00–$4,140.00	—	70%
CT angiography (CTA) of the neck inpatient CPT 70498 CTA NECK WC	$594.00	$1,980.00	$240.00–$4,140.00	—	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	43% 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	23% 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	23% 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	23% 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	44% 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	44% 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&PEL W CONTRAST	$721.80	$2,406.00	$240.00–$2,692.00	44% below	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	44% below	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, 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, without and then with contrast dye CPT 74178 CT ABD&PEL WO/W CONTRAST	$806.40	$2,688.00	$240.00–$3,003.00	44% 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	44% 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	50% 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	50% below	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 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 without contrast CPT 74150 CT ABDOMEN W/O CONT	$368.70	$1,229.00	$131.50–$1,416.00	52% 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	52% 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	50% 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	50% 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	40% 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	29% 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	48% 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	50% 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	50% 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 US CAROTID DUP BILAT	$233.40	$778.00	$158.59–$1,595.00	—	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 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 CT scan without and with contrast CPT 71270 CT CHEST W/W/O CONTRAST	$660.30	$2,201.00	$187.36–$2,399.00	37% below	70%
Chest CT scan without and with contrast inpatient CPT 71270 CT CHEST W/W/O CONTRAST	$660.30	$2,201.00	$187.36–$2,399.00	—	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	55% 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	54% below	70%
Chest X-ray, single view inpatient CPT 71045 XR CHEST SGL VIEW	$50.70	$169.00	$17.38–$200.62	—	70%
Collarbone (clavicle) X-ray, complete both sides CPT 73000 XR CLAVICLE BILATERAL	$63.60	$212.00	$24.12–$538.00	—	70%
Collarbone (clavicle) X-ray, complete CPT 73000 X-RAY EXAM OF COLLAR BONE	$44.70	$149.00	$24.12–$538.00	62% below	70%
Collarbone (clavicle) X-ray, complete one side CPT 73000 CLAVICLE LT	$44.70	$149.00	$24.12–$538.00	62% below	70%
Collarbone (clavicle) X-ray, complete one side CPT 73000 CLAVICLE RT	$44.70	$149.00	$24.12–$538.00	62% below	70%
Collarbone (clavicle) X-ray, complete inpatient both sides CPT 73000 XR CLAVICLE BILATERAL	$63.60	$212.00	$24.12–$538.00	—	70%
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 X-RAY EXAM OF COLLAR BONE	$44.70	$149.00	$24.12–$538.00	—	70%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 CLAVICLE RT	$44.70	$149.00	$24.12–$538.00	—	70%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 CLAVICLE LT	$44.70	$149.00	$24.12–$538.00	—	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	38% 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	38% below	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%
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%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DXA BONE DENSITY	$66.00	$220.00	$31.23–$281.74	55% below	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	55% 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 US OB	$144.30	$481.00	$87.54–$585.79	—	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%
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	50% 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 3D DIAG MAMMO BILATERAL	$95.70	$319.00	$88.54–$319.00	—	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 inpatient both sides CPT 77066 DX MAMMO INCL CAD BI	$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, 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 SCREENING LT	$33.00	$110.00	$69.00–$1,064.00	73% 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 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	51% 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 US ECHOCARDIOGRAM COMPLETE	$718.80	$2,396.00	$144.22–$4,902.00	6% below	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	6% below	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	6% below	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 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 US ECHOCARDIOGRAM COMPLETE	$718.80	$2,396.00	$144.22–$4,902.00	—	70%
Elbow X-ray, 2 views both sides CPT 73070 XR ELBOW 2V2 BILATERAL	$78.30	$261.00	$21.12–$591.00	—	70%
Elbow X-ray, 2 views CPT 73070 X-RAY EXAM OF ELBOW	$45.30	$151.00	$21.12–$591.00	65% below	70%
Elbow X-ray, 2 views one side CPT 73070 ELBOWS 2 VIEWS LT	$45.30	$151.00	$21.12–$591.00	65% below	70%
Elbow X-ray, 2 views one side CPT 73070 ELBOWS 2 VIEWS RT	$45.30	$151.00	$21.12–$591.00	65% below	70%
Elbow X-ray, 2 views inpatient both sides CPT 73070 XR ELBOW 2V2 BILATERAL	$78.30	$261.00	$21.12–$591.00	—	70%
Elbow X-ray, 2 views inpatient CPT 73070 X-RAY EXAM OF ELBOW	$45.30	$151.00	$21.12–$591.00	—	70%
Elbow X-ray, 2 views inpatient one side CPT 73070 ELBOWS 2 VIEWS LT	$45.30	$151.00	$21.12–$591.00	—	70%
Elbow X-ray, 2 views inpatient one side CPT 73070 ELBOWS 2 VIEWS RT	$45.30	$151.00	$21.12–$591.00	—	70%
Elbow X-ray, complete, 3 or more views both sides CPT 73080 XR ELBOW 3V2 BILATERAL	$78.30	$261.00	$23.37–$591.00	—	70%
Elbow X-ray, complete, 3 or more views CPT 73080 X-RAY EXAM OF ELBOW	$45.30	$151.00	$23.37–$591.00	66% below	70%
Elbow X-ray, complete, 3 or more views one side CPT 73080 XR ELBOW 3 VIEWS LT	$45.30	$151.00	$23.37–$591.00	66% below	70%
Elbow X-ray, complete, 3 or more views one side CPT 73080 XR ELBOW 3 VIEWS RT	$45.30	$151.00	$23.37–$591.00	66% below	70%
Elbow X-ray, complete, 3 or more views inpatient both sides CPT 73080 XR ELBOW 3V2 BILATERAL	$78.30	$261.00	$23.37–$591.00	—	70%
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 X-RAY EXAM OF ELBOW	$45.30	$151.00	$23.37–$591.00	—	70%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 XR ELBOW 3 VIEWS RT	$45.30	$151.00	$23.37–$591.00	—	70%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 XR ELBOW 3 VIEWS LT	$45.30	$151.00	$23.37–$591.00	—	70%
Eye socket (orbit) CT scan without contrast CPT 70480 CT ORBITS WO CONT	$208.80	$696.00	$152.16–$898.00	66% below	70%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT ORBITS WO CONT	$208.80	$696.00	$152.16–$898.00	—	70%
Facial bones X-ray, complete, 3 or more views CPT 70150 FACIAL BONES MIN 3 VIEWS	$63.60	$212.00	$34.22–$281.74	59% below	70%
Facial bones X-ray, complete, 3 or more views CPT 70150 X-RAY EXAM OF FACIAL BONES	$63.60	$212.00	$34.22–$281.74	59% below	70%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 FACIAL BONES MIN 3 VIEWS	$63.60	$212.00	$34.22–$281.74	—	70%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 X-RAY EXAM OF FACIAL BONES	$63.60	$212.00	$34.22–$281.74	—	70%
Forearm X-ray (radius and ulna), 2 views both sides CPT 73090 XR FOREARM 2VW BILATERAL	$78.30	$261.00	$21.50–$589.00	—	70%
Forearm X-ray (radius and ulna), 2 views CPT 73090 X-RAY EXAM OF FOREARM	$45.30	$151.00	$21.50–$589.00	61% below	70%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 FOREARM 2 VIEWS RT	$45.30	$151.00	$21.50–$589.00	61% below	70%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 FOREARM 2 VIEWS LT	$45.30	$151.00	$21.50–$589.00	61% below	70%
Forearm X-ray (radius and ulna), 2 views inpatient both sides CPT 73090 XR FOREARM 2VW BILATERAL	$78.30	$261.00	$21.50–$589.00	—	70%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 X-RAY EXAM OF FOREARM	$45.30	$151.00	$21.50–$589.00	—	70%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 FOREARM 2 VIEWS RT	$45.30	$151.00	$21.50–$589.00	—	70%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 FOREARM 2 VIEWS LT	$45.30	$151.00	$21.50–$589.00	—	70%
Hand X-ray, 2 views both sides CPT 73120 XR HAND 2VW BILATERAL	$78.30	$261.00	$22.99–$589.00	—	70%
Hand X-ray, 2 views one side CPT 73120 HAND 2 VIEWS RT	$45.30	$151.00	$22.99–$589.00	57% below	70%
Hand X-ray, 2 views one side CPT 73120 HAND 2 VIEWS LT	$45.30	$151.00	$22.99–$589.00	57% below	70%
Hand X-ray, 2 views inpatient both sides CPT 73120 XR HAND 2VW BILATERAL	$78.30	$261.00	$22.99–$589.00	—	70%
Hand X-ray, 2 views inpatient one side CPT 73120 HAND 2 VIEWS RT	$45.30	$151.00	$22.99–$589.00	—	70%
Hand X-ray, 2 views inpatient one side CPT 73120 HAND 2 VIEWS LT	$45.30	$151.00	$22.99–$589.00	—	70%
Heel bone (calcaneus) X-ray, 2 or more views both sides CPT 73650 XR HEEL/CALCANEUS 2V BILATERAL	$71.10	$237.00	$21.12–$771.00	—	70%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 XR HEEL/CALCANEOUS LT	$38.10	$127.00	$21.12–$771.00	65% below	70%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 XR HEEL/CALCANEOUS RT	$38.10	$127.00	$21.12–$771.00	65% below	70%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 CALCANEUS MIN 2 VIEWS RT	$38.10	$127.00	$21.12–$771.00	65% below	70%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 CALCANEUS MIN 2 VIEWS LT	$38.10	$127.00	$21.12–$771.00	65% below	70%
Heel bone (calcaneus) X-ray, 2 or more views inpatient both sides CPT 73650 XR HEEL/CALCANEUS 2V BILATERAL	$71.10	$237.00	$21.12–$771.00	—	70%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 CALCANEUS MIN 2 VIEWS RT	$38.10	$127.00	$21.12–$771.00	—	70%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 CALCANEUS MIN 2 VIEWS LT	$38.10	$127.00	$21.12–$771.00	—	70%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 XR HEEL/CALCANEOUS LT	$38.10	$127.00	$21.12–$771.00	—	70%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 XR HEEL/CALCANEOUS RT	$38.10	$127.00	$21.12–$771.00	—	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 RT	$57.90	$193.00	$31.23–$720.00	58% below	70%
Knee X-ray, 3 views one side CPT 73562 KNEE 3 VIEWS LT	$57.90	$193.00	$31.23–$720.00	58% 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%
Knee X-ray, complete, 4 or more views both sides CPT 73564 XR KNEE 4+VW BILATERAL	$99.00	$330.00	$34.22–$703.00	—	70%
Knee X-ray, complete, 4 or more views CPT 73564 X-RAY EXAM KNEE 4 OR MORE	$50.70	$169.00	$34.22–$703.00	68% below	70%
Knee X-ray, complete, 4 or more views one side CPT 73564 XR KNEE 4+ VIEWS LT	$50.70	$169.00	$34.22–$703.00	68% below	70%
Knee X-ray, complete, 4 or more views one side CPT 73564 KNEE MIN 4 VIEWS RT	$50.70	$169.00	$34.22–$703.00	68% below	70%
Knee X-ray, complete, 4 or more views inpatient both sides CPT 73564 XR KNEE 4+VW BILATERAL	$99.00	$330.00	$34.22–$703.00	—	70%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 X-RAY EXAM KNEE 4 OR MORE	$50.70	$169.00	$34.22–$703.00	—	70%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 XR KNEE 4+ VIEWS LT	$50.70	$169.00	$34.22–$703.00	—	70%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 KNEE MIN 4 VIEWS RT	$50.70	$169.00	$34.22–$703.00	—	70%
