Hospital Minot, ND

Kenmare Community Hospital

Kenmare Community Hospital in Kenmare, ND publishes cash prices for 408 common procedures listed here, from its own machine-readable price file updated Apr 1, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the North Dakota median for 207 of 406 procedures and below it for 151. By typical cash price it ranks #18 of 33 North Dakota hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.

Po Box 697, Kenmare, ND 58746 Collected Sep 27, 2026 Source price file Check a bill from this hospital (701) 385-4296

Critical access hospital (rural, 25 beds or fewer) Nonprofit hospital Emergency department CCN 351305 · CMS hospital register NPI 1366597650

Financial assistance

Nonprofit hospital: it must offer free or discounted care to patients who qualify. How to apply

Kenmare Community Hospital is a nonprofit hospital in the CMS register. Under section 501(r) of the federal tax code it must have a written Financial Assistance Policy with a free application, publish both on its website, and charge patients who qualify no more than the amounts generally billed to insured patients for emergency and other medically necessary care. Who qualifies depends on household income; the policy states the limits.

You can apply up to 240 days after the first bill. Before collection actions such as credit reporting or a lawsuit, the hospital must tell you about the policy and wait at least 120 days after that bill. Ask the billing office for the policy and the application before you pay, or search the hospital's website for “financial assistance”. Letters you can copy.

Source: IRS, section 501(r) requirements for nonprofit hospitals.

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs North Dakota	Off list
Abdominal CT scan without and with contrast CPT 74170 CT ABDOMEN W+W/O CONTRAST ADRENAL	$2,388.00	$2,985.00	—	16% above	20%
Abdominal CT scan without and with contrast CPT 74170 CT ABDOMEN W/ + W/O CONTRAST	$2,388.00	$2,985.00	—	16% above	20%
Abdominal CT scan without and with contrast inpatient CPT 74170 CT ABDOMEN W/ + W/O CONTRAST	$2,388.00	$2,985.00	—	—	20%
Abdominal CT scan without and with contrast inpatient CPT 74170 CT ABDOMEN W+W/O CONTRAST ADRENAL	$2,388.00	$2,985.00	—	—	20%
Abdominal X-ray, 2 views CPT 74019 XR ABDOMEN COMPLETE W/ DECUB/EREC	$252.00	$315.00	—	45% above	20%
Abdominal X-ray, 2 views inpatient CPT 74019 XR ABDOMEN COMPLETE W/ DECUB/EREC	$252.00	$315.00	—	—	20%
Ankle X-ray, complete, 3 or more views both sides CPT 73610 XR ANKLE COMPLETE BILATERAL	$428.80	$536.00	—	—	20%
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR ANKLE COMPLETE RIGHT	$214.40	$268.00	—	39% above	20%
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR ANKLE COMPLETE LEFT	$214.40	$268.00	—	39% above	20%
Ankle X-ray, complete, 3 or more views inpatient both sides CPT 73610 XR ANKLE COMPLETE BILATERAL	$428.80	$536.00	—	—	20%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR ANKLE COMPLETE RIGHT	$214.40	$268.00	—	—	20%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR ANKLE COMPLETE LEFT	$214.40	$268.00	—	—	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 US LE ANKLE/RADIAL BRACH INDICES	$194.40	$243.00	—	34% below	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 US LE ANKLE/RADIAL BRACH INDICES	$194.40	$243.00	—	—	20%
Arm CT scan without contrast (shoulder to hand, any part) both sides CPT 73200 CT ELBOW W/O CONTRAST BILATERAL	$2,513.60	$3,142.00	—	—	20%
Arm CT scan without contrast (shoulder to hand, any part) both sides CPT 73200 CT HUMERUS W/O CONTRAST BILATERAL	$2,513.60	$3,142.00	—	—	20%
Arm CT scan without contrast (shoulder to hand, any part) both sides CPT 73200 CT FOREARM W/O CONTRAST BILATERAL	$2,513.60	$3,142.00	—	—	20%
Arm CT scan without contrast (shoulder to hand, any part) both sides CPT 73200 CT HAND W/O CONTRAST BILATERAL	$2,513.60	$3,142.00	—	—	20%
Arm CT scan without contrast (shoulder to hand, any part) both sides CPT 73200 CT WRIST W/O CONTRAST BILATERAL	$2,513.60	$3,142.00	—	—	20%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 CT UPPER EXTREMITY W/O CONTRAST R	$1,256.80	$1,571.00	—	at median	20%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 CT UPPER EXTREMITY W/O CONTRAST L	$1,256.80	$1,571.00	—	at median	20%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 CT SHOULDER W/O CONTRAST BILATERA	$2,513.60	$3,142.00	—	100% above	20%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 CT UPPER EXTREMITY W/O CONTRAST B	$2,513.60	$3,142.00	—	100% above	20%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT HAND W/O CONTRAST RIGHT	$1,256.80	$1,571.00	—	at median	20%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT HUMERUS W/O CONTRAST LEFT	$1,256.80	$1,571.00	—	at median	20%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT HAND W/O CONTRAST LEFT	$1,256.80	$1,571.00	—	at median	20%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT FOREARM W/O CONTRAST RIGHT	$1,256.80	$1,571.00	—	at median	20%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT FOREARM W/O CONTRAST LEFT	$1,256.80	$1,571.00	—	at median	20%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT WRIST W/O CONTRAST RIGHT	$1,256.80	$1,571.00	—	at median	20%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT WRIST W/O CONTRAST LEFT	$1,256.80	$1,571.00	—	at median	20%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT SHOULDER W/O CONTRAST RIGHT	$1,256.80	$1,571.00	—	at median	20%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT SHOULDER W/O CONTRAST LEFT	$1,256.80	$1,571.00	—	at median	20%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT HUMERUS W/O CONTRAST RIGHT	$1,256.80	$1,571.00	—	at median	20%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT ELBOW W/O CONTRAST LEFT	$1,256.80	$1,571.00	—	at median	20%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT ELBOW W/O CONTRAST RIGHT	$1,256.80	$1,571.00	—	at median	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient both sides CPT 73200 CT FOREARM W/O CONTRAST BILATERAL	$2,513.60	$3,142.00	—	—	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient both sides CPT 73200 CT HUMERUS W/O CONTRAST BILATERAL	$2,513.60	$3,142.00	—	—	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient both sides CPT 73200 CT WRIST W/O CONTRAST BILATERAL	$2,513.60	$3,142.00	—	—	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient both sides CPT 73200 CT ELBOW W/O CONTRAST BILATERAL	$2,513.60	$3,142.00	—	—	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient both sides CPT 73200 CT HAND W/O CONTRAST BILATERAL	$2,513.60	$3,142.00	—	—	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 CT UPPER EXTREMITY W/O CONTRAST R	$1,256.80	$1,571.00	—	—	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 CT UPPER EXTREMITY W/O CONTRAST L	$1,256.80	$1,571.00	—	—	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 CT SHOULDER W/O CONTRAST BILATERA	$2,513.60	$3,142.00	—	—	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 CT UPPER EXTREMITY W/O CONTRAST B	$2,513.60	$3,142.00	—	—	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT HUMERUS W/O CONTRAST LEFT	$1,256.80	$1,571.00	—	—	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT WRIST W/O CONTRAST RIGHT	$1,256.80	$1,571.00	—	—	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT FOREARM W/O CONTRAST RIGHT	$1,256.80	$1,571.00	—	—	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT HAND W/O CONTRAST LEFT	$1,256.80	$1,571.00	—	—	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT HAND W/O CONTRAST RIGHT	$1,256.80	$1,571.00	—	—	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT SHOULDER W/O CONTRAST RIGHT	$1,256.80	$1,571.00	—	—	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT ELBOW W/O CONTRAST RIGHT	$1,256.80	$1,571.00	—	—	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT SHOULDER W/O CONTRAST LEFT	$1,256.80	$1,571.00	—	—	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT ELBOW W/O CONTRAST LEFT	$1,256.80	$1,571.00	—	—	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT HUMERUS W/O CONTRAST RIGHT	$1,256.80	$1,571.00	—	—	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT FOREARM W/O CONTRAST LEFT	$1,256.80	$1,571.00	—	—	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT WRIST W/O CONTRAST LEFT	$1,256.80	$1,571.00	—	—	20%
Barium swallow (esophagus X-ray with contrast) CPT 74220 XR ESOPHAGUS SINGLE CONTRAST	$557.60	$697.00	—	56% above	20%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 XR ESOPHAGUS SINGLE CONTRAST	$557.60	$697.00	—	—	20%
Bone scan, whole body (nuclear medicine) CPT 78306 NM BONE IMAGING WHOLE BODY	$672.00	$840.00	—	37% below	20%
Bone scan, whole body (nuclear medicine) CPT 78306 NM BONE SPECT WHOLE BODY	$672.00	$840.00	—	37% below	20%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM BONE SPECT WHOLE BODY	$672.00	$840.00	—	—	20%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM BONE IMAGING WHOLE BODY	$672.00	$840.00	—	—	20%
Breast ultrasound, complete, one breast both sides CPT 76641 US MA BREAST BILATERAL COMPLETE	$904.00	$1,130.00	—	—	20%
Breast ultrasound, complete, one breast both sides CPT 76641 US BREAST BILATERAL COMPLETE	$904.00	$1,130.00	—	—	20%
Breast ultrasound, complete, one breast one side CPT 76641 US MA BREAST RIGHT COMPLETE	$453.60	$567.00	—	28% above	20%
Breast ultrasound, complete, one breast one side CPT 76641 US MA BREAST LEFT COMPLETE	$453.60	$567.00	—	28% above	20%
Breast ultrasound, complete, one breast one side CPT 76641 US BREAST LEFT COMPLETE	$453.60	$567.00	—	28% above	20%
Breast ultrasound, complete, one breast one side CPT 76641 US BREAST RIGHT COMPLETE	$453.60	$567.00	—	28% above	20%
Breast ultrasound, complete, one breast inpatient both sides CPT 76641 US MA BREAST BILATERAL COMPLETE	$904.00	$1,130.00	—	—	20%
