Hospital

Mount Desert Island Hospital

Mount Desert Island Hospital in Bar Harbor, ME publishes cash prices for 314 common procedures listed here, from its own machine-readable price file (the file does not say when it was last updated). Compared with other hospitals in the state, its outpatient cash prices are below the Maine median for 148 of 304 procedures and above it for 148. By typical cash price it ranks #16 of 27 Maine hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

10 Wayman Ln, Bar Harbor, ME 04609 Collected Sep 27, 2026 Source price file (207) 288-5081

Critical access hospital (rural, 25 beds or fewer) Emergency department CCN 201304 · CMS hospital register

CMS price transparency record

The federal Centers for Medicare & Medicaid Services (CMS) enforces the rule that makes hospitals publish their prices. Its public enforcement list shows 3 actions for a hospital named Mount Desert Island Hospital in Bar Harbor, ME:

Apr 1, 2026 Warning notice
Jul 7, 2026 Corrective action plan requested
Jul 15, 2026 Case closed

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

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

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Maine	Off list
Bone scan, whole body (nuclear medicine) CPT 78306 NM Bone Imaging Whole Body - Report	$3,690.90	$4,101.00	$1,845.45–$4,101.00	167% above	10%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM Bone Imaging Whole Body - Report	$3,690.90	$4,101.00	$1,845.45–$4,101.00	—	10%
Breast ultrasound, complete, one breast one side CPT 76641 US Breast Complete Left	$591.30	$657.00	$295.65–$657.00	18% above	10%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US Breast Complete Left	$591.30	$657.00	$295.65–$657.00	—	10%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US Breast Limited Right	$164.70	$183.00	$82.35–$183.00	54% below	10%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US Breast Limited Left	$608.40	$676.00	$304.20–$676.00	71% above	10%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US Breast Limited Right	$164.70	$183.00	$82.35–$183.00	—	10%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US Breast Limited Left	$608.40	$676.00	$304.20–$676.00	—	10%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT Angio Chest	$315.00	$350.00	$157.50–$350.00	84% below	10%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT Angio Chest	$315.00	$350.00	$157.50–$350.00	—	10%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CT Angio Heart/Coronary Arteries	$288.00	$320.00	$144.00–$320.00	45% below	10%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 CT Angio Heart/Coronary Arteries	$288.00	$320.00	$144.00–$320.00	—	10%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abdomen and Pelvis w/ Contrast	$379.80	$422.00	$189.90–$422.00	79% below	10%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abdomen and Pelvis w/ Contrast	$379.80	$422.00	$189.90–$422.00	—	10%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT Abdomen and Pelvis w/ + w/o Contrast	$397.80	$442.00	$198.90–$442.00	82% below	10%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT Abdomen and Pelvis w/ + w/o Contrast	$397.80	$442.00	$198.90–$442.00	—	10%
CT scan of the abdomen without contrast CPT 74150 CT Abdomen w/o Contrast	$734.40	$816.00	$367.20–$816.00	22% below	10%
CT scan of the abdomen without contrast inpatient CPT 74150 CT Abdomen w/o Contrast	$734.40	$816.00	$367.20–$816.00	—	10%
CT scan of the head or brain, no contrast dye CPT 70450 CT Head w/o Contrast	$282.60	$314.00	$141.30–$314.00	76% below	10%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Head w/o Contrast	$282.60	$314.00	$141.30–$314.00	—	10%
CT scan of the head with contrast CPT 70460 CT Head w/ Contrast	$313.20	$348.00	$156.60–$348.00	81% below	10%
CT scan of the head with contrast inpatient CPT 70460 CT Head w/ Contrast	$313.20	$348.00	$156.60–$348.00	—	10%
CT scan of the head without and with contrast CPT 70470 CT Head w/ + w/o Contrast	$416.70	$463.00	$208.35–$463.00	75% below	10%
CT scan of the head without and with contrast inpatient CPT 70470 CT Head w/ + w/o Contrast	$416.70	$463.00	$208.35–$463.00	—	10%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 US Carotid Duplex Bilateral	$431.10	$479.00	$215.55–$479.00	—	10%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 US Carotid Duplex Bilateral	$431.10	$479.00	$215.55–$479.00	—	10%
Chest X-ray, 2 views CPT 71046 XR Chest 2 Views	$43.20	$48.00	$21.60–$48.00	79% below	10%
Chest X-ray, 2 views inpatient CPT 71046 XR Chest 2 Views	$43.20	$48.00	$21.60–$48.00	—	10%
Chest X-ray, single view CPT 71045 XR Chest 1 View Portable	$352.80	$392.00	$176.40–$392.00	93% above	10%
Chest X-ray, single view CPT 71045 XR Chest 1 View	$734.40	$816.00	$367.20–$816.00	301% above	10%
Chest X-ray, single view inpatient CPT 71045 XR Chest 1 View Portable	$352.80	$392.00	$176.40–$392.00	—	10%
Chest X-ray, single view inpatient CPT 71045 XR Chest 1 View	$734.40	$816.00	$367.20–$816.00	—	10%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US Retroperitoneal Complete	$148.50	$165.00	$74.25–$165.00	73% below	10%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US Retroperitoneal Complete	$148.50	$165.00	$74.25–$165.00	—	10%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 BD Bone Density DEXA App Skeleton - Report	$1,073.70	$1,193.00	$536.85–$1,193.00	505% above	10%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 BD Bone Density DEXA App Skeleton	$1,106.10	$1,229.00	$553.05–$1,229.00	523% above	10%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 BD Bone Density DEXA App Skeleton - Report	$1,073.70	$1,193.00	$536.85–$1,193.00	—	10%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 BD Bone Density DEXA App Skeleton	$1,106.10	$1,229.00	$553.05–$1,229.00	—	10%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Lung Cancer Screening Follow Up	$288.00	$320.00	$144.00–$320.00	69% below	10%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Chest w/o Contrast	$426.60	$474.00	$213.30–$474.00	55% below	10%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Lung Cancer Screening Follow Up	$288.00	$320.00	$144.00–$320.00	—	10%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Chest w/o Contrast	$426.60	$474.00	$213.30–$474.00	—	10%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Chest w/ Contrast	$426.60	$474.00	$213.30–$474.00	64% below	10%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Chest w/ Contrast	$426.60	$474.00	$213.30–$474.00	—	10%
Diagnostic mammogram, both breasts both sides CPT 77066 MG Mammo Diagnostic Bilateral w/ Tomo	$145.80	$162.00	$72.90–$162.00	—	10%
Diagnostic mammogram, both breasts both sides CPT 77066 MA 3D BILAT DIAGNOSTIC MAMMO W/CAD	$228.60	$254.00	$114.30–$254.00	—	10%
Diagnostic mammogram, both breasts both sides CPT 77066 MG Mammo Diagnostic Bilateral - Report	$770.40	$856.00	$385.20–$856.00	—	10%
Diagnostic mammogram, both breasts both sides CPT 77066 MG Mammo Diagnostic Bilateral	$2,349.90	$2,611.00	$1,174.95–$2,611.00	—	10%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MG Mammo Diagnostic Bilateral w/ Tomo	$145.80	$162.00	$72.90–$162.00	—	10%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MA 3D BILAT DIAGNOSTIC MAMMO W/CAD	$228.60	$254.00	$114.30–$254.00	—	10%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MG Mammo Diagnostic Bilateral - Report	$770.40	$856.00	$385.20–$856.00	—	10%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MG Mammo Diagnostic Bilateral	$2,349.90	$2,611.00	$1,174.95–$2,611.00	—	10%
Diagnostic mammogram, one breast one side CPT 77065 MG Mammo Diagnostic Left - Report	$47.70	$53.00	$23.85–$53.00	83% below	10%
Diagnostic mammogram, one breast one side CPT 77065 MG Mammo Diagnostic Right w/ Tomo	$125.10	$139.00	$62.55–$139.00	55% below	10%
Diagnostic mammogram, one breast one side CPT 77065 MG Mammo Diagnostic Left w/ Tomo	$125.10	$139.00	$62.55–$139.00	55% below	10%
Diagnostic mammogram, one breast one side CPT 77065 MA 3D LT UNI DIAGNOSTIC MAMMO W/CAD	$157.50	$175.00	$78.75–$175.00	44% below	10%
Diagnostic mammogram, one breast one side CPT 77065 MA 3D RT UNI DIAGNOSTIC MAMMO W/CAD	$157.50	$175.00	$78.75–$175.00	44% below	10%
Diagnostic mammogram, one breast one side CPT 77065 MG Mammo Diagnostic Left	$257.40	$286.00	$128.70–$286.00	8% below	10%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MG Mammo Diagnostic Left - Report	$47.70	$53.00	$23.85–$53.00	—	10%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MG Mammo Diagnostic Right w/ Tomo	$125.10	$139.00	$62.55–$139.00	—	10%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MG Mammo Diagnostic Left w/ Tomo	$125.10	$139.00	$62.55–$139.00	—	10%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA 3D LT UNI DIAGNOSTIC MAMMO W/CAD	$157.50	$175.00	$78.75–$175.00	—	10%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA 3D RT UNI DIAGNOSTIC MAMMO W/CAD	$157.50	$175.00	$78.75–$175.00	—	10%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MG Mammo Diagnostic Left	$257.40	$286.00	$128.70–$286.00	—	10%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 US Lower Ext Arterial Duplex Bilateral - Report	$682.20	$758.00	$341.10–$758.00	—	10%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 US Lower Ext Arterial Duplex Bilateral - Report	$682.20	$758.00	$341.10–$758.00	—	10%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US Lower Ext Venous Duplex Bilateral - Report	$142.20	$158.00	$71.10–$158.00	—	10%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US Upper Ext Venous Duplex Bilateral	$191.70	$213.00	$95.85–$213.00	—	10%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US Lower Ext Venous Duplex Bilateral - Report	$142.20	$158.00	$71.10–$158.00	—	10%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US Upper Ext Venous Duplex Bilateral	$191.70	$213.00	$95.85–$213.00	—	10%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 US Echo 2D Comp w/ Color Flow Doppler	$180.90	$201.00	$90.45–$201.00	88% below	10%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 US Echo 2D Comp w/ Color Flow Doppler EO - Report	$400.50	$445.00	$200.25–$445.00	74% below	10%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 US Echo 2D Comp w/ Color Flow Doppler	$180.90	$201.00	$90.45–$201.00	—	10%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 US Echo 2D Comp w/ Color Flow Doppler EO - Report	$400.50	$445.00	$200.25–$445.00	—	10%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 Sleep Study	$147.60	$164.00	$73.80–$164.00	36% below	10%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 SLEEP STUDY UNATTENDED INTERP	$415.80	$462.00	$207.90–$462.00	81% above	10%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 Sleep Study	$147.60	$164.00	$73.80–$164.00	—	10%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 SLEEP STUDY UNATTENDED INTERP	$415.80	$462.00	$207.90–$462.00	—	10%
Knee X-ray, 3 views one side CPT 73562 XR Knee 3 Views Left	$38.70	$43.00	$19.35–$43.00	85% below	10%
Knee X-ray, 3 views one side CPT 73562 XR Knee 3 Views Right	$109.80	$122.00	$54.90–$122.00	59% below	10%
Knee X-ray, 3 views inpatient one side CPT 73562 XR Knee 3 Views Left	$38.70	$43.00	$19.35–$43.00	—	10%
Knee X-ray, 3 views inpatient one side CPT 73562 XR Knee 3 Views Right	$109.80	$122.00	$54.90–$122.00	—	10%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT Lung Cancer Screening	$192.60	$214.00	$96.30–$214.00	2% below	10%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT Lung Cancer Screening	$192.60	$214.00	$96.30–$214.00	—	10%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LE Joint w/o Contrast Rt	$302.40	$336.00	$151.20–$336.00	82% below	10%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LE Joint w/o Contrast Lt	$394.20	$438.00	$197.10–$438.00	76% below	10%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI LE Joint w/o Contrast Rt	$302.40	$336.00	$151.20–$336.00	—	10%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI LE Joint w/o Contrast Lt	$394.20	$438.00	$197.10–$438.00	—	10%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LE Joint w/ + w/o Contrast Rt	$330.30	$367.00	$165.15–$367.00	90% below	10%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LE Joint w/ + w/o Contrast Lt	$390.60	$434.00	$195.30–$434.00	88% below	10%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI LE Joint w/ + w/o Contrast Rt	$330.30	$367.00	$165.15–$367.00	—	10%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI LE Joint w/ + w/o Contrast Lt	$390.60	$434.00	$195.30–$434.00	—	10%
MRI of the lower back, no contrast dye CPT 72148 MRI Spine Lumbar w/o Contrast	$402.30	$447.00	$201.15–$447.00	72% below	10%
MRI of the lower back, no contrast dye CPT 72148 MRI Spine Lumbar Limited	$539.10	$599.00	$269.55–$599.00	63% below	10%
MRI of the lower back, no contrast dye CPT 72148 MR LUMBAR SPINE SURVEY	$2,102.40	$2,336.00	$1,051.20–$2,336.00	46% above	10%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI Spine Lumbar w/o Contrast	$402.30	$447.00	$201.15–$447.00	—	10%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI Spine Lumbar Limited	$539.10	$599.00	$269.55–$599.00	—	10%
MRI of the lower back, no contrast dye inpatient CPT 72148 MR LUMBAR SPINE SURVEY	$2,102.40	$2,336.00	$1,051.20–$2,336.00	—	10%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI Spine Lumbar w/ + w/o Contrast - Report	$435.60	$484.00	$217.80–$484.00	85% below	10%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI Spine Lumbar w/ + w/o Contrast - Report	$435.60	$484.00	$217.80–$484.00	—	10%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI Spine Thoracic w/o Contrast	$402.30	$447.00	$201.15–$447.00	78% below	10%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MR THORACIC SPINE SURVEY	$2,102.40	$2,336.00	$1,051.20–$2,336.00	14% above	10%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI Spine Thoracic Limited	$3,625.20	$4,028.00	$1,812.60–$4,028.00	96% above	10%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI Spine Thoracic w/o Contrast	$402.30	$447.00	$201.15–$447.00	—	10%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MR THORACIC SPINE SURVEY	$2,102.40	$2,336.00	$1,051.20–$2,336.00	—	10%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI Spine Thoracic Limited	$3,625.20	$4,028.00	$1,812.60–$4,028.00	—	10%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI Spine Cervical w/ + w/o Contrast - Report	$396.00	$440.00	$198.00–$440.00	82% below	10%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI Spine Cervical w/ + w/o Contrast - Report	$396.00	$440.00	$198.00–$440.00	—	10%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI Spine Cervical w/o Contrast	$304.20	$338.00	$152.10–$338.00	79% below	10%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI Spine Entire w/o Contrast	$304.20	$338.00	$152.10–$338.00	79% below	10%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI Spine Cervical Limited	$3,690.90	$4,101.00	$1,845.45–$4,101.00	156% above	10%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI Spine Cervical w/o Contrast	$304.20	$338.00	$152.10–$338.00	—	10%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI Spine Entire w/o Contrast	$304.20	$338.00	$152.10–$338.00	—	10%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI Spine Cervical Limited	$3,690.90	$4,101.00	$1,845.45–$4,101.00	—	10%
MRI of the pelvis without and with contrast CPT 72197 MRI Pelvis w/ + w/o Contrast	$305.10	$339.00	$152.55–$339.00	88% below	10%
MRI of the pelvis without and with contrast CPT 72197 MR PELVIS W/ + W/O CONTRAST PRO	$539.10	$599.00	$269.55–$599.00	78% below	10%
MRI of the pelvis without and with contrast CPT 72197 MR PELVIS W/ + W/O CONTRAST	$3,692.70	$4,103.00	$1,846.35–$4,103.00	51% above	10%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI Pelvis w/ + w/o Contrast	$305.10	$339.00	$152.55–$339.00	—	10%
MRI of the pelvis without and with contrast inpatient CPT 72197 MR PELVIS W/ + W/O CONTRAST PRO	$539.10	$599.00	$269.55–$599.00	—	10%
MRI of the pelvis without and with contrast inpatient CPT 72197 MR PELVIS W/ + W/O CONTRAST	$3,692.70	$4,103.00	$1,846.35–$4,103.00	—	10%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI UE Joint w/o Contrast Rt	$402.30	$447.00	$201.15–$447.00	75% below	10%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI UE Joint w/o Contrast Rt	$402.30	$447.00	$201.15–$447.00	—	10%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US Pelvic Non OB Ltd	$226.80	$252.00	$113.40–$252.00	92% above	10%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US Pelvic Non OB Ltd	$226.80	$252.00	$113.40–$252.00	—	10%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US Pelvic Non OB Comp	$191.70	$213.00	$95.85–$213.00	53% below	10%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US Pelvic Non OB Comp	$191.70	$213.00	$95.85–$213.00	—	10%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB Less Than 14 Weeks Single	$990.90	$1,101.00	$495.45–$1,101.00	198% above	10%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OB Less Than 14 Weeks Single	$990.90	$1,101.00	$495.45–$1,101.00	—	10%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB Limited	$100.80	$112.00	$50.40–$112.00	37% below	10%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB Limited	$100.80	$112.00	$50.40–$112.00	—	10%
Screening mammogram, both breasts both sides CPT 77067 MG Mammo Screening Bilateral w/ Tomo MDIH Addon Profee	$125.10	$139.00	$62.55–$139.00	—	10%
Screening mammogram, both breasts both sides CPT 77067 MG Mammo Screening Bilateral	$125.10	$139.00	$62.55–$139.00	—	10%
Screening mammogram, both breasts both sides CPT 77067 MG Mammo Implant Digital Screening Bilat	$145.80	$162.00	$72.90–$162.00	—	10%
Screening mammogram, both breasts both sides CPT 77067 MA 3D Bilat ImplantScreening Mammo	$228.60	$254.00	$114.30–$254.00	—	10%
Screening mammogram, both breasts both sides CPT 77067 MA 3D Bilat Screening Mammo	$713.70	$793.00	$356.85–$793.00	—	10%
Screening mammogram, both breasts one side CPT 77067 MG Mammo Implant Screening Rt w/ Tomo	$101.70	$113.00	$50.85–$113.00	46% below	10%
Screening mammogram, both breasts one side CPT 77067 MG Mammo Screening Right w/ Tomo	$125.10	$139.00	$62.55–$139.00	34% below	10%
Screening mammogram, both breasts one side CPT 77067 MG Mammo Implant Screening Lt w/ Tomo	$125.10	$139.00	$62.55–$139.00	34% below	10%
Screening mammogram, both breasts one side CPT 77067 MG Mammo Screening Left w/ Tomo	$125.10	$139.00	$62.55–$139.00	34% below	10%
Screening mammogram, both breasts one side CPT 77067 MA 3D LT UNI Screening Mammo W/CAD	$228.60	$254.00	$114.30–$254.00	21% above	10%
Screening mammogram, both breasts one side CPT 77067 MA 3D RT UNI Screening Mammo W/CAD	$228.60	$254.00	$114.30–$254.00	21% above	10%
Screening mammogram, both breasts one side CPT 77067 MG Mammo Digital Screening Left	$247.50	$275.00	$123.75–$275.00	31% above	10%
Screening mammogram, both breasts one side CPT 77067 MG Mammo Digital Screening Left - Report	$963.00	$1,070.00	$481.50–$1,070.00	409% above	10%
Screening mammogram, both breasts one side CPT 77067 MG Mammo Digital Screening Right	$963.00	$1,070.00	$481.50–$1,070.00	409% above	10%
Screening mammogram, both breasts inpatient both sides CPT 77067 MG Mammo Implant Digital Screening Bilat	$145.80	$162.00	$72.90–$162.00	—	10%
Screening mammogram, both breasts inpatient both sides CPT 77067 MA 3D Bilat ImplantScreening Mammo	$228.60	$254.00	$114.30–$254.00	—	10%
Screening mammogram, both breasts inpatient both sides CPT 77067 MA 3D Bilat Screening Mammo	$713.70	$793.00	$356.85–$793.00	—	10%
Screening mammogram, both breasts inpatient one side CPT 77067 MA 3D RT UNI Screening Mammo W/CAD	$228.60	$254.00	$114.30–$254.00	—	10%
Screening mammogram, both breasts inpatient one side CPT 77067 MA 3D LT UNI Screening Mammo W/CAD	$228.60	$254.00	$114.30–$254.00	—	10%
Screening mammogram, both breasts inpatient one side CPT 77067 MG Mammo Digital Screening Left	$247.50	$275.00	$123.75–$275.00	—	10%
Screening mammogram, both breasts inpatient one side CPT 77067 MG Mammo Digital Screening Right	$963.00	$1,070.00	$481.50–$1,070.00	—	10%
Screening mammogram, both breasts inpatient one side CPT 77067 MG Mammo Digital Screening Left - Report	$963.00	$1,070.00	$481.50–$1,070.00	—	10%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR Shoulder Complete 2+ Views Left - Report	$49.50	$55.00	$24.75–$55.00	78% below	10%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR Shoulder Complete 2+ Views Right - Report	$75.60	$84.00	$37.80–$84.00	66% below	10%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR Shoulder Complete 2+ Views Left - Report	$49.50	$55.00	$24.75–$55.00	—	10%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR Shoulder Complete 2+ Views Right - Report	$75.60	$84.00	$37.80–$84.00	—	10%
Transvaginal pelvic ultrasound CPT 76830 US Transvaginal Non-OB	$345.60	$384.00	$172.80–$384.00	66% above	10%
Transvaginal pelvic ultrasound inpatient CPT 76830 US Transvaginal Non-OB	$345.60	$384.00	$172.80–$384.00	—	10%
Transvaginal ultrasound during pregnancy CPT 76817 US OB Transvaginal	$801.00	$890.00	$400.50–$890.00	297% above	10%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US OB Transvaginal	$801.00	$890.00	$400.50–$890.00	—	10%
Ultrasound of the scrotum and testicles CPT 76870 US Scrotum (Contents) - Report	$343.80	$382.00	$171.90–$382.00	at median	10%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US Scrotum (Contents) - Report	$343.80	$382.00	$171.90–$382.00	—	10%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Thyroid	$111.60	$124.00	$55.80–$124.00	43% below	10%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US Thyroid	$111.60	$124.00	$55.80–$124.00	—	10%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 XR Upper GI	$235.80	$262.00	$117.90–$262.00	67% below	10%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 XR Upper GI	$235.80	$262.00	$117.90–$262.00	—	10%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Upper Ext Venous Duplex Right - Report	$155.70	$173.00	$77.85–$173.00	75% below	10%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Lower Ext Venous Duplex Right	$173.70	$193.00	$86.85–$193.00	72% below	10%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Upper Ext Venous Duplex Left - Report	$209.70	$233.00	$104.85–$233.00	67% below	10%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Lower Ext Venous Duplex Left	$220.50	$245.00	$110.25–$245.00	65% below	10%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Upper Ext Venous Duplex Right - Report	$155.70	$173.00	$77.85–$173.00	—	10%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Lower Ext Venous Duplex Right	$173.70	$193.00	$86.85–$193.00	—	10%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Upper Ext Venous Duplex Left - Report	$209.70	$233.00	$104.85–$233.00	—	10%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Lower Ext Venous Duplex Left	$220.50	$245.00	$110.25–$245.00	—	10%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR Wrist Complete 3+ Views Right	$155.70	$173.00	$77.85–$173.00	42% below	10%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR Wrist Complete 3+ Views Right	$155.70	$173.00	$77.85–$173.00	—	10%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip 2-3 Views w/AP Pelvis Left	$224.10	$249.00	$112.05–$249.00	6% above	10%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip 2-3 Views w/AP Pelvis Right	$1,131.30	$1,257.00	$565.65–$1,257.00	433% above	10%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR Hip 2-3 Views w/AP Pelvis Left	$224.10	$249.00	$112.05–$249.00	—	10%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR Hip 2-3 Views w/AP Pelvis Right	$1,131.30	$1,257.00	$565.65–$1,257.00	—	10%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger(3rd Digit) 2+ Views Left	$43.20	$48.00	$21.60–$48.00	80% below	10%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger(3rd Digit) 2+ Views Left	$43.20	$48.00	$21.60–$48.00	—	10%
X-ray of the hand, 3 or more views one side CPT 73130 XR Hand Complete 3+ Views Left	$38.70	$43.00	$19.35–$43.00	82% below	10%
X-ray of the hand, 3 or more views one side CPT 73130 XR Hand Complete 3+ Views Right	$38.70	$43.00	$19.35–$43.00	82% below	10%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 XR Hand Complete 3+ Views Left	$38.70	$43.00	$19.35–$43.00	—	10%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 XR Hand Complete 3+ Views Right	$38.70	$43.00	$19.35–$43.00	—	10%
X-ray of the knee, 1 or 2 views one side CPT 73560 XR Knee 1 or 2 Views Right	$38.70	$43.00	$19.35–$43.00	83% below	10%
X-ray of the knee, 1 or 2 views one side CPT 73560 XR Knee 1 or 2 Views Left	$81.00	$90.00	$40.50–$90.00	64% below	10%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR Knee 1 or 2 Views Right	$38.70	$43.00	$19.35–$43.00	—	10%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR Knee 1 or 2 Views Left	$81.00	$90.00	$40.50–$90.00	—	10%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XR Spine Lumbosacral 2 or 3 Views - Report	$58.50	$65.00	$29.25–$65.00	78% below	10%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 XR Spine Lumbosacral 2 or 3 Views - Report	$58.50	$65.00	$29.25–$65.00	—	10%
X-ray of the lower back, 4 or more views CPT 72110 XR Spine Lumbosacral 4plus Views - Report	$58.50	$65.00	$29.25–$65.00	82% below	10%
X-ray of the lower back, 4 or more views inpatient CPT 72110 XR Spine Lumbosacral 4plus Views - Report	$58.50	$65.00	$29.25–$65.00	—	10%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 XR Spine Thoracic 2 Views	$49.50	$55.00	$24.75–$55.00	79% below	10%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 XR Spine Thoracic 2 Views	$49.50	$55.00	$24.75–$55.00	—	10%