Leg CT scan without contrast (hip to foot, any part) both sides CPT 73700 CT HIP BILAT WO	$368.70	$1,229.00	$123.69–$6,302.00	—	70%
Leg CT scan without contrast (hip to foot, any part) both sides CPT 73700 CT EXTREMITY LOWER BILAT WO	$368.70	$1,229.00	$123.69–$6,302.00	—	70%
Leg CT scan without contrast (hip to foot, any part) both sides CPT 73700 CT KNEE BILAT WO	$368.70	$1,229.00	$123.69–$6,302.00	—	70%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT LOW EXTREM W/O CTR RT	$368.70	$1,229.00	$123.69–$6,302.00	40% below	70%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT LOW EXTREM W/O CTR LT	$368.70	$1,229.00	$123.69–$6,302.00	40% below	70%
Leg CT scan without contrast (hip to foot, any part) inpatient both sides CPT 73700 CT KNEE BILAT WO	$368.70	$1,229.00	$123.69–$6,302.00	—	70%
Leg CT scan without contrast (hip to foot, any part) inpatient both sides CPT 73700 CT EXTREMITY LOWER BILAT WO	$368.70	$1,229.00	$123.69–$6,302.00	—	70%
Leg CT scan without contrast (hip to foot, any part) inpatient both sides CPT 73700 CT HIP BILAT WO	$368.70	$1,229.00	$123.69–$6,302.00	—	70%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT LOW EXTREM W/O CTR LT	$368.70	$1,229.00	$123.69–$6,302.00	—	70%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT LOW EXTREM W/O CTR RT	$368.70	$1,229.00	$123.69–$6,302.00	—	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	31% 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	31% 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	24% 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%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US LMTD JT/FCL EVL NVASC XTR	$170.10	$567.00	$34.60–$4,867.00	2% below	70%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US SOFT TISSUE EXT/AXIL/TORSO	$178.50	$595.00	$34.60–$4,867.00	3% above	70%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US GROIN	$178.50	$595.00	$34.60–$4,867.00	3% above	70%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US LOWER EXTREMITY LIMITED RT	$170.10	$567.00	$34.60–$4,867.00	2% below	70%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US LOWER EXTREMITY LIMITED LT	$170.10	$567.00	$34.60–$4,867.00	2% below	70%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US GROIN RT	$178.50	$595.00	$34.60–$4,867.00	3% above	70%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US UPPER EXTREMITY LIMITED RT	$280.80	$936.00	$34.60–$4,867.00	62% above	70%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US UPPER EXTREMITY LIMITED LT	$280.80	$936.00	$34.60–$4,867.00	62% above	70%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US LMTD JT/FCL EVL NVASC XTR	$170.10	$567.00	$34.60–$4,867.00	—	70%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US SOFT TISSUE EXT/AXIL/TORSO	$178.50	$595.00	$34.60–$4,867.00	—	70%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US GROIN	$178.50	$595.00	$34.60–$4,867.00	—	70%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US LOWER EXTREMITY LIMITED RT	$170.10	$567.00	$34.60–$4,867.00	—	70%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US LOWER EXTREMITY LIMITED LT	$170.10	$567.00	$34.60–$4,867.00	—	70%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US GROIN RT	$178.50	$595.00	$34.60–$4,867.00	—	70%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US UPPER EXTREMITY LIMITED RT	$280.80	$936.00	$34.60–$4,867.00	—	70%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US UPPER EXTREMITY LIMITED LT	$280.80	$936.00	$34.60–$4,867.00	—	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	232% 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	232% above	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%
Lower leg X-ray (tibia and fibula), 2 views both sides CPT 73590 XR TIBIA FIBULA 2VW BILATERAL	$78.30	$261.00	$23.74–$589.00	—	70%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 X-RAY EXAM OF LOWER LEG	$45.30	$151.00	$23.74–$589.00	62% below	70%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 TIBIA FIBULA 2 VIEWS RT	$45.30	$151.00	$23.74–$589.00	62% below	70%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 TIBIA FIBULA 2 VIEWS LT	$45.30	$151.00	$23.74–$589.00	62% below	70%
Lower leg X-ray (tibia and fibula), 2 views inpatient both sides CPT 73590 XR TIBIA FIBULA 2VW BILATERAL	$78.30	$261.00	$23.74–$589.00	—	70%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 X-RAY EXAM OF LOWER LEG	$45.30	$151.00	$23.74–$589.00	—	70%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 TIBIA FIBULA 2 VIEWS LT	$45.30	$151.00	$23.74–$589.00	—	70%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 TIBIA FIBULA 2 VIEWS RT	$45.30	$151.00	$23.74–$589.00	—	70%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 CERVICAL SPINE MIN 4 VW	$106.20	$354.00	$38.72–$398.00	48% below	70%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 X-RAY EXAM NECK SPINE 4/5VWS	$106.20	$354.00	$38.72–$398.00	48% below	70%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 CERVICAL SPINE MIN 4 VW	$106.20	$354.00	$38.72–$398.00	—	70%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 X-RAY EXAM NECK SPINE 4/5VWS	$106.20	$354.00	$38.72–$398.00	—	70%
Neck soft tissue CT scan with contrast CPT 70491 CT NECK WITH CONTRAST	$427.50	$1,425.00	$177.01–$1,643.00	38% below	70%
Neck soft tissue CT scan with contrast inpatient CPT 70491 CT NECK WITH CONTRAST	$427.50	$1,425.00	$177.01–$1,643.00	—	70%
Neck soft tissue CT scan without contrast CPT 70490 CT NECK W/O CONTRAST	$310.80	$1,036.00	$144.44–$1,236.00	54% below	70%
Neck soft tissue CT scan without contrast inpatient CPT 70490 CT NECK W/O CONTRAST	$310.80	$1,036.00	$144.44–$1,236.00	—	70%
Neck soft tissue X-ray CPT 70360 NECK SOFT TISSUE	$45.30	$151.00	$22.62–$200.62	64% below	70%
Neck soft tissue X-ray inpatient CPT 70360 NECK SOFT TISSUE	$45.30	$151.00	$22.62–$200.62	—	70%
Pelvic CT scan without contrast CPT 72192 CT PELVIS WO CONTRAST	$302.70	$1,009.00	$127.82–$1,180.00	56% below	70%
Pelvic CT scan without contrast inpatient CPT 72192 CT PELVIS WO CONTRAST	$302.70	$1,009.00	$127.82–$1,180.00	—	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	68% below	70%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 ULTRASOUND PELVIS COMP	$178.50	$595.00	$79.52–$1,601.00	36% below	70%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US BLADDER	$178.50	$595.00	$79.52–$1,601.00	36% 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 ULTRASOUND PELVIS COMP	$178.50	$595.00	$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%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OB US >/= 14 WKS SNGL FETUS	$178.50	$595.00	$95.24–$697.00	30% below	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	30% 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	21% 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	21% below	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 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, limited (heartbeat, position, fluid) CPT 76815 US OB LIMITED	$144.30	$481.00	$54.44–$584.00	17% below	70%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB LIMITED	$144.30	$481.00	$54.44–$584.00	—	70%
Rib X-ray, one side, 2 views CPT 71100 X-RAY EXAM RIBS UNI 2 VIEWS	$55.20	$184.00	$25.61–$403.00	61% below	70%
Rib X-ray, one side, 2 views one side CPT 71100 RIBS UNILAT 2 VIEWS RT	$55.20	$184.00	$25.61–$403.00	61% below	70%
Rib X-ray, one side, 2 views one side CPT 71100 RIBS UNILAT 2 VIEWS LT	$55.20	$184.00	$25.61–$403.00	61% below	70%
Rib X-ray, one side, 2 views inpatient CPT 71100 X-RAY EXAM RIBS UNI 2 VIEWS	$55.20	$184.00	$25.61–$403.00	—	70%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 RIBS UNILAT 2 VIEWS RT	$55.20	$184.00	$25.61–$403.00	—	70%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 RIBS UNILAT 2 VIEWS LT	$55.20	$184.00	$25.61–$403.00	—	70%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 RIBS UNILAT PA CHEST LT	$59.40	$198.00	$28.98–$396.00	60% below	70%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 RIBS UNILAT W PA CHST RT	$59.40	$198.00	$28.98–$396.00	60% below	70%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 X-RAY EXAM UNILAT RIBS/CHEST	$59.40	$198.00	$28.98–$396.00	60% below	70%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 X-RAY EXAM UNILAT RIBS/CHEST	$59.40	$198.00	$28.98–$396.00	—	70%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 RIBS UNILAT W PA CHST RT	$59.40	$198.00	$28.98–$396.00	—	70%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 RIBS UNILAT PA CHEST LT	$59.40	$198.00	$28.98–$396.00	—	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	25% 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 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 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 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 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 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 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 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 AXIAL VIEW 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 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%
Sinus X-ray, complete, 3 or more views CPT 70220 SINUSES MIN 3 VIEWS	$46.80	$156.00	$26.74–$200.62	71% below	70%
Sinus X-ray, complete, 3 or more views CPT 70220 X-RAY EXAM OF SINUSES	$46.80	$156.00	$26.74–$200.62	71% below	70%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 X-RAY EXAM OF SINUSES	$46.80	$156.00	$26.74–$200.62	—	70%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 SINUSES MIN 3 VIEWS	$46.80	$156.00	$26.74–$200.62	—	70%
Thigh bone (femur) X-ray, 2 or more views both sides CPT 73552 XR FEMUR 2V2 BILATERAL	$77.70	$259.00	$26.74–$1,133.00	—	70%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 X-RAY EXAM OF FEMUR	$50.70	$169.00	$26.74–$1,133.00	58% below	70%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 XR FEMUR LT 2 V	$50.70	$169.00	$26.74–$1,133.00	58% below	70%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 XR FEMUR RT 1 V	$50.70	$169.00	$26.74–$1,133.00	58% below	70%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 XR FEMUR RT 2 V'S	$50.70	$169.00	$26.74–$1,133.00	58% below	70%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 XR FEMUR LT 2 V'S	$50.70	$169.00	$26.74–$1,133.00	58% below	70%
Thigh bone (femur) X-ray, 2 or more views inpatient both sides CPT 73552 XR FEMUR 2V2 BILATERAL	$77.70	$259.00	$26.74–$1,133.00	—	70%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 X-RAY EXAM OF FEMUR	$50.70	$169.00	$26.74–$1,133.00	—	70%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 XR FEMUR LT 2 V'S	$50.70	$169.00	$26.74–$1,133.00	—	70%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 XR FEMUR LT 2 V	$50.70	$169.00	$26.74–$1,133.00	—	70%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 XR FEMUR RT 2 V'S	$50.70	$169.00	$26.74–$1,133.00	—	70%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 XR FEMUR RT 1 V	$50.70	$169.00	$26.74–$1,133.00	—	70%