Breast ultrasound, complete, one breast inpatient both sides CPT 76641 US BREAST BILATERAL COMPLETE	$904.00	$1,130.00	—	—	20%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US MA BREAST LEFT COMPLETE	$453.60	$567.00	—	—	20%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US BREAST RIGHT COMPLETE	$453.60	$567.00	—	—	20%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US BREAST LEFT COMPLETE	$453.60	$567.00	—	—	20%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US MA BREAST RIGHT COMPLETE	$453.60	$567.00	—	—	20%
Breast ultrasound, limited (one breast or one area) both sides CPT 76642 US MA BREAST BILATERAL LIMITED	$667.20	$834.00	—	—	20%
Breast ultrasound, limited (one breast or one area) both sides CPT 76642 US BREAST BILATERAL LIMITED	$667.20	$834.00	—	—	20%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST LEFT LIMITED	$333.60	$417.00	—	11% above	20%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US MA BREAST RIGHT LIMITED	$333.60	$417.00	—	11% above	20%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US MA BREAST LEFT LIMITED	$333.60	$417.00	—	11% above	20%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST RIGHT LIMITED	$333.60	$417.00	—	11% above	20%
Breast ultrasound, limited (one breast or one area) inpatient both sides CPT 76642 US BREAST BILATERAL LIMITED	$667.20	$834.00	—	—	20%
Breast ultrasound, limited (one breast or one area) inpatient both sides CPT 76642 US MA BREAST BILATERAL LIMITED	$667.20	$834.00	—	—	20%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US MA BREAST RIGHT LIMITED	$333.60	$417.00	—	—	20%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US BREAST LEFT LIMITED	$333.60	$417.00	—	—	20%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US BREAST RIGHT LIMITED	$333.60	$417.00	—	—	20%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US MA BREAST LEFT LIMITED	$333.60	$417.00	—	—	20%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CT ANGIO ABDOMEN/PELVIS W/CONTRAS	$2,758.40	$3,448.00	—	3% below	20%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CT VENOGRAM ABDOMEN/PELVIS W/CONT	$2,758.40	$3,448.00	—	3% below	20%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CT ANGIO ABDOMEN/PELVIS W/CONTRAS	$2,758.40	$3,448.00	—	—	20%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CT VENOGRAM ABDOMEN/PELVIS W/CONT	$2,758.40	$3,448.00	—	—	20%
CT angiography (CTA) of the head CPT 70496 CT ANGIO HEAD (ACUTE) W/PERFUSION	$2,254.40	$2,818.00	—	12% above	20%
CT angiography (CTA) of the head CPT 70496 CTV HEAD W + W/O CONTRAST	$2,254.40	$2,818.00	—	12% above	20%
CT angiography (CTA) of the head CPT 70496 CT ANGIO HEAD (NON-ACUTE) W/PERFU	$2,254.40	$2,818.00	—	12% above	20%
CT angiography (CTA) of the head CPT 70496 CT ANGIOGRAPHY HEAD STROKE	$2,254.40	$2,818.00	—	12% above	20%
CT angiography (CTA) of the head CPT 70496 CT ANGIOGRAPHY HEAD W/ + W/O CONT	$2,254.40	$2,818.00	—	12% above	20%
CT angiography (CTA) of the head inpatient CPT 70496 CT ANGIO HEAD (NON-ACUTE) W/PERFU	$2,254.40	$2,818.00	—	—	20%
CT angiography (CTA) of the head inpatient CPT 70496 CTV HEAD W + W/O CONTRAST	$2,254.40	$2,818.00	—	—	20%
CT angiography (CTA) of the head inpatient CPT 70496 CT ANGIOGRAPHY HEAD STROKE	$2,254.40	$2,818.00	—	—	20%
CT angiography (CTA) of the head inpatient CPT 70496 CT ANGIO HEAD (ACUTE) W/PERFUSION	$2,254.40	$2,818.00	—	—	20%
CT angiography (CTA) of the head inpatient CPT 70496 CT ANGIOGRAPHY HEAD W/ + W/O CONT	$2,254.40	$2,818.00	—	—	20%
CT angiography (CTA) of the neck CPT 70498 CT ANGIOGRAPHY NECK	$2,259.20	$2,824.00	—	13% above	20%
CT angiography (CTA) of the neck CPT 70498 CT ANGIOGRAPHY NECK STROKE	$2,259.20	$2,824.00	—	13% above	20%
CT angiography (CTA) of the neck inpatient CPT 70498 CT ANGIOGRAPHY NECK	$2,259.20	$2,824.00	—	—	20%
CT angiography (CTA) of the neck inpatient CPT 70498 CT ANGIOGRAPHY NECK STROKE	$2,259.20	$2,824.00	—	—	20%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT ANGIOGRAPHY CHEST - PE PROTOCO	$2,314.40	$2,893.00	—	11% above	20%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT ANGIOGRAPHY CHEST	$2,314.40	$2,893.00	—	11% above	20%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT ANGIOGRAPHY CHEST - AORTA PROT	$2,314.40	$2,893.00	—	11% above	20%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT ANGIOGRAPHY CHEST	$2,314.40	$2,893.00	—	—	20%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT ANGIOGRAPHY CHEST - AORTA PROT	$2,314.40	$2,893.00	—	—	20%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT ANGIOGRAPHY CHEST - PE PROTOCO	$2,314.40	$2,893.00	—	—	20%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CTA PRE-TAVR CORONARY IMAGING	$2,693.60	$3,367.00	—	43% above	20%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CT ANGIO CORONARY W/CONTRAST W/O	$2,693.60	$3,367.00	—	43% above	20%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CT ANGIO CORONARY W+WO CONTRAST	$2,693.60	$3,367.00	—	43% above	20%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CTA PRE-TAVR CORONARY/CHEST/ABD/P	$2,693.60	$3,367.00	—	43% above	20%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 CTA PRE-TAVR CORONARY IMAGING	$2,693.60	$3,367.00	—	—	20%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 CTA PRE-TAVR CORONARY/CHEST/ABD/P	$2,693.60	$3,367.00	—	—	20%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 CT ANGIO CORONARY W/CONTRAST W/O	$2,693.60	$3,367.00	—	—	20%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 CT ANGIO CORONARY W+WO CONTRAST	$2,693.60	$3,367.00	—	—	20%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT HEART WO CONTRAST QUAL CALC	$781.60	$977.00	—	82% above	20%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT PRE-TAVR CALCIUM SCORE	$781.60	$977.00	—	82% above	20%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT HEART WO CONTRAST QUAL CALC	$781.60	$977.00	—	—	20%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT PRE-TAVR CALCIUM SCORE	$781.60	$977.00	—	—	20%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABDOMEN/PELVIS W/O CONTRAST	$2,314.40	$2,893.00	—	40% above	20%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABDOMEN/PELVIS W/O CONTRAST	$2,314.40	$2,893.00	—	—	20%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABDOMEN/PELVIS W/ CONTRAST	$2,662.40	$3,328.00	—	8% above	20%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABDOMEN/PELVIS W/ CONTRAST	$2,662.40	$3,328.00	—	—	20%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABDOMEN/PELVIS 1+ SECTION/REGN	$3,060.80	$3,826.00	—	5% above	20%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABDOMEN/PELVIS 1+ SECTION/REGN	$3,060.80	$3,826.00	—	—	20%
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W/ CONTRAST	$2,076.80	$2,596.00	—	28% above	20%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN W/ CONTRAST	$2,076.80	$2,596.00	—	—	20%
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/O CONTRAST	$1,805.60	$2,257.00	—	45% above	20%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN W/O CONTRAST	$1,805.60	$2,257.00	—	—	20%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT SINUS W/O CONTRAST	$1,256.80	$1,571.00	—	18% above	20%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIAL W/O CONTRAST	$1,256.80	$1,571.00	—	18% above	20%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT SINUS MEDTRONIC	$1,256.80	$1,571.00	—	18% above	20%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT SINUS W/O CONTRAST	$1,256.80	$1,571.00	—	—	20%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILLOFACIAL W/O CONTRAST	$1,256.80	$1,571.00	—	—	20%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT SINUS MEDTRONIC	$1,256.80	$1,571.00	—	—	20%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD OR BRAIN W/O CONTRAST	$1,113.60	$1,392.00	—	3% above	20%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD W/O CON CRIT ACUTE STROKE	$1,113.60	$1,392.00	—	3% above	20%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD OR BRAIN W/O CONTRAST	$1,113.60	$1,392.00	—	—	20%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD W/O CON CRIT ACUTE STROKE	$1,113.60	$1,392.00	—	—	20%
CT scan of the head with contrast CPT 70460 CT HEAD PERFUSION ONLY	$1,280.00	$1,600.00	—	1% above	20%
CT scan of the head with contrast CPT 70460 CT HEAD OR BRAIN W/ CONTRAST	$1,280.00	$1,600.00	—	1% above	20%
CT scan of the head with contrast inpatient CPT 70460 CT HEAD OR BRAIN W/ CONTRAST	$1,280.00	$1,600.00	—	—	20%
CT scan of the head with contrast inpatient CPT 70460 CT HEAD PERFUSION ONLY	$1,280.00	$1,600.00	—	—	20%
CT scan of the head without and with contrast CPT 70470 CT HEAD OR BRAIN W/ + W/O CONTRAS	$1,472.00	$1,840.00	—	3% below	20%
CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD OR BRAIN W/ + W/O CONTRAS	$1,472.00	$1,840.00	—	—	20%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT SPINE LUMBAR W/O CONTRAST	$1,300.80	$1,626.00	—	at median	20%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT SPINE LUMBAR W/O CONTRAST	$1,300.80	$1,626.00	—	—	20%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT SPINE CERVICAL W/O CONTRAST	$1,264.80	$1,581.00	—	6% below	20%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT SPINE CERVICAL W/O CONTRAST	$1,264.80	$1,581.00	—	—	20%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/ CONTRAST	$1,547.20	$1,934.00	—	3% below	20%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/ CONTRAST	$1,547.20	$1,934.00	—	—	20%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 US CAROTID DUPLEX BILATERAL	$475.20	$594.00	—	—	20%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 US CAROTID DUPLEX BILATERAL	$475.20	$594.00	—	—	20%
Chest CT scan without and with contrast CPT 71270 CT CHEST W/ + W/O CONTRAST	$1,662.40	$2,078.00	—	3% below	20%
Chest CT scan without and with contrast inpatient CPT 71270 CT CHEST W/ + W/O CONTRAST	$1,662.40	$2,078.00	—	—	20%