X-ray of the nasal bones, 3 or more views CPT 70160 XR Nasal Bones 3+ Views	$43.20	$48.00	$21.60–$48.00	84% below	10%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 XR Nasal Bones 3+ Views	$43.20	$48.00	$21.60–$48.00	—	10%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XR Spine Cervical 2 or 3 Views	$42.30	$47.00	$21.15–$47.00	85% below	10%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 XR Spine Cervical 2 or 3 Views	$42.30	$47.00	$21.15–$47.00	—	10%
X-ray of the pelvis, 1 or 2 views CPT 72170 XR Pelvis 1 or 2 Views	$38.70	$43.00	$19.35–$43.00	81% below	10%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 XR Pelvis 1 or 2 Views	$38.70	$43.00	$19.35–$43.00	—	10%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XR Sacrum/Coccyx 2+ Views	$48.60	$54.00	$24.30–$54.00	82% below	10%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 XR Sacrum/Coccyx 2+ Views	$48.60	$54.00	$24.30–$54.00	—	10%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Maine	Off list
Allergy blood test, specific IgE, per allergen CPT 86003 Almond (F20) IgE QST	$9.90	$11.00	$4.95–$11.00	48% below	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Alternaria Alternata (M6) IgE QST	$10.80	$12.00	$5.40–$12.00	43% below	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Pecan Nut (F201) IgE QST	$11.34	$12.60	$5.67–$12.60	41% below	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Penicillium Notatum (M1) IgE QST	$11.34	$12.60	$5.67–$12.60	41% below	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Penicillium notatum (m1) Qst	$12.60	$14.00	$6.30–$14.00	34% below	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Pistachio (F203) IgE QST	$18.68	$20.76	$9.34–$20.76	2% below	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Tomato (f25) IgE QST	$18.90	$21.00	$9.45–$21.00	1% below	10%
Allergy blood test, specific IgE, per allergen CPT 86003 White-Faced Hornet (i2) IgE QST	$19.80	$22.00	$9.90–$22.00	4% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Lobster (F80) IgE QST	$19.80	$22.00	$9.90–$22.00	4% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 ZZAllergen Food Swordfish ALI	$19.80	$22.00	$9.90–$22.00	4% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 ZZAllergen Food Strawberry ALI	$19.80	$22.00	$9.90–$22.00	4% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Squid (F258) IgE QST	$19.80	$22.00	$9.90–$22.00	4% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Common ragweed (short) (w1) Qst	$19.80	$22.00	$9.90–$22.00	4% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Common Ragweed (Short) (W1) IgE QST	$19.80	$22.00	$9.90–$22.00	4% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Pineapple (F210) IgE QST	$19.80	$22.00	$9.90–$22.00	4% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 White mulberry (t70) Qst	$20.70	$23.00	$10.35–$23.00	8% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Cottonwood (T14) IgE QST	$20.70	$23.00	$10.35–$23.00	8% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Cottonwood (t14) Qst	$20.70	$23.00	$10.35–$23.00	8% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 ZZAllergen Food Rice ALI	$20.70	$23.00	$10.35–$23.00	8% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 86003- Food Allergy Profile QST	$20.70	$23.00	$10.35–$23.00	8% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Brazil Nut (F18) IgE QST	$21.60	$24.00	$10.80–$24.00	13% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Salmon (F41) IgE QST	$21.60	$24.00	$10.80–$24.00	13% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Pork (F26) IgE QST	$21.60	$24.00	$10.80–$24.00	13% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Dog dander (e5) Qst	$24.30	$27.00	$12.15–$27.00	27% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Timothy Grass (G6) IgE QST	$26.10	$29.00	$13.05–$29.00	37% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Scallop (F338) IgE QST	$27.90	$31.00	$13.95–$31.00	46% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Crab (F23) IgE QST	$30.60	$34.00	$15.30–$34.00	60% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 ZZAllergen Food Haddock ALI	$31.50	$35.00	$15.75–$35.00	65% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 ZZAllergen Food Onion ALI	$31.50	$35.00	$15.75–$35.00	65% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Lamb's Quarters (W10) IgE QST	$31.50	$35.00	$15.75–$35.00	65% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Celery (F85) IgE QST	$32.35	$35.94	$16.17–$35.94	70% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 ZZAllergen Food Potato White ALI	$32.40	$36.00	$16.20–$36.00	70% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Shrimp Class QST	$33.30	$37.00	$16.65–$37.00	75% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Sheep sorrel (w18) Qst	$33.30	$37.00	$16.65–$37.00	75% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Cat dander (e1) Qst	$33.30	$37.00	$16.65–$37.00	75% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Sesame Seed (F10) IgE QST	$33.30	$37.00	$16.65–$37.00	75% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Sheep Sorrel (W18) IgE QST	$33.30	$37.00	$16.65–$37.00	75% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Snail (f324) IgE QST	$33.30	$37.00	$16.65–$37.00	75% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Shrimp (F24) IgE QST	$33.30	$37.00	$16.65–$37.00	75% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Cat Dander (E1) IgE QST	$35.10	$39.00	$17.55–$39.00	84% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Banana (F92) IgE QST	$35.42	$39.36	$17.71–$39.36	86% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Oyster (F290) IgE QST	$38.70	$43.00	$19.35–$43.00	103% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Cultivated Wheat (G15 )IgE QST	$42.30	$47.00	$21.15–$47.00	122% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Soybean (F14) IgE QST	$43.20	$48.00	$21.60–$48.00	126% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Walnut (F256) IgE QST	$43.20	$48.00	$21.60–$48.00	126% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Codfish (F3) IgE QST	$44.10	$49.00	$22.05–$49.00	131% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Cockroach (I6) IgE QST	$44.10	$49.00	$22.05–$49.00	131% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Mountain Cedar (T6) IgE QST	$48.60	$54.00	$24.30–$54.00	155% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Blue Mussel (F37) IgE QST	$49.50	$55.00	$24.75–$55.00	159% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 ZZAllergen Food Port ALI	$53.10	$59.00	$26.55–$59.00	178% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Tuna (F40) IgE QST	$53.10	$59.00	$26.55–$59.00	178% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Wheat (F4) IgE QST	$54.00	$60.00	$27.00–$60.00	183% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Elm (T8) IgE QST	$59.40	$66.00	$29.70–$66.00	211% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Mouse Urine Proteins (e72) Qst	$66.60	$74.00	$33.30–$74.00	249% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Mycoplasma Pneumoniae Ab (IgM) QST	$67.50	$75.00	$33.75–$75.00	254% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Mouse Urine Proteins (E72) IgE QST	$69.30	$77.00	$34.65–$77.00	263% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 ZZAllergen Food Sole ALI	$70.20	$78.00	$35.10–$78.00	268% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Cockroach (i6) Qst	$75.60	$84.00	$37.80–$84.00	296% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Strawberry (f44) IgE QST	$75.60	$84.00	$37.80–$84.00	296% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Timothy grass (g6) Qst	$77.40	$86.00	$38.70–$86.00	306% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Mountain cedar (t6) Qst	$81.90	$91.00	$40.95–$91.00	329% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Rough Pigweed (W14) IgE QST	$83.70	$93.00	$41.85–$93.00	339% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Maple (box elder) (t1) Qst	$84.60	$94.00	$42.30–$94.00	343% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Rough pigweed (w14) Qst	$86.40	$96.00	$43.20–$96.00	353% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 ZZAllergen Food Perch ALI	$88.20	$98.00	$44.10–$98.00	362% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 ZZAllergen Food Pollack White ALI	$88.20	$98.00	$44.10–$98.00	362% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Bermuda grass (g2) Qst	$98.17	$109.08	$49.09–$109.08	415% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Bermuda Grass (G2) IgE QST	$98.17	$109.08	$49.09–$109.08	415% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Cow's Milk (F2) IgE QST	$102.60	$114.00	$51.30–$114.00	438% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Dermatophagoides Farinae (D2) IgE QST	$106.20	$118.00	$53.10–$118.00	457% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Parsley (F86) IgE QST	$107.10	$119.00	$53.55–$119.00	461% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Peach (f95) IgE QST	$107.10	$119.00	$53.55–$119.00	461% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Walnut Tree (T10) IgE QST	$110.70	$123.00	$55.35–$123.00	480% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 House Dust (Greer) (h1) IgE QST	$111.60	$124.00	$55.80–$124.00	485% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Egg White (F1) IgE QST	$117.90	$131.00	$58.95–$131.00	518% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Clam (F207) IgE QST	$122.40	$136.00	$61.20–$136.00	542% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Cladosporium Herbarum (M2) IgE QST	$122.40	$136.00	$61.20–$136.00	542% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Cladosporium herbarum (M2) IgE QST	$122.40	$136.00	$61.20–$136.00	542% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Cladosporium herbarum (m2) Qst	$122.40	$136.00	$61.20–$136.00	542% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Egg Yolk (F75) IgE QST	$124.20	$138.00	$62.10–$138.00	551% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Trout (F204) IgE QST	$126.23	$140.25	$63.11–$140.25	562% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Barley (F6) IgE QST	$126.90	$141.00	$63.45–$141.00	565% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 White Mulberry (T70) IgE QST	$136.80	$152.00	$68.40–$152.00	617% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Peanut (F13) IgE QST	$154.80	$172.00	$77.40–$172.00	711% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Mucor racemosus (M4) IgE QST	$157.50	$175.00	$78.75–$175.00	725% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Orange (f33) IgE QST	$171.90	$191.00	$85.95–$191.00	801% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Cashew Nut (F202) IgE QST	$181.80	$202.00	$90.90–$202.00	853% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Lamb's Quarters (Goose Foot) (w10) IgE QST	$181.80	$202.00	$90.90–$202.00	853% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 English Plantain (W9) IgE QST	$181.80	$202.00	$90.90–$202.00	853% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 D. Pteronyssinus (D1) IgE QST	$181.80	$202.00	$90.90–$202.00	853% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Walnut tree (t10) Qst	$184.50	$205.00	$92.25–$205.00	867% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Dermatophagoides farinae (d2) Qst	$191.70	$213.00	$95.85–$213.00	905% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 June Grass (Kentucky Blue) (g8) IgE QST	$193.50	$215.00	$96.75–$215.00	914% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Buckwheat (F11) IgE QST	$197.10	$219.00	$98.55–$219.00	933% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 White ash (t15) Qst	$208.80	$232.00	$104.40–$232.00	994% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Sycamore (T11) IgE QST	$212.40	$236.00	$106.20–$236.00	1013% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Sycamore (t11) Qst	$212.40	$236.00	$106.20–$236.00	1013% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Aspergillus Fumigatus (M3) IgE QST	$213.30	$237.00	$106.65–$237.00	1018% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Yellow Jacket (i3) IgE QST	$225.00	$250.00	$112.50–$250.00	1079% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Aspergillus fumigatus (m3) Qst	$236.70	$263.00	$118.35–$263.00	1141% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Paper Wasp (i4) IGE QST	$251.10	$279.00	$125.55–$279.00	1216% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 House Dust (Hollister-Stier) (h2) IgE QST	$255.60	$284.00	$127.80–$284.00	1240% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Elm (t8) Qst	$256.50	$285.00	$128.25–$285.00	1244% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Alternaria alternata (M6) IgE QST	$270.00	$300.00	$135.00–$300.00	1315% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Macadamia Nut (rf345) IgE QST	$279.00	$310.00	$139.50–$310.00	1362% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Dog Dander (E5) IgE QST	$279.00	$310.00	$139.50–$310.00	1362% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Lamb (F88) IgE QST	$279.00	$310.00	$139.50–$310.00	1362% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Rice (f9) IgE QST	$279.00	$310.00	$139.50–$310.00	1362% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Scallop (F338) IgE QST	$282.60	$314.00	$141.30–$314.00	1381% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 June Grass(Kentucky Blue) (G8) IgE QST	$287.10	$319.00	$143.55–$319.00	1405% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Honey Bee (i1) IgE QST	$322.20	$358.00	$161.10–$358.00	1589% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Hazelnut (F17) IgE QST	$324.90	$361.00	$162.45–$361.00	1603% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Dermatophagoides pteronyssinus (d1) Qst	$363.60	$404.00	$181.80–$404.00	1806% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Birch (t3) Qst	$414.00	$460.00	$207.00–$460.00	2070% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Birch (T3) IgE QST	$466.20	$518.00	$233.10–$518.00	2343% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Blueberry (f288) IgE QST	$480.60	$534.00	$240.30–$534.00	2419% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Maple (Box Elder) (T1) IgE QST	$510.30	$567.00	$255.15–$567.00	2575% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Galactose Alpha 1,3 Galactose IgE QST	$696.60	$774.00	$348.30–$774.00	3551% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Beef (F27) IgE QST	$729.90	$811.00	$364.95–$811.00	3725% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Respiratory Allergy Profile Region I QST	$1,114.20	$1,238.00	$557.10–$1,238.00	5740% above	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Almond (F20) IgE QST	$9.90	$11.00	$4.95–$11.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Alternaria Alternata (M6) IgE QST	$10.80	$12.00	$5.40–$12.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Pecan Nut (F201) IgE QST	$11.34	$12.60	$5.67–$12.60	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Penicillium Notatum (M1) IgE QST	$11.34	$12.60	$5.67–$12.60	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Penicillium notatum (m1) Qst	$12.60	$14.00	$6.30–$14.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Pistachio (F203) IgE QST	$18.68	$20.76	$9.34–$20.76	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Tomato (f25) IgE QST	$18.90	$21.00	$9.45–$21.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Common Ragweed (Short) (W1) IgE QST	$19.80	$22.00	$9.90–$22.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Common ragweed (short) (w1) Qst	$19.80	$22.00	$9.90–$22.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Pineapple (F210) IgE QST	$19.80	$22.00	$9.90–$22.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ZZAllergen Food Strawberry ALI	$19.80	$22.00	$9.90–$22.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Squid (F258) IgE QST	$19.80	$22.00	$9.90–$22.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ZZAllergen Food Swordfish ALI	$19.80	$22.00	$9.90–$22.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Lobster (F80) IgE QST	$19.80	$22.00	$9.90–$22.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 White-Faced Hornet (i2) IgE QST	$19.80	$22.00	$9.90–$22.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cottonwood (T14) IgE QST	$20.70	$23.00	$10.35–$23.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cottonwood (t14) Qst	$20.70	$23.00	$10.35–$23.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ZZAllergen Food Rice ALI	$20.70	$23.00	$10.35–$23.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 86003- Food Allergy Profile QST	$20.70	$23.00	$10.35–$23.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 White mulberry (t70) Qst	$20.70	$23.00	$10.35–$23.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Pork (F26) IgE QST	$21.60	$24.00	$10.80–$24.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Brazil Nut (F18) IgE QST	$21.60	$24.00	$10.80–$24.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Salmon (F41) IgE QST	$21.60	$24.00	$10.80–$24.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Dog dander (e5) Qst	$24.30	$27.00	$12.15–$27.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Timothy Grass (G6) IgE QST	$26.10	$29.00	$13.05–$29.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Scallop (F338) IgE QST	$27.90	$31.00	$13.95–$31.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Crab (F23) IgE QST	$30.60	$34.00	$15.30–$34.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ZZAllergen Food Onion ALI	$31.50	$35.00	$15.75–$35.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ZZAllergen Food Haddock ALI	$31.50	$35.00	$15.75–$35.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Lamb's Quarters (W10) IgE QST	$31.50	$35.00	$15.75–$35.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Celery (F85) IgE QST	$32.35	$35.94	$16.17–$35.94	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ZZAllergen Food Potato White ALI	$32.40	$36.00	$16.20–$36.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Snail (f324) IgE QST	$33.30	$37.00	$16.65–$37.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Shrimp (F24) IgE QST	$33.30	$37.00	$16.65–$37.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Sheep Sorrel (W18) IgE QST	$33.30	$37.00	$16.65–$37.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Shrimp Class QST	$33.30	$37.00	$16.65–$37.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cat dander (e1) Qst	$33.30	$37.00	$16.65–$37.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Sesame Seed (F10) IgE QST	$33.30	$37.00	$16.65–$37.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Sheep sorrel (w18) Qst	$33.30	$37.00	$16.65–$37.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cat Dander (E1) IgE QST	$35.10	$39.00	$17.55–$39.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Banana (F92) IgE QST	$35.42	$39.36	$17.71–$39.36	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Oyster (F290) IgE QST	$38.70	$43.00	$19.35–$43.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cultivated Wheat (G15 )IgE QST	$42.30	$47.00	$21.15–$47.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Soybean (F14) IgE QST	$43.20	$48.00	$21.60–$48.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Walnut (F256) IgE QST	$43.20	$48.00	$21.60–$48.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Codfish (F3) IgE QST	$44.10	$49.00	$22.05–$49.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cockroach (I6) IgE QST	$44.10	$49.00	$22.05–$49.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Mountain Cedar (T6) IgE QST	$48.60	$54.00	$24.30–$54.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Blue Mussel (F37) IgE QST	$49.50	$55.00	$24.75–$55.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Tuna (F40) IgE QST	$53.10	$59.00	$26.55–$59.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ZZAllergen Food Port ALI	$53.10	$59.00	$26.55–$59.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Wheat (F4) IgE QST	$54.00	$60.00	$27.00–$60.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Elm (T8) IgE QST	$59.40	$66.00	$29.70–$66.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Mouse Urine Proteins (e72) Qst	$66.60	$74.00	$33.30–$74.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Mycoplasma Pneumoniae Ab (IgM) QST	$67.50	$75.00	$33.75–$75.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Mouse Urine Proteins (E72) IgE QST	$69.30	$77.00	$34.65–$77.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ZZAllergen Food Sole ALI	$70.20	$78.00	$35.10–$78.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Strawberry (f44) IgE QST	$75.60	$84.00	$37.80–$84.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cockroach (i6) Qst	$75.60	$84.00	$37.80–$84.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Timothy grass (g6) Qst	$77.40	$86.00	$38.70–$86.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Mountain cedar (t6) Qst	$81.90	$91.00	$40.95–$91.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Rough Pigweed (W14) IgE QST	$83.70	$93.00	$41.85–$93.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Maple (box elder) (t1) Qst	$84.60	$94.00	$42.30–$94.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Rough pigweed (w14) Qst	$86.40	$96.00	$43.20–$96.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ZZAllergen Food Perch ALI	$88.20	$98.00	$44.10–$98.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ZZAllergen Food Pollack White ALI	$88.20	$98.00	$44.10–$98.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Bermuda Grass (G2) IgE QST	$98.17	$109.08	$49.09–$109.08	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Bermuda grass (g2) Qst	$98.17	$109.08	$49.09–$109.08	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cow's Milk (F2) IgE QST	$102.60	$114.00	$51.30–$114.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Dermatophagoides Farinae (D2) IgE QST	$106.20	$118.00	$53.10–$118.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Parsley (F86) IgE QST	$107.10	$119.00	$53.55–$119.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Peach (f95) IgE QST	$107.10	$119.00	$53.55–$119.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Walnut Tree (T10) IgE QST	$110.70	$123.00	$55.35–$123.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 House Dust (Greer) (h1) IgE QST	$111.60	$124.00	$55.80–$124.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Egg White (F1) IgE QST	$117.90	$131.00	$58.95–$131.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cladosporium herbarum (M2) IgE QST	$122.40	$136.00	$61.20–$136.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cladosporium Herbarum (M2) IgE QST	$122.40	$136.00	$61.20–$136.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cladosporium herbarum (m2) Qst	$122.40	$136.00	$61.20–$136.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Clam (F207) IgE QST	$122.40	$136.00	$61.20–$136.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Egg Yolk (F75) IgE QST	$124.20	$138.00	$62.10–$138.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Trout (F204) IgE QST	$126.23	$140.25	$63.11–$140.25	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Barley (F6) IgE QST	$126.90	$141.00	$63.45–$141.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 White Mulberry (T70) IgE QST	$136.80	$152.00	$68.40–$152.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Peanut (F13) IgE QST	$154.80	$172.00	$77.40–$172.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Mucor racemosus (M4) IgE QST	$157.50	$175.00	$78.75–$175.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Orange (f33) IgE QST	$171.90	$191.00	$85.95–$191.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 English Plantain (W9) IgE QST	$181.80	$202.00	$90.90–$202.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Lamb's Quarters (Goose Foot) (w10) IgE QST	$181.80	$202.00	$90.90–$202.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cashew Nut (F202) IgE QST	$181.80	$202.00	$90.90–$202.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 D. Pteronyssinus (D1) IgE QST	$181.80	$202.00	$90.90–$202.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Walnut tree (t10) Qst	$184.50	$205.00	$92.25–$205.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Dermatophagoides farinae (d2) Qst	$191.70	$213.00	$95.85–$213.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 June Grass (Kentucky Blue) (g8) IgE QST	$193.50	$215.00	$96.75–$215.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Buckwheat (F11) IgE QST	$197.10	$219.00	$98.55–$219.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 White ash (t15) Qst	$208.80	$232.00	$104.40–$232.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Sycamore (t11) Qst	$212.40	$236.00	$106.20–$236.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Sycamore (T11) IgE QST	$212.40	$236.00	$106.20–$236.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Aspergillus Fumigatus (M3) IgE QST	$213.30	$237.00	$106.65–$237.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Yellow Jacket (i3) IgE QST	$225.00	$250.00	$112.50–$250.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Aspergillus fumigatus (m3) Qst	$236.70	$263.00	$118.35–$263.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Paper Wasp (i4) IGE QST	$251.10	$279.00	$125.55–$279.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 House Dust (Hollister-Stier) (h2) IgE QST	$255.60	$284.00	$127.80–$284.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Elm (t8) Qst	$256.50	$285.00	$128.25–$285.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Alternaria alternata (M6) IgE QST	$270.00	$300.00	$135.00–$300.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Macadamia Nut (rf345) IgE QST	$279.00	$310.00	$139.50–$310.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Lamb (F88) IgE QST	$279.00	$310.00	$139.50–$310.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Rice (f9) IgE QST	$279.00	$310.00	$139.50–$310.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Dog Dander (E5) IgE QST	$279.00	$310.00	$139.50–$310.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Scallop (F338) IgE QST	$282.60	$314.00	$141.30–$314.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 June Grass(Kentucky Blue) (G8) IgE QST	$287.10	$319.00	$143.55–$319.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Honey Bee (i1) IgE QST	$322.20	$358.00	$161.10–$358.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Hazelnut (F17) IgE QST	$324.90	$361.00	$162.45–$361.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Dermatophagoides pteronyssinus (d1) Qst	$363.60	$404.00	$181.80–$404.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Birch (t3) Qst	$414.00	$460.00	$207.00–$460.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Birch (T3) IgE QST	$466.20	$518.00	$233.10–$518.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Blueberry (f288) IgE QST	$480.60	$534.00	$240.30–$534.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Maple (Box Elder) (T1) IgE QST	$510.30	$567.00	$255.15–$567.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Galactose Alpha 1,3 Galactose IgE QST	$696.60	$774.00	$348.30–$774.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Beef (F27) IgE QST	$729.90	$811.00	$364.95–$811.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Respiratory Allergy Profile Region I QST	$1,114.20	$1,238.00	$557.10–$1,238.00	—	10%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP Ab (IgG) QST	$73.80	$82.00	$36.90–$82.00	10% above	10%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CCP Ab (IgG) QST	$73.80	$82.00	$36.90–$82.00	—	10%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NT-Pro BNP	$20.70	$23.00	$10.35–$23.00	83% below	10%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 proBrain Natriuretic Peptide ALI	$32.40	$36.00	$16.20–$36.00	74% below	10%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NT-Pro BNP	$20.70	$23.00	$10.35–$23.00	—	10%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 proBrain Natriuretic Peptide ALI	$32.40	$36.00	$16.20–$36.00	—	10%