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT CHEST SPINE W/O DYE	$368.70	$1,229.00	$123.99–$1,385.00	51% below	70%
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT T-SPINE W/O CONTRAST	$368.70	$1,229.00	$123.99–$1,385.00	51% below	70%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT CHEST SPINE W/O DYE	$368.70	$1,229.00	$123.99–$1,385.00	—	70%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT T-SPINE W/O CONTRAST	$368.70	$1,229.00	$123.99–$1,385.00	—	70%
Toe X-ray, 2 or more views both sides CPT 73660 XR TOE(S) 2+VW BILATERAL	$50.70	$169.00	$22.62–$403.00	—	70%
Toe X-ray, 2 or more views one side CPT 73660 TOE(S) MIN 2 VIEWS LT	$31.80	$106.00	$22.62–$403.00	72% below	70%
Toe X-ray, 2 or more views one side CPT 73660 TOE(S) MIN 2 VIEWS RT	$31.80	$106.00	$22.62–$403.00	72% below	70%
Toe X-ray, 2 or more views inpatient both sides CPT 73660 XR TOE(S) 2+VW BILATERAL	$50.70	$169.00	$22.62–$403.00	—	70%
Toe X-ray, 2 or more views inpatient one side CPT 73660 TOE(S) MIN 2 VIEWS LT	$31.80	$106.00	$22.62–$403.00	—	70%
Toe X-ray, 2 or more views inpatient one side CPT 73660 TOE(S) MIN 2 VIEWS RT	$31.80	$106.00	$22.62–$403.00	—	70%
Transvaginal pelvic ultrasound CPT 76830 ULTRASOUND TRANSVAGINAL	$144.30	$481.00	$93.37–$591.00	32% 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	at median	70%
Transvaginal ultrasound during pregnancy CPT 76817 US PREGNANCY TRANSVAG	$180.30	$601.00	$61.55–$711.00	at median	70%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 TRANSVAGINAL US OBSTETRIC	$180.30	$601.00	$61.55–$711.00	—	70%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US PREGNANCY TRANSVAG	$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	34% below	70%
Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN COMPLETE	$197.70	$659.00	$86.63–$1,445.00	34% below	70%
Ultrasound of the abdomen, complete inpatient CPT 76700 ULTRASOUND ABDOMEN	$197.70	$659.00	$86.63–$1,445.00	—	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 scrotum and testicles CPT 76870 US SCROTUM/TESTICLES	$178.50	$595.00	$77.27–$696.00	17% 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 US THYROID	$178.50	$595.00	$92.62–$1,280.00	29% below	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	29% 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	29% below	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%
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%
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	32% 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	32% below	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%
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 arm X-ray (humerus), 2 views both sides CPT 73060 XR HUMERUS BILATERAL	$78.30	$261.00	$24.12–$891.00	—	70%
Upper arm X-ray (humerus), 2 views one side CPT 73060 HUMERUS MIN 2 VIEWS LT	$45.30	$151.00	$24.12–$891.00	65% below	70%
Upper arm X-ray (humerus), 2 views one side CPT 73060 HUMERUS MIN 2 VIEWS RT	$45.30	$151.00	$24.12–$891.00	65% below	70%
Upper arm X-ray (humerus), 2 views one side CPT 73060 XR HUMERUS LT	$45.30	$151.00	$24.12–$891.00	65% below	70%
Upper arm X-ray (humerus), 2 views one side CPT 73060 XR HUMERUS RT	$45.30	$151.00	$24.12–$891.00	65% below	70%
Upper arm X-ray (humerus), 2 views inpatient both sides CPT 73060 XR HUMERUS BILATERAL	$78.30	$261.00	$24.12–$891.00	—	70%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 XR HUMERUS LT	$45.30	$151.00	$24.12–$891.00	—	70%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 HUMERUS MIN 2 VIEWS RT	$45.30	$151.00	$24.12–$891.00	—	70%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 XR HUMERUS RT	$45.30	$151.00	$24.12–$891.00	—	70%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 HUMERUS MIN 2 VIEWS LT	$45.30	$151.00	$24.12–$891.00	—	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	34% 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	34% 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	34% below	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	81% above	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	81% 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 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 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 UPPER EXTREMITY RT	$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 LT	$466.50	$1,555.00	$107.41–$4,379.00	—	70%
Wrist X-ray, 2 views both sides CPT 73100 XR WRIST 2VW BILATERAL	$78.30	$261.00	$25.61–$625.00	—	70%
Wrist X-ray, 2 views CPT 73100 X-RAY EXAM OF WRIST	$50.70	$169.00	$25.61–$625.00	54% below	70%
Wrist X-ray, 2 views one side CPT 73100 XR WRIST 2 VIEWS RT	$50.70	$169.00	$25.61–$625.00	54% below	70%
Wrist X-ray, 2 views one side CPT 73100 XR WRIST 2 VIEWS LT	$50.70	$169.00	$25.61–$625.00	54% below	70%
Wrist X-ray, 2 views inpatient both sides CPT 73100 XR WRIST 2VW BILATERAL	$78.30	$261.00	$25.61–$625.00	—	70%
Wrist X-ray, 2 views inpatient CPT 73100 X-RAY EXAM OF WRIST	$50.70	$169.00	$25.61–$625.00	—	70%
Wrist X-ray, 2 views inpatient one side CPT 73100 XR WRIST 2 VIEWS RT	$50.70	$169.00	$25.61–$625.00	—	70%
Wrist X-ray, 2 views inpatient one side CPT 73100 XR WRIST 2 VIEWS LT	$50.70	$169.00	$25.61–$625.00	—	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	62% 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	62% 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	62% 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	65% 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	65% 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	16% below	70%
X-ray of the abdomen, 1 view CPT 74018 RADEX ABDOMEN 1 VIEW	$102.00	$340.00	$21.12–$369.00	16% below	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 abdomen, 1 view inpatient CPT 74018 XR 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 RT	$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 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 LT	$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 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	56% 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	56% 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	56% 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	56% 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	56% 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	56% 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	56% 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	$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 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 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 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 RT	$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, 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 RT	$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 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	71% below	70%
X-ray of the knee, 1 or 2 views CPT 73560 XR PATELLA	$45.30	$151.00	$26.36–$701.00	60% 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	71% 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	71% 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	60% 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 RT	$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 LT	$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 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 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 inpatient CPT 72100 LUMBOSACRAL 2-3 VIEWS	$95.40	$318.00	$28.23–$353.00	—	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, 4 or more views CPT 72110 X-RAY EXAM L-2 SPINE 4/>VWS	$95.40	$318.00	$37.22–$360.00	56% 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	56% 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	70% 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 X-RAY EXAM OF NASAL BONES	$63.60	$212.00	$28.98–$240.00	46% below	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	46% below	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 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 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 X-RAY EXAM NECK SPINE 2-3 VW	$106.20	$354.00	$28.23–$393.00	—	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 pelvis, 1 or 2 views CPT 72170 X-RAY EXAM OF PELVIS	$63.60	$212.00	$20.75–$281.74	52% 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	52% 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
ACTH blood test CPT 82024 ASSAY OF ACTH	$122.40	$408.00	$32.38–$408.00	13% above	70%
ACTH blood test CPT 82024 ACTH	$122.40	$408.00	$32.38–$408.00	13% above	70%
ACTH blood test inpatient CPT 82024 ACTH	$122.40	$408.00	$32.38–$408.00	—	70%
ACTH blood test inpatient CPT 82024 ASSAY OF ACTH	$122.40	$408.00	$32.38–$408.00	—	70%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALT (SGPT)	$16.80	$56.00	$4.44–$56.00	16% below	70%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALANINE AMINO (ALT) (SGPT)	$16.80	$56.00	$4.44–$56.00	16% below	70%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALT (SGPT)	$16.80	$56.00	$4.44–$56.00	—	70%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALANINE AMINO (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	70% above	70%
AST (aspartate aminotransferase) enzyme test CPT 84450 AST (SGOT)	$33.30	$111.00	$4.33–$111.00	70% above	70%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 TRANSFERASE (AST) (SGOT)	$33.30	$111.00	$4.33–$111.00	—	70%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 AST (SGOT)	$33.30	$111.00	$4.33–$111.00	—	70%
Albumin blood test CPT 82040 ASSAY OF SERUM ALBUMIN	$13.80	$46.00	$4.15–$46.00	12% below	70%
Albumin blood test CPT 82040 ALBUMIN SERUM	$13.80	$46.00	$4.15–$46.00	12% below	70%
Albumin blood test inpatient CPT 82040 ASSAY OF SERUM ALBUMIN	$13.80	$46.00	$4.15–$46.00	—	70%
Albumin blood test inpatient CPT 82040 ALBUMIN SERUM	$13.80	$46.00	$4.15–$46.00	—	70%
Aldosterone blood test CPT 82088 ASSAY OF ALDOSTERONE	$57.00	$190.00	$34.16–$190.00	41% below	70%
Aldosterone blood test CPT 82088 ALDOSTERONE	$57.00	$190.00	$34.16–$190.00	41% below	70%
Aldosterone blood test inpatient CPT 82088 ALDOSTERONE	$57.00	$190.00	$34.16–$190.00	—	70%
Aldosterone blood test inpatient CPT 82088 ASSAY OF ALDOSTERONE	$57.00	$190.00	$34.16–$190.00	—	70%
Alkaline phosphatase (ALP) blood test CPT 84075 ALK PHOS (ALP)	$45.00	$150.00	$4.34–$150.00	141% above	70%
Alkaline phosphatase (ALP) blood test CPT 84075 ASSAY ALKALINE PHOSPHATASE	$45.00	$150.00	$4.34–$150.00	141% above	70%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 ALK PHOS (ALP)	$45.00	$150.00	$4.34–$150.00	—	70%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 ASSAY ALKALINE PHOSPHATASE	$45.00	$150.00	$4.34–$150.00	—	70%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLG SPEC IGE CRUDE XTRC EA	$16.50	$55.00	$4.38–$55.00	58% above	70%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE EACH	$16.50	$55.00	$4.38–$55.00	58% 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%
Alpha-fetoprotein (AFP) blood test CPT 82105 ALPHA-FETOPROTEIN SERUM	$80.40	$268.00	$14.06–$268.00	49% above	70%