Chest X-ray, 2 views CPT 71046 XR CHEST 2 VIEWS PRE-OP	$232.80	$291.00	—	35% above	20%
Chest X-ray, 2 views CPT 71046 XR CHEST 2 VIEWS	$232.80	$291.00	—	35% above	20%
Chest X-ray, 2 views inpatient CPT 71046 XR CHEST 2 VIEWS	$232.80	$291.00	—	—	20%
Chest X-ray, 2 views inpatient CPT 71046 XR CHEST 2 VIEWS PRE-OP	$232.80	$291.00	—	—	20%
Chest X-ray, single view CPT 71045 XR CHEST EXPIRATION ONLY 1 VIEW	$232.80	$291.00	—	62% above	20%
Chest X-ray, single view CPT 71045 XR CHEST SPECIAL VIEWS	$232.80	$291.00	—	62% above	20%
Chest X-ray, single view CPT 71045 XR CHEST 1 VIEW ACUTE STROKE PRO	$232.80	$291.00	—	62% above	20%
Chest X-ray, single view CPT 71045 XR CHEST 1 VIEW AP FRONTAL	$232.80	$291.00	—	62% above	20%
Chest X-ray, single view CPT 71045 XR CHEST B-READ	$232.80	$291.00	—	62% above	20%
Chest X-ray, single view CPT 71045 XR CHEST 1 VIEW PRE-OP	$232.80	$291.00	—	62% above	20%
Chest X-ray, single view one side CPT 71045 XR CHEST DECUBITUS RIGHT	$232.80	$291.00	—	62% above	20%
Chest X-ray, single view one side CPT 71045 XR CHEST DECUBITUS LEFT	$232.80	$291.00	—	62% above	20%
Chest X-ray, single view inpatient CPT 71045 XR CHEST B-READ	$232.80	$291.00	—	—	20%
Chest X-ray, single view inpatient CPT 71045 XR CHEST 1 VIEW ACUTE STROKE PRO	$232.80	$291.00	—	—	20%
Chest X-ray, single view inpatient CPT 71045 XR CHEST SPECIAL VIEWS	$232.80	$291.00	—	—	20%
Chest X-ray, single view inpatient CPT 71045 XR CHEST 1 VIEW AP FRONTAL	$232.80	$291.00	—	—	20%
Chest X-ray, single view inpatient CPT 71045 XR CHEST 1 VIEW PRE-OP	$232.80	$291.00	—	—	20%
Chest X-ray, single view inpatient CPT 71045 XR CHEST EXPIRATION ONLY 1 VIEW	$232.80	$291.00	—	—	20%
Chest X-ray, single view inpatient one side CPT 71045 XR CHEST DECUBITUS RIGHT	$232.80	$291.00	—	—	20%
Chest X-ray, single view inpatient one side CPT 71045 XR CHEST DECUBITUS LEFT	$232.80	$291.00	—	—	20%
Collarbone (clavicle) X-ray, complete both sides CPT 73000 XR CLAVICLE BILATERAL	$289.60	$362.00	—	—	20%
Collarbone (clavicle) X-ray, complete one side CPT 73000 XR CLAVICLE LEFT	$186.40	$233.00	—	32% above	20%
Collarbone (clavicle) X-ray, complete one side CPT 73000 XR CLAVICLE RIGHT	$186.40	$233.00	—	32% above	20%
Collarbone (clavicle) X-ray, complete inpatient both sides CPT 73000 XR CLAVICLE BILATERAL	$289.60	$362.00	—	—	20%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 XR CLAVICLE RIGHT	$186.40	$233.00	—	—	20%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 XR CLAVICLE LEFT	$186.40	$233.00	—	—	20%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US ABDOMINAL AORTA	$485.60	$607.00	—	11% above	20%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US KIDNEY	$485.60	$607.00	—	11% above	20%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RETROPERITONEAL COMPLETE	$485.60	$607.00	—	11% above	20%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US KIDNEY	$485.60	$607.00	—	—	20%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RETROPERITONEAL COMPLETE	$485.60	$607.00	—	—	20%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US ABDOMINAL AORTA	$485.60	$607.00	—	—	20%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 BD BONE DENSITY DEXA AXIAL SKELET	$264.80	$331.00	—	4% above	20%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 BD BONE DENSITY DEXA AXIAL SKELET	$264.80	$331.00	—	—	20%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 XR TRINITY SCREENING DEXA PERIPHE	$20.00	$25.00	—	83% below	20%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 BD BONE DENSITY PERIPHERAL	$163.20	$204.00	—	41% above	20%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 XR TRINITY SCREENING DEXA PERIPHE	$20.00	$25.00	—	—	20%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 BD BONE DENSITY PERIPHERAL	$163.20	$204.00	—	—	20%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US PG COMPL W/DET SNGL	$781.60	$977.00	—	57% above	20%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US PG COMPL W/DET SNGL	$781.60	$977.00	—	—	20%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST W/O CONTRAST	$1,256.80	$1,571.00	—	3% above	20%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST W/O CON COVID CLINICAL	$1,256.80	$1,571.00	—	3% above	20%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST NODULE F/U LOW DOSE	$1,256.80	$1,571.00	—	3% above	20%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT LUNG SCREENING LOW DOSE FOLLOW	$1,256.80	$1,571.00	—	3% above	20%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST HI RES W/O CONTRAST	$1,256.80	$1,571.00	—	3% above	20%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST W/O CONTRAST	$1,256.80	$1,571.00	—	—	20%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST W/O CON COVID CLINICAL	$1,256.80	$1,571.00	—	—	20%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST NODULE F/U LOW DOSE	$1,256.80	$1,571.00	—	—	20%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT LUNG SCREENING LOW DOSE FOLLOW	$1,256.80	$1,571.00	—	—	20%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST HI RES W/O CONTRAST	$1,256.80	$1,571.00	—	—	20%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST W/ CONTRAST	$1,444.80	$1,806.00	—	3% above	20%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT CHEST W/ CONTRAST	$1,444.80	$1,806.00	—	—	20%
Diagnostic mammogram, both breasts both sides CPT 77066 MA MAMMO DIGITAL DIAG-BILAT	$416.00	$520.00	—	—	20%
Diagnostic mammogram, both breasts both sides CPT 77066 MA MAMMO POST LOC ADD VW BILAT	$416.00	$520.00	—	—	20%
Diagnostic mammogram, both breasts both sides CPT 77066 MA MAMMO DIGITAL ADD VW BILAT	$416.00	$520.00	—	—	20%
Diagnostic mammogram, both breasts CPT 77066 MA MAMMO BIL DIAG DIGITAL-MOBILE	$416.00	$520.00	—	33% below	20%
Diagnostic mammogram, both breasts CPT 77066 MA MAMMO ADDL VW BIL DIGITAL-MOBI	$416.00	$520.00	—	33% below	20%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MA MAMMO DIGITAL ADD VW BILAT	$416.00	$520.00	—	—	20%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MA MAMMO DIGITAL DIAG-BILAT	$416.00	$520.00	—	—	20%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MA MAMMO POST LOC ADD VW BILAT	$416.00	$520.00	—	—	20%
Diagnostic mammogram, both breasts inpatient CPT 77066 MA MAMMO ADDL VW BIL DIGITAL-MOBI	$416.00	$520.00	—	—	20%
Diagnostic mammogram, both breasts inpatient CPT 77066 MA MAMMO BIL DIAG DIGITAL-MOBILE	$416.00	$520.00	—	—	20%
Diagnostic mammogram, one breast CPT 77065 MA MAMMO DIGITAL ADD VW DIAG-SD	$378.40	$473.00	—	3% below	20%
Diagnostic mammogram, one breast one side CPT 77065 MA MAMMO DIGITAL DIAG-RT	$378.40	$473.00	—	3% below	20%
Diagnostic mammogram, one breast one side CPT 77065 MA MAMMO ADDL VW RT DIGITAL-MOBIL	$378.40	$473.00	—	3% below	20%
Diagnostic mammogram, one breast one side CPT 77065 MA MAMMO DIGITAL DIAG-LT	$378.40	$473.00	—	3% below	20%
Diagnostic mammogram, one breast one side CPT 77065 MA MAMMO DIGITAL ADD VW LT	$378.40	$473.00	—	3% below	20%
Diagnostic mammogram, one breast one side CPT 77065 MA MAMMO DIGITAL ADD VW RT	$378.40	$473.00	—	3% below	20%
Diagnostic mammogram, one breast one side CPT 77065 MA MAMMO POST LOC ADD VW RIGHT	$378.40	$473.00	—	3% below	20%
Diagnostic mammogram, one breast one side CPT 77065 MA MAMMO POST LOC ADD VW LEFT	$378.40	$473.00	—	3% below	20%
Diagnostic mammogram, one breast one side CPT 77065 MA MAMMO ADDL VW LT DIGITAL-MOBIL	$378.40	$473.00	—	3% below	20%
Diagnostic mammogram, one breast one side CPT 77065 MA MAMMO RT DIAG DIGITAL-MOBILE	$378.40	$473.00	—	3% below	20%
Diagnostic mammogram, one breast one side CPT 77065 MA MAMMO LT DIAG DIGITAL-MOBILE	$378.40	$473.00	—	3% below	20%
Diagnostic mammogram, one breast inpatient CPT 77065 MA MAMMO DIGITAL ADD VW DIAG-SD	$378.40	$473.00	—	—	20%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA MAMMO LT DIAG DIGITAL-MOBILE	$378.40	$473.00	—	—	20%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA MAMMO DIGITAL ADD VW RT	$378.40	$473.00	—	—	20%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA MAMMO DIGITAL ADD VW LT	$378.40	$473.00	—	—	20%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA MAMMO DIGITAL DIAG-RT	$378.40	$473.00	—	—	20%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA MAMMO POST LOC ADD VW RIGHT	$378.40	$473.00	—	—	20%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA MAMMO POST LOC ADD VW LEFT	$378.40	$473.00	—	—	20%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA MAMMO ADDL VW LT DIGITAL-MOBIL	$378.40	$473.00	—	—	20%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA MAMMO ADDL VW RT DIGITAL-MOBIL	$378.40	$473.00	—	—	20%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA MAMMO DIGITAL DIAG-LT	$378.40	$473.00	—	—	20%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA MAMMO RT DIAG DIGITAL-MOBILE	$378.40	$473.00	—	—	20%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 US LE ARTERIAL DUPLEX BILATERAL	$1,343.20	$1,679.00	—	—	20%
Duplex ultrasound of the leg arteries, both legs CPT 93925 US LE ARTERIAL DUPLEX GRAFT	$1,343.20	$1,679.00	—	56% above	20%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 US LE ARTERIAL DUPLEX BILATERAL	$1,343.20	$1,679.00	—	—	20%
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 US LE ARTERIAL DUPLEX GRAFT	$1,343.20	$1,679.00	—	—	20%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US UE VENOUS DUPLEX BILATERAL	$982.40	$1,228.00	—	—	20%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US LE VENOUS DUPLEX BILATERAL	$982.40	$1,228.00	—	—	20%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US LE VEIN MAPPING BILATERAL	$982.40	$1,228.00	—	—	20%