Basic metabolic panel (blood test) CPT 80048 iSTAT BMP	$21.60	$24.00	$10.80–$24.00	73% below	10%
Basic metabolic panel (blood test) CPT 80048 Basic Metabolic Panel	$354.38	$393.75	$177.19–$393.75	342% above	10%
Basic metabolic panel (blood test) inpatient CPT 80048 iSTAT BMP	$21.60	$24.00	$10.80–$24.00	—	10%
Basic metabolic panel (blood test) inpatient CPT 80048 Basic Metabolic Panel	$354.38	$393.75	$177.19–$393.75	—	10%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Bill Only AP 88305 Surg Level IV	$138.60	$154.00	$69.30–$154.00	3% below	10%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 Bill Only AP 88305 Surg Level IV	$138.60	$154.00	$69.30–$154.00	—	10%
Blood culture for bacteria CPT 87040 Blood Culture (First Set) MDIH	$487.80	$542.00	$243.90–$542.00	457% above	10%
Blood culture for bacteria CPT 87040 Blood Culture (Second Set) MDIH	$537.30	$597.00	$268.65–$597.00	513% above	10%
Blood culture for bacteria inpatient CPT 87040 Blood Culture (First Set) MDIH	$487.80	$542.00	$243.90–$542.00	—	10%
Blood culture for bacteria inpatient CPT 87040 Blood Culture (Second Set) MDIH	$537.30	$597.00	$268.65–$597.00	—	10%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 36415 Venous Draw Charge	$32.40	$36.00	$16.20–$36.00	163% above	10%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 36415 Venipuncture	$42.30	$47.00	$21.15–$47.00	244% above	10%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 36415 Collection of venous blood by venipuncture	$42.30	$47.00	$21.15–$47.00	244% above	10%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Kit Draw Fee	$3,444.30	$3,827.00	$1,722.15–$3,827.00	27902% above	10%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 36415 Venous Draw Charge	$32.40	$36.00	$16.20–$36.00	—	10%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 36415 Collection of venous blood by venipuncture	$42.30	$47.00	$21.15–$47.00	—	10%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 36415 Venipuncture	$42.30	$47.00	$21.15–$47.00	—	10%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Kit Draw Fee	$3,444.30	$3,827.00	$1,722.15–$3,827.00	—	10%
Blood lead test CPT 83655 Pedi Blood Lead STATE	$11.34	$12.60	$5.67–$12.60	74% below	10%
Blood lead test CPT 83655 Lead Level POC	$450.90	$501.00	$225.45–$501.00	925% above	10%
Blood lead test inpatient CPT 83655 Pedi Blood Lead STATE	$11.34	$12.60	$5.67–$12.60	—	10%
Blood lead test inpatient CPT 83655 Lead Level POC	$450.90	$501.00	$225.45–$501.00	—	10%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Cord ABO/Rh	$51.30	$57.00	$25.65–$57.00	4% above	10%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Cord ABO/Rh Retype	$102.60	$114.00	$51.30–$114.00	108% above	10%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Cord ABO/Rh	$51.30	$57.00	$25.65–$57.00	—	10%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Cord ABO/Rh Retype	$102.60	$114.00	$51.30–$114.00	—	10%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-Reactive Protein	$19.80	$22.00	$9.90–$22.00	44% below	10%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-Reactive Protein	$19.80	$22.00	$9.90–$22.00	—	10%
CA 19-9 blood test (tumor marker) CPT 86301 CA 19-9 QST	$21.60	$24.00	$10.80–$24.00	51% below	10%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA 19-9 QST	$21.60	$24.00	$10.80–$24.00	—	10%
CA-125 blood test (ovarian cancer marker) CPT 86304 CA 125 QST	$19.80	$22.00	$9.90–$22.00	77% below	10%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA 125 QST	$19.80	$22.00	$9.90–$22.00	—	10%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-CoV-2 RNA (COVID-19), Qualitative NAAT QST	$18.90	$21.00	$9.45–$21.00	66% below	10%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-CoV-2 (COVID-19) PCR (Liat)	$20.70	$23.00	$10.35–$23.00	63% below	10%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-CoV-2 (COVID-19) PCR (GeneXpert)	$322.20	$358.00	$161.10–$358.00	475% above	10%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-CoV-2 RNA (COVID-19), Qualitative NAAT QST	$18.90	$21.00	$9.45–$21.00	—	10%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-CoV-2 (COVID-19) PCR (Liat)	$20.70	$23.00	$10.35–$23.00	—	10%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-CoV-2 (COVID-19) PCR (GeneXpert)	$322.20	$358.00	$161.10–$358.00	—	10%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia trachomatis (GeneXpert)	$18.68	$20.76	$9.34–$20.76	72% below	10%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia Trachomatis RNA,TMA,Throat QST	$19.80	$22.00	$9.90–$22.00	70% below	10%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia Trachomatis RNA,TMA Rectal QST	$19.80	$22.00	$9.90–$22.00	70% below	10%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia Trachomatis RNA, TMA QST	$20.70	$23.00	$10.35–$23.00	69% below	10%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia trachomatis rRNA, Conjunctiva	$20.70	$23.00	$10.35–$23.00	69% below	10%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Bill Only AP 87491 CHLAMYDIA TRACHOMATIS	$1,386.90	$1,541.00	$693.45–$1,541.00	1975% above	10%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia trachomatis (GeneXpert)	$18.68	$20.76	$9.34–$20.76	—	10%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia Trachomatis RNA,TMA Rectal QST	$19.80	$22.00	$9.90–$22.00	—	10%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia Trachomatis RNA,TMA,Throat QST	$19.80	$22.00	$9.90–$22.00	—	10%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia Trachomatis RNA, TMA QST	$20.70	$23.00	$10.35–$23.00	—	10%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia trachomatis rRNA, Conjunctiva	$20.70	$23.00	$10.35–$23.00	—	10%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Bill Only AP 87491 CHLAMYDIA TRACHOMATIS	$1,386.90	$1,541.00	$693.45–$1,541.00	—	10%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel	$75.60	$84.00	$37.80–$84.00	9% above	10%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel	$75.60	$84.00	$37.80–$84.00	—	10%
Complete blood count (CBC) with differential CPT 85025 Anemia Pnl	$19.80	$22.00	$9.90–$22.00	53% below	10%
Complete blood count (CBC) with differential CPT 85025 CBC w/ Differential	$31.50	$35.00	$15.75–$35.00	25% below	10%
Complete blood count (CBC) with differential inpatient CPT 85025 Anemia Pnl	$19.80	$22.00	$9.90–$22.00	—	10%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC w/ Differential	$31.50	$35.00	$15.75–$35.00	—	10%
Complete blood count (CBC), no differential CPT 85027 Anemia Panel DC	$32.40	$36.00	$16.20–$36.00	5% above	10%
Complete blood count (CBC), no differential CPT 85027 CBC without Differential	$48.60	$54.00	$24.30–$54.00	58% above	10%
Complete blood count (CBC), no differential CPT 85027 CBC w/ Manual Differential	$73.80	$82.00	$36.90–$82.00	140% above	10%
Complete blood count (CBC), no differential inpatient CPT 85027 Anemia Panel DC	$32.40	$36.00	$16.20–$36.00	—	10%
Complete blood count (CBC), no differential inpatient CPT 85027 CBC without Differential	$48.60	$54.00	$24.30–$54.00	—	10%
Complete blood count (CBC), no differential inpatient CPT 85027 CBC w/ Manual Differential	$73.80	$82.00	$36.90–$82.00	—	10%
D-dimer blood test (blood clot marker) CPT 85379 D-Dimer Quantitative	$213.30	$237.00	$106.65–$237.00	219% above	10%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-Dimer Quantitative	$213.30	$237.00	$106.65–$237.00	—	10%
Estradiol blood test CPT 82670 Estradiol QST	$19.80	$22.00	$9.90–$22.00	80% below	10%
Estradiol blood test CPT 82670 Estradiol, Ultrasensitive LC/MS/MS QST	$120.60	$134.00	$60.30–$134.00	23% above	10%
Estradiol blood test CPT 82670 Estradiol: QST	$582.30	$647.00	$291.15–$647.00	495% above	10%
Estradiol blood test inpatient CPT 82670 Estradiol QST	$19.80	$22.00	$9.90–$22.00	—	10%
Estradiol blood test inpatient CPT 82670 Estradiol, Ultrasensitive LC/MS/MS QST	$120.60	$134.00	$60.30–$134.00	—	10%
Estradiol blood test inpatient CPT 82670 Estradiol: QST	$582.30	$647.00	$291.15–$647.00	—	10%
FSH (follicle-stimulating hormone) test CPT 83001 FSH QST	$19.80	$22.00	$9.90–$22.00	75% below	10%
FSH (follicle-stimulating hormone) test CPT 83001 FSH, Pediatrics QST	$216.49	$240.54	$108.24–$240.54	174% above	10%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH QST	$19.80	$22.00	$9.90–$22.00	—	10%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH, Pediatrics QST	$216.49	$240.54	$108.24–$240.54	—	10%
Fecal calprotectin (stool inflammation test) CPT 83993 Calprotectin, Stool QST	$279.00	$310.00	$139.50–$310.00	83% above	10%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 Calprotectin, Stool QST	$279.00	$310.00	$139.50–$310.00	—	10%
Ferritin blood test (iron stores) CPT 82728 Ferritin	$81.00	$90.00	$40.50–$90.00	16% above	10%
Ferritin blood test (iron stores) CPT 82728 Ferritin QST	$140.40	$156.00	$70.20–$156.00	102% above	10%
Ferritin blood test (iron stores) inpatient CPT 82728 Ferritin	$81.00	$90.00	$40.50–$90.00	—	10%
Ferritin blood test (iron stores) inpatient CPT 82728 Ferritin QST	$140.40	$156.00	$70.20–$156.00	—	10%
Folate (folic acid) blood test CPT 82746 Folate QST	$82.80	$92.00	$41.40–$92.00	21% above	10%
Folate (folic acid) blood test inpatient CPT 82746 Folate QST	$82.80	$92.00	$41.40–$92.00	—	10%
Free T3 thyroid hormone test CPT 84481 T3, Free QST	$171.90	$191.00	$85.95–$191.00	127% above	10%
Free T3 thyroid hormone test inpatient CPT 84481 T3, Free QST	$171.90	$191.00	$85.95–$191.00	—	10%
Free T4 (free thyroxine) thyroid blood test CPT 84439 84439 - T4, Free, Direct Dialysis & T4,Total QST	$57.60	$64.00	$28.80–$64.00	5% above	10%
Free T4 (free thyroxine) thyroid blood test CPT 84439 Free T4 Level	$76.55	$85.05	$38.27–$85.05	39% above	10%
Free T4 (free thyroxine) thyroid blood test CPT 84439 T4, Free, Direct Dialysis QST	$622.80	$692.00	$311.40–$692.00	1031% above	10%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 84439 - T4, Free, Direct Dialysis & T4,Total QST	$57.60	$64.00	$28.80–$64.00	—	10%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 Free T4 Level	$76.55	$85.05	$38.27–$85.05	—	10%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4, Free, Direct Dialysis QST	$622.80	$692.00	$311.40–$692.00	—	10%
Free testosterone test CPT 84402 Testosterone, Free QST	$117.90	$131.00	$58.95–$131.00	42% above	10%
Free testosterone test inpatient CPT 84402 Testosterone, Free QST	$117.90	$131.00	$58.95–$131.00	—	10%
Glucose tolerance test, 3 samples CPT 82951 .Gluc 1 Hr MDIH	$101.70	$113.00	$50.85–$113.00	59% above	10%
Glucose tolerance test, 3 samples CPT 82951 .GTT 2 HR 100gm	$122.40	$136.00	$61.20–$136.00	91% above	10%
Glucose tolerance test, 3 samples CPT 82951 .GTT 1 HR 100gm	$152.10	$169.00	$76.05–$169.00	138% above	10%
Glucose tolerance test, 3 samples CPT 82951 .Gluc 2 Hr MDIH	$171.00	$190.00	$85.50–$190.00	167% above	10%
Glucose tolerance test, 3 samples CPT 82951 .GTT 2 HR PP	$235.80	$262.00	$117.90–$262.00	268% above	10%
Glucose tolerance test, 3 samples CPT 82951 .Glucose Fasting	$235.80	$262.00	$117.90–$262.00	268% above	10%
Glucose tolerance test, 3 samples CPT 82951 .Gluc Fasting MDIH	$250.20	$278.00	$125.10–$278.00	291% above	10%
Glucose tolerance test, 3 samples inpatient CPT 82951 .Gluc 1 Hr MDIH	$101.70	$113.00	$50.85–$113.00	—	10%
Glucose tolerance test, 3 samples inpatient CPT 82951 .GTT 2 HR 100gm	$122.40	$136.00	$61.20–$136.00	—	10%
Glucose tolerance test, 3 samples inpatient CPT 82951 .GTT 1 HR 100gm	$152.10	$169.00	$76.05–$169.00	—	10%
Glucose tolerance test, 3 samples inpatient CPT 82951 .Gluc 2 Hr MDIH	$171.00	$190.00	$85.50–$190.00	—	10%
Glucose tolerance test, 3 samples inpatient CPT 82951 .GTT 2 HR PP	$235.80	$262.00	$117.90–$262.00	—	10%
Glucose tolerance test, 3 samples inpatient CPT 82951 .Glucose Fasting	$235.80	$262.00	$117.90–$262.00	—	10%
Glucose tolerance test, 3 samples inpatient CPT 82951 .Gluc Fasting MDIH	$250.20	$278.00	$125.10–$278.00	—	10%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Neisseria gonorrhoeae rRNA, Conjunctiva	$21.60	$24.00	$10.80–$24.00	61% below	10%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Neisseria Gonorrhoeae RNA,TMA,Throat QST	$21.60	$24.00	$10.80–$24.00	61% below	10%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Neisseria gonorrhoeae (GeneXpert)	$92.70	$103.00	$46.35–$103.00	69% above	10%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Neisseria Gonorrhoeae RNA, TMA QST	$501.30	$557.00	$250.65–$557.00	816% above	10%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Bill Only AP 87591 NEISSERIA GONORRHOEAE	$1,386.90	$1,541.00	$693.45–$1,541.00	2434% above	10%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Neisseria Gonorrhoeae RNA,TMA Rectal QST	$1,529.10	$1,699.00	$764.55–$1,699.00	2693% above	10%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Neisseria gonorrhoeae rRNA, Conjunctiva	$21.60	$24.00	$10.80–$24.00	—	10%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Neisseria Gonorrhoeae RNA,TMA,Throat QST	$21.60	$24.00	$10.80–$24.00	—	10%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Neisseria gonorrhoeae (GeneXpert)	$92.70	$103.00	$46.35–$103.00	—	10%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Neisseria Gonorrhoeae RNA, TMA QST	$501.30	$557.00	$250.65–$557.00	—	10%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Bill Only AP 87591 NEISSERIA GONORRHOEAE	$1,386.90	$1,541.00	$693.45–$1,541.00	—	10%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Neisseria Gonorrhoeae RNA,TMA Rectal QST	$1,529.10	$1,699.00	$764.55–$1,699.00	—	10%
H. pylori antibody blood test CPT 86677 Rapid Urease Test	$15.30	$17.00	$7.65–$17.00	79% below	10%
H. pylori antibody blood test inpatient CPT 86677 Rapid Urease Test	$15.30	$17.00	$7.65–$17.00	—	10%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 RNA, Quantitative, Real-Time PCR w/Reflex to Genotype (RTI, PI, Integrase) QST	$152.10	$169.00	$76.05–$169.00	19% below	10%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV-1 RNA, Quantitative, Real-Time PCR w/Reflex to Genotype (RTI, PI, Integrase) QST	$152.10	$169.00	$76.05–$169.00	—	10%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV 1/2 Ag/Ab, Fourth Gen w/Rfl QST	$9.90	$11.00	$4.95–$11.00	74% below	10%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV 1/2 Ag/Ab, Fourth Gen w/Rfl QST	$9.90	$11.00	$4.95–$11.00	—	10%
HPV test for high-risk types, one combined (pooled) result CPT 87624 Bill Only AP 87624 HPV, High Risk Types	$788.40	$876.00	$394.20–$876.00	1009% above	10%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 Bill Only AP 87624 HPV, High Risk Types	$788.40	$876.00	$394.20–$876.00	—	10%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1c POC	$20.70	$23.00	$10.35–$23.00	49% below	10%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1c POCT	$77.40	$86.00	$38.70–$86.00	91% above	10%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1c w/eAG	$286.20	$318.00	$143.10–$318.00	607% above	10%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hemoglobin A1c POC	$20.70	$23.00	$10.35–$23.00	—	10%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hemoglobin A1c POCT	$77.40	$86.00	$38.70–$86.00	—	10%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hemoglobin A1c w/eAG	$286.20	$318.00	$143.10–$318.00	—	10%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hep B Surface Ab Ql QST	$44.10	$49.00	$22.05–$49.00	at median	10%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hep B Surface Ab Ql QST	$44.10	$49.00	$22.05–$49.00	—	10%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hep B Surface Ag QST	$44.10	$49.00	$22.05–$49.00	5% below	10%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hep B Surface Ag w/Refl Confirm QST	$44.10	$49.00	$22.05–$49.00	5% below	10%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hep B Surface Ag w/Refl Confirm QST	$44.10	$49.00	$22.05–$49.00	—	10%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hep B Surface Ag QST	$44.10	$49.00	$22.05–$49.00	—	10%
Hepatitis C antibody blood test (screening) CPT 86803 Hep C Ab w/Refl To HCV RNA, Qn, PCR QST	$25.20	$28.00	$12.60–$28.00	63% below	10%
Hepatitis C antibody blood test (screening) CPT 86803 Hep C Ab QST	$140.40	$156.00	$70.20–$156.00	107% above	10%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 Hep C Ab w/Refl To HCV RNA, Qn, PCR QST	$25.20	$28.00	$12.60–$28.00	—	10%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 Hep C Ab QST	$140.40	$156.00	$70.20–$156.00	—	10%
Hepatitis C viral load (HCV RNA) test CPT 87522 Hep C Viral RNA Genotype, LiPA(R) QST	$140.40	$156.00	$70.20–$156.00	18% below	10%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Hep C Viral RNA Genotype, LiPA(R) QST	$140.40	$156.00	$70.20–$156.00	—	10%
Herpes blood test, HSV-1 antibody CPT 86695 HSV 1 IgG, Type Specific Ab QST	$64.80	$72.00	$32.40–$72.00	39% above	10%
Herpes blood test, HSV-1 antibody CPT 86695 HSV 2 IgG, Type Specific Ab QST	$112.73	$125.25	$56.36–$125.25	142% above	10%
Herpes blood test, HSV-1 antibody CPT 86695 HSV 1 IgG Index CSF: QST	$249.30	$277.00	$124.65–$277.00	435% above	10%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HSV 1 IgG, Type Specific Ab QST	$64.80	$72.00	$32.40–$72.00	—	10%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HSV 2 IgG, Type Specific Ab QST	$112.73	$125.25	$56.36–$125.25	—	10%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HSV 1 IgG Index CSF: QST	$249.30	$277.00	$124.65–$277.00	—	10%
Herpes blood test, HSV-2 antibody CPT 86696 Herpes Simplex Virus 2 (IgG), w/Reflex to HSV-2 Inhibition QST	$81.90	$91.00	$40.95–$91.00	32% above	10%
Herpes blood test, HSV-2 antibody CPT 86696 HSV 2 IgG, Type Specific Ab QST	$112.73	$125.25	$56.36–$125.25	82% above	10%
Herpes blood test, HSV-2 antibody CPT 86696 HSV 2 IgG Index CSF: QST	$112.73	$125.25	$56.36–$125.25	82% above	10%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 Herpes Simplex Virus 2 (IgG), w/Reflex to HSV-2 Inhibition QST	$81.90	$91.00	$40.95–$91.00	—	10%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HSV 2 IgG Index CSF: QST	$112.73	$125.25	$56.36–$125.25	—	10%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HSV 2 IgG, Type Specific Ab QST	$112.73	$125.25	$56.36–$125.25	—	10%
High-sensitivity CRP (hs-CRP) test CPT 86141 Cardio IQ(R) HS CRP QST	$47.28	$52.53	$23.64–$52.53	3% below	10%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 Cardio IQ(R) HS CRP QST	$47.28	$52.53	$23.64–$52.53	—	10%
Homocysteine blood test CPT 83090 Homocysteine QST	$258.30	$287.00	$129.15–$287.00	284% above	10%
Homocysteine blood test inpatient CPT 83090 Homocysteine QST	$258.30	$287.00	$129.15–$287.00	—	10%
Insulin blood test CPT 83525 Insulin QST	$19.80	$22.00	$9.90–$22.00	60% below	10%
Insulin blood test inpatient CPT 83525 Insulin QST	$19.80	$22.00	$9.90–$22.00	—	10%
Iron blood test (serum iron) CPT 83540 Iron Level	$73.80	$82.00	$36.90–$82.00	127% above	10%
Iron blood test (serum iron) inpatient CPT 83540 Iron Level	$73.80	$82.00	$36.90–$82.00	—	10%
Kidney function blood test panel CPT 80069 Renal Pnl	$280.80	$312.00	$140.40–$312.00	319% above	10%
Kidney function blood test panel inpatient CPT 80069 Renal Pnl	$280.80	$312.00	$140.40–$312.00	—	10%
Lipase blood test (pancreas enzyme) CPT 83690 Lipase Level	$264.60	$294.00	$132.30–$294.00	501% above	10%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase Level	$264.60	$294.00	$132.30–$294.00	—	10%
Lyme disease antibody test CPT 86618 zzLyme Antibody ALI	$32.40	$36.00	$16.20–$36.00	55% below	10%
Lyme disease antibody test CPT 86618 Lyme Disease Ab, Total w/Rfx Western Blot (IgG, IgM) QST	$99.00	$110.00	$49.50–$110.00	38% above	10%
Lyme disease antibody test CPT 86618 Lyme Disease Ab w/Rfx Blot (IgG,IgM) QST	$189.90	$211.00	$94.95–$211.00	165% above	10%
Lyme disease antibody test CPT 86618 CSF Lyme Ab by ELISA ALI	$213.30	$237.00	$106.65–$237.00	198% above	10%
Lyme disease antibody test inpatient CPT 86618 zzLyme Antibody ALI	$32.40	$36.00	$16.20–$36.00	—	10%
Lyme disease antibody test inpatient CPT 86618 Lyme Disease Ab, Total w/Rfx Western Blot (IgG, IgM) QST	$99.00	$110.00	$49.50–$110.00	—	10%
Lyme disease antibody test inpatient CPT 86618 Lyme Disease Ab w/Rfx Blot (IgG,IgM) QST	$189.90	$211.00	$94.95–$211.00	—	10%
Lyme disease antibody test inpatient CPT 86618 CSF Lyme Ab by ELISA ALI	$213.30	$237.00	$106.65–$237.00	—	10%
Magnesium blood test CPT 83735 MAGNESIUM, RANDOM URINE QST	$66.60	$74.00	$33.30–$74.00	66% above	10%
Magnesium blood test CPT 83735 Magnesium Level	$120.60	$134.00	$60.30–$134.00	201% above	10%
Magnesium blood test CPT 83735 Magnesium, 24H Ur w/o Creatinine QST	$256.50	$285.00	$128.25–$285.00	540% above	10%
Magnesium blood test CPT 83735 Magnesium, RBC QST	$256.50	$285.00	$128.25–$285.00	540% above	10%
Magnesium blood test inpatient CPT 83735 MAGNESIUM, RANDOM URINE QST	$66.60	$74.00	$33.30–$74.00	—	10%
Magnesium blood test inpatient CPT 83735 Magnesium Level	$120.60	$134.00	$60.30–$134.00	—	10%
Magnesium blood test inpatient CPT 83735 Magnesium, RBC QST	$256.50	$285.00	$128.25–$285.00	—	10%
Magnesium blood test inpatient CPT 83735 Magnesium, 24H Ur w/o Creatinine QST	$256.50	$285.00	$128.25–$285.00	—	10%
Measles (rubeola) antibody test CPT 86765 Measles Ab (IgG) QST	$256.50	$285.00	$128.25–$285.00	706% above	10%
Measles (rubeola) antibody test CPT 86765 Measles Antibody (IgG) QST	$256.50	$285.00	$128.25–$285.00	706% above	10%
Measles (rubeola) antibody test inpatient CPT 86765 Measles Ab (IgG) QST	$256.50	$285.00	$128.25–$285.00	—	10%
Measles (rubeola) antibody test inpatient CPT 86765 Measles Antibody (IgG) QST	$256.50	$285.00	$128.25–$285.00	—	10%
Mono test (heterophile antibody, Monospot) CPT 86308 Mono Screen POCT	$58.50	$65.00	$29.25–$65.00	69% above	10%
Mono test (heterophile antibody, Monospot) CPT 86308 Monospot Clinic POC (RE)	$2,407.50	$2,675.00	$1,203.75–$2,675.00	6844% above	10%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 Mono Screen POCT	$58.50	$65.00	$29.25–$65.00	—	10%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 Monospot Clinic POC (RE)	$2,407.50	$2,675.00	$1,203.75–$2,675.00	—	10%
PSA (prostate-specific antigen) blood test, free CPT 84154 84154-PSA (Free and Total) QST	$12.60	$14.00	$6.30–$14.00	86% below	10%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 84154-PSA (Free and Total) QST	$12.60	$14.00	$6.30–$14.00	—	10%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Diagnostic	$35.10	$39.00	$17.55–$39.00	42% below	10%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA, Total with Reflex to PSA, Free QST	$48.60	$54.00	$24.30–$54.00	20% below	10%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA, Post-Prostatectomy QST	$67.50	$75.00	$33.75–$75.00	11% above	10%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA, Post Prostatectomy with HAMA Treatment QST	$98.10	$109.00	$49.05–$109.00	62% above	10%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA Diagnostic	$35.10	$39.00	$17.55–$39.00	—	10%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA, Total with Reflex to PSA, Free QST	$48.60	$54.00	$24.30–$54.00	—	10%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA, Post-Prostatectomy QST	$67.50	$75.00	$33.75–$75.00	—	10%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA, Post Prostatectomy with HAMA Treatment QST	$98.10	$109.00	$49.05–$109.00	—	10%
Pap test (liquid-based, automated screening with review) CPT 88175 Bill Only AP 88175 Thinprep Pap Test Imaging	$3,211.20	$3,568.00	$1,605.60–$3,568.00	4821% above	10%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 Bill Only AP 88175 Thinprep Pap Test Imaging	$3,211.20	$3,568.00	$1,605.60–$3,568.00	—	10%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 Bill Only AP 88142 Cyto Gyn Liquid Prep	$2,216.70	$2,463.00	$1,108.35–$2,463.00	3170% above	10%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 Bill Only AP 88142 Cyto Gyn Liquid Prep	$2,216.70	$2,463.00	$1,108.35–$2,463.00	—	10%