Alpha-fetoprotein (AFP) blood test CPT 82105 AFP, TUMOR MARKER	$80.40	$268.00	$14.06–$268.00	49% above	70%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 ALPHA-FETOPROTEIN SERUM	$80.40	$268.00	$14.06–$268.00	—	70%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 AFP, TUMOR MARKER	$80.40	$268.00	$14.06–$268.00	—	70%
Ammonia blood test CPT 82140 ASSAY OF AMMONIA	$50.10	$167.00	$12.22–$167.00	at median	70%
Ammonia blood test CPT 82140 AMMONIA	$50.10	$167.00	$12.22–$167.00	at median	70%
Ammonia blood test inpatient CPT 82140 AMMONIA	$50.10	$167.00	$12.22–$167.00	—	70%
Ammonia blood test inpatient CPT 82140 ASSAY OF AMMONIA	$50.10	$167.00	$12.22–$167.00	—	70%
Amylase blood test CPT 82150 AMYLASE BLD	$30.60	$102.00	$5.44–$102.00	37% above	70%
Amylase blood test CPT 82150 ASSAY OF AMYLASE	$30.60	$102.00	$5.44–$102.00	37% above	70%
Amylase blood test inpatient CPT 82150 ASSAY OF AMYLASE	$30.60	$102.00	$5.44–$102.00	—	70%
Amylase blood test inpatient CPT 82150 AMYLASE BLD	$30.60	$102.00	$5.44–$102.00	—	70%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP ANTIBODY	$33.90	$113.00	$10.85–$113.00	26% below	70%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP AB	$33.90	$113.00	$10.85–$113.00	26% 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	50% above	70%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA QUAL SCREEN	$99.00	$330.00	$10.13–$552.00	122% above	70%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODIES	$99.00	$330.00	$10.13–$552.00	122% 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 ANTINUCLEAR ANTIBODIES	$99.00	$330.00	$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%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NATRIURETIC PEPTIDE	$33.00	$110.00	$28.46–$110.00	50% below	70%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 ASSAY OF NATRIURETIC PEPTIDE	$33.00	$110.00	$28.46–$110.00	50% 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%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE BODY FLUID	$15.90	$53.00	$7.22–$441.00	46% below	70%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE OTHR SPECIMN AEROBIC	$15.90	$53.00	$7.22–$441.00	46% below	70%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE THROAT	$29.10	$97.00	$7.22–$441.00	at median	70%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE SPUTUM	$29.10	$97.00	$7.22–$441.00	at median	70%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE ROUTINE	$29.10	$97.00	$7.22–$441.00	at median	70%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE GENITAL	$29.10	$97.00	$7.22–$441.00	at median	70%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE BODY FLUID	$15.90	$53.00	$7.22–$441.00	—	70%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE OTHR SPECIMN AEROBIC	$15.90	$53.00	$7.22–$441.00	—	70%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE ROUTINE	$29.10	$97.00	$7.22–$441.00	—	70%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE SPUTUM	$29.10	$97.00	$7.22–$441.00	—	70%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE THROAT	$29.10	$97.00	$7.22–$441.00	—	70%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE GENITAL	$29.10	$97.00	$7.22–$441.00	—	70%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL	$28.80	$96.00	$7.10–$96.00	18% below	70%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PNL TOTAL CA	$28.80	$96.00	$7.10–$96.00	18% below	70%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL	$28.80	$96.00	$7.10–$96.00	—	70%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PNL TOTAL CA	$28.80	$96.00	$7.10–$96.00	—	70%
Bilirubin blood test, total CPT 82247 BILIRUBIN TOT	$13.80	$46.00	$4.21–$46.00	19% below	70%
Bilirubin blood test, total CPT 82247 BILIRUBIN TOTAL	$13.80	$46.00	$4.21–$46.00	19% below	70%
Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN TOT	$13.80	$46.00	$4.21–$46.00	—	70%
Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN TOTAL	$13.80	$46.00	$4.21–$46.00	—	70%
Blood culture for bacteria CPT 87040 BLOOD CULTURE FOR BACTERIA	$29.10	$97.00	$8.65–$97.00	36% below	70%
Blood culture for bacteria CPT 87040 CULTURE BLOOD	$29.10	$97.00	$8.65–$97.00	36% 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 VENI-PUNCTURE SPECIMEN	$3.00	$10.00	$1.80–$20.00	64% below	70%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE	$3.00	$10.00	$1.80–$20.00	64% below	70%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLL VENOUS BLD VENIPUNCTURE	$3.00	$10.00	$1.80–$20.00	64% below	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 draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENI-PUNCTURE SPECIMEN	$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	41% above	70%
Blood glucose (sugar) test CPT 82947 ASSAY GLUCOSE BLOOD QUANT	$19.80	$66.00	$3.29–$66.00	41% 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 ASSAY OF LEAD	$21.60	$72.00	$10.15–$72.00	23% below	70%
Blood lead test CPT 83655 LEAD BLOOD	$21.60	$72.00	$10.15–$72.00	23% below	70%
Blood lead test inpatient CPT 83655 ASSAY OF LEAD	$21.60	$72.00	$10.15–$72.00	—	70%
Blood lead test inpatient CPT 83655 LEAD BLOOD	$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	49% below	70%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 CHORIONIC GONADOTROPIN ASSAY	$16.50	$55.00	$6.29–$55.00	49% 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	51% 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	51% 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%
Blood urea nitrogen (BUN) test CPT 84520 ASSAY OF UREA NITROGEN	$13.80	$46.00	$3.31–$46.00	18% below	70%
Blood urea nitrogen (BUN) test CPT 84520 BUN	$13.80	$46.00	$3.31–$46.00	18% below	70%
Blood urea nitrogen (BUN) test inpatient CPT 84520 ASSAY OF UREA NITROGEN	$13.80	$46.00	$3.31–$46.00	—	70%
Blood urea nitrogen (BUN) test inpatient CPT 84520 BUN	$13.80	$46.00	$3.31–$46.00	—	70%
C-peptide blood test CPT 84681 ASSAY OF C-PEPTIDE	$23.40	$78.00	$17.44–$78.00	58% below	70%
C-peptide blood test CPT 84681 C-PEPTIDE	$23.40	$78.00	$17.44–$78.00	58% below	70%
C-peptide blood test inpatient CPT 84681 ASSAY OF C-PEPTIDE	$23.40	$78.00	$17.44–$78.00	—	70%
C-peptide blood test inpatient CPT 84681 C-PEPTIDE	$23.40	$78.00	$17.44–$78.00	—	70%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN	$41.70	$139.00	$4.34–$139.00	77% 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 CA 125	$72.30	$241.00	$17.44–$241.00	36% above	70%
CA-125 blood test (ovarian cancer marker) CPT 86304 IMMUNOASSAY TUMOR CA 125	$72.30	$241.00	$17.44–$241.00	36% above	70%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA 125	$72.30	$241.00	$17.44–$241.00	—	70%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 IMMUNOASSAY TUMOR CA 125	$72.30	$241.00	$17.44–$241.00	—	70%
Calcium blood test, total CPT 82310 CALCIUM TOT	$15.00	$50.00	$4.32–$50.00	25% below	70%
Calcium blood test, total CPT 82310 ASSAY OF CALCIUM	$15.00	$50.00	$4.32–$50.00	25% below	70%
Calcium blood test, total inpatient CPT 82310 CALCIUM TOT	$15.00	$50.00	$4.32–$50.00	—	70%
Calcium blood test, total inpatient CPT 82310 ASSAY OF CALCIUM	$15.00	$50.00	$4.32–$50.00	—	70%
Carcinoembryonic antigen (CEA) test CPT 82378 CEA	$97.80	$326.00	$15.91–$326.00	65% above	70%
Carcinoembryonic antigen (CEA) test CPT 82378 CARCINOEMBRYONIC ANTIGEN	$97.80	$326.00	$15.91–$326.00	65% above	70%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CEA	$97.80	$326.00	$15.91–$326.00	—	70%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CARCINOEMBRYONIC ANTIGEN	$97.80	$326.00	$15.91–$326.00	—	70%
Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA ZOSTER IGG	$21.00	$70.00	$10.80–$140.00	46% below	70%
Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA-ZOSTER ANTIBODY	$21.00	$70.00	$10.80–$140.00	46% below	70%
Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA ZOSTER IGM	$21.00	$70.00	$10.80–$140.00	46% below	70%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA-ZOSTER ANTIBODY	$21.00	$70.00	$10.80–$140.00	—	70%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA ZOSTER IGM	$21.00	$70.00	$10.80–$140.00	—	70%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA ZOSTER IGG	$21.00	$70.00	$10.80–$140.00	—	70%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA, TMA, SWAB	$44.10	$147.00	$29.42–$294.00	27% 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	27% 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	27% below	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%
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%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL	$27.00	$90.00	$11.23–$90.00	46% 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	39% below	70%
Complete blood count (CBC) with differential CPT 85025 CBC AUTO DIFF	$16.50	$55.00	$6.52–$143.00	39% below	70%
Complete blood count (CBC) with differential CPT 85025 CBC WITH MAN DIFF	$26.40	$88.00	$6.52–$143.00	2% below	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 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 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	55% below	70%
Comprehensive metabolic panel (blood test) CPT 80053 COMP METABOLIC PANEL	$34.20	$114.00	$8.86–$114.00	55% below	70%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMP METABOLIC PANEL	$34.20	$114.00	$8.86–$114.00	—	70%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHEN METABOLIC PANEL	$34.20	$114.00	$8.86–$114.00	—	70%
Cortisol blood test, total CPT 82533 CORTISOL TOTAL	$29.10	$97.00	$13.67–$194.00	24% below	70%
Cortisol blood test, total CPT 82533 CORTISOL, A.M. SPECIMEN	$29.10	$97.00	$13.67–$194.00	24% below	70%
Cortisol blood test, total CPT 82533 TOTAL CORTISOL	$29.10	$97.00	$13.67–$194.00	24% below	70%
Cortisol blood test, total inpatient CPT 82533 CORTISOL, A.M. SPECIMEN	$29.10	$97.00	$13.67–$194.00	—	70%
Cortisol blood test, total inpatient CPT 82533 TOTAL CORTISOL	$29.10	$97.00	$13.67–$194.00	—	70%
Cortisol blood test, total inpatient CPT 82533 CORTISOL TOTAL	$29.10	$97.00	$13.67–$194.00	—	70%
Creatine kinase (CK) blood test, total CPT 82550 CREATINE KINASE (CK)	$25.80	$86.00	$5.46–$86.00	15% above	70%
Creatine kinase (CK) blood test, total CPT 82550 ASSAY OF CK (CPK)	$25.80	$86.00	$5.46–$86.00	15% above	70%
Creatine kinase (CK) blood test, total inpatient CPT 82550 ASSAY OF CK (CPK)	$25.80	$86.00	$5.46–$86.00	—	70%
Creatine kinase (CK) blood test, total inpatient CPT 82550 CREATINE KINASE (CK)	$25.80	$86.00	$5.46–$86.00	—	70%
Creatinine blood test CPT 82565 CREATININE BLD	$26.10	$87.00	$4.30–$87.00	49% above	70%
Creatinine blood test CPT 82565 ASSAY OF CREATININE	$26.10	$87.00	$4.30–$87.00	49% above	70%
Creatinine blood test inpatient CPT 82565 CREATININE BLD	$26.10	$87.00	$4.30–$87.00	—	70%
Creatinine blood test inpatient CPT 82565 ASSAY OF CREATININE	$26.10	$87.00	$4.30–$87.00	—	70%
D-dimer blood test (blood clot marker) CPT 85379 D-DIMER QUANT	$21.00	$70.00	$8.53–$70.00	58% below	70%
D-dimer blood test (blood clot marker) CPT 85379 FIBRIN DEGRADATION QUANT	$21.00	$70.00	$8.53–$70.00	58% below	70%
D-dimer blood test (blood clot marker) inpatient CPT 85379 FIBRIN DEGRADATION QUANT	$21.00	$70.00	$8.53–$70.00	—	70%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-DIMER QUANT	$21.00	$70.00	$8.53–$70.00	—	70%