Duplex ultrasound of the leg veins, both legs CPT 93970 US LE VENOUS INSUFFICIENCY/REFLUX	$982.40	$1,228.00	—	32% above	20%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US LE VEIN MAPPING BILATERAL	$982.40	$1,228.00	—	—	20%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US LE VENOUS DUPLEX BILATERAL	$982.40	$1,228.00	—	—	20%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US UE VENOUS DUPLEX BILATERAL	$982.40	$1,228.00	—	—	20%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 US LE VENOUS INSUFFICIENCY/REFLUX	$982.40	$1,228.00	—	—	20%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 US ECHOCARDIOGRAM PEDIATRIC	$924.80	$1,156.00	—	20% above	20%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 US ECHOCARD/2D/M-MODE	$924.80	$1,156.00	—	20% above	20%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 US ECHOCARDIOGRAM COMPLETE	$924.80	$1,156.00	—	20% above	20%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 US ECHOCARDIOGRAM COMPLETE.	$924.80	$1,156.00	—	20% above	20%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 US ECHOCARD/2D/M-MODE	$924.80	$1,156.00	—	—	20%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 US ECHOCARDIOGRAM PEDIATRIC	$924.80	$1,156.00	—	—	20%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 US ECHOCARDIOGRAM COMPLETE	$924.80	$1,156.00	—	—	20%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 US ECHOCARDIOGRAM COMPLETE.	$924.80	$1,156.00	—	—	20%
Elbow X-ray, 2 views both sides CPT 73070 XR ELBOW 1 VIEW BILATERAL	$289.60	$362.00	—	—	20%
Elbow X-ray, 2 views both sides CPT 73070 XR ELBOW 2 VIEWS BILATERAL	$289.60	$362.00	—	—	20%
Elbow X-ray, 2 views one side CPT 73070 XR ELBOW 1 VIEW LEFT	$186.40	$233.00	—	36% above	20%
Elbow X-ray, 2 views one side CPT 73070 XR ELBOW 2 VIEWS LEFT	$186.40	$233.00	—	36% above	20%
Elbow X-ray, 2 views one side CPT 73070 XR ELBOW 1 VIEW RIGHT	$186.40	$233.00	—	36% above	20%
Elbow X-ray, 2 views one side CPT 73070 XR ELBOW 2 VIEWS RIGHT	$186.40	$233.00	—	36% above	20%
Elbow X-ray, 2 views inpatient both sides CPT 73070 XR ELBOW 1 VIEW BILATERAL	$289.60	$362.00	—	—	20%
Elbow X-ray, 2 views inpatient both sides CPT 73070 XR ELBOW 2 VIEWS BILATERAL	$289.60	$362.00	—	—	20%
Elbow X-ray, 2 views inpatient one side CPT 73070 XR ELBOW 1 VIEW RIGHT	$186.40	$233.00	—	—	20%
Elbow X-ray, 2 views inpatient one side CPT 73070 XR ELBOW 2 VIEWS LEFT	$186.40	$233.00	—	—	20%
Elbow X-ray, 2 views inpatient one side CPT 73070 XR ELBOW 1 VIEW LEFT	$186.40	$233.00	—	—	20%
Elbow X-ray, 2 views inpatient one side CPT 73070 XR ELBOW 2 VIEWS RIGHT	$186.40	$233.00	—	—	20%
Elbow X-ray, complete, 3 or more views both sides CPT 73080 XR ELBOW 3 VWS COMPLETE BILATERAL	$312.00	$390.00	—	—	20%
Elbow X-ray, complete, 3 or more views one side CPT 73080 XR ELBOW 3 VWS COMPLETE LEFT	$204.80	$256.00	—	26% above	20%
Elbow X-ray, complete, 3 or more views one side CPT 73080 XR ELBOW 3 VWS COMPLETE RIGHT	$204.80	$256.00	—	26% above	20%
Elbow X-ray, complete, 3 or more views inpatient both sides CPT 73080 XR ELBOW 3 VWS COMPLETE BILATERAL	$312.00	$390.00	—	—	20%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 XR ELBOW 3 VWS COMPLETE LEFT	$204.80	$256.00	—	—	20%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 XR ELBOW 3 VWS COMPLETE RIGHT	$204.80	$256.00	—	—	20%
Eye socket (orbit) CT scan without contrast CPT 70480 CT ORBIT SELLA ETC. W/O CONTRAST	$1,378.40	$1,723.00	—	at median	20%
Eye socket (orbit) CT scan without contrast CPT 70480 CT TEMPORAL BONE W/O CONTRAST	$1,378.40	$1,723.00	—	at median	20%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT ORBIT SELLA ETC. W/O CONTRAST	$1,378.40	$1,723.00	—	—	20%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT TEMPORAL BONE W/O CONTRAST	$1,378.40	$1,723.00	—	—	20%
Facial bones X-ray, complete, 3 or more views CPT 70150 XR FACIAL BONES MINIMUM 3 VIEWS	$264.80	$331.00	—	36% above	20%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 XR FACIAL BONES MINIMUM 3 VIEWS	$264.80	$331.00	—	—	20%
Forearm X-ray (radius and ulna), 2 views both sides CPT 73090 XR FOREARM 1 VIEW BILATERAL	$289.60	$362.00	—	—	20%
Forearm X-ray (radius and ulna), 2 views both sides CPT 73090 XR FOREARM 2 VIEWS BILATERAL	$289.60	$362.00	—	—	20%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 XR FOREARM 2 VIEWS RIGHT	$186.40	$233.00	—	27% above	20%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 XR FOREARM 1 VIEW LEFT	$186.40	$233.00	—	27% above	20%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 XR FOREARM 1 VIEW RIGHT	$186.40	$233.00	—	27% above	20%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 XR FOREARM 2 VIEWS LEFT	$186.40	$233.00	—	27% above	20%
Forearm X-ray (radius and ulna), 2 views inpatient both sides CPT 73090 XR FOREARM 2 VIEWS BILATERAL	$289.60	$362.00	—	—	20%
Forearm X-ray (radius and ulna), 2 views inpatient both sides CPT 73090 XR FOREARM 1 VIEW BILATERAL	$289.60	$362.00	—	—	20%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 XR FOREARM 2 VIEWS RIGHT	$186.40	$233.00	—	—	20%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 XR FOREARM 1 VIEW RIGHT	$186.40	$233.00	—	—	20%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 XR FOREARM 2 VIEWS LEFT	$186.40	$233.00	—	—	20%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 XR FOREARM 1 VIEW LEFT	$186.40	$233.00	—	—	20%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM HEPATOBILIARY DUCT IMAGING	$566.40	$708.00	—	52% below	20%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM HEPATOBILIARY DUCT IMAGING	$566.40	$708.00	—	—	20%
Hand X-ray, 2 views both sides CPT 73120 XR HAND 1 VIEW BILATERAL	$372.80	$466.00	—	—	20%
Hand X-ray, 2 views both sides CPT 73120 XR HAND 2 VIEWS BILATERAL	$372.80	$466.00	—	—	20%
Hand X-ray, 2 views one side CPT 73120 XR HAND 2 VIEWS LEFT	$186.40	$233.00	—	32% above	20%
Hand X-ray, 2 views one side CPT 73120 XR HAND 1 VIEW RIGHT	$186.40	$233.00	—	32% above	20%
Hand X-ray, 2 views one side CPT 73120 XR HAND 2 VIEWS RIGHT	$186.40	$233.00	—	32% above	20%
Hand X-ray, 2 views one side CPT 73120 XR HAND 1 VIEW LEFT	$186.40	$233.00	—	32% above	20%
Hand X-ray, 2 views inpatient both sides CPT 73120 XR HAND 2 VIEWS BILATERAL	$372.80	$466.00	—	—	20%
Hand X-ray, 2 views inpatient both sides CPT 73120 XR HAND 1 VIEW BILATERAL	$372.80	$466.00	—	—	20%
Hand X-ray, 2 views inpatient one side CPT 73120 XR HAND 2 VIEWS RIGHT	$186.40	$233.00	—	—	20%
Hand X-ray, 2 views inpatient one side CPT 73120 XR HAND 1 VIEW RIGHT	$186.40	$233.00	—	—	20%
Hand X-ray, 2 views inpatient one side CPT 73120 XR HAND 2 VIEWS LEFT	$186.40	$233.00	—	—	20%
Hand X-ray, 2 views inpatient one side CPT 73120 XR HAND 1 VIEW LEFT	$186.40	$233.00	—	—	20%
Heel bone (calcaneus) X-ray, 2 or more views both sides CPT 73650 XR CALCANEOUS BILATERAL	$289.60	$362.00	—	—	20%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 XR CALCANEOUS MIN 2VW RT	$186.40	$233.00	—	29% above	20%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 XR CALCANEOUS MIN 2VW LT	$186.40	$233.00	—	29% above	20%
Heel bone (calcaneus) X-ray, 2 or more views inpatient both sides CPT 73650 XR CALCANEOUS BILATERAL	$289.60	$362.00	—	—	20%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 XR CALCANEOUS MIN 2VW RT	$186.40	$233.00	—	—	20%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 XR CALCANEOUS MIN 2VW LT	$186.40	$233.00	—	—	20%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 SLEEP STUDY UNATT&RESP EFFT	$316.80	$396.00	—	10% below	20%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 SLEEP STUDY UNATT&RESP EFFT	$316.80	$396.00	—	—	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 POLYSOMNOGRAPHY-CPAP STUDY (52)	$2,240.00	$2,800.00	—	8% below	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 POLYSOMNOGRAPHY-SPLIT NIGHT STUD	$2,240.00	$2,800.00	—	8% below	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 POLYSOMNOGRAPHY-CPAP STUDY	$2,240.00	$2,800.00	—	8% below	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 POLYSOMNOGRAPHY-CPAP STUDY	$2,240.00	$2,800.00	—	—	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 POLYSOMNOGRAPHY-SPLIT NIGHT STUD	$2,240.00	$2,800.00	—	—	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 POLYSOMNOGRAPHY-CPAP STUDY (52)	$2,240.00	$2,800.00	—	—	20%
Knee X-ray, 3 views both sides CPT 73562 XR KNEE 3 VWS W/AP STANDING BILAT	$204.80	$256.00	—	—	20%
Knee X-ray, 3 views both sides CPT 73562 XR KNEE 3 VIEWS BILATERAL	$289.60	$362.00	—	—	20%
Knee X-ray, 3 views one side CPT 73562 XR KNEE 3 VWS W/AP STANDING RIGHT	$204.80	$256.00	—	11% above	20%
Knee X-ray, 3 views one side CPT 73562 XR KNEE 3 VWS W/AP STANDING LEFT	$204.80	$256.00	—	11% above	20%
Knee X-ray, 3 views one side CPT 73562 XR KNEE 3 VIEWS LEFT	$204.80	$256.00	—	11% above	20%
Knee X-ray, 3 views one side CPT 73562 XR KNEE 3 VIEWS RIGHT	$204.80	$256.00	—	11% above	20%
Knee X-ray, 3 views inpatient both sides CPT 73562 XR KNEE 3 VWS W/AP STANDING BILAT	$204.80	$256.00	—	—	20%
Knee X-ray, 3 views inpatient both sides CPT 73562 XR KNEE 3 VIEWS BILATERAL	$289.60	$362.00	—	—	20%
Knee X-ray, 3 views inpatient one side CPT 73562 XR KNEE 3 VIEWS LEFT	$204.80	$256.00	—	—	20%
Knee X-ray, 3 views inpatient one side CPT 73562 XR KNEE 3 VWS W/AP STANDING RIGHT	$204.80	$256.00	—	—	20%
Knee X-ray, 3 views inpatient one side CPT 73562 XR KNEE 3 VWS W/AP STANDING LEFT	$204.80	$256.00	—	—	20%
Knee X-ray, 3 views inpatient one side CPT 73562 XR KNEE 3 VIEWS RIGHT	$204.80	$256.00	—	—	20%
Knee X-ray, complete, 4 or more views both sides CPT 73564 XR KNEE 4 VWS W/AP STANDING BILAT	$529.60	$662.00	—	—	20%
Knee X-ray, complete, 4 or more views both sides CPT 73564 XR KNEE COMP 4 OR MORE VWS BILAT	$529.60	$662.00	—	—	20%
Knee X-ray, complete, 4 or more views one side CPT 73564 XR KNEE 4 VWS W/AP STANDING LEFT	$264.80	$331.00	—	36% above	20%
Knee X-ray, complete, 4 or more views one side CPT 73564 XR KNEE COMP 4 OR MORE VWS RIGHT	$264.80	$331.00	—	36% above	20%
Knee X-ray, complete, 4 or more views one side CPT 73564 XR KNEE COMP 4 OR MORE VWS LEFT	$264.80	$331.00	—	36% above	20%