Parathyroid hormone (PTH) blood test CPT 83970 PTH, Intact w/o Calcium QST	$119.70	$133.00	$59.85–$133.00	31% above	10%
Parathyroid hormone (PTH) blood test CPT 83970 PTH Intact	$325.80	$362.00	$162.90–$362.00	258% above	10%
Parathyroid hormone (PTH) blood test CPT 83970 Parathyroid Hormone,Intact QST	$369.00	$410.00	$184.50–$410.00	305% above	10%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH, Intact w/o Calcium QST	$119.70	$133.00	$59.85–$133.00	—	10%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH Intact	$325.80	$362.00	$162.90–$362.00	—	10%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 Parathyroid Hormone,Intact QST	$369.00	$410.00	$184.50–$410.00	—	10%
Partial thromboplastin time (PTT) clotting test CPT 85730 Partial Thromboplastin Time	$11.34	$12.60	$5.67–$12.60	71% below	10%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT LA w/Rfx to Hexagonal Phase Conf QST	$11.70	$13.00	$5.85–$13.00	70% below	10%
Partial thromboplastin time (PTT) clotting test CPT 85730 85730 - PTT-LA w/Reflex to Hexagonal Phase Confirmation	$12.60	$14.00	$6.30–$14.00	67% below	10%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT, Activated QST	$26.10	$29.00	$13.05–$29.00	33% below	10%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT LA Screen QST	$256.50	$285.00	$128.25–$285.00	563% above	10%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT LA QST	$256.50	$285.00	$128.25–$285.00	563% above	10%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Partial Thromboplastin Time	$11.34	$12.60	$5.67–$12.60	—	10%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT LA w/Rfx to Hexagonal Phase Conf QST	$11.70	$13.00	$5.85–$13.00	—	10%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 85730 - PTT-LA w/Reflex to Hexagonal Phase Confirmation	$12.60	$14.00	$6.30–$14.00	—	10%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT, Activated QST	$26.10	$29.00	$13.05–$29.00	—	10%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT LA QST	$256.50	$285.00	$128.25–$285.00	—	10%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT LA Screen QST	$256.50	$285.00	$128.25–$285.00	—	10%
Progesterone blood test CPT 84144 Progesterone QST	$21.60	$24.00	$10.80–$24.00	75% below	10%
Progesterone blood test inpatient CPT 84144 Progesterone QST	$21.60	$24.00	$10.80–$24.00	—	10%
Prothrombin time (PT/INR) clotting test CPT 85610 PT (INR)	$19.80	$22.00	$9.90–$22.00	29% below	10%
Prothrombin time (PT/INR) clotting test CPT 85610 Instr PT	$21.09	$23.43	$10.54–$23.43	25% below	10%
Prothrombin time (PT/INR) clotting test CPT 85610 PT/INR Clinic POC (RE)	$57.60	$64.00	$28.80–$64.00	106% above	10%
Prothrombin time (PT/INR) clotting test CPT 85610 PT QST	$120.60	$134.00	$60.30–$134.00	331% above	10%
Prothrombin time (PT/INR) clotting test CPT 85610 PT/INR POCT	$279.00	$310.00	$139.50–$310.00	896% above	10%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT (INR)	$19.80	$22.00	$9.90–$22.00	—	10%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Instr PT	$21.09	$23.43	$10.54–$23.43	—	10%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT/INR Clinic POC (RE)	$57.60	$64.00	$28.80–$64.00	—	10%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT QST	$120.60	$134.00	$60.30–$134.00	—	10%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT/INR POCT	$279.00	$310.00	$139.50–$310.00	—	10%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 Urine Drug Screen POC (RE)	$399.60	$444.00	$199.80–$444.00	1120% above	10%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 Urine Drug Screen POC (RE)	$399.60	$444.00	$199.80–$444.00	—	10%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Strep A Clinic POC (RE)	$38.70	$43.00	$19.35–$43.00	2% below	10%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Strep A POCT	$351.90	$391.00	$175.95–$391.00	789% above	10%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 Strep A Clinic POC (RE)	$38.70	$43.00	$19.35–$43.00	—	10%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 Strep A POCT	$351.90	$391.00	$175.95–$391.00	—	10%
Rheumatoid factor (RF) test CPT 86431 Rheumatoid Factor QST	$495.00	$550.00	$247.50–$550.00	1444% above	10%
Rheumatoid factor (RF) test inpatient CPT 86431 Rheumatoid Factor QST	$495.00	$550.00	$247.50–$550.00	—	10%
Rubella antibody test (immunity check) CPT 86762 Rubella IgM Ab QST	$51.30	$57.00	$25.65–$57.00	41% above	10%
Rubella antibody test (immunity check) CPT 86762 Rubella Immune Status QST	$207.90	$231.00	$103.95–$231.00	473% above	10%
Rubella antibody test (immunity check) inpatient CPT 86762 Rubella IgM Ab QST	$51.30	$57.00	$25.65–$57.00	—	10%
Rubella antibody test (immunity check) inpatient CPT 86762 Rubella Immune Status QST	$207.90	$231.00	$103.95–$231.00	—	10%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 Sed Rate (ESR) Auto	$297.90	$331.00	$148.95–$331.00	861% above	10%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 Sed Rate (ESR) Auto	$297.90	$331.00	$148.95–$331.00	—	10%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 Semen Analysis Post Vas	$114.30	$127.00	$57.15–$127.00	47% above	10%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 Bill Only SPERM MORPHOMETRY	$144.00	$160.00	$72.00–$160.00	85% above	10%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 Semen Analysis Post Vasectomy	$256.50	$285.00	$128.25–$285.00	229% above	10%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 Semen Analysis	$282.60	$314.00	$141.30–$314.00	262% above	10%
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 Semen Analysis Post Vas	$114.30	$127.00	$57.15–$127.00	—	10%
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 Bill Only SPERM MORPHOMETRY	$144.00	$160.00	$72.00–$160.00	—	10%
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 Semen Analysis Post Vasectomy	$256.50	$285.00	$128.25–$285.00	—	10%
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 Semen Analysis	$282.60	$314.00	$141.30–$314.00	—	10%
Stool ova and parasites exam CPT 87177 87177 Ova+Parasites, Conc/Perm Smear MB QST	$15.30	$17.00	$7.65–$17.00	51% below	10%
Stool ova and parasites exam CPT 87177 Ova+Parasites, Conc/Perm Smear QST	$21.60	$24.00	$10.80–$24.00	31% below	10%
Stool ova and parasites exam CPT 87177 Ova and Parasites with Giardia Ag MB QST	$107.10	$119.00	$53.55–$119.00	240% above	10%
Stool ova and parasites exam CPT 87177 O and P Source QST	$256.50	$285.00	$128.25–$285.00	714% above	10%
Stool ova and parasites exam CPT 87177 Ova & Parasites, Conc & Perm Smr MB QST	$352.80	$392.00	$176.40–$392.00	1020% above	10%
Stool ova and parasites exam inpatient CPT 87177 87177 Ova+Parasites, Conc/Perm Smear MB QST	$15.30	$17.00	$7.65–$17.00	—	10%
Stool ova and parasites exam inpatient CPT 87177 Ova+Parasites, Conc/Perm Smear QST	$21.60	$24.00	$10.80–$24.00	—	10%
Stool ova and parasites exam inpatient CPT 87177 Ova and Parasites with Giardia Ag MB QST	$107.10	$119.00	$53.55–$119.00	—	10%
Stool ova and parasites exam inpatient CPT 87177 O and P Source QST	$256.50	$285.00	$128.25–$285.00	—	10%
Stool ova and parasites exam inpatient CPT 87177 Ova & Parasites, Conc & Perm Smr MB QST	$352.80	$392.00	$176.40–$392.00	—	10%
Stool test for hidden blood (guaiac FOBT) CPT 82270 Hemosure iFOB Diagnostic	$19.80	$22.00	$9.90–$22.00	8% above	10%
Stool test for hidden blood (guaiac FOBT) CPT 82270 Occult Blood Screen 1	$119.70	$133.00	$59.85–$133.00	551% above	10%
Stool test for hidden blood (guaiac FOBT) CPT 82270 Hemoccult Stool POCT	$279.00	$310.00	$139.50–$310.00	1416% above	10%
Stool test for hidden blood (guaiac FOBT) CPT 82270 Screening Fecal Occult Blood	$2,205.90	$2,451.00	$1,102.95–$2,451.00	11889% above	10%
Stool test for hidden blood (guaiac FOBT) CPT 82270 Occult Blood Stool POC Clinic (RE)	$2,534.38	$2,815.98	$1,267.19–$2,815.98	13674% above	10%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Hemosure iFOB Diagnostic	$19.80	$22.00	$9.90–$22.00	—	10%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Occult Blood Screen 1	$119.70	$133.00	$59.85–$133.00	—	10%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Hemoccult Stool POCT	$279.00	$310.00	$139.50–$310.00	—	10%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Screening Fecal Occult Blood	$2,205.90	$2,451.00	$1,102.95–$2,451.00	—	10%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Occult Blood Stool POC Clinic (RE)	$2,534.38	$2,815.98	$1,267.19–$2,815.98	—	10%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 Fecal Occult Blood (iFOBT) Clinic POC (RE)	$76.50	$85.00	$38.25–$85.00	69% above	10%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 Fecal Occult Blood (iFOBT) Clinic POC (RE)	$76.50	$85.00	$38.25–$85.00	—	10%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 VDRL, S QST	$35.10	$39.00	$17.55–$39.00	21% above	10%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 VDRL, CSF QST	$51.30	$57.00	$25.65–$57.00	77% above	10%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 VDRL, S QST	$35.10	$39.00	$17.55–$39.00	—	10%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 VDRL, CSF QST	$51.30	$57.00	$25.65–$57.00	—	10%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Quantiferon TB Gold Plus, 4T, Incubated QST	$44.10	$49.00	$22.05–$49.00	59% below	10%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Quantiferon TB Gold Plus, 4T, Incubated	$69.30	$77.00	$34.65–$77.00	35% below	10%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 Quantiferon TB Gold Plus, 4T, Incubated QST	$44.10	$49.00	$22.05–$49.00	—	10%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 Quantiferon TB Gold Plus, 4T, Incubated	$69.30	$77.00	$34.65–$77.00	—	10%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone, Total, MS QST	$47.70	$53.00	$23.85–$53.00	39% below	10%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Tot,Male,Adult QST	$213.30	$237.00	$106.65–$237.00	173% above	10%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone, Total, LC/MS/MS QST	$495.00	$550.00	$247.50–$550.00	533% above	10%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone, Ttl, Males (Adult), Immunoassay QST	$511.20	$568.00	$255.60–$568.00	553% above	10%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone, Total, MS QST	$47.70	$53.00	$23.85–$53.00	—	10%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone Tot,Male,Adult QST	$213.30	$237.00	$106.65–$237.00	—	10%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone, Total, LC/MS/MS QST	$495.00	$550.00	$247.50–$550.00	—	10%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone, Ttl, Males (Adult), Immunoassay QST	$511.20	$568.00	$255.60–$568.00	—	10%
Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroid Peroxidase Abs QST	$58.50	$65.00	$29.25–$65.00	21% below	10%
Thyroid peroxidase (TPO) antibody test CPT 86376 Liver Cytosolic Antigen Type 1 (LC-1) Antibody, IgG QST	$313.20	$348.00	$156.60–$348.00	324% above	10%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Thyroid Peroxidase Abs QST	$58.50	$65.00	$29.25–$65.00	—	10%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Liver Cytosolic Antigen Type 1 (LC-1) Antibody, IgG QST	$313.20	$348.00	$156.60–$348.00	—	10%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Stimulating Hormone	$24.30	$27.00	$12.15–$27.00	66% below	10%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Cascading Reflex QST	$60.30	$67.00	$30.15–$67.00	16% below	10%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Stimulating Hormone	$24.30	$27.00	$12.15–$27.00	—	10%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Cascading Reflex QST	$60.30	$67.00	$30.15–$67.00	—	10%
Trichomonas test (NAAT) CPT 87661 Trichomonas Vaginalis (TV), TMA QST	$20.17	$22.41	$10.08–$22.41	76% below	10%
Trichomonas test (NAAT) CPT 87661 Trichomonas Vaginalis (GeneXpert)	$21.60	$24.00	$10.80–$24.00	75% below	10%
Trichomonas test (NAAT) CPT 87661 Trichomonas Vaginalis RNA, Ql, TMA QST	$86.40	$96.00	$43.20–$96.00	2% above	10%
Trichomonas test (NAAT) inpatient CPT 87661 Trichomonas Vaginalis (TV), TMA QST	$20.17	$22.41	$10.08–$22.41	—	10%
Trichomonas test (NAAT) inpatient CPT 87661 Trichomonas Vaginalis (GeneXpert)	$21.60	$24.00	$10.80–$24.00	—	10%
Trichomonas test (NAAT) inpatient CPT 87661 Trichomonas Vaginalis RNA, Ql, TMA QST	$86.40	$96.00	$43.20–$96.00	—	10%
Uric acid blood test CPT 84550 Uric Acid	$130.28	$144.75	$65.14–$144.75	357% above	10%
Uric acid blood test inpatient CPT 84550 Uric Acid	$130.28	$144.75	$65.14–$144.75	—	10%
Urinalysis without microscope exam, automated CPT 81003 Specific Gravity Urine	$21.60	$24.00	$10.80–$24.00	14% above	10%
Urinalysis without microscope exam, automated inpatient CPT 81003 Specific Gravity Urine	$21.60	$24.00	$10.80–$24.00	—	10%
Urinalysis without microscope exam, manual CPT 81002 .Urinalysis POCT	$157.50	$175.00	$78.75–$175.00	898% above	10%
Urinalysis without microscope exam, manual inpatient CPT 81002 .Urinalysis POCT	$157.50	$175.00	$78.75–$175.00	—	10%
Urine culture for bacteria, with colony count CPT 87086 Culture Urine MB QST	$308.70	$343.00	$154.35–$343.00	426% above	10%
Urine culture for bacteria, with colony count inpatient CPT 87086 Culture Urine MB QST	$308.70	$343.00	$154.35–$343.00	—	10%
Urine pregnancy test, read by color change CPT 81025 Urine Pregnancy Qual POCT	$20.70	$23.00	$10.35–$23.00	26% below	10%
Urine pregnancy test, read by color change CPT 81025 Urine Pregnancy Test Clinic POC (RE)	$159.30	$177.00	$79.65–$177.00	467% above	10%
Urine pregnancy test, read by color change CPT 81025 Pregnancy Test Urine Qual	$814.50	$905.00	$407.25–$905.00	2801% above	10%
Urine pregnancy test, read by color change inpatient CPT 81025 Urine Pregnancy Qual POCT	$20.70	$23.00	$10.35–$23.00	—	10%
Urine pregnancy test, read by color change inpatient CPT 81025 Urine Pregnancy Test Clinic POC (RE)	$159.30	$177.00	$79.65–$177.00	—	10%
Urine pregnancy test, read by color change inpatient CPT 81025 Pregnancy Test Urine Qual	$814.50	$905.00	$407.25–$905.00	—	10%
Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B12 Level	$531.00	$590.00	$265.50–$590.00	556% above	10%
Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B12 QST	$531.00	$590.00	$265.50–$590.00	556% above	10%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Vitamin B12 Level	$531.00	$590.00	$265.50–$590.00	—	10%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Vitamin B12 QST	$531.00	$590.00	$265.50–$590.00	—	10%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D,25-Oh QST	$155.70	$173.00	$77.85–$173.00	54% above	10%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 25-OH Vit D (D2,D3), LC/MS/MS QST	$157.50	$175.00	$78.75–$175.00	56% above	10%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D 25 Hydroxy Level	$213.30	$237.00	$106.65–$237.00	111% above	10%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D,25-Oh QST	$155.70	$173.00	$77.85–$173.00	—	10%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 25-OH Vit D (D2,D3), LC/MS/MS QST	$157.50	$175.00	$78.75–$175.00	—	10%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D 25 Hydroxy Level	$213.30	$237.00	$106.65–$237.00	—	10%
Zinc blood test CPT 84630 Zinc, RBC QST	$20.70	$23.00	$10.35–$23.00	44% below	10%
Zinc blood test CPT 84630 Zinc QST	$44.10	$49.00	$22.05–$49.00	19% above	10%
Zinc blood test inpatient CPT 84630 Zinc, RBC QST	$20.70	$23.00	$10.35–$23.00	—	10%
Zinc blood test inpatient CPT 84630 Zinc QST	$44.10	$49.00	$22.05–$49.00	—	10%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Beta hCG Quantitative	$99.00	$110.00	$49.50–$110.00	50% above	10%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Beta hCG Quantitative	$99.00	$110.00	$49.50–$110.00	—	10%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Maine	Off list
Arthroscopic ACL reconstruction or repair of the knee CPT 29888 29888 Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction	$3,258.00	$3,620.00	$1,629.00–$3,620.00	15% above	10%
Arthroscopic ACL reconstruction or repair of the knee inpatient CPT 29888 29888 Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction	$3,258.00	$3,620.00	$1,629.00–$3,620.00	—	10%
Botox injections for chronic migraine both sides CPT 64615 64615 Chemodenervation of muscle(s); muscle(s) innervated nerves, bilateral	$411.30	$457.00	$205.65–$457.00	—	10%
Botox injections for chronic migraine inpatient both sides CPT 64615 64615 Chemodenervation of muscle(s); muscle(s) innervated nerves, bilateral	$411.30	$457.00	$205.65–$457.00	—	10%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 27786 Closed treatment of distal fibular fracture (lateral malleolus); without manipulation	$1,027.80	$1,142.00	$513.90–$1,142.00	272% above	10%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 27786 Closed treatment of distal fibular fracture (lateral malleolus); without manipulation	$1,027.80	$1,142.00	$513.90–$1,142.00	—	10%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 28470 Closed treatment of metatarsal fracture; without manipulation, each	$853.20	$948.00	$426.60–$948.00	267% above	10%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 28470 Closed treatment of metatarsal fracture; without manipulation, each	$853.20	$948.00	$426.60–$948.00	—	10%
Bunion correction with a bone cut near the head of the first metatarsal CPT 28296 28296 Correction, hallux valgus (bunion), with or without sesamoidectomy; with metatarsal osteotomy	$2,365.20	$2,628.00	$1,182.60–$2,628.00	43% above	10%
Bunion correction with a bone cut near the head of the first metatarsal inpatient CPT 28296 28296 Correction, hallux valgus (bunion), with or without sesamoidectomy; with metatarsal osteotomy	$2,365.20	$2,628.00	$1,182.60–$2,628.00	—	10%
Bunion correction with removal of part of the big toe joint CPT 28292 28292 CORRECTION, HALLUX VALGUS (BUNIONECTOMY), WITH SESAMOIDECTOMY, WHEN PERFORMED; WITH RE ProFee	$1,228.50	$1,365.00	$614.25–$1,365.00	—	10%
Bunion correction with removal of part of the big toe joint inpatient CPT 28292 28292 CORRECTION, HALLUX VALGUS (BUNIONECTOMY), WITH SESAMOIDECTOMY, WHEN PERFORMED; WITH RE ProFee	$1,228.50	$1,365.00	$614.25–$1,365.00	—	10%
Cardioversion, elective (restoring heart rhythm) CPT 92960 92960 CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL ProFee	$1,466.10	$1,629.00	$733.05–$1,629.00	209% above	10%
Cardioversion, elective (restoring heart rhythm) CPT 92960 92960 PHY CARDIOVERSION EXTERNAL ProFee	$1,910.70	$2,123.00	$955.35–$2,123.00	303% above	10%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 92960 CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL ProFee	$1,466.10	$1,629.00	$733.05–$1,629.00	—	10%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 92960 PHY CARDIOVERSION EXTERNAL ProFee	$1,910.70	$2,123.00	$955.35–$2,123.00	—	10%
Carpal tunnel release, open surgery CPT 64721 64721 NEUROPLASTY AND/OR TRANSPOSITION; MEDIAN NERVE AT CARPAL TUNNEL ProFee	$3,258.00	$3,620.00	$1,629.00–$3,620.00	226% above	10%
Carpal tunnel release, open surgery inpatient CPT 64721 64721 NEUROPLASTY AND/OR TRANSPOSITION; MEDIAN NERVE AT CARPAL TUNNEL ProFee	$3,258.00	$3,620.00	$1,629.00–$3,620.00	—	10%
Cataract surgery with lens implant CPT 66984 66984 EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1 STAGE ProFee	$1,262.70	$1,403.00	$631.35–$1,403.00	—	10%
Cataract surgery with lens implant inpatient CPT 66984 66984 EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1 STAGE ProFee	$1,262.70	$1,403.00	$631.35–$1,403.00	—	10%
Cervical biopsy CPT 57500 57500 Biopsy of cervix, single or multiple, or local excision of lesion, w/ or w/o fulguration	$466.20	$518.00	$233.10–$518.00	at median	10%
Cervical biopsy inpatient CPT 57500 57500 Biopsy of cervix, single or multiple, or local excision of lesion, w/ or w/o fulguration	$466.20	$518.00	$233.10–$518.00	—	10%
Cesarean delivery, including prenatal and postpartum care CPT 59510 59510 ROUTINE OBSTETRIC CARE INCLUDING ANTEPARTUM CARE, CESAREAN DELIVERY, AND POSTPARTUM CA ProFee	$3,544.20	$3,938.00	$1,772.10–$3,938.00	3% below	10%
Cesarean delivery, including prenatal and postpartum care inpatient CPT 59510 59510 ROUTINE OBSTETRIC CARE INCLUDING ANTEPARTUM CARE, CESAREAN DELIVERY, AND POSTPARTUM CA ProFee	$3,544.20	$3,938.00	$1,772.10–$3,938.00	—	10%
Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 54161 CIRCUMCISION, SURGICAL EXCISION OTHER THAN CLAMP, DEVICE, OR DORSAL SLIT; OLDER THAN 2 ProFee	$2,511.00	$2,790.00	$1,255.50–$2,790.00	215% above	10%
Circumcision by surgical excision, older than 28 days (children and adults) inpatient CPT 54161 54161 CIRCUMCISION, SURGICAL EXCISION OTHER THAN CLAMP, DEVICE, OR DORSAL SLIT; OLDER THAN 2 ProFee	$2,511.00	$2,790.00	$1,255.50–$2,790.00	—	10%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 54150 CIRCUMCISION CLAMP OTH DEV W/BLOCK CHARGE	$296.10	$329.00	$148.05–$329.00	4% above	10%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 54150 CIRCUMCISION CLAMP OTH DEV W/BLOCK CHARGE	$296.10	$329.00	$148.05–$329.00	—	10%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 25600 Closed treatment of distal radial fracture without manipulation	$290.70	$323.00	$145.35–$323.00	11% above	10%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 25600 Closed treatment of distal radial fracture (eg, Colles or Smith type) or ephiphyseal separatio	$1,013.40	$1,126.00	$506.70–$1,126.00	289% above	10%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 25600 Closed treatment of distal radial fracture without manipulation	$290.70	$323.00	$145.35–$323.00	—	10%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 25600 Closed treatment of distal radial fracture (eg, Colles or Smith type) or ephiphyseal separatio	$1,013.40	$1,126.00	$506.70–$1,126.00	—	10%
Colonoscopy with polyp removal CPT 45385 45385 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare techniq	$1,940.40	$2,156.00	$970.20–$2,156.00	34% above	10%
Colonoscopy with polyp removal CPT 45385 45385 COLONOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE ProFee	$2,848.50	$3,165.00	$1,424.25–$3,165.00	96% above	10%
Colonoscopy with polyp removal inpatient CPT 45385 45385 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare techniq	$1,940.40	$2,156.00	$970.20–$2,156.00	—	10%
Colonoscopy with polyp removal inpatient CPT 45385 45385 COLONOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE ProFee	$2,848.50	$3,165.00	$1,424.25–$3,165.00	—	10%
Colonoscopy with tissue sample CPT 45380 45380 COLONOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE ProFee	$2,634.30	$2,927.00	$1,317.15–$2,927.00	81% above	10%
Colonoscopy with tissue sample inpatient CPT 45380 45380 COLONOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE ProFee	$2,634.30	$2,927.00	$1,317.15–$2,927.00	—	10%
Colonoscopy, diagnostic CPT 45378 45378 COLONOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR ProFee	$4,424.40	$4,916.00	$2,212.20–$4,916.00	290% above	10%
Colonoscopy, diagnostic inpatient CPT 45378 45378 COLONOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR ProFee	$4,424.40	$4,916.00	$2,212.20–$4,916.00	—	10%
Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 57460 Colposcopy of the cervix incl. upper vagina; with loop electrode biopsy(s) of the cervix	$842.40	$936.00	$421.20–$936.00	25% above	10%
Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 57460 COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH LOOP ELECTRODE BIOPSY(S ProFee	$1,793.70	$1,993.00	$896.85–$1,993.00	166% above	10%
Colposcopy with LEEP (loop electrosurgical excision) inpatient CPT 57460 57460 Colposcopy of the cervix incl. upper vagina; with loop electrode biopsy(s) of the cervix	$842.40	$936.00	$421.20–$936.00	—	10%
Colposcopy with LEEP (loop electrosurgical excision) inpatient CPT 57460 57460 COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH LOOP ELECTRODE BIOPSY(S ProFee	$1,793.70	$1,993.00	$896.85–$1,993.00	—	10%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 57454 Colposcopy of the cervix incl. vagina w/ biopsy of cervix and endocervical curettage	$603.90	$671.00	$301.95–$671.00	202% above	10%
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 57454 Colposcopy of the cervix incl. vagina w/ biopsy of cervix and endocervical curettage	$603.90	$671.00	$301.95–$671.00	—	10%
Complex cataract surgery with lens implant CPT 66982 66982 EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1-STAGE ProFee	$478.80	$532.00	$239.40–$532.00	—	10%
Complex cataract surgery with lens implant inpatient CPT 66982 66982 EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1-STAGE ProFee	$478.80	$532.00	$239.40–$532.00	—	10%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 52000 Cystourethroscopy (separate procedure)	$684.00	$760.00	$342.00–$760.00	48% above	10%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 52000 CYSTOURETHROSCOPY (SEPARATE PROCEDURE) ProFee	$2,622.60	$2,914.00	$1,311.30–$2,914.00	467% above	10%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 52000 Cystourethroscopy (separate procedure)	$684.00	$760.00	$342.00–$760.00	—	10%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 52000 CYSTOURETHROSCOPY (SEPARATE PROCEDURE) ProFee	$2,622.60	$2,914.00	$1,311.30–$2,914.00	—	10%
D&C (dilation and curettage), not related to pregnancy CPT 58120 58120 DILATION AND CURETTAGE, DIAGNOSTIC AND/OR THERAPEUTIC (NONOBSTETRICAL) ProFee	$1,695.60	$1,884.00	$847.80–$1,884.00	8% above	10%
D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 58120 DILATION AND CURETTAGE, DIAGNOSTIC AND/OR THERAPEUTIC (NONOBSTETRICAL) ProFee	$1,695.60	$1,884.00	$847.80–$1,884.00	—	10%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 17000 Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettemen	$193.50	$215.00	$96.75–$215.00	110% above	10%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 17000 Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettemen	$193.50	$215.00	$96.75–$215.00	—	10%