DHEA sulfate (DHEA-S) blood test CPT 82627 DEHYDROEPIANDROSTERONE	$24.90	$83.00	$18.64–$83.00	57% below	70%
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA SULFATE	$24.90	$83.00	$18.64–$83.00	57% below	70%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DEHYDROEPIANDROSTERONE	$24.90	$83.00	$18.64–$83.00	—	70%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA SULFATE	$24.90	$83.00	$18.64–$83.00	—	70%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZR	$24.90	$83.00	$47.89–$499.00	21% below	70%
Drug screen by lab instrument (any number of drug classes) CPT 80307 ALCOHOL QN	$24.90	$83.00	$47.89–$499.00	21% below	70%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG SCR ABUSE URINE	$33.00	$110.00	$47.89–$499.00	5% above	70%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG SCR COMP BLOOD	$91.80	$306.00	$47.89–$499.00	191% above	70%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZR	$24.90	$83.00	$47.89–$499.00	—	70%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 ALCOHOL QN	$24.90	$83.00	$47.89–$499.00	—	70%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG SCR ABUSE URINE	$33.00	$110.00	$47.89–$499.00	—	70%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG SCR COMP BLOOD	$91.80	$306.00	$47.89–$499.00	—	70%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 ELECTROLYTE PANEL	$60.00	$200.00	$5.88–$200.00	57% above	70%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 ELECTROLYTE PANEL	$60.00	$200.00	$5.88–$200.00	—	70%
Estradiol blood test CPT 82670 ESTRADIOL	$67.80	$226.00	$23.42–$226.00	10% above	70%
Estradiol blood test CPT 82670 ASSAY OF TOTAL ESTRADIOL	$67.80	$226.00	$23.42–$226.00	10% above	70%
Estradiol blood test inpatient CPT 82670 ESTRADIOL	$67.80	$226.00	$23.42–$226.00	—	70%
Estradiol blood test inpatient CPT 82670 ASSAY OF TOTAL 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	45% below	70%
FSH (follicle-stimulating hormone) test CPT 83001 FSH	$31.50	$105.00	$15.58–$105.00	45% below	70%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH	$31.50	$105.00	$15.58–$105.00	—	70%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 ASSAY OF GONADOTROPIN (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	64% above	70%
Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN FECAL	$171.60	$572.00	$16.45–$572.00	64% above	70%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CALPROTECTIN FECAL	$171.60	$572.00	$16.45–$572.00	—	70%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 ASSAY FOR CALPROTECTIN FECAL	$171.60	$572.00	$16.45–$572.00	—	70%
Ferritin blood test (iron stores) CPT 82728 ASSAY OF FERRITIN	$26.40	$88.00	$11.42–$88.00	43% below	70%
Ferritin blood test (iron stores) CPT 82728 FERRITIN	$26.40	$88.00	$11.42–$88.00	43% 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 ASSAY OF FOLIC ACID SERUM	$26.40	$88.00	$12.32–$88.00	34% below	70%
Folate (folic acid) blood test CPT 82746 FOLIC ACID	$26.40	$88.00	$12.32–$88.00	34% below	70%
Folate (folic acid) blood test inpatient CPT 82746 FOLIC ACID	$26.40	$88.00	$12.32–$88.00	—	70%
Folate (folic acid) blood test inpatient CPT 82746 ASSAY OF FOLIC ACID SERUM	$26.40	$88.00	$12.32–$88.00	—	70%
Free T3 thyroid hormone test CPT 84481 FREE ASSAY (FT-3)	$29.40	$98.00	$13.43–$98.00	35% below	70%
Free T3 thyroid hormone test CPT 84481 T3 FREE	$29.40	$98.00	$13.43–$98.00	35% 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	5% above	70%
Free T4 (free thyroxine) thyroid blood test CPT 84439 ASSAY OF FREE THYROXINE	$36.60	$122.00	$7.56–$122.00	5% above	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 T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4 FREE	$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	50% below	70%
Free testosterone test CPT 84402 TESTOSTERONE FREE	$31.50	$105.00	$21.34–$105.00	50% below	70%
Free testosterone test inpatient CPT 84402 TESTOSTERONE FREE	$31.50	$105.00	$21.34–$105.00	—	70%
Free testosterone test inpatient CPT 84402 ASSAY OF FREE TESTOSTERONE	$31.50	$105.00	$21.34–$105.00	—	70%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 GAMMA GT	$6.90	$23.00	$6.04–$23.00	72% below	70%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 ASSAY OF GGT	$6.90	$23.00	$6.04–$23.00	72% below	70%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 GAMMA GT	$6.90	$23.00	$6.04–$23.00	—	70%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 ASSAY OF GGT	$6.90	$23.00	$6.04–$23.00	—	70%
Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE TEST (GTT)	$31.50	$105.00	$10.79–$105.00	30% below	70%
Glucose tolerance test, 3 samples CPT 82951 GTT 1ST 3 SPECIMENS	$31.50	$105.00	$10.79–$105.00	30% 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	26% below	70%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GC AMP PROBE	$66.90	$223.00	$29.42–$373.00	10% above	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	10% 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 N.GONORRHOEAE DNA AMP PROB	$66.90	$223.00	$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%
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 1/2 4TH GEN, RFLX CONF	$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 AG W/HIV-1&-2 AB AG IA	$49.50	$165.00	$20.47–$165.00	—	70%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN A1C	$28.50	$95.00	$8.14–$95.00	14% below	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	14% 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%
Hemoglobin blood test CPT 85018 HEMOGLOBIN	$9.90	$33.00	$1.99–$33.00	10% below	70%
Hemoglobin blood test inpatient CPT 85018 HEMOGLOBIN	$9.90	$33.00	$1.99–$33.00	—	70%
Hepatitis B core antibody test (total) CPT 86704 HEP B CORE TOTAL AB	$45.90	$153.00	$10.10–$306.00	59% above	70%
Hepatitis B core antibody test (total) CPT 86704 HEP B CORE ANTIBODY TOTAL	$45.90	$153.00	$10.10–$306.00	59% above	70%
Hepatitis B core antibody test (total) CPT 86704 HEP B CORE AB TOTAL	$45.90	$153.00	$10.10–$306.00	59% above	70%
Hepatitis B core antibody test (total) inpatient CPT 86704 HEP B CORE ANTIBODY TOTAL	$45.90	$153.00	$10.10–$306.00	—	70%
Hepatitis B core antibody test (total) inpatient CPT 86704 HEP B CORE TOTAL AB	$45.90	$153.00	$10.10–$306.00	—	70%
Hepatitis B core antibody test (total) inpatient CPT 86704 HEP B CORE AB TOTAL	$45.90	$153.00	$10.10–$306.00	—	70%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURFACE AB	$45.90	$153.00	$9.01–$306.00	58% above	70%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HB S AB QUAL	$45.90	$153.00	$9.01–$306.00	58% 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	58% 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 HB S AB QUAL	$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 antigen (HBsAg) test CPT 87340 HEPATITIS B SURFACE AG IA	$45.90	$153.00	$8.66–$153.00	25% above	70%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEP B S AG EIA	$45.90	$153.00	$8.66–$153.00	25% 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 AB TEST	$99.90	$333.00	$11.96–$666.00	122% above	70%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C REFLEX QNT	$99.90	$333.00	$11.96–$666.00	122% above	70%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C AB QUAL	$99.90	$333.00	$11.96–$666.00	122% 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 AB QUAL	$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 viral load (HCV RNA) test CPT 87522 HCV RNA, PCR QUAL/QUANT	$97.80	$326.00	$35.91–$326.00	21% below	70%
Hepatitis C viral load (HCV RNA) test CPT 87522 HEPATITIS C REVRS TRNSCRPJ	$97.80	$326.00	$35.91–$326.00	21% 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 TYPE 2 TEST	$72.30	$241.00	$16.23–$241.00	63% above	70%
Herpes blood test, HSV-2 antibody CPT 86696 HERPES SIMPLEX 2 AB IGG	$72.30	$241.00	$16.23–$241.00	63% above	70%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HERPES SIMPLEX 2 AB IGG	$72.30	$241.00	$16.23–$241.00	—	70%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HERPES SIMPLEX TYPE 2 TEST	$72.30	$241.00	$16.23–$241.00	—	70%
High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROTEIN(CRP)HIGH SENSITIVITY	$41.70	$139.00	$10.85–$139.00	5% below	70%
High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROTEIN HS	$41.70	$139.00	$10.85–$139.00	5% below	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%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-REACTIVE PROTEIN HS	$41.70	$139.00	$10.85–$139.00	—	70%
Homocysteine blood test CPT 83090 ASSAY OF HOMOCYSTEINE	$102.00	$340.00	$14.14–$340.00	78% above	70%
Homocysteine blood test CPT 83090 HOMOCYSTEINE QN	$102.00	$340.00	$14.14–$340.00	78% above	70%
Homocysteine blood test inpatient CPT 83090 ASSAY OF HOMOCYSTEINE	$102.00	$340.00	$14.14–$340.00	—	70%
Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINE QN	$102.00	$340.00	$14.14–$340.00	—	70%
Insulin blood test CPT 83525 INSULIN	$23.40	$78.00	$9.59–$156.00	33% below	70%
Insulin blood test CPT 83525 ASSAY OF INSULIN	$23.40	$78.00	$9.59–$156.00	33% below	70%
Insulin blood test CPT 83525 INSULIN TOTAL	$23.40	$78.00	$9.59–$156.00	33% below	70%
Insulin blood test inpatient CPT 83525 INSULIN TOTAL	$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 ASSAY OF INSULIN	$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	80% above	70%
Iron blood test (serum iron) CPT 83540 ASSAY OF IRON	$39.00	$130.00	$5.43–$130.00	80% 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	40% below	70%
Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING (TIBC)	$19.80	$66.00	$7.33–$226.00	40% below	70%
Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING CAPACITY	$48.00	$160.00	$7.33–$226.00	47% 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	46% 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	42% below	70%
LH (luteinizing hormone) test CPT 83002 LH	$31.50	$105.00	$15.53–$105.00	42% 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%
Lactate (lactic acid) blood test CPT 83605 ASSAY OF LACTIC ACID	$18.30	$61.00	$8.95–$61.00	35% below	70%
Lactate (lactic acid) blood test CPT 83605 LACTIC ACID BODY FL	$18.30	$61.00	$8.95–$61.00	35% below	70%
Lactate (lactic acid) blood test inpatient CPT 83605 ASSAY OF LACTIC ACID	$18.30	$61.00	$8.95–$61.00	—	70%
Lactate (lactic acid) blood test inpatient CPT 83605 LACTIC ACID BODY FL	$18.30	$61.00	$8.95–$61.00	—	70%
Lactate dehydrogenase (LDH) blood test CPT 83615 LDH (LD)	$15.90	$53.00	$5.06–$53.00	24% below	70%
Lactate dehydrogenase (LDH) blood test CPT 83615 LACTATE (LD) (LDH) ENZYME	$15.90	$53.00	$5.06–$53.00	24% below	70%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH (LD)	$15.90	$53.00	$5.06–$53.00	—	70%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LACTATE (LD) (LDH) ENZYME	$15.90	$53.00	$5.06–$53.00	—	70%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE	$43.50	$145.00	$5.77–$145.00	60% above	70%
Lipase blood test (pancreas enzyme) CPT 83690 ASSAY OF LIPASE	$43.50	$145.00	$5.77–$145.00	60% above	70%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 ASSAY OF LIPASE	$43.50	$145.00	$5.77–$145.00	—	70%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 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	31% 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	29% below	70%