Knee X-ray, complete, 4 or more views one side CPT 73564 XR KNEE 4 VWS W/AP STANDING RIGHT	$264.80	$331.00	—	36% above	20%
Knee X-ray, complete, 4 or more views inpatient both sides CPT 73564 XR KNEE 4 VWS W/AP STANDING BILAT	$529.60	$662.00	—	—	20%
Knee X-ray, complete, 4 or more views inpatient both sides CPT 73564 XR KNEE COMP 4 OR MORE VWS BILAT	$529.60	$662.00	—	—	20%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 XR KNEE 4 VWS W/AP STANDING RIGHT	$264.80	$331.00	—	—	20%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 XR KNEE COMP 4 OR MORE VWS LEFT	$264.80	$331.00	—	—	20%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 XR KNEE COMP 4 OR MORE VWS RIGHT	$264.80	$331.00	—	—	20%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 XR KNEE 4 VWS W/AP STANDING LEFT	$264.80	$331.00	—	—	20%
Leg CT scan without contrast (hip to foot, any part) both sides CPT 73700 CT FEMUR W/O CONTRAST BILATERAL	$2,520.00	$3,150.00	—	—	20%
Leg CT scan without contrast (hip to foot, any part) both sides CPT 73700 CT FOOT W/O CONTRAST BILATERAL	$2,520.00	$3,150.00	—	—	20%
Leg CT scan without contrast (hip to foot, any part) both sides CPT 73700 CT KNEE W/O CONTRAST BILATERAL	$2,520.00	$3,150.00	—	—	20%
Leg CT scan without contrast (hip to foot, any part) both sides CPT 73700 CT ANKLE W/O CONTRAST BILATERAL	$2,520.00	$3,150.00	—	—	20%
Leg CT scan without contrast (hip to foot, any part) both sides CPT 73700 CT HIP W/O CONTRAST BILATERAL	$2,520.00	$3,150.00	—	—	20%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT TIBIA/FIBULA W/O CONTRAST RIGH	$1,260.00	$1,575.00	—	4% above	20%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT LOWER EXTREMITY W/O CONTRAST L	$1,260.00	$1,575.00	—	4% above	20%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT LOWER EXTREMITY W/O CONTRAST R	$1,260.00	$1,575.00	—	4% above	20%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT TIBIA/FIBULA W/O CONTRAST BILA	$2,520.00	$3,150.00	—	108% above	20%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT LOWER EXTREMITY W/O CONTRAST B	$2,520.00	$3,150.00	—	108% above	20%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT ANKLE LEFT GUIDANCE FOR OR	$1,260.00	$1,575.00	—	4% above	20%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT HIP W/O CONTRAST RIGHT	$1,260.00	$1,575.00	—	4% above	20%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT HIP W/O CONTRAST LEFT	$1,260.00	$1,575.00	—	4% above	20%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT TIBIA/FIBULA W/O CONTRAST LEFT	$1,260.00	$1,575.00	—	4% above	20%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT KNEE W/O CONTRAST RIGHT	$1,260.00	$1,575.00	—	4% above	20%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT KNEE W/O CONTRAST LEFT	$1,260.00	$1,575.00	—	4% above	20%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT ANKLE W/O CONTRAST LEFT	$1,260.00	$1,575.00	—	4% above	20%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT ANKLE W/O CONTRAST RIGHT	$1,260.00	$1,575.00	—	4% above	20%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT FEMUR W/O CONTRAST LEFT	$1,260.00	$1,575.00	—	4% above	20%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT FEMUR W/O CONTRAST RIGHT	$1,260.00	$1,575.00	—	4% above	20%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT FOOT W/O CONTRAST LEFT	$1,260.00	$1,575.00	—	4% above	20%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT FOOT W/O CONTRAST RIGHT	$1,260.00	$1,575.00	—	4% above	20%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT ANKLE RIGHT GUIDANCE FOR OR	$1,260.00	$1,575.00	—	4% above	20%
Leg CT scan without contrast (hip to foot, any part) inpatient both sides CPT 73700 CT KNEE W/O CONTRAST BILATERAL	$2,520.00	$3,150.00	—	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient both sides CPT 73700 CT FEMUR W/O CONTRAST BILATERAL	$2,520.00	$3,150.00	—	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient both sides CPT 73700 CT HIP W/O CONTRAST BILATERAL	$2,520.00	$3,150.00	—	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient both sides CPT 73700 CT ANKLE W/O CONTRAST BILATERAL	$2,520.00	$3,150.00	—	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient both sides CPT 73700 CT FOOT W/O CONTRAST BILATERAL	$2,520.00	$3,150.00	—	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 CT LOWER EXTREMITY W/O CONTRAST L	$1,260.00	$1,575.00	—	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 CT LOWER EXTREMITY W/O CONTRAST R	$1,260.00	$1,575.00	—	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 CT TIBIA/FIBULA W/O CONTRAST RIGH	$1,260.00	$1,575.00	—	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 CT LOWER EXTREMITY W/O CONTRAST B	$2,520.00	$3,150.00	—	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 CT TIBIA/FIBULA W/O CONTRAST BILA	$2,520.00	$3,150.00	—	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT KNEE W/O CONTRAST LEFT	$1,260.00	$1,575.00	—	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT FOOT W/O CONTRAST RIGHT	$1,260.00	$1,575.00	—	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT ANKLE LEFT GUIDANCE FOR OR	$1,260.00	$1,575.00	—	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT ANKLE W/O CONTRAST LEFT	$1,260.00	$1,575.00	—	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT FOOT W/O CONTRAST LEFT	$1,260.00	$1,575.00	—	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT ANKLE W/O CONTRAST RIGHT	$1,260.00	$1,575.00	—	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT HIP W/O CONTRAST LEFT	$1,260.00	$1,575.00	—	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT ANKLE RIGHT GUIDANCE FOR OR	$1,260.00	$1,575.00	—	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT FEMUR W/O CONTRAST LEFT	$1,260.00	$1,575.00	—	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT FEMUR W/O CONTRAST RIGHT	$1,260.00	$1,575.00	—	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT TIBIA/FIBULA W/O CONTRAST LEFT	$1,260.00	$1,575.00	—	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT KNEE W/O CONTRAST RIGHT	$1,260.00	$1,575.00	—	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT HIP W/O CONTRAST RIGHT	$1,260.00	$1,575.00	—	—	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMEN RUQ	$453.60	$567.00	—	17% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US GALLBLADDER	$453.60	$567.00	—	17% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ETC ABDOMEN LIMITED	$453.60	$567.00	—	17% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US PYLORIC VALVE	$453.60	$567.00	—	17% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US LIVER	$453.60	$567.00	—	17% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMEN LIMITED	$453.60	$567.00	—	17% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US SPLEEN	$453.60	$567.00	—	17% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US PANCREAS	$453.60	$567.00	—	17% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US PYLORIC VALVE	$453.60	$567.00	—	—	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US GALLBLADDER	$453.60	$567.00	—	—	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US LIVER	$453.60	$567.00	—	—	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US PANCREAS	$453.60	$567.00	—	—	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US SPLEEN	$453.60	$567.00	—	—	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMEN RUQ	$453.60	$567.00	—	—	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 ETC ABDOMEN LIMITED	$453.60	$567.00	—	—	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMEN LIMITED	$453.60	$567.00	—	—	20%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US EXTREMITY NON-VASCULAR	$453.60	$567.00	—	87% above	20%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 ETC EXTREMITY NON-VASCULAR	$453.60	$567.00	—	87% above	20%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US SUPERFICIAL AREA	$453.60	$567.00	—	87% above	20%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US SUPERFICIAL AREA	$453.60	$567.00	—	—	20%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 ETC EXTREMITY NON-VASCULAR	$453.60	$567.00	—	—	20%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US EXTREMITY NON-VASCULAR	$453.60	$567.00	—	—	20%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT LUNG SCREENING LOW DOSE INITIA	$1,018.40	$1,273.00	—	36% above	20%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT LUNG SCREENING LOW DOSE YEARLY	$1,018.40	$1,273.00	—	36% above	20%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT LUNG SCREENING LOW DOSE INITIA	$1,018.40	$1,273.00	—	—	20%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT LUNG SCREENING LOW DOSE YEARLY	$1,018.40	$1,273.00	—	—	20%
Lower leg X-ray (tibia and fibula), 2 views both sides CPT 73590 XR TIBIA/FIBULA BILATERAL	$289.60	$362.00	—	—	20%
Lower leg X-ray (tibia and fibula), 2 views both sides CPT 73590 XR TIBIA/FIBULA 1 VIEW BILATERAL	$289.60	$362.00	—	—	20%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 XR TIBIA/FIBULA 1 VIEW LEFT	$186.40	$233.00	—	18% above	20%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 XR TIBIA/FIBULA 2 VIEWS LEFT	$186.40	$233.00	—	18% above	20%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 XR TIBIA/FIBULA 1 VIEW RIGHT	$186.40	$233.00	—	18% above	20%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 XR TIBIA/FIBULA 2 VIEWS RIGHT	$186.40	$233.00	—	18% above	20%
Lower leg X-ray (tibia and fibula), 2 views inpatient both sides CPT 73590 XR TIBIA/FIBULA 1 VIEW BILATERAL	$289.60	$362.00	—	—	20%
Lower leg X-ray (tibia and fibula), 2 views inpatient both sides CPT 73590 XR TIBIA/FIBULA BILATERAL	$289.60	$362.00	—	—	20%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 XR TIBIA/FIBULA 1 VIEW LEFT	$186.40	$233.00	—	—	20%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 XR TIBIA/FIBULA 2 VIEWS RIGHT	$186.40	$233.00	—	—	20%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 XR TIBIA/FIBULA 2 VIEWS LEFT	$186.40	$233.00	—	—	20%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 XR TIBIA/FIBULA 1 VIEW RIGHT	$186.40	$233.00	—	—	20%