Earwax removal by irrigation (rinsing), one ear both sides CPT 69209 69209 Removal Impacted Cerumen Using Irrigation/Lavage, Bilateral	$299.70	$333.00	$149.85–$333.00	—	10%
Earwax removal by irrigation (rinsing), one ear CPT 69209 69209 REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE	$115.20	$128.00	$57.60–$128.00	156% above	10%
Earwax removal by irrigation (rinsing), one ear CPT 69209 69209 Ear Irrigation POC	$149.40	$166.00	$74.70–$166.00	232% above	10%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 69209 REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATERAL TechFee	$159.30	$177.00	$79.65–$177.00	254% above	10%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 69209 REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATERAL Pro	$673.20	$748.00	$336.60–$748.00	1396% above	10%
Earwax removal by irrigation (rinsing), one ear inpatient both sides CPT 69209 69209 Removal Impacted Cerumen Using Irrigation/Lavage, Bilateral	$299.70	$333.00	$149.85–$333.00	—	10%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 69209 REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE	$115.20	$128.00	$57.60–$128.00	—	10%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 69209 Ear Irrigation POC	$149.40	$166.00	$74.70–$166.00	—	10%
Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 69209 REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATERAL TechFee	$159.30	$177.00	$79.65–$177.00	—	10%
Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 69209 REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATERAL Pro	$673.20	$748.00	$336.60–$748.00	—	10%
Earwax removal with instruments, one ear both sides CPT 69210 69210 Removal impacted cerumen requiring instrumentation, Bilat	$117.90	$131.00	$58.95–$131.00	—	10%
Earwax removal with instruments, one ear CPT 69210 69210 REMOVAL IMPACTED CERUMEN-ER SERV PROCEDU	$117.90	$131.00	$58.95–$131.00	109% above	10%
Earwax removal with instruments, one ear one side CPT 69210 69210 Removal impacted cerumen requiring instrumentation, unilateral	$117.90	$131.00	$58.95–$131.00	109% above	10%
Earwax removal with instruments, one ear one side CPT 69210 69210 REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT ProFee	$217.80	$242.00	$108.90–$242.00	285% above	10%
Earwax removal with instruments, one ear one side CPT 69210 69210 REMOVAL IMPACTED CERUMEN REQUIRING INSTRUMENTATION, UNILATERAL ProFee	$3,948.30	$4,387.00	$1,974.15–$4,387.00	6888% above	10%
Earwax removal with instruments, one ear inpatient both sides CPT 69210 69210 Removal impacted cerumen requiring instrumentation, Bilat	$117.90	$131.00	$58.95–$131.00	—	10%
Earwax removal with instruments, one ear inpatient CPT 69210 69210 REMOVAL IMPACTED CERUMEN-ER SERV PROCEDU	$117.90	$131.00	$58.95–$131.00	—	10%
Earwax removal with instruments, one ear inpatient one side CPT 69210 69210 Removal impacted cerumen requiring instrumentation, unilateral	$117.90	$131.00	$58.95–$131.00	—	10%
Earwax removal with instruments, one ear inpatient one side CPT 69210 69210 REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT ProFee	$217.80	$242.00	$108.90–$242.00	—	10%
Earwax removal with instruments, one ear inpatient one side CPT 69210 69210 REMOVAL IMPACTED CERUMEN REQUIRING INSTRUMENTATION, UNILATERAL ProFee	$3,948.30	$4,387.00	$1,974.15–$4,387.00	—	10%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 58100 Endometrial biopsy with or w/o endocer biopsy, w/o cervical dilation, any method	$369.00	$410.00	$184.50–$410.00	108% above	10%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 58100 Endometrial biopsy with or w/o endocer biopsy, w/o cervical dilation, any method	$369.00	$410.00	$184.50–$410.00	—	10%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 62321 ESI cervical or thoracic with fluoroscopy	$1,258.20	$1,398.00	$629.10–$1,398.00	58% above	10%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 62321 ESI cervical or thoracic with fluoroscopy	$1,258.20	$1,398.00	$629.10–$1,398.00	—	10%
Eye injection into the vitreous (intravitreal injection) both sides CPT 67028 67028 Bilateral intravitreal injection of a pharmacologic agent	$645.30	$717.00	$322.65–$717.00	—	10%
Eye injection into the vitreous (intravitreal injection) CPT 67028 67028 INTRAVITREAL INJECTION OF A PHARMACOLOGIC AGENT (SEPARATE PROCEDURE) ProFee	$2,000.70	$2,223.00	$1,000.35–$2,223.00	751% above	10%
Eye injection into the vitreous (intravitreal injection) inpatient both sides CPT 67028 67028 Bilateral intravitreal injection of a pharmacologic agent	$645.30	$717.00	$322.65–$717.00	—	10%
Eye injection into the vitreous (intravitreal injection) inpatient CPT 67028 67028 INTRAVITREAL INJECTION OF A PHARMACOLOGIC AGENT (SEPARATE PROCEDURE) ProFee	$2,000.70	$2,223.00	$1,000.35–$2,223.00	—	10%
Facet joint injection, lower back, one level, with imaging guidance both sides CPT 64493 64493 - Lumbar/Sacral Bilateral	$2,242.80	$2,492.00	$1,121.40–$2,492.00	—	10%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 64493 Injection Paravertebral Facet Joint - single level	$1,121.40	$1,246.00	$560.70–$1,246.00	26% above	10%
Facet joint injection, lower back, one level, with imaging guidance inpatient both sides CPT 64493 64493 - Lumbar/Sacral Bilateral	$2,242.80	$2,492.00	$1,121.40–$2,492.00	—	10%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 64493 Injection Paravertebral Facet Joint - single level	$1,121.40	$1,246.00	$560.70–$1,246.00	—	10%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 49593 repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigel	$1,651.50	$1,835.00	$825.75–$1,835.00	6% above	10%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm inpatient CPT 49593 49593 repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigel	$1,651.50	$1,835.00	$825.75–$1,835.00	—	10%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 49591 Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigel	$936.00	$1,040.00	$468.00–$1,040.00	6% above	10%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm inpatient CPT 49591 49591 Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigel	$936.00	$1,040.00	$468.00–$1,040.00	—	10%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 45330 SIGMOIDOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING O ProFee	$529.20	$588.00	$264.60–$588.00	22% above	10%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 45330 SIGMOIDOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING O ProFee	$529.20	$588.00	$264.60–$588.00	—	10%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 47563 LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH CHOLANGIOGRAPHY ProFee	$1,019.70	$1,133.00	$509.85–$1,133.00	38% below	10%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery inpatient CPT 47563 47563 LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH CHOLANGIOGRAPHY ProFee	$1,019.70	$1,133.00	$509.85–$1,133.00	—	10%
Hammertoe correction surgery CPT 28285 28285 CORRECTION, HAMMERTOE (EG, INTERPHALANGEAL FUSION, PARTIAL OR TOTAL PHALANGECTOMY) ProFee	$1,097.10	$1,219.00	$548.55–$1,219.00	14% above	10%
Hammertoe correction surgery inpatient CPT 28285 28285 CORRECTION, HAMMERTOE (EG, INTERPHALANGEAL FUSION, PARTIAL OR TOTAL PHALANGECTOMY) ProFee	$1,097.10	$1,219.00	$548.55–$1,219.00	—	10%
Hemorrhoid banding (rubber band ligation) CPT 46221 46221 Hemorrhoidectomy, internal, by rubber band ligation(s)	$936.00	$1,040.00	$468.00–$1,040.00	25% above	10%
Hemorrhoid banding (rubber band ligation) CPT 46221 46221 HEMORRHOIDECTOMY, INTERNAL, BY RUBBER BAND LIGATION(S) ProFee	$2,283.30	$2,537.00	$1,141.65–$2,537.00	204% above	10%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 46221 Hemorrhoidectomy, internal, by rubber band ligation(s)	$936.00	$1,040.00	$468.00–$1,040.00	—	10%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 46221 HEMORRHOIDECTOMY, INTERNAL, BY RUBBER BAND LIGATION(S) ProFee	$2,283.30	$2,537.00	$1,141.65–$2,537.00	—	10%
Hysterectomy through an abdominal incision (total) CPT 58150 58150 TOTAL ABDOMINAL HYSTERECTOMY (CORPUS AND CERVIX), WITH OR WITHOUT REMOVAL OF TUBE(S), ProFee	$1,170.00	$1,300.00	$585.00–$1,300.00	46% below	10%
Hysterectomy through an abdominal incision (total) inpatient CPT 58150 58150 TOTAL ABDOMINAL HYSTERECTOMY (CORPUS AND CERVIX), WITH OR WITHOUT REMOVAL OF TUBE(S), ProFee	$1,170.00	$1,300.00	$585.00–$1,300.00	—	10%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 XR Hysterosalpingography Cath/Injection	$43.20	$48.00	$21.60–$48.00	81% below	10%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 58340 Catheterization and introduction of saline or contrast material for infusion	$181.80	$202.00	$90.90–$202.00	21% below	10%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 XR Hysterosalpingography Cath/Injection	$43.20	$48.00	$21.60–$48.00	—	10%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 58340 Catheterization and introduction of saline or contrast material for infusion	$181.80	$202.00	$90.90–$202.00	—	10%
Hysteroscopy with endometrial ablation CPT 58563 58563 HYSTEROSCOPY, SURGICAL; WITH ENDOMETRIAL ABLATION (EG, ENDOMETRIAL RESECTION, ELECTROS ProFee	$1,361.70	$1,513.00	$680.85–$1,513.00	23% below	10%
Hysteroscopy with endometrial ablation inpatient CPT 58563 58563 HYSTEROSCOPY, SURGICAL; WITH ENDOMETRIAL ABLATION (EG, ENDOMETRIAL RESECTION, ELECTROS ProFee	$1,361.70	$1,513.00	$680.85–$1,513.00	—	10%
Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 58558 Hysteroscopy, surgical; w/ biopsy of endometrium and/or polypectomy, with or w/o D & C	$810.90	$901.00	$405.45–$901.00	27% below	10%
Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 58558 HYSTEROSCOPY, SURGICAL; WITH SAMPLING (BIOPSY) OF ENDOMETRIUM AND/OR POLYPECTOMY, WITH ProFee	$3,081.60	$3,424.00	$1,540.80–$3,424.00	177% above	10%
Hysteroscopy with uterine lining sampling and/or polyp removal inpatient CPT 58558 58558 Hysteroscopy, surgical; w/ biopsy of endometrium and/or polypectomy, with or w/o D & C	$810.90	$901.00	$405.45–$901.00	—	10%
Hysteroscopy with uterine lining sampling and/or polyp removal inpatient CPT 58558 58558 HYSTEROSCOPY, SURGICAL; WITH SAMPLING (BIOPSY) OF ENDOMETRIUM AND/OR POLYPECTOMY, WITH ProFee	$3,081.60	$3,424.00	$1,540.80–$3,424.00	—	10%
IUD insertion (the device itself billed separately) CPT 58300 58300 Insertion of intrauterine device (IUD)	$263.70	$293.00	$131.85–$293.00	242% above	10%
IUD insertion (the device itself billed separately) CPT 58300 58300 Insertion of Intrauterine Device - Admin Injection Charge	$476.10	$529.00	$238.05–$529.00	518% above	10%
IUD insertion (the device itself billed separately) CPT 58300 58300 Insertion of Intrauterine Device - AMB IUD Admin Charge	$878.40	$976.00	$439.20–$976.00	1041% above	10%
IUD insertion (the device itself billed separately) CPT 58300 58300 Insertion of Intrauterine Device.	$5,990.40	$6,656.00	$2,995.20–$6,656.00	7680% above	10%
IUD insertion (the device itself billed separately) inpatient CPT 58300 58300 Insertion of intrauterine device (IUD)	$263.70	$293.00	$131.85–$293.00	—	10%
IUD insertion (the device itself billed separately) inpatient CPT 58300 58300 Insertion of Intrauterine Device - Admin Injection Charge	$476.10	$529.00	$238.05–$529.00	—	10%
IUD insertion (the device itself billed separately) inpatient CPT 58300 58300 Insertion of Intrauterine Device - AMB IUD Admin Charge	$878.40	$976.00	$439.20–$976.00	—	10%
IUD insertion (the device itself billed separately) inpatient CPT 58300 58300 Insertion of Intrauterine Device.	$5,990.40	$6,656.00	$2,995.20–$6,656.00	—	10%
Incision and drainage of a simple or single skin abscess CPT 10060 10060 INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE TechFee	$302.40	$336.00	$151.20–$336.00	101% above	10%
Incision and drainage of a simple or single skin abscess CPT 10060 10060 INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE ProFee	$359.10	$399.00	$179.55–$399.00	138% above	10%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 10060 INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE TechFee	$302.40	$336.00	$151.20–$336.00	—	10%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 10060 INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE ProFee	$359.10	$399.00	$179.55–$399.00	—	10%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 49505 REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OLDER; REDUCIBLE ProFee	$1,260.90	$1,401.00	$630.45–$1,401.00	6% below	10%
Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 49505 REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OLDER; REDUCIBLE ProFee	$1,260.90	$1,401.00	$630.45–$1,401.00	—	10%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 20550 Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar fascia)	$204.30	$227.00	$102.15–$227.00	23% above	10%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 20550: Injection(s); tendon sheath - Admin Injection Charge	$352.80	$392.00	$176.40–$392.00	112% above	10%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 20550: Injection(s); tendon sheath - AMB Only Inj Med Admin Charge	$443.70	$493.00	$221.85–$493.00	167% above	10%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 20550 INJECTION(S); SINGLE TENDON SHEATH, OR LIGAMENT, APONEUROSIS (EG, PLANTAR FASCIA) ProFee	$999.90	$1,111.00	$499.95–$1,111.00	502% above	10%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 20550 Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar fascia)	$204.30	$227.00	$102.15–$227.00	—	10%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 20550: Injection(s); tendon sheath - Admin Injection Charge	$352.80	$392.00	$176.40–$392.00	—	10%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 20550: Injection(s); tendon sheath - AMB Only Inj Med Admin Charge	$443.70	$493.00	$221.85–$493.00	—	10%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 20550 INJECTION(S); SINGLE TENDON SHEATH, OR LIGAMENT, APONEUROSIS (EG, PLANTAR FASCIA) ProFee	$999.90	$1,111.00	$499.95–$1,111.00	—	10%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 20610 Arthrocentesis aspiration and/or injection major joint or bursa without ultrasound guidance	$377.10	$419.00	$188.55–$419.00	98% above	10%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 20610-L Drain/inj joint/bursa w/o us	$981.90	$1,091.00	$490.95–$1,091.00	416% above	10%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 20610 ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, MAJOR JOINT OR BURSA (EG, SHOULDER, HIP, ProFee	$4,453.20	$4,948.00	$2,226.60–$4,948.00	2238% above	10%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 XR Joint/Bursa Major Arthr/Asp/Inj Right	$49.50	$55.00	$24.75–$55.00	74% below	10%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 20610 Arthrocentesis aspiration and/or injection major joint or bursa without ultrasound guidance	$377.10	$419.00	$188.55–$419.00	—	10%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 20610-L Drain/inj joint/bursa w/o us	$981.90	$1,091.00	$490.95–$1,091.00	—	10%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 20610 ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, MAJOR JOINT OR BURSA (EG, SHOULDER, HIP, ProFee	$4,453.20	$4,948.00	$2,226.60–$4,948.00	—	10%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 XR Joint/Bursa Major Arthr/Asp/Inj Right	$49.50	$55.00	$24.75–$55.00	—	10%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 11981 Insertion, non-biodegradable drug delivery implant	$425.70	$473.00	$212.85–$473.00	286% above	10%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 11981 Insertion, non-biodegradable drug delivery implant	$425.70	$473.00	$212.85–$473.00	—	10%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 20605 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa	$221.40	$246.00	$110.70–$246.00	22% above	10%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 20605-L xyphoid joint injection	$558.00	$620.00	$279.00–$620.00	208% above	10%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 20605 ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, INTERMEDIATE JOINT OR BURSA (EG, TEMPOROM ProFee	$1,873.80	$2,082.00	$936.90–$2,082.00	933% above	10%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 20605 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa	$221.40	$246.00	$110.70–$246.00	—	10%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 20605-L xyphoid joint injection	$558.00	$620.00	$279.00–$620.00	—	10%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 20605 ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, INTERMEDIATE JOINT OR BURSA (EG, TEMPOROM ProFee	$1,873.80	$2,082.00	$936.90–$2,082.00	—	10%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 20600 Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes)	$208.80	$232.00	$104.40–$232.00	4% above	10%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 20600 ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, SMALL JOINT OR BURSA (EG, FINGERS, TOES); ProFee	$1,233.00	$1,370.00	$616.50–$1,370.00	513% above	10%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 20600 Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes)	$208.80	$232.00	$104.40–$232.00	—	10%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 20600 ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, SMALL JOINT OR BURSA (EG, FINGERS, TOES); ProFee	$1,233.00	$1,370.00	$616.50–$1,370.00	—	10%
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 44970 LAPAROSCOPY, SURGICAL, APPENDECTOMY ProFee	$3,416.40	$3,796.00	$1,708.20–$3,796.00	90% above	10%
Laparoscopic appendectomy (appendix removal through small cuts) inpatient CPT 44970 44970 LAPAROSCOPY, SURGICAL, APPENDECTOMY ProFee	$3,416.40	$3,796.00	$1,708.20–$3,796.00	—	10%
Laparoscopic fundoplication (anti-reflux surgery) CPT 43280 43280 LAPAROSCOPY, SURGICAL, ESOPHAGOGASTRIC FUNDOPLASTY (EG, NISSEN, TOUPET PROCEDURES) ProFee	$1,571.40	$1,746.00	$785.70–$1,746.00	21% below	10%
Laparoscopic fundoplication (anti-reflux surgery) inpatient CPT 43280 43280 LAPAROSCOPY, SURGICAL, ESOPHAGOGASTRIC FUNDOPLASTY (EG, NISSEN, TOUPET PROCEDURES) ProFee	$1,571.40	$1,746.00	$785.70–$1,746.00	—	10%
Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries CPT 58571 58571 LAPAROSCOPY, SURGICAL, WITH TOTAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REMOVAL ProFee	$2,316.60	$2,574.00	$1,158.30–$2,574.00	15% above	10%
Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries inpatient CPT 58571 58571 LAPAROSCOPY, SURGICAL, WITH TOTAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REMOVAL ProFee	$2,316.60	$2,574.00	$1,158.30–$2,574.00	—	10%
Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 49650 LAPAROSCOPY, SURGICAL; REPAIR INITIAL INGUINAL HERNIA ProFee	$5,637.60	$6,264.00	$2,818.80–$6,264.00	484% above	10%
Laparoscopic inguinal (groin) hernia repair, first repair on that side inpatient CPT 49650 49650 LAPAROSCOPY, SURGICAL; REPAIR INITIAL INGUINAL HERNIA ProFee	$5,637.60	$6,264.00	$2,818.80–$6,264.00	—	10%
Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 58661 LAPAROSCOPY, SURGICAL; WITH REMOVAL OF ADNEXAL STRUCTURES (PARTIAL OR TOTAL OOPHORECTO ProFee	$3,556.80	$3,952.00	$1,778.40–$3,952.00	104% above	10%
Laparoscopic removal of fallopian tubes and/or ovaries inpatient CPT 58661 58661 LAPAROSCOPY, SURGICAL; WITH REMOVAL OF ADNEXAL STRUCTURES (PARTIAL OR TOTAL OOPHORECTO ProFee	$3,556.80	$3,952.00	$1,778.40–$3,952.00	—	10%
Laser treatment of clouding after cataract surgery (YAG) CPT 66821 66821 Discission of secondary membranous cataract; laser surgery (1 or more stages)	$881.10	$979.00	$440.55–$979.00	172% above	10%
Laser treatment of clouding after cataract surgery (YAG) CPT 66821 66821 DISCISSION OF SECONDARY MEMBRANOUS CATARACT (OPACIFIED POSTERIOR LENS CAPSULE AND/OR A ProFee	$887.40	$986.00	$443.70–$986.00	174% above	10%
Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 66821 Discission of secondary membranous cataract; laser surgery (1 or more stages)	$881.10	$979.00	$440.55–$979.00	—	10%
Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 66821 DISCISSION OF SECONDARY MEMBRANOUS CATARACT (OPACIFIED POSTERIOR LENS CAPSULE AND/OR A ProFee	$887.40	$986.00	$443.70–$986.00	—	10%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 12031 REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HA ProFee	$219.60	$244.00	$109.80–$244.00	24% below	10%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 12031 Repair, intermediate; wounds of scalp, axillae, trunk, extremities; <2.5cm	$602.10	$669.00	$301.05–$669.00	109% above	10%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 12031 REPAIR INTERMEDIATE S/A/T/E 2.5 CM/< ProFee	$1,501.20	$1,668.00	$750.60–$1,668.00	421% above	10%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 12031 REPAIR INTERMEDIATE S/A/T/E 2.5 CM/< TechFee	$1,685.70	$1,873.00	$842.85–$1,873.00	485% above	10%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 12031 REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HA ProFee	$219.60	$244.00	$109.80–$244.00	—	10%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 12031 Repair, intermediate; wounds of scalp, axillae, trunk, extremities; <2.5cm	$602.10	$669.00	$301.05–$669.00	—	10%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 12031 REPAIR INTERMEDIATE S/A/T/E 2.5 CM/< ProFee	$1,501.20	$1,668.00	$750.60–$1,668.00	—	10%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 12031 REPAIR INTERMEDIATE S/A/T/E 2.5 CM/< TechFee	$1,685.70	$1,873.00	$842.85–$1,873.00	—	10%
Lower-back epidural injection, with imaging guidance CPT 62323 62323 ESI lumbar or sacral with fluoroscopy	$1,210.50	$1,345.00	$605.25–$1,345.00	36% above	10%
Lower-back epidural injection, with imaging guidance CPT 62323 62323 INJECTION(S), DIAGNOSTIC/THERAPEUTIC INTERLAMINAR EPIDURAL, LUMBAR OR SACRAL, W/ IMAGING (PRO)	$5,171.40	$5,746.00	$2,585.70–$5,746.00	482% above	10%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 62323 ESI lumbar or sacral with fluoroscopy	$1,210.50	$1,345.00	$605.25–$1,345.00	—	10%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 62323 INJECTION(S), DIAGNOSTIC/THERAPEUTIC INTERLAMINAR EPIDURAL, LUMBAR OR SACRAL, W/ IMAGING (PRO)	$5,171.40	$5,746.00	$2,585.70–$5,746.00	—	10%
Lower-back epidural injection, without imaging guidance CPT 62322 62322 ESI lumbar or sacral	$533.70	$593.00	$266.85–$593.00	26% below	10%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 62322 ESI lumbar or sacral	$533.70	$593.00	$266.85–$593.00	—	10%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 64483 Injection Transforaminal Epidural - single level	$1,268.10	$1,409.00	$634.05–$1,409.00	45% above	10%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 64483 Injection Transforaminal Epidural - single level	$1,268.10	$1,409.00	$634.05–$1,409.00	—	10%
Lumpectomy (partial mastectomy) CPT 19301 19301 MASTECTOMY, PARTIAL (EG, LUMPECTOMY, TYLECTOMY, QUADRANTECTOMY, SEGMENTECTOMY); ProFee	$323.10	$359.00	$161.55–$359.00	70% below	10%
Lumpectomy (partial mastectomy) CPT 19301 19301 Mastectomy, partial	$3,176.10	$3,529.00	$1,588.05–$3,529.00	194% above	10%
Lumpectomy (partial mastectomy) inpatient CPT 19301 19301 MASTECTOMY, PARTIAL (EG, LUMPECTOMY, TYLECTOMY, QUADRANTECTOMY, SEGMENTECTOMY); ProFee	$323.10	$359.00	$161.55–$359.00	—	10%
Lumpectomy (partial mastectomy) inpatient CPT 19301 19301 Mastectomy, partial	$3,176.10	$3,529.00	$1,588.05–$3,529.00	—	10%
Mastectomy (total removal of the breast) CPT 19303 19303 MASTECTOMY, SIMPLE, COMPLETE ProFee	$902.70	$1,003.00	$451.35–$1,003.00	32% below	10%
Mastectomy (total removal of the breast) inpatient CPT 19303 19303 MASTECTOMY, SIMPLE, COMPLETE ProFee	$902.70	$1,003.00	$451.35–$1,003.00	—	10%
Miscarriage treatment with D&C, first trimester CPT 59820 59820 Treatment of missed abortion, completed surgically; first trimester	$2,319.30	$2,577.00	$1,159.65–$2,577.00	41% above	10%
Miscarriage treatment with D&C, first trimester CPT 59820 59820 TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY; FIRST TRIMESTER ProFee	$2,459.70	$2,733.00	$1,229.85–$2,733.00	50% above	10%
Miscarriage treatment with D&C, first trimester inpatient CPT 59820 59820 Treatment of missed abortion, completed surgically; first trimester	$2,319.30	$2,577.00	$1,159.65–$2,577.00	—	10%
Miscarriage treatment with D&C, first trimester inpatient CPT 59820 59820 TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY; FIRST TRIMESTER ProFee	$2,459.70	$2,733.00	$1,229.85–$2,733.00	—	10%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 11400 Excision, benign lesion including margins; trunk, arms or legs; < 0.5cm	$162.00	$180.00	$81.00–$180.00	8% above	10%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 11400 Excision, benign lesion including margins; trunk, arms or legs; < 0.5cm	$162.00	$180.00	$81.00–$180.00	—	10%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 11440 Excision, benign lesion including margins; face, ears, eyelids, nose, lips; < 0.5cm	$209.70	$233.00	$104.85–$233.00	14% below	10%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 11440 Excision, benign lesion including margins; face, ears, eyelids, nose, lips; < 0.5cm	$209.70	$233.00	$104.85–$233.00	—	10%
Nail removal (partial or complete), one nail CPT 11730 11730 AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; SINGLE ProFee	$322.20	$358.00	$161.10–$358.00	173% above	10%
Nail removal (partial or complete), one nail CPT 11730 11730 Avulsion of nail plate, partial or complete, simple; single	$350.10	$389.00	$175.05–$389.00	196% above	10%