Magnesium blood test CPT 83735 ASSAY OF MAGNESIUM	$15.90	$53.00	$5.62–$53.00	29% below	70%
Magnesium blood test inpatient CPT 83735 MAGNESIUM BLD	$15.90	$53.00	$5.62–$53.00	—	70%
Magnesium blood test inpatient CPT 83735 ASSAY OF MAGNESIUM	$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	33% above	70%
Measles (rubeola) antibody test CPT 86765 RUBEOLA IGM ANTIBODY	$43.20	$144.00	$10.80–$144.00	33% above	70%
Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA IGM ANTIBODY	$43.20	$144.00	$10.80–$144.00	—	70%
Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA ANTIBODY	$43.20	$144.00	$10.80–$144.00	—	70%
Mono test (heterophile antibody, Monospot) CPT 86308 HETEROPHILE ANTIBODY SCREEN	$18.60	$62.00	$4.34–$62.00	19% below	70%
Mono test (heterophile antibody, Monospot) CPT 86308 MONO SCR (HETEROPHILE)	$18.60	$62.00	$4.34–$62.00	19% below	70%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONO SCR (HETEROPHILE)	$18.60	$62.00	$4.34–$62.00	—	70%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HETEROPHILE ANTIBODY SCREEN	$18.60	$62.00	$4.34–$62.00	—	70%
Mumps immunity blood test CPT 86735 MUMPS VIRUS IGG	$45.30	$151.00	$10.94–$151.00	47% above	70%
Mumps immunity blood test CPT 86735 MUMPS ANTIBODY	$45.30	$151.00	$10.94–$151.00	47% above	70%
Mumps immunity blood test inpatient CPT 86735 MUMPS VIRUS IGG	$45.30	$151.00	$10.94–$151.00	—	70%
Mumps immunity blood test inpatient CPT 86735 MUMPS ANTIBODY	$45.30	$151.00	$10.94–$151.00	—	70%
PSA (prostate-specific antigen) blood test, free CPT 84154 ASSAY OF PSA FREE	$71.10	$237.00	$15.42–$237.00	46% above	70%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA TOTAL AND FREE	$71.10	$237.00	$15.42–$237.00	46% 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 ASSAY OF PSA TOTAL	$34.80	$116.00	$15.42–$116.00	21% below	70%
PSA (prostate-specific antigen) blood test, total CPT 84153 PROS SPEC AG (PSA)	$34.80	$116.00	$15.42–$116.00	21% 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 ASSAY OF PARATHORMONE	$33.00	$110.00	$33.00–$110.00	64% below	70%
Parathyroid hormone (PTH) blood test CPT 83970 PTH INTACT	$33.00	$110.00	$33.00–$110.00	64% below	70%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH INTACT	$33.00	$110.00	$33.00–$110.00	—	70%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 ASSAY OF PARATHORMONE	$33.00	$110.00	$33.00–$110.00	—	70%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT	$31.50	$105.00	$5.03–$105.00	51% above	70%
Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PARTIAL	$31.50	$105.00	$5.03–$105.00	51% above	70%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT	$31.50	$105.00	$5.03–$105.00	—	70%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME PARTIAL	$31.50	$105.00	$5.03–$105.00	—	70%
Phosphorus (phosphate) blood test CPT 84100 PHOSPHORUS BLD	$9.00	$30.00	$3.98–$30.00	47% below	70%
Phosphorus (phosphate) blood test CPT 84100 ASSAY OF PHOSPHORUS	$9.00	$30.00	$3.98–$30.00	47% below	70%
Phosphorus (phosphate) blood test inpatient CPT 84100 PHOSPHORUS BLD	$9.00	$30.00	$3.98–$30.00	—	70%
Phosphorus (phosphate) blood test inpatient CPT 84100 ASSAY OF PHOSPHORUS	$9.00	$30.00	$3.98–$30.00	—	70%
Potassium blood test CPT 84132 POTASSIUM BLD	$14.10	$47.00	$3.85–$47.00	20% below	70%
Potassium blood test CPT 84132 ASSAY OF SERUM POTASSIUM	$14.10	$47.00	$3.85–$47.00	20% below	70%
Potassium blood test inpatient CPT 84132 POTASSIUM BLD	$14.10	$47.00	$3.85–$47.00	—	70%
Potassium blood test inpatient CPT 84132 ASSAY OF SERUM POTASSIUM	$14.10	$47.00	$3.85–$47.00	—	70%
Progesterone blood test CPT 84144 PROGESTERONE	$66.30	$221.00	$17.49–$221.00	19% above	70%
Progesterone blood test CPT 84144 ASSAY OF PROGESTERONE	$66.30	$221.00	$17.49–$221.00	19% above	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	37% above	70%
Prolactin blood test CPT 84146 PROLACTIN	$89.40	$298.00	$16.25–$298.00	37% 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 PROTIME	$19.80	$66.00	$3.29–$66.00	37% above	70%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME	$19.80	$66.00	$3.29–$66.00	37% above	70%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTIME	$19.80	$66.00	$3.29–$66.00	—	70%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME	$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	253% above	70%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA VIRUS A AG OIA	$81.90	$273.00	$10.06–$273.00	253% 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	19% 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	19% below	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%
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%
Renin blood test CPT 84244 ASSAY OF RENIN	$23.70	$79.00	$18.44–$79.00	61% below	70%
Renin blood test CPT 84244 RENIN	$23.70	$79.00	$18.44–$79.00	61% below	70%
Renin blood test inpatient CPT 84244 ASSAY OF RENIN	$23.70	$79.00	$18.44–$79.00	—	70%
Renin blood test inpatient CPT 84244 RENIN	$23.70	$79.00	$18.44–$79.00	—	70%
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANT	$22.80	$76.00	$4.76–$76.00	3% below	70%
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR, QUANT	$22.80	$76.00	$4.76–$76.00	3% 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	29% above	70%
Rubella antibody test (immunity check) CPT 86762 RUBELLA IGM ANTIBODY	$43.20	$144.00	$12.07–$288.00	29% above	70%
Rubella antibody test (immunity check) CPT 86762 RUBELLA ANTIBODY	$43.20	$144.00	$12.07–$288.00	29% above	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 IGM 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%
Sodium blood test CPT 84295 ASSAY OF SERUM SODIUM	$16.80	$56.00	$4.03–$56.00	6% below	70%
Sodium blood test CPT 84295 SODIUM BLD	$16.80	$56.00	$4.03–$56.00	6% below	70%
Sodium blood test inpatient CPT 84295 SODIUM BLD	$16.80	$56.00	$4.03–$56.00	—	70%
Sodium blood test inpatient CPT 84295 ASSAY OF SERUM SODIUM	$16.80	$56.00	$4.03–$56.00	—	70%
Syphilis antibody test (Treponema pallidum) CPT 86780 T. PALLIDUM TOTAL AB	$24.90	$83.00	$11.38–$83.00	12% below	70%
Syphilis antibody test (Treponema pallidum) CPT 86780 TREPONEMA PALLIDUM	$24.90	$83.00	$11.38–$83.00	12% below	70%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 TREPONEMA PALLIDUM	$24.90	$83.00	$11.38–$83.00	—	70%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 T. PALLIDUM TOTAL AB	$24.90	$83.00	$11.38–$83.00	—	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	45% above	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	45% above	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	142% above	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 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 QUANTIFERON TB GOLD	$33.00	$110.00	$33.00–$155.80	74% below	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	74% 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	45% below	70%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TOTAL	$33.00	$110.00	$21.65–$220.00	45% below	70%
Testosterone blood test, total (not free testosterone) CPT 84403 ASSAY OF TOTAL TESTOSTERONE	$33.00	$110.00	$21.65–$220.00	45% 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 LKM MICROSOME AB	$36.00	$120.00	$12.20–$276.00	7% below	70%
Thyroid peroxidase (TPO) antibody test CPT 86376 MICROSOMAL ANTIBODY EACH	$36.00	$120.00	$12.20–$276.00	7% below	70%
Thyroid peroxidase (TPO) antibody test CPT 86376 THYROID PEROXIDASE AB	$46.80	$156.00	$12.20–$276.00	21% 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	33% below	70%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 ASSAY THYROID STIM HORMONE	$27.60	$92.00	$14.08–$92.00	33% below	70%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH	$27.60	$92.00	$14.08–$92.00	—	70%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 ASSAY THYROID STIM HORMONE	$27.60	$92.00	$14.08–$92.00	—	70%
Total IgE blood test CPT 82785 IGE	$29.10	$97.00	$13.81–$97.00	24% below	70%
Total IgE blood test CPT 82785 ASSAY OF IGE	$29.10	$97.00	$13.81–$97.00	24% below	70%
Total IgE blood test inpatient CPT 82785 ASSAY OF IGE	$29.10	$97.00	$13.81–$97.00	—	70%
Total IgE blood test inpatient CPT 82785 IGE	$29.10	$97.00	$13.81–$97.00	—	70%
Total cholesterol blood test CPT 82465 CHOLESTEROL BLD	$18.90	$63.00	$3.65–$63.00	23% above	70%
Total cholesterol blood test CPT 82465 ASSAY BLD/SERUM CHOLESTEROL	$18.90	$63.00	$3.65–$63.00	23% above	70%
Total cholesterol blood test inpatient CPT 82465 CHOLESTEROL BLD	$18.90	$63.00	$3.65–$63.00	—	70%
Total cholesterol blood test inpatient CPT 82465 ASSAY BLD/SERUM CHOLESTEROL	$18.90	$63.00	$3.65–$63.00	—	70%
Total thyroxine (T4) blood test CPT 84436 ASSAY OF TOTAL THYROXINE	$36.60	$122.00	$5.77–$122.00	42% above	70%
Total thyroxine (T4) blood test CPT 84436 T4 TOTAL	$36.60	$122.00	$5.77–$122.00	42% above	70%
Total thyroxine (T4) blood test inpatient CPT 84436 T4 TOTAL	$36.60	$122.00	$5.77–$122.00	—	70%
Total thyroxine (T4) blood test inpatient CPT 84436 ASSAY OF TOTAL THYROXINE	$36.60	$122.00	$5.77–$122.00	—	70%
Total triiodothyronine (T3) blood test CPT 84480 T3 TOTAL	$44.70	$149.00	$8.73–$149.00	2% above	70%
Total triiodothyronine (T3) blood test CPT 84480 ASSAY TRIIODOTHYRONINE (T3)	$44.70	$149.00	$8.73–$149.00	2% above	70%
Total triiodothyronine (T3) blood test inpatient CPT 84480 ASSAY TRIIODOTHYRONINE (T3)	$44.70	$149.00	$8.73–$149.00	—	70%
Total triiodothyronine (T3) blood test inpatient CPT 84480 T3 TOTAL	$44.70	$149.00	$8.73–$149.00	—	70%
Transferrin blood test CPT 84466 TRANSFERRIN	$19.80	$66.00	$10.70–$66.00	51% below	70%
Transferrin blood test CPT 84466 ASSAY OF TRANSFERRIN	$19.80	$66.00	$10.70–$66.00	51% below	70%
Transferrin blood test inpatient CPT 84466 ASSAY OF TRANSFERRIN	$19.80	$66.00	$10.70–$66.00	—	70%
Transferrin blood test inpatient CPT 84466 TRANSFERRIN	$19.80	$66.00	$10.70–$66.00	—	70%
Trichomonas test (NAAT) CPT 87661 TRICHOMONAS, SWAB, AMP	$16.50	$55.00	$28.72–$349.00	70% below	70%
Trichomonas test (NAAT) CPT 87661 TRICHOMONAS, URINE, AMP	$44.10	$147.00	$28.72–$349.00	20% below	70%
Trichomonas test (NAAT) CPT 87661 TRICHOMONAS, VAG SWAB, AMP	$44.10	$147.00	$28.72–$349.00	20% below	70%
Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS AMPLIF	$44.10	$147.00	$28.72–$349.00	20% 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 VAGINALIS AMPLIF	$44.10	$147.00	$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%
Triglycerides blood test CPT 84478 TRIGLYCERIDES	$9.00	$30.00	$4.82–$30.00	62% below	70%
Triglycerides blood test CPT 84478 ASSAY OF TRIGLYCERIDES	$9.00	$30.00	$4.82–$30.00	62% below	70%
Triglycerides blood test inpatient CPT 84478 ASSAY OF TRIGLYCERIDES	$9.00	$30.00	$4.82–$30.00	—	70%
Triglycerides blood test inpatient CPT 84478 TRIGLYCERIDES	$9.00	$30.00	$4.82–$30.00	—	70%
Troponin test, quantitative CPT 84484 ASSAY OF TROPONIN QUANT	$24.90	$83.00	$8.25–$83.00	41% below	70%
Troponin test, quantitative CPT 84484 TROPONIN QUANT	$24.90	$83.00	$8.25–$83.00	41% below	70%
Troponin test, quantitative inpatient CPT 84484 TROPONIN QUANT	$24.90	$83.00	$8.25–$83.00	—	70%