MR angiography (MRA) of the head without contrast CPT 70544 MRV HEAD W/O CONTRAST	$1,584.00	$1,980.00	—	28% below	20%
MR angiography (MRA) of the head without contrast CPT 70544 MRA HEAD W/O CONTRAST 2	$1,584.00	$1,980.00	—	28% below	20%
MR angiography (MRA) of the head without contrast CPT 70544 MRA HEAD W/O CONTRAST W/DIFFUSION	$1,584.00	$1,980.00	—	28% below	20%
MR angiography (MRA) of the head without contrast CPT 70544 MRA HEAD W/O CONTRAST	$1,584.00	$1,980.00	—	28% below	20%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRV HEAD W/O CONTRAST	$1,584.00	$1,980.00	—	—	20%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRA HEAD W/O CONTRAST	$1,584.00	$1,980.00	—	—	20%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRA HEAD W/O CONTRAST W/DIFFUSION	$1,584.00	$1,980.00	—	—	20%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRA HEAD W/O CONTRAST 2	$1,584.00	$1,980.00	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 MRI ANKLE W/O CONTRAST BILATERAL	$3,864.80	$4,831.00	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 MRI HIP W/O CONTRAST BILATERAL	$3,864.80	$4,831.00	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 MRI KNEE W/O CONTRAST BILATERAL	$3,864.80	$4,831.00	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI LE JOINT W/O CONTRAST BILATER	$3,864.80	$4,831.00	—	100% above	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LE JOINT W/O CONTRAST RIGHT	$1,932.80	$2,416.00	—	at median	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI ANKLE W/O CONTRAST RIGHT	$1,932.80	$2,416.00	—	at median	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP W/O CONTRAST LEFT	$1,932.80	$2,416.00	—	at median	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP W/O CONTRAST RIGHT	$1,932.80	$2,416.00	—	at median	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE W/O CONTRAST LEFT	$1,932.80	$2,416.00	—	at median	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE W/O CONTRAST RIGHT	$1,932.80	$2,416.00	—	at median	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LE JOINT W/O CONTRAST LEFT	$1,932.80	$2,416.00	—	at median	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI ANKLE W/O CONTRAST LEFT	$1,932.80	$2,416.00	—	at median	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient both sides CPT 73721 MRI KNEE W/O CONTRAST BILATERAL	$3,864.80	$4,831.00	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient both sides CPT 73721 MRI HIP W/O CONTRAST BILATERAL	$3,864.80	$4,831.00	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient both sides CPT 73721 MRI ANKLE W/O CONTRAST BILATERAL	$3,864.80	$4,831.00	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI LE JOINT W/O CONTRAST BILATER	$3,864.80	$4,831.00	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI HIP W/O CONTRAST RIGHT	$1,932.80	$2,416.00	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI ANKLE W/O CONTRAST LEFT	$1,932.80	$2,416.00	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI KNEE W/O CONTRAST RIGHT	$1,932.80	$2,416.00	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI HIP W/O CONTRAST LEFT	$1,932.80	$2,416.00	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI ANKLE W/O CONTRAST RIGHT	$1,932.80	$2,416.00	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI LE JOINT W/O CONTRAST LEFT	$1,932.80	$2,416.00	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI LE JOINT W/O CONTRAST RIGHT	$1,932.80	$2,416.00	—	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI KNEE W/O CONTRAST LEFT	$1,932.80	$2,416.00	—	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye both sides CPT 73723 MRI LE JOINT W/ + W/O CONTRAST BI	$5,357.60	$6,697.00	—	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye both sides CPT 73723 MRI ANKLE W/ + W/O CONTRAST BILAT	$5,357.60	$6,697.00	—	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI LE JOINT W/ + W/O CONTRAST RI	$2,680.80	$3,351.00	—	14% below	20%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI LE JOINT W/ + W/O CONTRAST LE	$2,680.80	$3,351.00	—	14% below	20%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI HIP W/ + W/O CONTRAST BILATER	$5,357.60	$6,697.00	—	71% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI KNEE W/ + W/O CONTRAST BILATE	$5,357.60	$6,697.00	—	71% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI ANKLE W/ + W/O CONTRAST RIGHT	$2,680.80	$3,351.00	—	14% below	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI KNEE W/ + W/O CONTRAST RIGHT	$2,680.80	$3,351.00	—	14% below	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI ANKLE W/ + W/O CONTRAST LEFT	$2,680.80	$3,351.00	—	14% below	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI HIP W/ + W/O CONTRAST LEFT	$2,680.80	$3,351.00	—	14% below	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI HIP W/ + W/O CONTRAST RIGHT	$2,680.80	$3,351.00	—	14% below	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI KNEE W/ + W/O CONTRAST LEFT	$2,680.80	$3,351.00	—	14% below	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient both sides CPT 73723 MRI ANKLE W/ + W/O CONTRAST BILAT	$5,357.60	$6,697.00	—	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient both sides CPT 73723 MRI LE JOINT W/ + W/O CONTRAST BI	$5,357.60	$6,697.00	—	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI LE JOINT W/ + W/O CONTRAST LE	$2,680.80	$3,351.00	—	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI LE JOINT W/ + W/O CONTRAST RI	$2,680.80	$3,351.00	—	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI KNEE W/ + W/O CONTRAST BILATE	$5,357.60	$6,697.00	—	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI HIP W/ + W/O CONTRAST BILATER	$5,357.60	$6,697.00	—	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI ANKLE W/ + W/O CONTRAST RIGHT	$2,680.80	$3,351.00	—	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI HIP W/ + W/O CONTRAST RIGHT	$2,680.80	$3,351.00	—	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI HIP W/ + W/O CONTRAST LEFT	$2,680.80	$3,351.00	—	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI KNEE W/ + W/O CONTRAST LEFT	$2,680.80	$3,351.00	—	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI ANKLE W/ + W/O CONTRAST LEFT	$2,680.80	$3,351.00	—	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI KNEE W/ + W/O CONTRAST RIGHT	$2,680.80	$3,351.00	—	—	20%
MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN W/O CONTRAST	$1,932.80	$2,416.00	—	at median	20%
MRI of the abdomen without contrast CPT 74181 MRI CHOLANGIOPANCREATOGRAM (MRCP)	$1,932.80	$2,416.00	—	at median	20%
MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN W/O CONTRAST	$1,932.80	$2,416.00	—	—	20%
MRI of the abdomen without contrast inpatient CPT 74181 MRI CHOLANGIOPANCREATOGRAM (MRCP)	$1,932.80	$2,416.00	—	—	20%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN W/ + W/O CONTRAST	$3,221.60	$4,027.00	—	at median	20%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABDOMEN W/ + W/O CONTRAST	$3,221.60	$4,027.00	—	—	20%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O CONTRAST	$1,064.80	$1,331.00	—	39% below	20%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN DIFFUSION IMAGING LTD W	$1,064.80	$1,331.00	—	39% below	20%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN - DIFFUSION IMAGING	$1,064.80	$1,331.00	—	39% below	20%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN DIFFUSION IMAGING LTD W	$1,064.80	$1,331.00	—	—	20%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN - DIFFUSION IMAGING	$1,064.80	$1,331.00	—	—	20%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN W/O CONTRAST	$1,064.80	$1,331.00	—	—	20%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W/ + W/O CONTRAST	$3,221.60	$4,027.00	—	7% above	20%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN W/ + W/O CONTRAST	$3,221.60	$4,027.00	—	—	20%
MRI of the lower back, no contrast dye CPT 72148 MRI SPINE LUMBAR W/O CONTRAST	$2,440.00	$3,050.00	—	26% above	20%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI SPINE LUMBAR W/O CONTRAST	$2,440.00	$3,050.00	—	—	20%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI SPINE LUMBAR W/ + W/O CONTRAS	$3,608.00	$4,510.00	—	16% above	20%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI SPINE LUMBAR W/ + W/O CONTRAS	$3,608.00	$4,510.00	—	—	20%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI SPINE THORACIC W/O CONTRAST	$2,440.00	$3,050.00	—	18% above	20%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI SPINE THORACIC W/O CONTRAST	$2,440.00	$3,050.00	—	—	20%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI SPINE CERVICAL W/ + W/O CONTR	$3,608.00	$4,510.00	—	17% above	20%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI SPINE CERVICAL W/ + W/O CONTR	$3,608.00	$4,510.00	—	—	20%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI SPINE CERVICAL W/O CONTRAST	$2,440.00	$3,050.00	—	27% above	20%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI SPINE CERVICAL W/O CONTRAST	$2,440.00	$3,050.00	—	—	20%
MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS W/ + W/O CONTRAST	$3,221.60	$4,027.00	—	5% above	20%
MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS PROSTATE W+W/O CONTRAS	$3,221.60	$4,027.00	—	5% above	20%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS W/ + W/O CONTRAST	$3,221.60	$4,027.00	—	—	20%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS PROSTATE W+W/O CONTRAS	$3,221.60	$4,027.00	—	—	20%
MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS W/O CONTRAST	$2,440.00	$3,050.00	—	10% above	20%
MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS DYNAMIC W/O CONTRAST	$2,440.00	$3,050.00	—	10% above	20%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS W/O CONTRAST	$2,440.00	$3,050.00	—	—	20%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS DYNAMIC W/O CONTRAST	$2,440.00	$3,050.00	—	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye both sides CPT 73221 MRI ELBOW W/O CONTRAST BILATERAL	$3,864.80	$4,831.00	—	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye both sides CPT 73221 MRI WRIST W/O CONTRAST BILATERAL	$3,864.80	$4,831.00	—	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI SHOULDER W/O CONTRAST BILATER	$3,864.80	$4,831.00	—	100% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI UE JOINT W/O CONTRAST BILATER	$3,864.80	$4,831.00	—	100% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI UE JOINT W/O CONTRAST RIGHT	$1,932.80	$2,416.00	—	at median	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI WRIST W/O CONTRAST LEFT	$1,932.80	$2,416.00	—	at median	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI SHOULDER W/O CONTRAST LEFT	$1,932.80	$2,416.00	—	at median	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI SHOULDER W/O CONTRAST RIGHT	$1,932.80	$2,416.00	—	at median	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI UE JOINT W/O CONTRAST LEFT	$1,932.80	$2,416.00	—	at median	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI ELBOW W/O CONTRAST RIGHT	$1,932.80	$2,416.00	—	at median	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI WRIST W/O CONTRAST RIGHT	$1,932.80	$2,416.00	—	at median	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI ELBOW W/O CONTRAST LEFT	$1,932.80	$2,416.00	—	at median	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient both sides CPT 73221 MRI ELBOW W/O CONTRAST BILATERAL	$3,864.80	$4,831.00	—	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient both sides CPT 73221 MRI WRIST W/O CONTRAST BILATERAL	$3,864.80	$4,831.00	—	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MRI UE JOINT W/O CONTRAST BILATER	$3,864.80	$4,831.00	—	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MRI SHOULDER W/O CONTRAST BILATER	$3,864.80	$4,831.00	—	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI SHOULDER W/O CONTRAST RIGHT	$1,932.80	$2,416.00	—	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI UE JOINT W/O CONTRAST LEFT	$1,932.80	$2,416.00	—	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI ELBOW W/O CONTRAST RIGHT	$1,932.80	$2,416.00	—	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI UE JOINT W/O CONTRAST RIGHT	$1,932.80	$2,416.00	—	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI WRIST W/O CONTRAST LEFT	$1,932.80	$2,416.00	—	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI WRIST W/O CONTRAST RIGHT	$1,932.80	$2,416.00	—	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI ELBOW W/O CONTRAST LEFT	$1,932.80	$2,416.00	—	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI SHOULDER W/O CONTRAST LEFT	$1,932.80	$2,416.00	—	—	20%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 XR SPINE CERVICAL MINIMUM 4 VIEWS	$264.80	$331.00	—	17% above	20%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 XR SPINE CERVICAL MINIMUM 4 VIEWS	$264.80	$331.00	—	—	20%
Neck soft tissue CT scan with contrast CPT 70491 CT SOFT TISSUE NECK W/ CONTRAST	$1,444.80	$1,806.00	—	1% above	20%
Neck soft tissue CT scan with contrast inpatient CPT 70491 CT SOFT TISSUE NECK W/ CONTRAST	$1,444.80	$1,806.00	—	—	20%
Neck soft tissue CT scan without contrast CPT 70490 CT SOFT TISSUE NECK W/O CONTRAST.	$1,256.80	$1,571.00	—	2% above	20%
Neck soft tissue CT scan without contrast CPT 70490 CT SOFT TISSUE NECK W/O CONTRAST	$1,256.80	$1,571.00	—	2% above	20%
Neck soft tissue CT scan without contrast inpatient CPT 70490 CT SOFT TISSUE NECK W/O CONTRAST	$1,256.80	$1,571.00	—	—	20%
Neck soft tissue CT scan without contrast inpatient CPT 70490 CT SOFT TISSUE NECK W/O CONTRAST.	$1,256.80	$1,571.00	—	—	20%
Neck soft tissue X-ray CPT 70360 XR NECK SOFT TISSUE	$176.80	$221.00	—	21% above	20%
Neck soft tissue X-ray CPT 70360 XR NECK SOFT TISSUE ADENOID PROTO	$176.80	$221.00	—	21% above	20%
Neck soft tissue X-ray inpatient CPT 70360 XR NECK SOFT TISSUE	$176.80	$221.00	—	—	20%
Neck soft tissue X-ray inpatient CPT 70360 XR NECK SOFT TISSUE ADENOID PROTO	$176.80	$221.00	—	—	20%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM MYOCARDIAL SPECT MULTI REST/ST	$1,950.40	$2,438.00	—	11% below	20%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM MYOCARDIAL SPECT MULTI REST/ST	$1,950.40	$2,438.00	—	—	20%
OCT scan of the retina (optical coherence tomography) CPT 92134 CPTR OPHTH DX IMG POST SEGMT	$83.20	$104.00	—	21% above	20%
OCT scan of the retina (optical coherence tomography) inpatient CPT 92134 CPTR OPHTH DX IMG POST SEGMT	$83.20	$104.00	—	—	20%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET/CT SKULL-THIGH SUBSEQUENT	$2,374.40	$2,968.00	—	40% below	20%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET/CT SKULL-THIGH	$2,374.40	$2,968.00	—	40% below	20%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET/CT SKULL-THIGH SUBSEQUENT	$2,374.40	$2,968.00	—	—	20%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET/CT SKULL-THIGH	$2,374.40	$2,968.00	—	—	20%
Pelvic CT scan without contrast CPT 72192 CT PELVIS W/O CONTRAST	$1,345.60	$1,682.00	—	9% above	20%
Pelvic CT scan without contrast inpatient CPT 72192 CT PELVIS W/O CONTRAST	$1,345.60	$1,682.00	—	—	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIS NON-OB LIMITED W OR W/O	$453.60	$567.00	—	38% above	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US BLADDER W/MEASUREMENT	$453.60	$567.00	—	38% above	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 ETC PELVIS LIMITED	$453.60	$567.00	—	38% above	20%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US BLADDER W/MEASUREMENT	$453.60	$567.00	—	—	20%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 ETC PELVIS LIMITED	$453.60	$567.00	—	—	20%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIS NON-OB LIMITED W OR W/O	$453.60	$567.00	—	—	20%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIS NON-OB COMPLETE	$479.20	$599.00	—	6% above	20%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIS CRITICAL(TORSION)	$479.20	$599.00	—	6% above	20%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIS CRITICAL(TORSION)	$479.20	$599.00	—	—	20%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIS NON-OB COMPLETE	$479.20	$599.00	—	—	20%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US FETAL DEATH	$580.00	$725.00	—	14% above	20%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US PG >1ST TRIM SNGL	$580.00	$725.00	—	14% above	20%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US PG >1ST TRIM SNGL	$580.00	$725.00	—	—	20%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US FETAL DEATH	$580.00	$725.00	—	—	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US PREGNANCY 1ST TRIMESTER	$476.00	$595.00	—	18% above	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US PREGNANCY 1ST TRIMESTER	$476.00	$595.00	—	—	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US PREGNANCY LIMITED SGL W OR W/O	$453.60	$567.00	—	41% above	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US PREGNANCY LIMITED TWIN W OR W/	$1,104.00	$1,380.00	—	243% above	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US PREG LMT TWIN W/TV W OR W/O D	$1,104.00	$1,380.00	—	243% above	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US PREGNANCY LIMITED SGL W OR W/O	$453.60	$567.00	—	—	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US PREGNANCY LIMITED TWIN W OR W/	$1,104.00	$1,380.00	—	—	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US PREG LMT TWIN W/TV W OR W/O D	$1,104.00	$1,380.00	—	—	20%
Rib X-ray, one side, 2 views one side CPT 71100 XR RIBS ROUTINE LEFT	$186.40	$233.00	—	9% above	20%
Rib X-ray, one side, 2 views one side CPT 71100 XR RIBS ROUTINE RIGHT	$186.40	$233.00	—	9% above	20%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 XR RIBS ROUTINE LEFT	$186.40	$233.00	—	—	20%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 XR RIBS ROUTINE RIGHT	$186.40	$233.00	—	—	20%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 XR RIBS W/ 1 VIEW CHEST RIGHT	$264.80	$331.00	—	41% above	20%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 XR RIBS W/ 1 VIEW CHEST LEFT	$264.80	$331.00	—	41% above	20%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 XR RIBS W/ 1 VIEW CHEST LEFT	$264.80	$331.00	—	—	20%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 XR RIBS W/ 1 VIEW CHEST RIGHT	$264.80	$331.00	—	—	20%
Screening mammogram, both breasts both sides CPT 77067 MA MAMMO DIGITAL SCREEN-BILAT	$344.00	$430.00	—	—	20%
Screening mammogram, both breasts CPT 77067 MA MAMMO UNI SCREEN DIGITAL-MOBIL	$344.00	$430.00	—	5% below	20%
Screening mammogram, both breasts CPT 77067 MA MAMMO BIL SCREEN DIGITAL-MOBIL	$344.00	$430.00	—	5% below	20%
Screening mammogram, both breasts one side CPT 77067 MA MAMMO DIGITAL SCREEN-UNILAT	$344.00	$430.00	—	5% below	20%
Screening mammogram, both breasts inpatient both sides CPT 77067 MA MAMMO DIGITAL SCREEN-BILAT	$344.00	$430.00	—	—	20%
Screening mammogram, both breasts inpatient CPT 77067 MA MAMMO UNI SCREEN DIGITAL-MOBIL	$344.00	$430.00	—	—	20%
Screening mammogram, both breasts inpatient CPT 77067 MA MAMMO BIL SCREEN DIGITAL-MOBIL	$344.00	$430.00	—	—	20%
Screening mammogram, both breasts inpatient one side CPT 77067 MA MAMMO DIGITAL SCREEN-UNILAT	$344.00	$430.00	—	—	20%
Shoulder X-ray, complete, 2 or more views both sides CPT 73030 XR SHOULDER COMPLETE BILATERAL	$289.60	$362.00	—	—	20%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR SHOULDER COMPLETE LEFT	$186.40	$233.00	—	5% above	20%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR SHOULDER COMPLETE RIGHT	$186.40	$233.00	—	5% above	20%