Nail removal (partial or complete), one nail CPT 11730 11730 AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 TechFee	$492.30	$547.00	$246.15–$547.00	317% above	10%
Nail removal (partial or complete), one nail inpatient CPT 11730 11730 AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; SINGLE ProFee	$322.20	$358.00	$161.10–$358.00	—	10%
Nail removal (partial or complete), one nail inpatient CPT 11730 11730 Avulsion of nail plate, partial or complete, simple; single	$350.10	$389.00	$175.05–$389.00	—	10%
Nail removal (partial or complete), one nail inpatient CPT 11730 11730 AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 TechFee	$492.30	$547.00	$246.15–$547.00	—	10%
Occipital nerve block (injection for headaches) CPT 64405 64405 NJX AA&/STRD GR OCPL NRV ProFee	$262.80	$292.00	$131.40–$292.00	13% above	10%
Occipital nerve block (injection for headaches) CPT 64405 64405 Injection, anesthetic agent; greater occipital nerve	$314.10	$349.00	$157.05–$349.00	36% above	10%
Occipital nerve block (injection for headaches) CPT 64405 64405 Injection(s), anesthetic agent(s) and/or steroid, greater occipital nerve	$418.50	$465.00	$209.25–$465.00	81% above	10%
Occipital nerve block (injection for headaches) CPT 64405 64405 INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NRV TechFee	$592.20	$658.00	$296.10–$658.00	156% above	10%
Occipital nerve block (injection for headaches) inpatient CPT 64405 64405 NJX AA&/STRD GR OCPL NRV ProFee	$262.80	$292.00	$131.40–$292.00	—	10%
Occipital nerve block (injection for headaches) inpatient CPT 64405 64405 Injection, anesthetic agent; greater occipital nerve	$314.10	$349.00	$157.05–$349.00	—	10%
Occipital nerve block (injection for headaches) inpatient CPT 64405 64405 Injection(s), anesthetic agent(s) and/or steroid, greater occipital nerve	$418.50	$465.00	$209.25–$465.00	—	10%
Occipital nerve block (injection for headaches) inpatient CPT 64405 64405 INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NRV TechFee	$592.20	$658.00	$296.10–$658.00	—	10%
Paracentesis with imaging guidance CPT 49083 49083 PARACENTESIS W GUIDANCE ProFee	$123.30	$137.00	$61.65–$137.00	84% below	10%
Paracentesis with imaging guidance CPT 49083 US Paracentesis	$227.70	$253.00	$113.85–$253.00	70% below	10%
Paracentesis with imaging guidance CPT 49083 49083 Abdominal paracentesis with imaging guidance	$359.10	$399.00	$179.55–$399.00	53% below	10%
Paracentesis with imaging guidance CPT 49083 49083 ABDOMINAL PARACENTESIS (DIAGNOSTIC OR THERAPEUTIC) WITH IMAGING GUIDANCE ProFee	$1,274.40	$1,416.00	$637.20–$1,416.00	66% above	10%
Paracentesis with imaging guidance inpatient CPT 49083 49083 PARACENTESIS W GUIDANCE ProFee	$123.30	$137.00	$61.65–$137.00	—	10%
Paracentesis with imaging guidance inpatient CPT 49083 US Paracentesis	$227.70	$253.00	$113.85–$253.00	—	10%
Paracentesis with imaging guidance inpatient CPT 49083 49083 Abdominal paracentesis with imaging guidance	$359.10	$399.00	$179.55–$399.00	—	10%
Paracentesis with imaging guidance inpatient CPT 49083 49083 ABDOMINAL PARACENTESIS (DIAGNOSTIC OR THERAPEUTIC) WITH IMAGING GUIDANCE ProFee	$1,274.40	$1,416.00	$637.20–$1,416.00	—	10%
Partial knee replacement (one compartment) CPT 27446 27446 ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL OR LATERAL COMPARTMENT ProFee	$2,491.20	$2,768.00	$1,245.60–$2,768.00	at median	10%
Partial knee replacement (one compartment) inpatient CPT 27446 27446 ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL OR LATERAL COMPARTMENT ProFee	$2,491.20	$2,768.00	$1,245.60–$2,768.00	—	10%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 11750 EXCISION NAIL MATRIX PERMANENT REMOVAL TechFee	$77.40	$86.00	$38.70–$86.00	72% below	10%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 11750 EXCISION OF NAIL AND NAIL MATRIX, PARTIAL OR COMPLETE (EG, INGROWN OR DEFORMED NAIL), ProFee	$222.30	$247.00	$111.15–$247.00	21% below	10%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 11750 Excision of nail and nail matrix, partial or complete, for permanent removal	$791.10	$879.00	$395.55–$879.00	182% above	10%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 11750 EXCISION NAIL MATRIX PERMANENT REMOVAL TechFee	$77.40	$86.00	$38.70–$86.00	—	10%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 11750 EXCISION OF NAIL AND NAIL MATRIX, PARTIAL OR COMPLETE (EG, INGROWN OR DEFORMED NAIL), ProFee	$222.30	$247.00	$111.15–$247.00	—	10%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 11750 Excision of nail and nail matrix, partial or complete, for permanent removal	$791.10	$879.00	$395.55–$879.00	—	10%
Prostate biopsy CPT 55700 US Biopsy Prostate	$734.40	$816.00	$367.20–$816.00	at median	10%
Prostate biopsy CPT 55700 55700 BIOPSY, PROSTATE; NEEDLE OR PUNCH, SINGLE OR MULTIPLE, ANY APPROACH ProFee	$882.90	$981.00	$441.45–$981.00	20% above	10%
Prostate biopsy inpatient CPT 55700 US Biopsy Prostate	$734.40	$816.00	$367.20–$816.00	—	10%
Prostate biopsy inpatient CPT 55700 55700 BIOPSY, PROSTATE; NEEDLE OR PUNCH, SINGLE OR MULTIPLE, ANY APPROACH ProFee	$882.90	$981.00	$441.45–$981.00	—	10%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 64635 Destruction,neurolytic,paravertebral facet joint nerve,w/imaging;lumb/sac,single facet	$1,763.10	$1,959.00	$881.55–$1,959.00	3% above	10%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 64635 Destruction,neurolytic,paravertebral facet joint nerve,w/imaging;lumb/sac,single facet	$1,763.10	$1,959.00	$881.55–$1,959.00	—	10%
Removal of a breast lump, open surgery CPT 19120 19120 EXCISION OF CYST, FIBROADENOMA, OR OTHER BENIGN OR MALIGNANT TUMOR, ABERRANT BREAST TI ProFee	$529.20	$588.00	$264.60–$588.00	56% below	10%
Removal of a breast lump, open surgery CPT 19120 19120 BREAST BIOPSY,EXCISIONAL	$3,185.10	$3,539.00	$1,592.55–$3,539.00	163% above	10%
Removal of a breast lump, open surgery inpatient CPT 19120 19120 EXCISION OF CYST, FIBROADENOMA, OR OTHER BENIGN OR MALIGNANT TUMOR, ABERRANT BREAST TI ProFee	$529.20	$588.00	$264.60–$588.00	—	10%
Removal of a breast lump, open surgery inpatient CPT 19120 19120 BREAST BIOPSY,EXCISIONAL	$3,185.10	$3,539.00	$1,592.55–$3,539.00	—	10%
Removal of a foreign object under the skin, simple CPT 10120 10120 INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE TechFee	$61.20	$68.00	$30.60–$68.00	65% below	10%
Removal of a foreign object under the skin, simple CPT 10120 10120 INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE ProFee	$198.00	$220.00	$99.00–$220.00	13% above	10%
Removal of a foreign object under the skin, simple inpatient CPT 10120 10120 INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE TechFee	$61.20	$68.00	$30.60–$68.00	—	10%
Removal of a foreign object under the skin, simple inpatient CPT 10120 10120 INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE ProFee	$198.00	$220.00	$99.00–$220.00	—	10%
Removal of one lobe of the thyroid (lobectomy) one side CPT 60220 60220 TOTAL THYROID LOBECTOMY, UNILATERAL; WITH OR WITHOUT ISTHMUSECTOMY ProFee	$540.00	$600.00	$270.00–$600.00	55% below	10%
Removal of one lobe of the thyroid (lobectomy) inpatient one side CPT 60220 60220 TOTAL THYROID LOBECTOMY, UNILATERAL; WITH OR WITHOUT ISTHMUSECTOMY ProFee	$540.00	$600.00	$270.00–$600.00	—	10%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 G0121 SCRN COLONOSCOPY PT NOT H ProFee	$352.80	$392.00	$176.40–$392.00	61% below	10%
Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 G0121 SCRN COLONOSCOPY PT NOT H ProFee	$352.80	$392.00	$176.40–$392.00	—	10%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 G0105 COLONOSCOPY SCREEN, HIGH RISK ProFee	$295.20	$328.00	$147.60–$328.00	69% below	10%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 G0105 COLONOSCOPY SCREEN, HIGH RISK ProFee	$295.20	$328.00	$147.60–$328.00	—	10%
Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 50590 Lithotripsy, extracorporeal shock wave	$1,846.80	$2,052.00	$923.40–$2,052.00	25% below	10%
Shock-wave lithotripsy to break up kidney stones (from outside the body) inpatient CPT 50590 50590 Lithotripsy, extracorporeal shock wave	$1,846.80	$2,052.00	$923.40–$2,052.00	—	10%
Short arm cast (elbow to hand) CPT 29075 29075 Application, cast; elbow to finger (short arm)	$175.50	$195.00	$87.75–$195.00	4% below	10%
Short arm cast (elbow to hand) CPT 29075 29075 APPLICATION CAST ELBOW FINGER SHORT ARM ProFee	$1,281.60	$1,424.00	$640.80–$1,424.00	601% above	10%
Short arm cast (elbow to hand) CPT 29075 29075 APPLICATION, CAST; ELBOW TO FINGER (SHORT ARM) ProFee	$4,308.30	$4,787.00	$2,154.15–$4,787.00	2257% above	10%
Short arm cast (elbow to hand) inpatient CPT 29075 29075 Application, cast; elbow to finger (short arm)	$175.50	$195.00	$87.75–$195.00	—	10%
Short arm cast (elbow to hand) inpatient CPT 29075 29075 APPLICATION CAST ELBOW FINGER SHORT ARM ProFee	$1,281.60	$1,424.00	$640.80–$1,424.00	—	10%
Short arm cast (elbow to hand) inpatient CPT 29075 29075 APPLICATION, CAST; ELBOW TO FINGER (SHORT ARM) ProFee	$4,308.30	$4,787.00	$2,154.15–$4,787.00	—	10%
Short arm splint (forearm and hand) CPT 29125 29125 Application of short arm splint (forearm to hand) static	$120.60	$134.00	$60.30–$134.00	18% above	10%
Short arm splint (forearm and hand) CPT 29125 29125 APPLICATION SHORT ARM SPLINT (ED ProFee) FOREARM-HAND;STATIC	$541.80	$602.00	$270.90–$602.00	432% above	10%
Short arm splint (forearm and hand) CPT 29125 29125 APPLICATION OF SHORT ARM SPLINT (FOREARM TO HAND); STATIC ProFee	$1,660.50	$1,845.00	$830.25–$1,845.00	1531% above	10%
Short arm splint (forearm and hand) CPT 29125 29125 APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC TechFee	$1,755.00	$1,950.00	$877.50–$1,950.00	1624% above	10%
Short arm splint (forearm and hand) inpatient CPT 29125 29125 Application of short arm splint (forearm to hand) static	$120.60	$134.00	$60.30–$134.00	—	10%
Short arm splint (forearm and hand) inpatient CPT 29125 29125 APPLICATION SHORT ARM SPLINT (ED ProFee) FOREARM-HAND;STATIC	$541.80	$602.00	$270.90–$602.00	—	10%
Short arm splint (forearm and hand) inpatient CPT 29125 29125 APPLICATION OF SHORT ARM SPLINT (FOREARM TO HAND); STATIC ProFee	$1,660.50	$1,845.00	$830.25–$1,845.00	—	10%
Short arm splint (forearm and hand) inpatient CPT 29125 29125 APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC TechFee	$1,755.00	$1,950.00	$877.50–$1,950.00	—	10%
Short leg cast (below the knee) CPT 29405 29405 Application of short leg cast (below knee to toes)	$199.80	$222.00	$99.90–$222.00	14% above	10%
Short leg cast (below the knee) CPT 29405 29405 APPLICATION SHORT LEG CAST BELOW KNEE-TOE ProFee	$870.30	$967.00	$435.15–$967.00	396% above	10%
Short leg cast (below the knee) CPT 29405 29405 APPLICATION OF SHORT LEG CAST (BELOW KNEE TO TOES) ProFee	$1,792.80	$1,992.00	$896.40–$1,992.00	922% above	10%
Short leg cast (below the knee) inpatient CPT 29405 29405 Application of short leg cast (below knee to toes)	$199.80	$222.00	$99.90–$222.00	—	10%
Short leg cast (below the knee) inpatient CPT 29405 29405 APPLICATION SHORT LEG CAST BELOW KNEE-TOE ProFee	$870.30	$967.00	$435.15–$967.00	—	10%
Short leg cast (below the knee) inpatient CPT 29405 29405 APPLICATION OF SHORT LEG CAST (BELOW KNEE TO TOES) ProFee	$1,792.80	$1,992.00	$896.40–$1,992.00	—	10%
Short leg splint (calf to foot) CPT 29515 29515 Application of short leg splint (calf to foot)	$150.30	$167.00	$75.15–$167.00	49% above	10%
Short leg splint (calf to foot) CPT 29515 29515 APPLICATION SHORT LEG SPLINT CALF FOOT ProFee	$439.20	$488.00	$219.60–$488.00	336% above	10%
Short leg splint (calf to foot) CPT 29515 29515 APPLICATION SHORT LEG SPLINT CALF FOOT TechFee	$855.90	$951.00	$427.95–$951.00	751% above	10%
Short leg splint (calf to foot) CPT 29515 29515 APPLICATION OF SHORT LEG SPLINT (CALF TO FOOT) ProFee	$1,690.20	$1,878.00	$845.10–$1,878.00	1580% above	10%
Short leg splint (calf to foot) inpatient CPT 29515 29515 Application of short leg splint (calf to foot)	$150.30	$167.00	$75.15–$167.00	—	10%
Short leg splint (calf to foot) inpatient CPT 29515 29515 APPLICATION SHORT LEG SPLINT CALF FOOT ProFee	$439.20	$488.00	$219.60–$488.00	—	10%
Short leg splint (calf to foot) inpatient CPT 29515 29515 APPLICATION SHORT LEG SPLINT CALF FOOT TechFee	$855.90	$951.00	$427.95–$951.00	—	10%
Short leg splint (calf to foot) inpatient CPT 29515 29515 APPLICATION OF SHORT LEG SPLINT (CALF TO FOOT) ProFee	$1,690.20	$1,878.00	$845.10–$1,878.00	—	10%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 29824 ARTHROSCOPY, SHOULDER, SURGICAL; DISTAL CLAVICULECTOMY INCLUDING DISTAL ARTICULAR SURF ProFee	$3,339.90	$3,711.00	$1,669.95–$3,711.00	153% above	10%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) inpatient CPT 29824 29824 ARTHROSCOPY, SHOULDER, SURGICAL; DISTAL CLAVICULECTOMY INCLUDING DISTAL ARTICULAR SURF ProFee	$3,339.90	$3,711.00	$1,669.95–$3,711.00	—	10%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 29826 ARTHROSCOPY, SHOULDER, SURGICAL; DECOMPRESSION OF SUBACROMIAL SPACE WITH PARTIAL ACROM ProFee	$1,844.10	$2,049.00	$922.05–$2,049.00	211% above	10%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 29826 ARTHROSCOPY, SHOULDER, SURGICAL; DECOMPRESSION OF SUBACROMIAL SPACE WITH PARTIAL ACROM ProFee	$1,844.10	$2,049.00	$922.05–$2,049.00	—	10%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/< ProFee	$102.60	$114.00	$51.30–$114.00	22% below	10%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/< TechFee	$242.10	$269.00	$121.05–$269.00	84% above	10%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 12001 Simple repair of wounds; scalp, neck, axillae, genitalia, trunk, extremeties; <2.5cm	$272.70	$303.00	$136.35–$303.00	107% above	10%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 12001 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK ProFee	$476.10	$529.00	$238.05–$529.00	262% above	10%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/< ProFee	$102.60	$114.00	$51.30–$114.00	—	10%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/< TechFee	$242.10	$269.00	$121.05–$269.00	—	10%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 12001 Simple repair of wounds; scalp, neck, axillae, genitalia, trunk, extremeties; <2.5cm	$272.70	$303.00	$136.35–$303.00	—	10%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 12001 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK ProFee	$476.10	$529.00	$238.05–$529.00	—	10%
Skin biopsy, punch, one lesion CPT 11104 11104 Punch biopsy of skin (including simple closure, when performed) single lesion	$354.60	$394.00	$177.30–$394.00	62% above	10%
Skin biopsy, punch, one lesion CPT 11104 11104 Biopsy of skin, subcutaneous tissue and/or mucous membrane; single lesion	$354.60	$394.00	$177.30–$394.00	62% above	10%
Skin biopsy, punch, one lesion inpatient CPT 11104 11104 Biopsy of skin, subcutaneous tissue and/or mucous membrane; single lesion	$354.60	$394.00	$177.30–$394.00	—	10%
Skin biopsy, punch, one lesion inpatient CPT 11104 11104 Punch biopsy of skin (including simple closure, when performed) single lesion	$354.60	$394.00	$177.30–$394.00	—	10%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 11600 Excision, malignant lesion including margins, trunk, arms, or legs; < 0.5cm	$268.20	$298.00	$134.10–$298.00	12% below	10%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 11600 EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAMETER 0 ProFee	$566.10	$629.00	$283.05–$629.00	85% above	10%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 11600 Excision, malignant lesion including margins, trunk, arms, or legs; < 0.5cm	$268.20	$298.00	$134.10–$298.00	—	10%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 11600 EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAMETER 0 ProFee	$566.10	$629.00	$283.05–$629.00	—	10%
Skin tag removal, up to 15 tags CPT 11200 11200 Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions	$216.00	$240.00	$108.00–$240.00	86% above	10%
Skin tag removal, up to 15 tags inpatient CPT 11200 11200 Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions	$216.00	$240.00	$108.00–$240.00	—	10%
Spinal tap (lumbar puncture), diagnostic CPT 62270 62270-Lumbar Puncture Diagnostic TechFee	$209.70	$233.00	$104.85–$233.00	54% below	10%
Spinal tap (lumbar puncture), diagnostic CPT 62270 62270 SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC ProFee	$432.90	$481.00	$216.45–$481.00	4% below	10%
Spinal tap (lumbar puncture), diagnostic CPT 62270 62270 Spinal puncture, lumbar, diagnostic	$616.50	$685.00	$308.25–$685.00	37% above	10%
Spinal tap (lumbar puncture), diagnostic CPT 62270 62270 SPINAL PUNCTURE LUMBAR ER SERV PROCEDURE	$616.50	$685.00	$308.25–$685.00	37% above	10%
Spinal tap (lumbar puncture), diagnostic CPT 62270 300183 (62270) DIAGNOSTIC LUMBAR PUNCTURE	$720.00	$800.00	$360.00–$800.00	60% above	10%
Spinal tap (lumbar puncture), diagnostic CPT 62270 62270 SPINAL PUNCTURE LUMBAR DIAGNOSTIC ProFee	$1,145.70	$1,273.00	$572.85–$1,273.00	154% above	10%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 62270-Lumbar Puncture Diagnostic TechFee	$209.70	$233.00	$104.85–$233.00	—	10%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 62270 SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC ProFee	$432.90	$481.00	$216.45–$481.00	—	10%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 62270 Spinal puncture, lumbar, diagnostic	$616.50	$685.00	$308.25–$685.00	—	10%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 62270 SPINAL PUNCTURE LUMBAR ER SERV PROCEDURE	$616.50	$685.00	$308.25–$685.00	—	10%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 300183 (62270) DIAGNOSTIC LUMBAR PUNCTURE	$720.00	$800.00	$360.00–$800.00	—	10%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 62270 SPINAL PUNCTURE LUMBAR DIAGNOSTIC ProFee	$1,145.70	$1,273.00	$572.85–$1,273.00	—	10%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 12002 SMPL REPAIR SCALP NECK/AX/GENIT/TRUNK 2.6 7.5CM ProFee	$107.10	$119.00	$53.55–$119.00	35% below	10%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 12002 Simple repair of wounds; scalp, neck, axillae, genitalia, trunk, extremeties; 2.6-7.5cm	$291.60	$324.00	$145.80–$324.00	76% above	10%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 12002 SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM TechFee	$380.70	$423.00	$190.35–$423.00	130% above	10%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 12002 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK ProFee	$419.40	$466.00	$209.70–$466.00	154% above	10%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 12002 SMPL REPAIR SCALP NECK/AX/GENIT/TRUNK 2.6 7.5CM ProFee	$107.10	$119.00	$53.55–$119.00	—	10%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 12002 Simple repair of wounds; scalp, neck, axillae, genitalia, trunk, extremeties; 2.6-7.5cm	$291.60	$324.00	$145.80–$324.00	—	10%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 12002 SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM TechFee	$380.70	$423.00	$190.35–$423.00	—	10%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 12002 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK ProFee	$419.40	$466.00	$209.70–$466.00	—	10%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 12011 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS M ProFee	$66.60	$74.00	$33.30–$74.00	56% below	10%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 12011 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/< ProFee	$96.30	$107.00	$48.15–$107.00	37% below	10%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 12011 Simple repair of wounds of face, ears, eyelids, nose, lips, mucous membra; <2.5cm	$287.10	$319.00	$143.55–$319.00	88% above	10%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 12011 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS M ProFee	$66.60	$74.00	$33.30–$74.00	—	10%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 12011 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/< ProFee	$96.30	$107.00	$48.15–$107.00	—	10%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 12011 Simple repair of wounds of face, ears, eyelids, nose, lips, mucous membra; <2.5cm	$287.10	$319.00	$143.55–$319.00	—	10%
TURP (transurethral resection of the prostate) CPT 52601 52601 Transurethral electrosurgical resection of prostate, incld control of postoperative bleeding	$4,441.50	$4,935.00	$2,220.75–$4,935.00	136% above	10%
TURP (transurethral resection of the prostate) inpatient CPT 52601 52601 Transurethral electrosurgical resection of prostate, incld control of postoperative bleeding	$4,441.50	$4,935.00	$2,220.75–$4,935.00	—	10%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 11102 Tangential Biopsy Skin Single Lesion(Shave, Scoop, saucerize, Curette)	$282.60	$314.00	$141.30–$314.00	65% above	10%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 11102 Tangential Biopsy Skin Single Lesion(Shave, Scoop, saucerize, Curette)	$282.60	$314.00	$141.30–$314.00	—	10%
Thoracentesis with imaging guidance CPT 32555 US Thoracentesis	$155.70	$173.00	$77.85–$173.00	76% below	10%
Thoracentesis with imaging guidance CPT 32555 32555 Thoracentesis, needle or catheter, aspiration of the pleural space; with imaging guidance	$2,227.50	$2,475.00	$1,113.75–$2,475.00	244% above	10%
Thoracentesis with imaging guidance CPT 32555 32555 THORACENTESIS, NEEDLE OR CATHETER, ASPIRATION OF THE PLEURAL SPACE; WITH IMAGING GUIDA ProFee	$2,241.00	$2,490.00	$1,120.50–$2,490.00	246% above	10%
Thoracentesis with imaging guidance inpatient CPT 32555 US Thoracentesis	$155.70	$173.00	$77.85–$173.00	—	10%
Thoracentesis with imaging guidance inpatient CPT 32555 32555 Thoracentesis, needle or catheter, aspiration of the pleural space; with imaging guidance	$2,227.50	$2,475.00	$1,113.75–$2,475.00	—	10%
Thoracentesis with imaging guidance inpatient CPT 32555 32555 THORACENTESIS, NEEDLE OR CATHETER, ASPIRATION OF THE PLEURAL SPACE; WITH IMAGING GUIDA ProFee	$2,241.00	$2,490.00	$1,120.50–$2,490.00	—	10%
Total hip replacement CPT 27130 27130 ARTHROPLASTY, ACETABULAR AND PROXIMAL FEMORAL PROSTHETIC REPLACEMENT (TOTAL HIP ARTHRO ProFee	$1,403.10	$1,559.00	$701.55–$1,559.00	44% below	10%
Total hip replacement inpatient CPT 27130 27130 ARTHROPLASTY, ACETABULAR AND PROXIMAL FEMORAL PROSTHETIC REPLACEMENT (TOTAL HIP ARTHRO ProFee	$1,403.10	$1,559.00	$701.55–$1,559.00	—	10%
Total knee replacement CPT 27447 27447 ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL AND LATERAL COMPARTMENTS WITH OR WITHO ProFee	$3,195.00	$3,550.00	$1,597.50–$3,550.00	at median	10%
Total knee replacement inpatient CPT 27447 27447 ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL AND LATERAL COMPARTMENTS WITH OR WITHO ProFee	$3,195.00	$3,550.00	$1,597.50–$3,550.00	—	10%
Total shoulder replacement CPT 23472 23472 ARTHROPLASTY, GLENOHUMERAL JOINT; TOTAL SHOULDER (GLENOID AND PROXIMAL HUMERAL REPLACE ProFee	$1,294.20	$1,438.00	$647.10–$1,438.00	48% below	10%
Total shoulder replacement inpatient CPT 23472 23472 ARTHROPLASTY, GLENOHUMERAL JOINT; TOTAL SHOULDER (GLENOID AND PROXIMAL HUMERAL REPLACE ProFee	$1,294.20	$1,438.00	$647.10–$1,438.00	—	10%
Total thyroid removal (thyroidectomy) CPT 60240 60240 Thyroidectomy, total or complete	$8,654.40	$9,616.00	$4,327.20–$9,616.00	269% above	10%
Total thyroid removal (thyroidectomy) inpatient CPT 60240 60240 Thyroidectomy, total or complete	$8,654.40	$9,616.00	$4,327.20–$9,616.00	—	10%
Trigger finger release surgery CPT 26055 26055 TENDON SHEATH INCISION (EG, FOR TRIGGER FINGER) ProFee	$2,062.80	$2,292.00	$1,031.40–$2,292.00	113% above	10%
Trigger finger release surgery inpatient CPT 26055 26055 TENDON SHEATH INCISION (EG, FOR TRIGGER FINGER) ProFee	$2,062.80	$2,292.00	$1,031.40–$2,292.00	—	10%
Trigger point injections, 1 or 2 muscles CPT 20552 20552 Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)	$216.90	$241.00	$108.45–$241.00	59% above	10%
Trigger point injections, 1 or 2 muscles CPT 20552 20552 - Piriformis Injection	$307.80	$342.00	$153.90–$342.00	126% above	10%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 20552 Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)	$216.90	$241.00	$108.45–$241.00	—	10%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 20552 - Piriformis Injection	$307.80	$342.00	$153.90–$342.00	—	10%
Tubal ligation, laparoscopic (tubes sealed by cautery) CPT 58670 58670 LAPAROSCOPY, SURGICAL; WITH FULGURATION OF OVIDUCTS (WITH OR WITHOUT TRANSECTION) ProFee	$767.70	$853.00	$383.85–$853.00	at median	10%
Tubal ligation, laparoscopic (tubes sealed by cautery) inpatient CPT 58670 58670 LAPAROSCOPY, SURGICAL; WITH FULGURATION OF OVIDUCTS (WITH OR WITHOUT TRANSECTION) ProFee	$767.70	$853.00	$383.85–$853.00	—	10%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US Breast Biopsy Right	$416.70	$463.00	$208.35–$463.00	74% below	10%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US Breast Biopsy Left	$728.10	$809.00	$364.05–$809.00	55% below	10%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 US Breast Biopsy Right	$416.70	$463.00	$208.35–$463.00	—	10%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 US Breast Biopsy Left	$728.10	$809.00	$364.05–$809.00	—	10%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 43249 Esophagogastroduodenoscop >30 mm diameter, balloon dilation of esophagus	$1,446.30	$1,607.00	$723.15–$1,607.00	33% above	10%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 43249 BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; DIAG ProFee	$2,187.90	$2,431.00	$1,093.95–$2,431.00	101% above	10%
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 43249 Esophagogastroduodenoscop >30 mm diameter, balloon dilation of esophagus	$1,446.30	$1,607.00	$723.15–$1,607.00	—	10%
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 43249 BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; DIAG ProFee	$2,187.90	$2,431.00	$1,093.95–$2,431.00	—	10%