Troponin test, quantitative inpatient CPT 84484 ASSAY OF TROPONIN QUANT	$24.90	$83.00	$8.25–$83.00	—	70%
Uric acid blood test CPT 84550 ASSAY OF BLOOD/URIC ACID	$9.00	$30.00	$3.79–$30.00	49% below	70%
Uric acid blood test CPT 84550 URIC ACID BLD	$9.00	$30.00	$3.79–$30.00	49% 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	59% below	70%
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS AUTO W/SCOPE	$9.90	$33.00	$2.66–$33.00	59% below	70%
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS AUTO W/SCOPE	$9.90	$33.00	$2.66–$33.00	—	70%
Urinalysis with microscope exam, automated inpatient CPT 81001 UA W MICROSCOPIC AUTO	$9.90	$33.00	$2.66–$33.00	—	70%
Urinalysis without microscope exam, automated CPT 81003 UA W O MICRO AUTO	$9.90	$33.00	$1.88–$66.00	12% above	70%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS AUTO W/O SCOPE	$9.90	$33.00	$1.88–$66.00	12% above	70%
Urinalysis without microscope exam, automated CPT 81003 PH UR AUTO	$9.90	$33.00	$1.88–$66.00	12% above	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 PH UR AUTO	$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, manual CPT 81002 UA W O MICRO MANUAL	$13.20	$44.00	$2.14–$44.00	87% above	70%
Urinalysis without microscope exam, manual CPT 81002 URINALYSIS NONAUTO W/O SCOPE	$13.20	$44.00	$2.14–$44.00	87% 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	46% below	70%
Urine culture for bacteria, with colony count CPT 87086 URINE CULTURE/COLONY COUNT	$19.80	$66.00	$6.77–$66.00	46% 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 microalbumin (albumin) test CPT 82043 ALBUMIN, URINE, RANDOM	$23.10	$77.00	$4.85–$154.00	17% above	70%
Urine microalbumin (albumin) test CPT 82043 UR ALBUMIN QUANTITATIVE	$23.10	$77.00	$4.85–$154.00	17% above	70%
Urine microalbumin (albumin) test CPT 82043 MICROALBUMIN QN	$23.10	$77.00	$4.85–$154.00	17% above	70%
Urine microalbumin (albumin) test inpatient CPT 82043 ALBUMIN, URINE, RANDOM	$23.10	$77.00	$4.85–$154.00	—	70%
Urine microalbumin (albumin) test inpatient CPT 82043 UR ALBUMIN QUANTITATIVE	$23.10	$77.00	$4.85–$154.00	—	70%
Urine microalbumin (albumin) test inpatient CPT 82043 MICROALBUMIN QN	$23.10	$77.00	$4.85–$154.00	—	70%
Urine pregnancy test, read by color change CPT 81025 PREG URINE QUAL	$16.50	$55.00	$5.30–$55.00	19% below	70%
Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY TEST	$16.50	$55.00	$5.30–$55.00	19% 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 B-12	$33.60	$112.00	$12.64–$112.00	16% below	70%
Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B12	$33.60	$112.00	$12.64–$112.00	16% below	70%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B-12	$33.60	$112.00	$12.64–$112.00	—	70%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B12	$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	58% 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	58% 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%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 VIT D 1 25-DIHYDROXY	$49.50	$165.00	$32.27–$165.00	52% below	70%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 VITAMIN D 1 25 DIHY	$49.50	$165.00	$32.27–$165.00	52% below	70%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 VIT D 1 25-DIHYDROXY	$49.50	$165.00	$32.27–$165.00	—	70%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 VITAMIN D 1 25 DIHY	$49.50	$165.00	$32.27–$165.00	—	70%
Zinc blood test CPT 84630 ASSAY OF ZINC	$51.60	$172.00	$9.55–$172.00	57% above	70%
Zinc blood test CPT 84630 ZINC BLOOD	$51.60	$172.00	$9.55–$172.00	57% 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 CHORIONIC GONADOTROPIN TEST	$69.30	$231.00	$12.62–$231.00	39% above	70%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG BETA QUANTITATIVE	$69.30	$231.00	$12.62–$231.00	39% 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	$546.60	$1,822.00	$398.67–$7,815.95	70% below	70%
Appendectomy, open surgery inpatient CPT 44950 APPENDECTOMY	$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 COR HLX VLGS DSTL MTAR OSTEO	$433.95	$1,446.50	$433.95–$6,881.13	88% below	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	88% 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	91% 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	57% below	70%
Colonoscopy with polyp removal CPT 45385 COLONOSCOPY RML LESI	$370.80	$1,236.00	$331.45–$2,524.31	57% below	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 polyp removal inpatient CPT 45385 COLONOSCOPY RML LESI	$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	59% below	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	66% below	70%
Colonoscopy, diagnostic CPT 45378 DIAGNOSTIC COLONOSCOPY	$1,161.00	$3,870.00	$244.11–$1,920.17	41% 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	49% below	70%
Earwax removal with instruments, one ear CPT 69210 REMOVE IMPACTED EAR WAX UNI	$33.00	$110.00	$33.00–$1,300.00	49% 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	92% 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%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 DIAGNOSTIC SIGMOIDOSCOPY	$148.50	$495.00	$81.87–$1,920.17	71% below	70%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 FLEX SIGMOIDOSCOPY	$148.50	$495.00	$81.87–$1,920.17	71% below	70%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 FLEX SIGMOIDOSCOPY	$148.50	$495.00	$81.87–$1,920.17	—	70%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 DIAGNOSTIC SIGMOIDOSCOPY	$148.50	$495.00	$81.87–$1,920.17	—	70%
Gallbladder removal, laparoscopic CPT 47562 LAPAROSCOPIC CHOLECYSTECTOMY	$561.90	$1,873.00	$455.38–$12,150.50	81% below	70%
Gallbladder removal, laparoscopic CPT 47562 LAP INC HERNIA REPAI	$561.90	$1,873.00	$455.38–$12,150.50	81% below	70%
Gallbladder removal, laparoscopic CPT 47562 LAP CHOLESYSTECTOMY	$561.90	$1,873.00	$455.38–$12,150.50	81% below	70%
Gallbladder removal, laparoscopic inpatient CPT 47562 LAP CHOLESYSTECTOMY	$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 INC HERNIA REPAI	$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	83% 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	84% 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 OF HAMMERTOE	$325.95	$1,086.50	$325.95–$6,881.13	90% below	70%
Hammertoe correction surgery CPT 28285 REPAIR HAMMERTOE	$325.95	$1,086.50	$325.95–$6,881.13	90% below	70%
Hammertoe correction surgery inpatient CPT 28285 REPAIR HAMMERTOE	$325.95	$1,086.50	$325.95–$6,881.13	—	70%
Hammertoe correction surgery inpatient CPT 28285 REPAIR OF 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	76% 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	76% 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 HYSTERECTOMY	$864.60	$2,882.00	$647.11–$10,737.37	65% below	70%
Hysterectomy through an abdominal incision (total) inpatient CPT 58150 TOTAL HYSTERECTOMY	$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	85% 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	52% 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	52% 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 ABSCESS SIMPLE/SINGLE	$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 SKIN ABSCESS	$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	86% 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	86% below	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%
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%
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 LAP APPENDECTOMY	$512.40	$1,708.00	$365.16–$12,150.50	89% below	70%
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 LAPAROSCOPY APPENDECTOMY	$512.40	$1,708.00	$365.16–$12,150.50	89% below	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 appendectomy (appendix removal through small cuts) inpatient CPT 44970 LAP APPENDECTOMY	$512.40	$1,708.00	$365.16–$12,150.50	—	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	92% 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 removal of fallopian tubes and/or ovaries CPT 58661 LAPAROSCOPY REMOVAL ADNEXAL STRUCTURES	$548.40	$1,828.00	$548.40–$12,150.50	91% below	70%
Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 LAPAROSCOPY REMOVE ADNEXA	$548.40	$1,828.00	$548.40–$12,150.50	91% below	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 LAC/LAYER2.5ORLESS/SCALP,TRUNK	$72.60	$242.00	$72.60–$1,300.00	79% below	70%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 INTMD RPR S/A/T/EXT 2.5 CM/<	$72.60	$242.00	$72.60–$1,300.00	79% below	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%
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%
Mastectomy (total removal of the breast) CPT 19303 MASTECTOMY SIMPLE	$813.90	$2,713.00	$584.09–$13,164.98	83% below	70%
Mastectomy (total removal of the breast) CPT 19303 MAST SIMPLE COMPLETE	$813.90	$2,713.00	$584.09–$13,164.98	83% below	70%
Mastectomy (total removal of the breast) inpatient CPT 19303 MAST SIMPLE COMPLETE	$813.90	$2,713.00	$584.09–$13,164.98	—	70%
Mastectomy (total removal of the breast) inpatient CPT 19303 MASTECTOMY SIMPLE	$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 BENIGN LESION	$104.10	$347.00	$67.27–$1,533.38	73% below	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	73% below	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), 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), 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	76% below	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	76% 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 SIMPLE 1	$66.00	$220.00	$55.60–$1,300.00	56% below	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 inpatient CPT 11730 AVULSION NAIL PLATE/FAC	$66.00	$220.00	$55.60–$1,300.00	—	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%
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	72% below	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	72% below	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%
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%
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	82% 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	56% 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	56% 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	25% below	70%
Short arm splint (forearm and hand) CPT 29125 APPL.SHORT ARM SPLINT FAC	$99.00	$330.00	$63.97–$330.00	25% below	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 arm splint (forearm and hand) inpatient CPT 29125 APPL SHORT ARM SPLINT STATIC	$99.00	$330.00	$63.97–$330.00	—	70%
Short leg splint (calf to foot) CPT 29515 APPL OF SHORT LEG SPLINT FAC	$66.00	$220.00	$66.00–$336.18	57% below	70%
Short leg splint (calf to foot) CPT 29515 APPLICATION SHORT LEG SPLINT	$66.00	$220.00	$66.00–$336.18	57% below	70%
Short leg splint (calf to foot) inpatient CPT 29515 APPLICATION SHORT LEG SPLINT	$66.00	$220.00	$66.00–$336.18	—	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%