Upper endoscopy (EGD) with biopsy CPT 43239 43239 ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH BIOPSY, SINGLE OR MULTIPLE ProFee	$569.70	$633.00	$284.85–$633.00	35% below	10%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 43239 ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH BIOPSY, SINGLE OR MULTIPLE ProFee	$569.70	$633.00	$284.85–$633.00	—	10%
Upper endoscopy (EGD) with injection into the lining CPT 43236 43236 Esophagogastroduodenoscopy, flexible,transoral; w/ directed submucosal injection(s), any subst	$1,028.70	$1,143.00	$514.35–$1,143.00	11% above	10%
Upper endoscopy (EGD) with injection into the lining inpatient CPT 43236 43236 Esophagogastroduodenoscopy, flexible,transoral; w/ directed submucosal injection(s), any subst	$1,028.70	$1,143.00	$514.35–$1,143.00	—	10%
Upper endoscopy (EGD), diagnostic CPT 43235 43235 ESOPHAGOGASTRODUODENOSCOPY FLEXIBLE TRANSORAL DIAGNOSTIC INCLUDING COLLECTION OF S ProFee	$526.50	$585.00	$263.25–$585.00	30% below	10%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 43235 ESOPHAGOGASTRODUODENOSCOPY FLEXIBLE TRANSORAL DIAGNOSTIC INCLUDING COLLECTION OF S ProFee	$526.50	$585.00	$263.25–$585.00	—	10%
Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 52353 Cystourethroscopy with ureteroscopy and/or pyeloscopy with lithotripsy	$1,170.90	$1,301.00	$585.45–$1,301.00	26% above	10%
Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 52353 CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH LITHOTRIPSY (URETERAL CAT ProFee	$1,740.60	$1,934.00	$870.30–$1,934.00	87% above	10%
Ureteroscopy with laser stone breaking (lithotripsy) inpatient CPT 52353 52353 Cystourethroscopy with ureteroscopy and/or pyeloscopy with lithotripsy	$1,170.90	$1,301.00	$585.45–$1,301.00	—	10%
Ureteroscopy with laser stone breaking (lithotripsy) inpatient CPT 52353 52353 CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH LITHOTRIPSY (URETERAL CAT ProFee	$1,740.60	$1,934.00	$870.30–$1,934.00	—	10%
Vaginal birth after cesarean (VBAC), including prenatal and postpartum care CPT 59610 59610 ROUTINE OBSTETRIC CARE INCLUDING ANTEPARTUM CARE, VAGINAL DELIVERY (WITH OR WITHOUT EP ProFee	$6,170.40	$6,856.00	$3,085.20–$6,856.00	—	10%
Vaginal birth after cesarean (VBAC), including prenatal and postpartum care inpatient CPT 59610 59610 ROUTINE OBSTETRIC CARE INCLUDING ANTEPARTUM CARE, VAGINAL DELIVERY (WITH OR WITHOUT EP ProFee	$6,170.40	$6,856.00	$3,085.20–$6,856.00	—	10%
Vaginal delivery, including prenatal and postpartum care CPT 59400 59400 ROUTINE OBSTETRIC CARE INCLUDING ANTEPARTUM CARE, VAGINAL DELIVERY (WITH OR WITHOUT EP ProFee	$3,036.60	$3,374.00	$1,518.30–$3,374.00	8% below	10%
Vaginal delivery, including prenatal and postpartum care inpatient CPT 59400 59400 ROUTINE OBSTETRIC CARE INCLUDING ANTEPARTUM CARE, VAGINAL DELIVERY (WITH OR WITHOUT EP ProFee	$3,036.60	$3,374.00	$1,518.30–$3,374.00	—	10%
Vasectomy, one or both sides, including follow-up semen testing both sides CPT 55250 55250 Vasectomy, unilateral or bilateral, including postoperative semen examination(s)	$1,532.70	$1,703.00	$766.35–$1,703.00	—	10%
Vasectomy, one or both sides, including follow-up semen testing both sides CPT 55250 55250 VASECTOMY, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE), INCLUDING POSTOPERATIVE SEMEN ProFee	$1,666.80	$1,852.00	$833.40–$1,852.00	—	10%
Vasectomy, one or both sides, including follow-up semen testing inpatient both sides CPT 55250 55250 Vasectomy, unilateral or bilateral, including postoperative semen examination(s)	$1,532.70	$1,703.00	$766.35–$1,703.00	—	10%
Vasectomy, one or both sides, including follow-up semen testing inpatient both sides CPT 55250 55250 VASECTOMY, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE), INCLUDING POSTOPERATIVE SEMEN ProFee	$1,666.80	$1,852.00	$833.40–$1,852.00	—	10%
Wart removal, up to 14 warts CPT 17110 17110 Destruction of benign lesions 1-14 lesions	$397.80	$442.00	$198.90–$442.00	230% above	10%
Wart removal, up to 14 warts inpatient CPT 17110 17110 Destruction of benign lesions 1-14 lesions	$397.80	$442.00	$198.90–$442.00	—	10%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 11042 DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/< TechFee	$572.40	$636.00	$286.20–$636.00	213% above	10%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 11042 DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/< ProFee	$885.60	$984.00	$442.80–$984.00	384% above	10%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 11042 DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/< TechFee	$572.40	$636.00	$286.20–$636.00	—	10%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 11042 DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/< ProFee	$885.60	$984.00	$442.80–$984.00	—	10%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Maine	Off list
Blood transfusion (giving blood or blood components) CPT 36430 36430 Transfusion 6 HR	$114.30	$127.00	$57.15–$127.00	77% below	10%
Blood transfusion (giving blood or blood components) CPT 36430 36430 Transfusion 5 HR	$140.40	$156.00	$70.20–$156.00	71% below	10%
Blood transfusion (giving blood or blood components) CPT 36430 36430 Transfusion 4 HR	$183.60	$204.00	$91.80–$204.00	63% below	10%
Blood transfusion (giving blood or blood components) CPT 36430 36430 Transfusion 3 HR	$187.20	$208.00	$93.60–$208.00	62% below	10%
Blood transfusion (giving blood or blood components) CPT 36430 36430 Transfusion 2 HR	$423.00	$470.00	$211.50–$470.00	14% below	10%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 36430 Transfusion 6 HR	$114.30	$127.00	$57.15–$127.00	—	10%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 36430 Transfusion 5 HR	$140.40	$156.00	$70.20–$156.00	—	10%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 36430 Transfusion 4 HR	$183.60	$204.00	$91.80–$204.00	—	10%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 36430 Transfusion 3 HR	$187.20	$208.00	$93.60–$208.00	—	10%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 36430 Transfusion 2 HR	$423.00	$470.00	$211.50–$470.00	—	10%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 94640 PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT	$678.60	$754.00	$339.30–$754.00	259% above	10%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 94640 PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT	$678.60	$754.00	$339.30–$754.00	—	10%
Chemotherapy IV infusion, first hour CPT 96413 96413 - CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG	$77.40	$86.00	$38.70–$86.00	82% below	10%
Chemotherapy IV infusion, first hour CPT 96413 96413 Chem IV Infusion, up to 1 HR	$248.40	$276.00	$124.20–$276.00	41% below	10%
Chemotherapy IV infusion, first hour inpatient CPT 96413 96413 - CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG	$77.40	$86.00	$38.70–$86.00	—	10%
Chemotherapy IV infusion, first hour inpatient CPT 96413 96413 Chem IV Infusion, up to 1 HR	$248.40	$276.00	$124.20–$276.00	—	10%
Critical care, first 30 to 74 minutes CPT 99291 99291 Level 6 ED TechFee	$623.70	$693.00	$311.85–$693.00	36% below	10%
Critical care, first 30 to 74 minutes inpatient CPT 99291 99291 Level 6 ED TechFee	$623.70	$693.00	$311.85–$693.00	—	10%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 93005 EKG ROU/12L REPEAT PRO TechFee	$28.80	$32.00	$14.40–$32.00	73% below	10%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 CV ECG Acquisition	$154.80	$172.00	$77.40–$172.00	45% above	10%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 93005 EKG w/ 12+ leads; Tracing Only	$186.30	$207.00	$93.15–$207.00	74% above	10%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG POC	$359.10	$399.00	$179.55–$399.00	236% above	10%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 93005 EKG ROU/12L REPEAT PRO TechFee	$28.80	$32.00	$14.40–$32.00	—	10%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 CV ECG Acquisition	$154.80	$172.00	$77.40–$172.00	—	10%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 93005 EKG w/ 12+ leads; Tracing Only	$186.30	$207.00	$93.15–$207.00	—	10%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG POC	$359.10	$399.00	$179.55–$399.00	—	10%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 99281-E&M that may not require the presence of a physician or other qualified healthcare prof.	$342.90	$381.00	$171.45–$381.00	277% above	10%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 99281 EMERGENCY DEPARTMENT VISIT LIMITED/MINOR PROB ProFee	$501.30	$557.00	$250.65–$557.00	451% above	10%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 99281 ED VISIT FOR E&M PATIENT, LEV 1, MAY NOT REQ PRESENCE OF PHYSICIAN OR OTHER, CC	$1,044.90	$1,161.00	$522.45–$1,161.00	1048% above	10%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 99281-E&M that may not require the presence of a physician or other qualified healthcare prof.	$342.90	$381.00	$171.45–$381.00	—	10%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 99281 EMERGENCY DEPARTMENT VISIT LIMITED/MINOR PROB ProFee	$501.30	$557.00	$250.65–$557.00	—	10%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 99281 ED VISIT FOR E&M PATIENT, LEV 1, MAY NOT REQ PRESENCE OF PHYSICIAN OR OTHER, CC	$1,044.90	$1,161.00	$522.45–$1,161.00	—	10%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 99282 EMERGENCY DEPARTMENT VISIT LOW/MODER SEVERITY ProFee	$206.10	$229.00	$103.05–$229.00	16% above	10%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 99282-E&M req. a medically appropriate hx and/or exam and straightforward medical decision making	$480.60	$534.00	$240.30–$534.00	171% above	10%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 99282 ED VISIT E&M PATIENT, LEV 2, REQ MED APPROP HSTRY/EXAM/MDM, CC	$1,044.90	$1,161.00	$522.45–$1,161.00	490% above	10%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 99282 EMERGENCY DEPARTMENT VISIT LOW/MODER SEVERITY ProFee	$206.10	$229.00	$103.05–$229.00	—	10%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 99282-E&M req. a medically appropriate hx and/or exam and straightforward medical decision making	$480.60	$534.00	$240.30–$534.00	—	10%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 99282 ED VISIT E&M PATIENT, LEV 2, REQ MED APPROP HSTRY/EXAM/MDM, CC	$1,044.90	$1,161.00	$522.45–$1,161.00	—	10%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 99283 Level 3 ED TechFee	$213.30	$237.00	$106.65–$237.00	36% below	10%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 99283-E&M req. a medically appropriate hx and/or exam and low level medical decision making	$232.20	$258.00	$116.10–$258.00	31% below	10%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 99283 EMERGENCY DEPARTMENT VISIT MODERATE SEVERITY ProFee	$337.50	$375.00	$168.75–$375.00	1% above	10%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 99283 Level 3 ED TechFee	$213.30	$237.00	$106.65–$237.00	—	10%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 99283-E&M req. a medically appropriate hx and/or exam and low level medical decision making	$232.20	$258.00	$116.10–$258.00	—	10%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 99283 EMERGENCY DEPARTMENT VISIT MODERATE SEVERITY ProFee	$337.50	$375.00	$168.75–$375.00	—	10%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 99284 EMERGENCY DEPARTMENT VISIT HIGH/URGENT SEVERITY ProFee	$360.90	$401.00	$180.45–$401.00	41% below	10%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 99284-E&M req. a medically appropriate hx and/or exam and moderate level of medical decision making	$386.10	$429.00	$193.05–$429.00	36% below	10%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 99284 Level 4 ED TechFee	$807.30	$897.00	$403.65–$897.00	33% above	10%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 99284 EMERGENCY DEPARTMENT VISIT HIGH/URGENT SEVERITY ProFee	$360.90	$401.00	$180.45–$401.00	—	10%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 99284-E&M req. a medically appropriate hx and/or exam and moderate level of medical decision making	$386.10	$429.00	$193.05–$429.00	—	10%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 99284 Level 4 ED TechFee	$807.30	$897.00	$403.65–$897.00	—	10%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 99285 ED VISIT E M PATIENT, LEV 5, REQ MED APPROP HSTRY/EXAM/HIGH MDM, CC	$270.00	$300.00	$135.00–$300.00	73% below	10%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 99285-E&M req. a medically appropriate hx and/or exam and high level of medical decision making	$533.70	$593.00	$266.85–$593.00	46% below	10%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 99285 ED VISIT E M PATIENT, LEV 5, REQ MED APPROP HSTRY/EXAM/HIGH MDM, CC	$270.00	$300.00	$135.00–$300.00	—	10%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 99285-E&M req. a medically appropriate hx and/or exam and high level of medical decision making	$533.70	$593.00	$266.85–$593.00	—	10%
Exercise stress test, tracing only, the hospital charge CPT 93017 MDIH ST-TECH COMPONENT	$1,044.90	$1,161.00	$522.45–$1,161.00	85% above	10%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 MDIH ST-TECH COMPONENT	$1,044.90	$1,161.00	$522.45–$1,161.00	—	10%
Family therapy with the patient, 50 minutes CPT 90847 Telehealth FAMILY WITH PATIENT PRESENT	$409.50	$455.00	$204.75–$455.00	151% above	10%
Family therapy with the patient, 50 minutes CPT 90847 90847 Family psychotherapy, conjoint psychotherapy, with patient present	$885.60	$984.00	$442.80–$984.00	444% above	10%
Family therapy with the patient, 50 minutes inpatient CPT 90847 Telehealth FAMILY WITH PATIENT PRESENT	$409.50	$455.00	$204.75–$455.00	—	10%
Family therapy with the patient, 50 minutes inpatient CPT 90847 90847 Family psychotherapy, conjoint psychotherapy, with patient present	$885.60	$984.00	$442.80–$984.00	—	10%
Family therapy without the patient, 50 minutes CPT 90846 Telehealth FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT	$48.60	$54.00	$24.30–$54.00	64% below	10%
Family therapy without the patient, 50 minutes CPT 90846 90846 Family psychotherapy without the patient present	$496.80	$552.00	$248.40–$552.00	270% above	10%
Family therapy without the patient, 50 minutes inpatient CPT 90846 Telehealth FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT	$48.60	$54.00	$24.30–$54.00	—	10%
Family therapy without the patient, 50 minutes inpatient CPT 90846 90846 Family psychotherapy without the patient present	$496.80	$552.00	$248.40–$552.00	—	10%
Group psychotherapy session CPT 90853 90853 Group psychotherapy (other than of a multiple-family group)	$711.00	$790.00	$355.50–$790.00	1070% above	10%
Group psychotherapy session inpatient CPT 90853 90853 Group psychotherapy (other than of a multiple-family group)	$711.00	$790.00	$355.50–$790.00	—	10%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360 - IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR	$177.30	$197.00	$88.65–$197.00	14% below	10%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360-IV Hydration 31-60 minutes	$252.90	$281.00	$126.45–$281.00	23% above	10%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360 HYDRATE IV INFUSE 1ST HR CHARGE	$255.60	$284.00	$127.80–$284.00	25% above	10%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360 - ED Hydration, first hour	$1,454.40	$1,616.00	$727.20–$1,616.00	608% above	10%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 96360 - IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR	$177.30	$197.00	$88.65–$197.00	—	10%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 96360-IV Hydration 31-60 minutes	$252.90	$281.00	$126.45–$281.00	—	10%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 96360 HYDRATE IV INFUSE 1ST HR CHARGE	$255.60	$284.00	$127.80–$284.00	—	10%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 96360 - ED Hydration, first hour	$1,454.40	$1,616.00	$727.20–$1,616.00	—	10%
IV infusion of a medicine, first hour CPT 96365 96365- ED IV tx, first hour	$257.40	$286.00	$128.70–$286.00	20% below	10%
IV infusion of a medicine, first hour CPT 96365 96365 INTRAVENOUS INFUSION, FOR THERAPY, PROPHYLAXIS, OR DIAGNOSIS TechFee	$390.60	$434.00	$195.30–$434.00	22% above	10%
IV infusion of a medicine, first hour inpatient CPT 96365 96365- ED IV tx, first hour	$257.40	$286.00	$128.70–$286.00	—	10%
IV infusion of a medicine, first hour inpatient CPT 96365 96365 INTRAVENOUS INFUSION, FOR THERAPY, PROPHYLAXIS, OR DIAGNOSIS TechFee	$390.60	$434.00	$195.30–$434.00	—	10%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 Therapeutic Injection; subcutaneous or intramuscular - AMB Only Inj Med Admin Charge	$41.40	$46.00	$20.70–$46.00	38% below	10%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372: SUBQ/IM - AMB Only Admin Charge	$41.40	$46.00	$20.70–$46.00	38% below	10%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 inj subq/im - AMB Only Inj Med Admin Charge	$41.40	$46.00	$20.70–$46.00	38% below	10%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372: SUBQ/IM - Admin Injection Charge	$46.80	$52.00	$23.40–$52.00	30% below	10%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 Non-Chemo SQ/IM Injection	$254.70	$283.00	$127.35–$283.00	280% above	10%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 ED Subq/IM Injection	$274.50	$305.00	$137.25–$305.00	310% above	10%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 INJECTION IM/SQ-THER, PROPHY, DIAGNOSTIC	$312.30	$347.00	$156.15–$347.00	366% above	10%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular:	$495.90	$551.00	$247.95–$551.00	640% above	10%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 inj subq/im - AMB Only Inj Med Admin Charge	$41.40	$46.00	$20.70–$46.00	—	10%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372: SUBQ/IM - AMB Only Admin Charge	$41.40	$46.00	$20.70–$46.00	—	10%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 Therapeutic Injection; subcutaneous or intramuscular - AMB Only Inj Med Admin Charge	$41.40	$46.00	$20.70–$46.00	—	10%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372: SUBQ/IM - Admin Injection Charge	$46.80	$52.00	$23.40–$52.00	—	10%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 Non-Chemo SQ/IM Injection	$254.70	$283.00	$127.35–$283.00	—	10%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 ED Subq/IM Injection	$274.50	$305.00	$137.25–$305.00	—	10%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 INJECTION IM/SQ-THER, PROPHY, DIAGNOSTIC	$312.30	$347.00	$156.15–$347.00	—	10%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular:	$495.90	$551.00	$247.95–$551.00	—	10%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 Telehealth Psychiatric diagnostic evaluation	$43.20	$48.00	$21.60–$48.00	75% below	10%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 90791 Psychiatric diagnostic evaluation	$314.10	$349.00	$157.05–$349.00	78% above	10%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 90791 PSYCH EVAL ProFee	$2,013.30	$2,237.00	$1,006.65–$2,237.00	1042% above	10%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 Telehealth Psychiatric diagnostic evaluation	$43.20	$48.00	$21.60–$48.00	—	10%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 90791 Psychiatric diagnostic evaluation	$314.10	$349.00	$157.05–$349.00	—	10%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 90791 PSYCH EVAL ProFee	$2,013.30	$2,237.00	$1,006.65–$2,237.00	—	10%
Neuromuscular re-education, 15 minutes CPT 97112 OT Neuromuscular Reeducation Charges	$97.20	$108.00	$48.60–$108.00	at median	10%
Neuromuscular re-education, 15 minutes CPT 97112 OT Neuromuscular Reeducation Assist Unit	$1,208.70	$1,343.00	$604.35–$1,343.00	1144% above	10%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 OT Neuromuscular Reeducation Charges	$97.20	$108.00	$48.60–$108.00	—	10%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 OT Neuromuscular Reeducation Assist Unit	$1,208.70	$1,343.00	$604.35–$1,343.00	—	10%
New patient office visit, about 30 minutes CPT 99203 Telehealth OFFICE VISIT/DETAILED/NEW L3	$30.60	$34.00	$15.30–$34.00	71% below	10%
New patient office visit, about 30 minutes CPT 99203 99203 Office/Outpatient Visit - New Patient, Level 3 - 30-44 min	$43.20	$48.00	$21.60–$48.00	60% below	10%
New patient office visit, about 30 minutes CPT 99203 99203 CLINIC FEE-NEW PT LEVEL 3 EXPANDED CHARGE	$90.90	$101.00	$45.45–$101.00	15% below	10%
New patient office visit, about 30 minutes CPT 99203 99203 Office/Outpatient Visit - New Patient, Level 3 (30-44 min)	$238.50	$265.00	$119.25–$265.00	122% above	10%
New patient office visit, about 30 minutes CPT 99203 99203 CLINIC FEE-NEW PT LEVEL 3 EXPANDED CHARGE Pro Fee	$313.20	$348.00	$156.60–$348.00	192% above	10%
New patient office visit, about 30 minutes CPT 99203 99203 PRO LEVEL 3 VISIT NEW PT ProFee	$416.70	$463.00	$208.35–$463.00	288% above	10%
New patient office visit, about 30 minutes inpatient CPT 99203 Telehealth OFFICE VISIT/DETAILED/NEW L3	$30.60	$34.00	$15.30–$34.00	—	10%
New patient office visit, about 30 minutes inpatient CPT 99203 99203 Office/Outpatient Visit - New Patient, Level 3 - 30-44 min	$43.20	$48.00	$21.60–$48.00	—	10%
New patient office visit, about 30 minutes inpatient CPT 99203 99203 CLINIC FEE-NEW PT LEVEL 3 EXPANDED CHARGE	$90.90	$101.00	$45.45–$101.00	—	10%
New patient office visit, about 30 minutes inpatient CPT 99203 99203 Office/Outpatient Visit - New Patient, Level 3 (30-44 min)	$238.50	$265.00	$119.25–$265.00	—	10%
New patient office visit, about 30 minutes inpatient CPT 99203 99203 CLINIC FEE-NEW PT LEVEL 3 EXPANDED CHARGE Pro Fee	$313.20	$348.00	$156.60–$348.00	—	10%
New patient office visit, about 30 minutes inpatient CPT 99203 99203 PRO LEVEL 3 VISIT NEW PT ProFee	$416.70	$463.00	$208.35–$463.00	—	10%
New patient office visit, about 45 minutes CPT 99204 99204 Office/Outpatient Visit - New Patient, Level 4 (45-59 min)	$171.90	$191.00	$85.95–$191.00	6% above	10%
New patient office visit, about 45 minutes CPT 99204 99204 CLINIC FEE-NEW PT LEVEL 4 EXPANDED CHARGE Pro Fee	$171.90	$191.00	$85.95–$191.00	6% above	10%
New patient office visit, about 45 minutes CPT 99204 99204 CLINIC FEE-NEW PT LEVEL 4 EXPANDED CHARGE	$250.20	$278.00	$125.10–$278.00	54% above	10%
New patient office visit, about 45 minutes CPT 99204 99204 PRO LEVEL 4 VISIT NEW PT ProFee	$300.60	$334.00	$150.30–$334.00	85% above	10%
New patient office visit, about 45 minutes CPT 99204 Telehealth OFFICE VISIT/NEW PATIENT L4	$345.60	$384.00	$172.80–$384.00	112% above	10%
New patient office visit, about 45 minutes inpatient CPT 99204 99204 CLINIC FEE-NEW PT LEVEL 4 EXPANDED CHARGE Pro Fee	$171.90	$191.00	$85.95–$191.00	—	10%
New patient office visit, about 45 minutes inpatient CPT 99204 99204 Office/Outpatient Visit - New Patient, Level 4 (45-59 min)	$171.90	$191.00	$85.95–$191.00	—	10%
New patient office visit, about 45 minutes inpatient CPT 99204 99204 CLINIC FEE-NEW PT LEVEL 4 EXPANDED CHARGE	$250.20	$278.00	$125.10–$278.00	—	10%
New patient office visit, about 45 minutes inpatient CPT 99204 99204 PRO LEVEL 4 VISIT NEW PT ProFee	$300.60	$334.00	$150.30–$334.00	—	10%
New patient office visit, about 45 minutes inpatient CPT 99204 Telehealth OFFICE VISIT/NEW PATIENT L4	$345.60	$384.00	$172.80–$384.00	—	10%
New patient office visit, about 60 minutes CPT 99205 99205 CLINIC FEE-NEW PT LEVEL 5 EXPANDED CHARGE Pro Fee	$247.50	$275.00	$123.75–$275.00	1% above	10%
New patient office visit, about 60 minutes CPT 99205 99205 CLINIC FEE-NEW PT LEVEL 5 EXPANDED CHARGE	$331.20	$368.00	$165.60–$368.00	35% above	10%
New patient office visit, about 60 minutes CPT 99205 Telehealth OFFICE VISIT/NEW PATIENT L5	$359.10	$399.00	$179.55–$399.00	47% above	10%
New patient office visit, about 60 minutes CPT 99205 99205 Office/Outpatient Visit - New Patient, Level 5 (60 Min)	$359.10	$399.00	$179.55–$399.00	47% above	10%
New patient office visit, about 60 minutes inpatient CPT 99205 99205 CLINIC FEE-NEW PT LEVEL 5 EXPANDED CHARGE Pro Fee	$247.50	$275.00	$123.75–$275.00	—	10%
New patient office visit, about 60 minutes inpatient CPT 99205 99205 CLINIC FEE-NEW PT LEVEL 5 EXPANDED CHARGE	$331.20	$368.00	$165.60–$368.00	—	10%
New patient office visit, about 60 minutes inpatient CPT 99205 Telehealth OFFICE VISIT/NEW PATIENT L5	$359.10	$399.00	$179.55–$399.00	—	10%
New patient office visit, about 60 minutes inpatient CPT 99205 99205 Office/Outpatient Visit - New Patient, Level 5 (60 Min)	$359.10	$399.00	$179.55–$399.00	—	10%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 Telehealth OFFICE VISIT/NEW PATIENT L2	$60.30	$67.00	$30.15–$67.00	8% below	10%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 99202 CLINIC FEE-NEW PT LEVEL 2 EXPANDED CHARGE	$84.60	$94.00	$42.30–$94.00	29% above	10%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 99202 CLINIC FEE-NEW PT LEVEL 2 EXPANDED CHARGE Pro Fee	$198.00	$220.00	$99.00–$220.00	203% above	10%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 99202 Office/Outpatient Visit - New Patient, Level 2 (15-29 mins)	$245.70	$273.00	$122.85–$273.00	276% above	10%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 99202 PRO LEVEL 2 VISIT NEW PT ProFee	$319.50	$355.00	$159.75–$355.00	389% above	10%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 Telehealth OFFICE VISIT/NEW PATIENT L2	$60.30	$67.00	$30.15–$67.00	—	10%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 99202 CLINIC FEE-NEW PT LEVEL 2 EXPANDED CHARGE	$84.60	$94.00	$42.30–$94.00	—	10%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 99202 CLINIC FEE-NEW PT LEVEL 2 EXPANDED CHARGE Pro Fee	$198.00	$220.00	$99.00–$220.00	—	10%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 99202 Office/Outpatient Visit - New Patient, Level 2 (15-29 mins)	$245.70	$273.00	$122.85–$273.00	—	10%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 99202 PRO LEVEL 2 VISIT NEW PT ProFee	$319.50	$355.00	$159.75–$355.00	—	10%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 97802 MNT INIT INDIV EA 15 MIN CHARGE	$400.50	$445.00	$200.25–$445.00	763% above	10%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 97802 MNT INIT INDIV EA 15 MIN CHARGE	$400.50	$445.00	$200.25–$445.00	—	10%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT High Complex Units	$99.00	$110.00	$49.50–$110.00	61% below	10%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT High Complex Units	$99.00	$110.00	$49.50–$110.00	—	10%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 OT Manual Therapy Charge Units	$693.00	$770.00	$346.50–$770.00	692% above	10%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 OT Manual Therapy Charge Units	$693.00	$770.00	$346.50–$770.00	—	10%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT Therapeutic Exercise Assistant units	$72.00	$80.00	$36.00–$80.00	16% above	10%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT Therapeutic Exercise Assit Units	$84.60	$94.00	$42.30–$94.00	37% above	10%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT Therapeutic Exercise Assistant units	$72.00	$80.00	$36.00–$80.00	—	10%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT Therapeutic Exercise Assit Units	$84.60	$94.00	$42.30–$94.00	—	10%