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	71% 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	71% below	70%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 RPR S/N/AX/GEN/TRNK 2.5CM/<	$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 LAC-SIM/2.5ORLESS/SCP,TRNK,EXT	$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	57% 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 LAC SIM/2.6-7.5/SCALP/TRNK/FAC	$38.10	$127.00	$77.91–$439.22	81% 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 RPR S/N/AX/GEN/TRNK2.6-7.5CM	$38.10	$127.00	$77.91–$439.22	81% 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	74% 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	76% 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	75% 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	61% below	70%
Upper endoscopy (EGD) with biopsy CPT 43239 EGD BIOPSY SINGLE/MULTIPLE	$302.40	$1,008.00	$211.18–$1,975.57	61% below	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 biopsy inpatient CPT 43239 EGD BIOPSY SINGLE/MULTIPLE	$302.40	$1,008.00	$211.18–$1,975.57	—	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	53% below	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	53% below	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) 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), 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	$232.20	$774.00	$187.40–$1,975.57	—	70%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 EGD DIAGNOSTIC BRUSH WASH	$232.20	$774.00	$187.40–$1,975.57	—	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	75% below	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	75% 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	63% 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	63% 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	31% below	70%
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION	$690.30	$2,301.00	$47.51–$6,761.00	45% 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 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 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 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 INITIAL	$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 SUBSEQ	$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 INITIAL	$66.00	$220.00	$21.12–$1,071.00	—	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 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 AIRWAY INHALATION TREATMENT	$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	6% below	70%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE FAC	$792.00	$2,640.00	$237.72–$2,640.00	6% below	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 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%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ELECTROCARDIOGRAM TRACING	$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	75% 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	38% below	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	38% below	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 ER LEVEL 2	$165.00	$550.00	$46.95–$550.00	3% below	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	3% below	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 2 of 5, straightforward problem inpatient CPT 99282 ER LEVEL 2	$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	2% below	70%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ER LEVEL 3	$264.00	$880.00	$70.30–$880.00	2% below	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 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 4 of 5, moderate-complexity problem CPT 99284 ER LEVEL 4	$412.50	$1,375.00	$129.55–$1,375.00	3% below	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	3% below	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 EMERGENCY DEPT VISIT HI MDM	$561.00	$1,870.00	$188.42–$1,870.00	5% above	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	5% above	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%
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%
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 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 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 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 IV INFUSION 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 OP IV 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	75% below	70%
IV infusion of a medicine, first hour CPT 96365 OP IV THERAPY INITIAL	$95.40	$318.00	$85.85–$563.47	55% 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	55% 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 OP IV THERAPY INITIAL	$95.40	$318.00	$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 push of a medicine, first drug CPT 96374 THER/PROPH/DIAG INJ IV PUSH	$27.60	$92.00	$47.87–$563.47	75% below	70%
IV push of a medicine, first drug CPT 96374 OP IV PUSH INITIAL	$27.60	$92.00	$47.87–$563.47	75% below	70%
IV push of a medicine, first drug CPT 96374 IVP INJ INITIAL DRUG	$27.60	$92.00	$47.87–$563.47	75% below	70%
IV push of a medicine, first drug inpatient CPT 96374 OP IV PUSH INITIAL	$27.60	$92.00	$47.87–$563.47	—	70%
IV push of a medicine, first drug inpatient CPT 96374 THER/PROPH/DIAG INJ IV PUSH	$27.60	$92.00	$47.87–$563.47	—	70%
IV push of a medicine, first drug inpatient CPT 96374 IVP INJ INITIAL DRUG	$27.60	$92.00	$47.87–$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	44% below	70%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 PSYCH DIAGNOSTIC EVALUATION	$66.00	$220.00	$66.00–$330.20	44% 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	15% below	70%
Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSCULAR REEDUCATION	$33.00	$110.00	$27.96–$110.00	15% below	70%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEUROMUSCULAR RE-EDUC	$33.00	$110.00	$27.96–$110.00	—	70%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEUROMUSCULAR REEDUCATION	$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	39% below	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	23% 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 60 minutes CPT 99205 OFFICE O/P NEW HI 60 MIN	$102.30	$341.00	$57.00–$341.00	11% below	70%
New patient office visit, about 60 minutes CPT 99205 LEVEL 5 NP	$102.30	$341.00	$57.00–$341.00	11% below	70%
New patient office visit, about 60 minutes inpatient CPT 99205 LEVEL 5 NP	$102.30	$341.00	$57.00–$341.00	—	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%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT EVALUATION INITIAL - HIGH	$59.40	$198.00	$58.94–$208.64	53% 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	53% 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	40% 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	40% 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	57% 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	57% 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	30% below	70%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THERAPY	$27.00	$90.00	$23.71–$90.00	30% 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 EXERCISES	$33.00	$110.00	$11.00–$110.00	—	70%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC EXERCISE	$33.00	$110.00	$11.00–$110.00	—	70%
Psychotherapy session, 45 minutes CPT 90834 IOP GROUP THERAPY	$99.00	$330.00	$92.93–$330.20	25% below	70%
Psychotherapy session, 45 minutes CPT 90834 PSYTX W PT 45 MINUTES	$99.00	$330.00	$92.93–$330.20	25% below	70%
Psychotherapy session, 45 minutes inpatient CPT 90834 PSYTX W PT 45 MINUTES	$99.00	$330.00	$92.93–$330.20	—	70%
Psychotherapy session, 45 minutes inpatient CPT 90834 IOP GROUP THERAPY	$99.00	$330.00	$92.93–$330.20	—	70%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 BEHAV CHNG SMOKING 3-10 MIN	$33.00	$110.00	$13.79–$110.00	72% above	70%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 SMOKING CESSATION	$33.00	$110.00	$13.79–$110.00	72% 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	38% below	70%
Specialist consultation, low complexity or 30+ minutes CPT 99243 CONSULT DETAILED	$78.00	$260.00	$59.83–$260.00	38% 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	22% below	70%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 CONSULT COMP/MOD	$115.80	$386.00	$65.38–$386.00	22% 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	18% 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
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DTAP VACCINE < 7 YRS IM	$27.60	$92.00	$27.60–$92.00	22% below	70%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DTAP < 7 YEARS	$27.60	$92.00	$27.60–$92.00	22% below	70%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DTAP VACCINE < 7 YRS IM	$27.60	$92.00	$27.60–$92.00	—	70%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DTAP < 7 YEARS	$27.60	$92.00	$27.60–$92.00	—	70%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEP B 5MCG/.5ML PED VAC	$91.87	$306.25	$33.20–$306.25	135% above	70%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPB VACC 3 DOSE PED/ADOL IM	$91.87	$306.25	$33.20–$306.25	135% above	70%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEP B 5MCG/.5ML PED VAC	$91.87	$306.25	$33.20–$306.25	—	70%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEPB VACC 3 DOSE PED/ADOL IM	$91.87	$306.25	$33.20–$306.25	—	70%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMO 23 VAC ADLT J	$139.80	$466.00	$133.47–$466.00	4% 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	4% 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	17% above	70%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE IM	$764.40	$2,548.00	$282.31–$2,548.00	17% above	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 TETANUS DIPTHERIA TOXOIC 0.5 ML INJ	$54.90	$183.00	$38.97–$183.00	23% above	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	23% 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 VACCINE 7 YRS/> IM	$30.30	$101.00	$39.69–$310.50	53% below	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	53% 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	2% below	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 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 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 VACCINE ADMINISTRATION	$12.90	$43.00	$10.00–$86.00	68% below	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 inpatient CPT 90471 IMMUNIZATION ADMIN	$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 VACCINE ADMINISTRATION	$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	76% 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	76% 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	76% below	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 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 IMM ADM EA ADD VACC	$6.60	$22.00	$10.00–$44.00	—	70%

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

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

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

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

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

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

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

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

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

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