Preventive checkup, new patient aged 18–39 CPT 99385 99385 Preventive Evaluation, New Pt; 18-39 Yrs	$579.60	$644.00	$289.80–$644.00	430% above	10%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 99385 Preventive Evaluation, New Pt; 18-39 Yrs	$579.60	$644.00	$289.80–$644.00	—	10%
Preventive checkup, new patient aged 40–64 CPT 99386 99386 Preventive Evaluation, New Pt; 40-64 Yrs	$745.20	$828.00	$372.60–$828.00	442% above	10%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 99386 Preventive Evaluation, New Pt; 40-64 Yrs	$745.20	$828.00	$372.60–$828.00	—	10%
Preventive checkup, new patient aged 65 or older CPT 99387 99387 Preventive Evaluation, New Pt; 65+ Yrs	$216.00	$240.00	$108.00–$240.00	113% above	10%
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 99387 Preventive Evaluation, New Pt; 65+ Yrs	$216.00	$240.00	$108.00–$240.00	—	10%
Preventive checkup, returning patient aged 18–39 CPT 99395 99395 Preventive Evaluation, Established Pt; 18-39 Yrs	$257.40	$286.00	$128.70–$286.00	146% above	10%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 99395 Preventive Evaluation, Established Pt; 18-39 Yrs	$257.40	$286.00	$128.70–$286.00	—	10%
Preventive checkup, returning patient aged 40–64 CPT 99396 99396 Preventive Evaluation, Established Pt; 40-64 Yrs	$318.60	$354.00	$159.30–$354.00	205% above	10%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 99396 Preventive Evaluation, Established Pt; 40-64 Yrs	$318.60	$354.00	$159.30–$354.00	—	10%
Preventive checkup, returning patient aged 65 or older CPT 99397 99397 SPI Physical 65+	$296.10	$329.00	$148.05–$329.00	165% above	10%
Preventive checkup, returning patient aged 65 or older CPT 99397 99397 Preventive Evaluation, Established Pt; 65+ Yrs	$313.20	$348.00	$156.60–$348.00	180% above	10%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 99397 SPI Physical 65+	$296.10	$329.00	$148.05–$329.00	—	10%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 99397 Preventive Evaluation, Established Pt; 65+ Yrs	$313.20	$348.00	$156.60–$348.00	—	10%
Psychiatric evaluation with medical services CPT 90792 Telehealth PSYCH DX EVAL WITH MED SERVICE-FAC	$88.20	$98.00	$44.10–$98.00	59% below	10%
Psychiatric evaluation with medical services CPT 90792 90792 Psychiatric diagnostic evaluation with medical services	$171.90	$191.00	$85.95–$191.00	20% below	10%
Psychiatric evaluation with medical services CPT 90792 90792 PSYCH DIAG EVAL W/MED SRVCS ProFee	$618.30	$687.00	$309.15–$687.00	189% above	10%
Psychiatric evaluation with medical services inpatient CPT 90792 Telehealth PSYCH DX EVAL WITH MED SERVICE-FAC	$88.20	$98.00	$44.10–$98.00	—	10%
Psychiatric evaluation with medical services inpatient CPT 90792 90792 Psychiatric diagnostic evaluation with medical services	$171.90	$191.00	$85.95–$191.00	—	10%
Psychiatric evaluation with medical services inpatient CPT 90792 90792 PSYCH DIAG EVAL W/MED SRVCS ProFee	$618.30	$687.00	$309.15–$687.00	—	10%
Psychological testing evaluation by a psychologist or physician, first hour CPT 96130 96130 Psychological testing evaluation services by physician or other qualified health care professi	$82.80	$92.00	$41.40–$92.00	57% below	10%
Psychological testing evaluation by a psychologist or physician, first hour inpatient CPT 96130 96130 Psychological testing evaluation services by physician or other qualified health care professi	$82.80	$92.00	$41.40–$92.00	—	10%
Psychotherapy for crisis, first 60 minutes CPT 90839 90839 Telehealth Psychotherapy for crisis; first 60 minutes	$60.30	$67.00	$30.15–$67.00	77% below	10%
Psychotherapy for crisis, first 60 minutes CPT 90839 90839 Psychotherapy for crisis first 60 minutes	$302.40	$336.00	$151.20–$336.00	13% above	10%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 90839 Telehealth Psychotherapy for crisis; first 60 minutes	$60.30	$67.00	$30.15–$67.00	—	10%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 90839 Psychotherapy for crisis first 60 minutes	$302.40	$336.00	$151.20–$336.00	—	10%
Psychotherapy session, 30 minutes CPT 90832 90832 IND PSYCOTHRPY 30 MI CHARGE	$148.50	$165.00	$74.25–$165.00	45% above	10%
Psychotherapy session, 30 minutes CPT 90832 90832 Psychotherapy, 30 min with patient	$283.50	$315.00	$141.75–$315.00	178% above	10%
Psychotherapy session, 30 minutes CPT 90832 90832 Telehealth PSYCHOTHERAPY 30 MIS W/PATIENT AND/OR F	$323.10	$359.00	$161.55–$359.00	216% above	10%
Psychotherapy session, 30 minutes CPT 90832 90832 Psychotherapy, 30 minutes with patient and/or family member	$396.00	$440.00	$198.00–$440.00	288% above	10%
Psychotherapy session, 30 minutes inpatient CPT 90832 90832 IND PSYCOTHRPY 30 MI CHARGE	$148.50	$165.00	$74.25–$165.00	—	10%
Psychotherapy session, 30 minutes inpatient CPT 90832 90832 Psychotherapy, 30 min with patient	$283.50	$315.00	$141.75–$315.00	—	10%
Psychotherapy session, 30 minutes inpatient CPT 90832 90832 Telehealth PSYCHOTHERAPY 30 MIS W/PATIENT AND/OR F	$323.10	$359.00	$161.55–$359.00	—	10%
Psychotherapy session, 30 minutes inpatient CPT 90832 90832 Psychotherapy, 30 minutes with patient and/or family member	$396.00	$440.00	$198.00–$440.00	—	10%
Psychotherapy session, 45 minutes CPT 90834 90834 Psychotherapy, 45 minutes with patient and/or family member	$183.60	$204.00	$91.80–$204.00	14% above	10%
Psychotherapy session, 45 minutes CPT 90834 90834 IND PSYCHTHRPY 45 MI CHARGE	$196.20	$218.00	$98.10–$218.00	22% above	10%
Psychotherapy session, 45 minutes CPT 90834 90834 Telehealth PSYCHOTHERAPY 45 MIN W/PT /OR FAM	$302.40	$336.00	$151.20–$336.00	88% above	10%
Psychotherapy session, 45 minutes inpatient CPT 90834 90834 Psychotherapy, 45 minutes with patient and/or family member	$183.60	$204.00	$91.80–$204.00	—	10%
Psychotherapy session, 45 minutes inpatient CPT 90834 90834 IND PSYCHTHRPY 45 MI CHARGE	$196.20	$218.00	$98.10–$218.00	—	10%
Psychotherapy session, 45 minutes inpatient CPT 90834 90834 Telehealth PSYCHOTHERAPY 45 MIN W/PT /OR FAM	$302.40	$336.00	$151.20–$336.00	—	10%
Psychotherapy session, 60 minutes CPT 90837 90837 Psychotherapy, 60 minutes with patient and/or family member	$92.70	$103.00	$46.35–$103.00	24% below	10%
Psychotherapy session, 60 minutes CPT 90837 90837 Telehealth Psychotherapy, 60 minutes with patient and/or family m	$149.40	$166.00	$74.70–$166.00	22% above	10%
Psychotherapy session, 60 minutes CPT 90837 90837 INDIVIDUAL PSYCHOTHERAPY- 60 MINUTES	$270.00	$300.00	$135.00–$300.00	121% above	10%
Psychotherapy session, 60 minutes inpatient CPT 90837 90837 Psychotherapy, 60 minutes with patient and/or family member	$92.70	$103.00	$46.35–$103.00	—	10%
Psychotherapy session, 60 minutes inpatient CPT 90837 90837 Telehealth Psychotherapy, 60 minutes with patient and/or family m	$149.40	$166.00	$74.70–$166.00	—	10%
Psychotherapy session, 60 minutes inpatient CPT 90837 90837 INDIVIDUAL PSYCHOTHERAPY- 60 MINUTES	$270.00	$300.00	$135.00–$300.00	—	10%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 99406 Smoking Cessation Counseling 3 To 10 min ProFee	$45.90	$51.00	$22.95–$51.00	85% above	10%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 99406 Smoking/Tobacco Cessation Counseling 3-10 Min	$255.60	$284.00	$127.80–$284.00	931% above	10%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 99406 Smoking Cessation Counseling 3 To 10 min ProFee	$45.90	$51.00	$22.95–$51.00	—	10%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 99406 Smoking/Tobacco Cessation Counseling 3-10 Min	$255.60	$284.00	$127.80–$284.00	—	10%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Telehealth OFFICE VISIT/COMPREHENSIVE L5	$33.30	$37.00	$16.65–$37.00	75% below	10%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 99215 OUT PATIENT SURGERY FACILITY	$119.70	$133.00	$59.85–$133.00	9% below	10%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 99215 CLINIC FEE-EST PT LEVEL 5 COMPREHENS CHARGE Pro Fee	$250.20	$278.00	$125.10–$278.00	90% above	10%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 99215 CLINIC FEE-EST PT LEVEL 5 COMPREHENS CHARGE	$253.80	$282.00	$126.90–$282.00	93% above	10%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 99215 Office/Outpatient Visit - Established Patient, Level 5 (40-54 min).	$415.80	$462.00	$207.90–$462.00	216% above	10%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 99215 VST EST PAT COMPRE/HIGH/COMPLX ProFee	$492.30	$547.00	$246.15–$547.00	275% above	10%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Telehealth OFFICE VISIT/COMPREHENSIVE L5	$33.30	$37.00	$16.65–$37.00	—	10%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 99215 OUT PATIENT SURGERY FACILITY	$119.70	$133.00	$59.85–$133.00	—	10%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 99215 CLINIC FEE-EST PT LEVEL 5 COMPREHENS CHARGE Pro Fee	$250.20	$278.00	$125.10–$278.00	—	10%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 99215 CLINIC FEE-EST PT LEVEL 5 COMPREHENS CHARGE	$253.80	$282.00	$126.90–$282.00	—	10%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 99215 Office/Outpatient Visit - Established Patient, Level 5 (40-54 min).	$415.80	$462.00	$207.90–$462.00	—	10%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 99215 VST EST PAT COMPRE/HIGH/COMPLX ProFee	$492.30	$547.00	$246.15–$547.00	—	10%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Telehealth OFFICE/ O/P VISIT EST - LEVEL 3	$19.80	$22.00	$9.90–$22.00	70% below	10%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 99213 CLINIC FEE-EST PT LEVEL 3 EXPANDED CHARGE Pro Fee	$30.60	$34.00	$15.30–$34.00	54% below	10%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 99213 CLINIC FEE-EST PT LEVEL 3 EXPANDED CHARGE	$36.90	$41.00	$18.45–$41.00	45% below	10%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 99213 Office/Outpatient Visit - Established Patient,Level 3 (20-29 min)	$120.60	$134.00	$60.30–$134.00	81% above	10%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 99213 Office/Outpatient Visit - Established Patient, Level 3	$198.00	$220.00	$99.00–$220.00	197% above	10%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 99213 PRO VST EST PAT EXPANDED/STRGHTFWD ProFee	$572.40	$636.00	$286.20–$636.00	759% above	10%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Telehealth OFFICE/ O/P VISIT EST - LEVEL 3	$19.80	$22.00	$9.90–$22.00	—	10%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 99213 CLINIC FEE-EST PT LEVEL 3 EXPANDED CHARGE Pro Fee	$30.60	$34.00	$15.30–$34.00	—	10%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 99213 CLINIC FEE-EST PT LEVEL 3 EXPANDED CHARGE	$36.90	$41.00	$18.45–$41.00	—	10%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 99213 Office/Outpatient Visit - Established Patient,Level 3 (20-29 min)	$120.60	$134.00	$60.30–$134.00	—	10%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 99213 Office/Outpatient Visit - Established Patient, Level 3	$198.00	$220.00	$99.00–$220.00	—	10%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 99213 PRO VST EST PAT EXPANDED/STRGHTFWD ProFee	$572.40	$636.00	$286.20–$636.00	—	10%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Telehealth OFFICE/ O/P VISIT EST - LEVEL 4	$46.80	$52.00	$23.40–$52.00	49% below	10%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214 PRO VST EST PAT DET/LOW/MOD/COMPL ProFee	$66.60	$74.00	$33.30–$74.00	27% below	10%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214 Office/Outpatient Visit - Established Patient, Level 4	$178.20	$198.00	$89.10–$198.00	94% above	10%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214 CLINIC FEE-EST PT LEVEL 4 EXPANDED CHARGE Pro Fee	$198.00	$220.00	$99.00–$220.00	116% above	10%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214 CLINIC FEE-EST PT LEVEL 4 EXPANDED CHARGE	$203.40	$226.00	$101.70–$226.00	122% above	10%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214 Office/Outpatient Visit - Established Patient,Level 4 (30-39 min)	$253.80	$282.00	$126.90–$282.00	176% above	10%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Telehealth OFFICE/ O/P VISIT EST - LEVEL 4	$46.80	$52.00	$23.40–$52.00	—	10%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 99214 PRO VST EST PAT DET/LOW/MOD/COMPL ProFee	$66.60	$74.00	$33.30–$74.00	—	10%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 99214 Office/Outpatient Visit - Established Patient, Level 4	$178.20	$198.00	$89.10–$198.00	—	10%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 99214 CLINIC FEE-EST PT LEVEL 4 EXPANDED CHARGE Pro Fee	$198.00	$220.00	$99.00–$220.00	—	10%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 99214 CLINIC FEE-EST PT LEVEL 4 EXPANDED CHARGE	$203.40	$226.00	$101.70–$226.00	—	10%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 99214 Office/Outpatient Visit - Established Patient,Level 4 (30-39 min)	$253.80	$282.00	$126.90–$282.00	—	10%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212 Office/Outpatient Visit - Established Patient, Level 2	$47.70	$53.00	$23.85–$53.00	5% below	10%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212 CLINIC FEE-EST PT LEVEL 2 EXPANDED CHARGE	$90.90	$101.00	$45.45–$101.00	80% above	10%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212 CLINIC FEE-EST PT LEVEL 2 EXPANDED CHARGE Pro Fee	$90.90	$101.00	$45.45–$101.00	80% above	10%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212 PRO VST EST PAT FOCUSED/STRGHTFWD ProFee	$250.20	$278.00	$125.10–$278.00	396% above	10%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Telehealth OFFICE/ O/P VISIT EST - LEVEL 2	$344.70	$383.00	$172.35–$383.00	584% above	10%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 99212 Office/Outpatient Visit - Established Patient, Level 2	$47.70	$53.00	$23.85–$53.00	—	10%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 99212 CLINIC FEE-EST PT LEVEL 2 EXPANDED CHARGE	$90.90	$101.00	$45.45–$101.00	—	10%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 99212 CLINIC FEE-EST PT LEVEL 2 EXPANDED CHARGE Pro Fee	$90.90	$101.00	$45.45–$101.00	—	10%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 99212 PRO VST EST PAT FOCUSED/STRGHTFWD ProFee	$250.20	$278.00	$125.10–$278.00	—	10%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Telehealth OFFICE/ O/P VISIT EST - LEVEL 2	$344.70	$383.00	$172.35–$383.00	—	10%
Specialist consultation, low complexity or 30+ minutes CPT 99243 99243 LEVEL 3 OUTPT CONSULT ProFee	$17.10	$19.00	$8.55–$19.00	84% below	10%
Specialist consultation, low complexity or 30+ minutes CPT 99243 99243 LEVEL 3 OUTPT CONSULT ProFee - HUMB	$162.00	$180.00	$81.00–$180.00	56% above	10%
Specialist consultation, low complexity or 30+ minutes CPT 99243 99243 Office Consultation, Level 3	$188.10	$209.00	$94.05–$209.00	81% above	10%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 99243 LEVEL 3 OUTPT CONSULT ProFee	$17.10	$19.00	$8.55–$19.00	—	10%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 99243 LEVEL 3 OUTPT CONSULT ProFee - HUMB	$162.00	$180.00	$81.00–$180.00	—	10%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 99243 Office Consultation, Level 3	$188.10	$209.00	$94.05–$209.00	—	10%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 99244 LEVEL 4 OUTPT CONSULT ProFee	$120.60	$134.00	$60.30–$134.00	9% below	10%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 99244 LEVEL 4 OUTPT CONSULT ProFee - HUMB	$234.90	$261.00	$117.45–$261.00	78% above	10%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 99244 LEVEL 4 OUTPT CONSULT ProFee	$120.60	$134.00	$60.30–$134.00	—	10%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 99244 LEVEL 4 OUTPT CONSULT ProFee - HUMB	$234.90	$261.00	$117.45–$261.00	—	10%
Spirometry (breathing test) CPT 94010 Pulmonary Function Test w/o Bronchodilator	$811.80	$902.00	$405.90–$902.00	442% above	10%
Spirometry (breathing test) inpatient CPT 94010 Pulmonary Function Test w/o Bronchodilator	$811.80	$902.00	$405.90–$902.00	—	10%
Spirometry before and after a bronchodilator CPT 94060 Pulmonary Function Test w/ Bronchodilator	$1,791.00	$1,990.00	$895.50–$1,990.00	387% above	10%
Spirometry before and after a bronchodilator inpatient CPT 94060 Pulmonary Function Test w/ Bronchodilator	$1,791.00	$1,990.00	$895.50–$1,990.00	—	10%
Therapeutic activities (functional training), 15 minutes CPT 97530 OT Therapeutic Activities Charges	$72.00	$80.00	$36.00–$80.00	18% below	10%
Therapeutic activities (functional training), 15 minutes CPT 97530 PT Therapeutic Activity Assistant Units	$84.60	$94.00	$42.30–$94.00	4% below	10%
Therapeutic activities (functional training), 15 minutes CPT 97530 OT Therapeutic Activities Assistant Units	$109.80	$122.00	$54.90–$122.00	25% above	10%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 OT Therapeutic Activities Charges	$72.00	$80.00	$36.00–$80.00	—	10%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 PT Therapeutic Activity Assistant Units	$84.60	$94.00	$42.30–$94.00	—	10%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 OT Therapeutic Activities Assistant Units	$109.80	$122.00	$54.90–$122.00	—	10%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Maine	Off list
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 SARS-CoV-2 (COVID-19) mRNA-LNP vaccine 925-26)(cvx 312) preservative-free 50 mcg/0.5 mL Sus[MDIH]	$139.48	$154.98	$69.74–$154.98	13% below	10%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 SARS-CoV-2 (COVID-19) mRNA-LNP vaccine 925-26)(cvx 312) preservative-free 50 mcg/0.5 mL Sus[MDIH]	$139.48	$154.98	$69.74–$154.98	—	10%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 90716 Varicella virus vaccine, live, for subcutaneous use	$324.00	$360.00	$162.00–$360.00	109% above	10%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 90716 Varicella virus vaccine, live, for subcutaneous use	$324.00	$360.00	$162.00–$360.00	—	10%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 90656 Influenza virus vaccine, trivalent, split virus fluarix	$42.30	$47.00	$21.15–$47.00	92% above	10%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 90653 Influenza vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use (Fluad)	$43.20	$48.00	$21.60–$48.00	96% above	10%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 influenza virus vaccine, inactivated PF trivalent Sus UD 2025-2026 [MDIH]	$44.55	$49.50	$22.28–$49.50	102% above	10%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 90656 no prsv 3+> - AMB influenza vacc Charge	$424.80	$472.00	$212.40–$472.00	1827% above	10%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 90656 Influenza virus vaccine, trivalent, split virus fluarix	$42.30	$47.00	$21.15–$47.00	—	10%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 90653 Influenza vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use (Fluad)	$43.20	$48.00	$21.60–$48.00	—	10%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 influenza virus vaccine, inactivated PF trivalent Sus UD 2025-2026 [MDIH]	$44.55	$49.50	$22.28–$49.50	—	10%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 90656 no prsv 3+> - AMB influenza vacc Charge	$424.80	$472.00	$212.40–$472.00	—	10%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 90651 Vaccine- Gardasil 9 VFC	$637.20	$708.00	$318.60–$708.00	205% above	10%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 90651 Vaccine- Gardasil 9 VFC	$637.20	$708.00	$318.60–$708.00	—	10%
Hepatitis A vaccine, adult dose CPT 90632 90632 Hepatitis A vaccine, adult dosage, for intramuscular use	$259.20	$288.00	$129.60–$288.00	223% above	10%
Hepatitis A vaccine, adult dose inpatient CPT 90632 90632 Hepatitis A vaccine, adult dosage, for intramuscular use	$259.20	$288.00	$129.60–$288.00	—	10%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 90746 Vaccine - Hepatitis B Adult Vaccine	$222.30	$247.00	$111.15–$247.00	312% above	10%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 90746 Vaccine - Hepatitis B Adult Vaccine	$222.30	$247.00	$111.15–$247.00	—	10%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 90662 Fluzone High Dose Charge	$126.00	$140.00	$63.00–$140.00	10% above	10%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 influenza virus vaccine, inactivated high-dose PF trivalent Sus UD 2025-2026 [MDIH]	$139.50	$155.00	$69.75–$155.00	22% above	10%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 90662 prsv free inc antig - AMB influenza vacc Charge	$461.70	$513.00	$230.85–$513.00	303% above	10%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 90662 Fluzone High Dose Charge	$126.00	$140.00	$63.00–$140.00	—	10%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 influenza virus vaccine, inactivated high-dose PF trivalent Sus UD 2025-2026 [MDIH]	$139.50	$155.00	$69.75–$155.00	—	10%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 90662 prsv free inc antig - AMB influenza vacc Charge	$461.70	$513.00	$230.85–$513.00	—	10%
MMR vaccine (measles, mumps and rubella), live CPT 90707 90707 Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use	$286.20	$318.00	$143.10–$318.00	176% above	10%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 90707 Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use	$286.20	$318.00	$143.10–$318.00	—	10%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 90620 Meningococcal vaccine, Serogroup B, 2 dose schedule, for IM use	$414.00	$460.00	$207.00–$460.00	181% above	10%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 90620 Meningococcal vaccine, Serogroup B, 2 dose schedule, for IM use	$414.00	$460.00	$207.00–$460.00	—	10%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 pneumococcal 20-valent conjugate vaccine - Sus [MDIH]	$315.54	$350.60	$157.77–$350.60	18% below	10%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 pneumococcal 20-valent conjugate vaccine - Sus [MDIH]	$315.54	$350.60	$157.77–$350.60	—	10%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 90732 Pneumococcal polysaccharide vaccine, 23-valent, for subcutaneous or intramuscular use	$295.20	$328.00	$147.60–$328.00	226% above	10%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 90732 Pneumococcal polysaccharide vaccine, 23-valent, for subcutaneous or intramuscular use	$295.20	$328.00	$147.60–$328.00	—	10%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 90750 Zoster (shingles) vaccine (HZV), recombinant, subunit, adjuvanted, for intramuscular use	$324.00	$360.00	$162.00–$360.00	277% above	10%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 90750 Zoster (shingles) vaccine (HZV), recombinant, subunit, adjuvanted, for intramuscular use	$324.00	$360.00	$162.00–$360.00	—	10%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 90714 Tenivac - Tetanus and diphtheria toxoids (Td), over 18	$76.50	$85.00	$38.25–$85.00	83% above	10%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 90714 Tenivac - Tetanus and diphtheria toxoids (Td), over 18	$76.50	$85.00	$38.25–$85.00	—	10%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Tdap (Boostrix) - AMB Tdap Charge	$41.40	$46.00	$20.70–$46.00	2% below	10%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 tetanus/diphth/pertuss (Tdap) vaccine [MDIH]	$170.66	$189.63	$85.33–$189.63	302% above	10%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Tdap (Boostrix) - AMB Tdap Charge	$41.40	$46.00	$20.70–$46.00	—	10%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 tetanus/diphth/pertuss (Tdap) vaccine [MDIH]	$170.66	$189.63	$85.33–$189.63	—	10%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471 Immunization administration: first vaccine	$19.42	$21.58	$9.71–$21.58	16% above	10%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471 ADM VACCINE SINGLE CHARGE.	$69.30	$77.00	$34.65–$77.00	312% above	10%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471 IMMUNIZATION ADMIN ONE CHARGE	$109.80	$122.00	$54.90–$122.00	554% above	10%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 90471 Immunization administration: first vaccine	$19.42	$21.58	$9.71–$21.58	—	10%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 90471 ADM VACCINE SINGLE CHARGE.	$69.30	$77.00	$34.65–$77.00	—	10%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 90471 IMMUNIZATION ADMIN ONE CHARGE	$109.80	$122.00	$54.90–$122.00	—	10%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 90472 Immunization administration; each additional vaccine	$10.80	$12.00	$5.40–$12.00	42% below	10%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 90472 Immunization administration; each additional vaccine	$10.80	$12.00	$5.40–$12.00	—	10%

Source file: https://www.mdihospital.org/wp-content/uploads/2026/07/010211979_mount-desert-island-hospital_standardcharges-2.csv