Shoulder X-ray, complete, 2 or more views inpatient both sides CPT 73030 XR SHOULDER COMPLETE BILATERAL	$289.60	$362.00	—	—	20%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR SHOULDER COMPLETE LEFT	$186.40	$233.00	—	—	20%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR SHOULDER COMPLETE RIGHT	$186.40	$233.00	—	—	20%
Sinus X-ray, complete, 3 or more views CPT 70220 XR SINUSES PARANASAL COMPLETE	$186.40	$233.00	—	4% above	20%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 XR SINUSES PARANASAL COMPLETE	$186.40	$233.00	—	—	20%
Skull X-ray, fewer than 4 views CPT 70250 XR SKULL < 4 VIEWS	$264.80	$331.00	—	59% above	20%
Skull X-ray, fewer than 4 views inpatient CPT 70250 XR SKULL < 4 VIEWS	$264.80	$331.00	—	—	20%
Sleep study in a lab (polysomnography) CPT 95810 POLYSOMNOGRAPHY-DIAGNOSTIC	$2,240.00	$2,800.00	—	8% below	20%
Sleep study in a lab (polysomnography) CPT 95810 POLYSOMNOGRAPHY-DIAGNOSTIC (52)	$2,240.00	$2,800.00	—	8% below	20%
Sleep study in a lab (polysomnography) inpatient CPT 95810 POLYSOMNOGRAPHY-DIAGNOSTIC	$2,240.00	$2,800.00	—	—	20%
Sleep study in a lab (polysomnography) inpatient CPT 95810 POLYSOMNOGRAPHY-DIAGNOSTIC (52)	$2,240.00	$2,800.00	—	—	20%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 US REST/STRESS ECHOCARDIOGRAM.	$924.80	$1,156.00	—	at median	20%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 US REST/STRESS ECHO W/CONTRAST.	$924.80	$1,156.00	—	at median	20%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 US REST/STRESS ECHO COMPLETE	$924.80	$1,156.00	—	at median	20%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 US REST/STRESS ECHO W/CONTRAST.	$924.80	$1,156.00	—	—	20%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 US REST/STRESS ECHOCARDIOGRAM.	$924.80	$1,156.00	—	—	20%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 US REST/STRESS ECHO COMPLETE	$924.80	$1,156.00	—	—	20%
Swallow study (modified barium swallow, video X-ray) CPT 74230 XR SWALLOWING FUNCTION W/ VIDEO	$494.40	$618.00	—	2% below	20%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 XR SWALLOWING FUNCTION W/ VIDEO	$494.40	$618.00	—	—	20%
Thigh bone (femur) X-ray, 2 or more views both sides CPT 73552 XR FEMUR BILATERAL	$289.60	$362.00	—	—	20%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 XR FEMUR 2 VIEWS LEFT	$186.40	$233.00	—	13% above	20%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 XR FEMUR 2 VIEWS RIGHT	$186.40	$233.00	—	13% above	20%
Thigh bone (femur) X-ray, 2 or more views inpatient both sides CPT 73552 XR FEMUR BILATERAL	$289.60	$362.00	—	—	20%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 XR FEMUR 2 VIEWS LEFT	$186.40	$233.00	—	—	20%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 XR FEMUR 2 VIEWS RIGHT	$186.40	$233.00	—	—	20%
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT SPINE THORACIC W/O CONTRAST	$1,279.20	$1,599.00	—	1% below	20%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT SPINE THORACIC W/O CONTRAST	$1,279.20	$1,599.00	—	—	20%
Toe X-ray, 2 or more views one side CPT 73660 XR TOES GREAT 2V RT	$163.20	$204.00	—	28% above	20%
Toe X-ray, 2 or more views one side CPT 73660 XR TOES 3RD DIGIT 2V RT	$163.20	$204.00	—	28% above	20%
Toe X-ray, 2 or more views one side CPT 73660 XR TOES GREAT 2V LT	$163.20	$204.00	—	28% above	20%
Toe X-ray, 2 or more views one side CPT 73660 XR TOES 2ND DIGIT 2V LT	$163.20	$204.00	—	28% above	20%
Toe X-ray, 2 or more views one side CPT 73660 XR TOES 4TH DIGIT 2V LT	$163.20	$204.00	—	28% above	20%
Toe X-ray, 2 or more views one side CPT 73660 XR TOES 5TH DIGIT 2V RT	$163.20	$204.00	—	28% above	20%
Toe X-ray, 2 or more views one side CPT 73660 XR TOES 3RD DIGIT 2V LT	$163.20	$204.00	—	28% above	20%
Toe X-ray, 2 or more views one side CPT 73660 XR TOES 2ND DIGIT 2V RT	$163.20	$204.00	—	28% above	20%
Toe X-ray, 2 or more views one side CPT 73660 XR TOES 4TH DIGIT 2V RT	$163.20	$204.00	—	28% above	20%
Toe X-ray, 2 or more views one side CPT 73660 XR TOES 5TH DIGIT 2V LT	$163.20	$204.00	—	28% above	20%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR TOES 2ND DIGIT 2V RT	$163.20	$204.00	—	—	20%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR TOES 2ND DIGIT 2V LT	$163.20	$204.00	—	—	20%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR TOES 3RD DIGIT 2V LT	$163.20	$204.00	—	—	20%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR TOES 3RD DIGIT 2V RT	$163.20	$204.00	—	—	20%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR TOES 4TH DIGIT 2V LT	$163.20	$204.00	—	—	20%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR TOES 4TH DIGIT 2V RT	$163.20	$204.00	—	—	20%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR TOES 5TH DIGIT 2V LT	$163.20	$204.00	—	—	20%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR TOES 5TH DIGIT 2V RT	$163.20	$204.00	—	—	20%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR TOES GREAT 2V LT	$163.20	$204.00	—	—	20%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR TOES GREAT 2V RT	$163.20	$204.00	—	—	20%
Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL	$552.80	$691.00	—	15% above	20%
Transvaginal pelvic ultrasound CPT 76830 US OVARIAN FOLLICLES	$552.80	$691.00	—	15% above	20%
Transvaginal pelvic ultrasound inpatient CPT 76830 US OVARIAN FOLLICLES	$552.80	$691.00	—	—	20%
Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL	$552.80	$691.00	—	—	20%
Transvaginal ultrasound during pregnancy CPT 76817 US PREGNANCY TRANSVAGINAL	$453.60	$567.00	—	37% above	20%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US PREGNANCY TRANSVAGINAL	$453.60	$567.00	—	—	20%
Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN COMPLETE	$592.00	$740.00	—	15% above	20%
Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMEN COMPLETE	$592.00	$740.00	—	—	20%
Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM CRITICAL(TORSION) W/DO	$585.60	$732.00	—	41% above	20%
Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM (CONTENTS)	$585.60	$732.00	—	41% above	20%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM (CONTENTS)	$585.60	$732.00	—	—	20%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM CRITICAL(TORSION) W/DO	$585.60	$732.00	—	—	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US HEAD/NECK SOFT TISSUE	$560.00	$700.00	—	17% above	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US THYROID	$560.00	$700.00	—	17% above	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US HEAD/NECK SOFT TISSUE	$560.00	$700.00	—	—	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US THYROID	$560.00	$700.00	—	—	20%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 XR UPPER GI W/ KUB SINGLE CONTRAS	$577.60	$722.00	—	11% above	20%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 XR UPPER GI W/SMALL BOWEL SINGLE	$577.60	$722.00	—	11% above	20%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 XR UPPER GI W/O KUB- EXAM	$577.60	$722.00	—	11% above	20%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 XR UPPER GI W/ KUB SINGLE CONTRAS	$577.60	$722.00	—	—	20%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 XR UPPER GI W/O KUB- EXAM	$577.60	$722.00	—	—	20%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 XR UPPER GI W/SMALL BOWEL SINGLE	$577.60	$722.00	—	—	20%
Upper arm X-ray (humerus), 2 views both sides CPT 73060 XR HUMERUS BILATERAL	$289.60	$362.00	—	—	20%
Upper arm X-ray (humerus), 2 views both sides CPT 73060 XR HUMERUS 1 VIEW BILATERAL	$289.60	$362.00	—	—	20%
Upper arm X-ray (humerus), 2 views one side CPT 73060 XR HUMERUS 1 VIEW RIGHT	$186.40	$233.00	—	30% above	20%
Upper arm X-ray (humerus), 2 views one side CPT 73060 XR HUMERUS LEFT	$186.40	$233.00	—	30% above	20%
Upper arm X-ray (humerus), 2 views one side CPT 73060 XR HUMERUS RIGHT	$186.40	$233.00	—	30% above	20%
Upper arm X-ray (humerus), 2 views one side CPT 73060 XR HUMERUS 1 VIEW LEFT	$186.40	$233.00	—	30% above	20%
Upper arm X-ray (humerus), 2 views inpatient both sides CPT 73060 XR HUMERUS 1 VIEW BILATERAL	$289.60	$362.00	—	—	20%
Upper arm X-ray (humerus), 2 views inpatient both sides CPT 73060 XR HUMERUS BILATERAL	$289.60	$362.00	—	—	20%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 XR HUMERUS LEFT	$186.40	$233.00	—	—	20%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 XR HUMERUS 1 VIEW LEFT	$186.40	$233.00	—	—	20%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 XR HUMERUS RIGHT	$186.40	$233.00	—	—	20%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 XR HUMERUS 1 VIEW RIGHT	$186.40	$233.00	—	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 US LE VENOUS INSUFFICIENCY/REFL R	$664.80	$831.00	—	28% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 US LE VENOUS INSUFFICIENCY/REFL L	$664.80	$831.00	—	28% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US LE VENOUS DUPLEX LEFT	$664.80	$831.00	—	28% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US LE VEIN MAPPING RIGHT	$664.80	$831.00	—	28% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US UE VENOUS DUPLEX RIGHT	$664.80	$831.00	—	28% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US LE VEIN MAPPING LEFT	$664.80	$831.00	—	28% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US LE VENOUS DUPLEX RIGHT	$664.80	$831.00	—	28% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US UE VENOUS DUPLEX LEFT	$664.80	$831.00	—	28% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 US LE VENOUS INSUFFICIENCY/REFL L	$664.80	$831.00	—	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 US LE VENOUS INSUFFICIENCY/REFL R	$664.80	$831.00	—	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US UE VENOUS DUPLEX RIGHT	$664.80	$831.00	—	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US LE VENOUS DUPLEX RIGHT	$664.80	$831.00	—	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US LE VEIN MAPPING LEFT	$664.80	$831.00	—	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US LE VENOUS DUPLEX LEFT	$664.80	$831.00	—	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US UE VENOUS DUPLEX LEFT	$664.80	$831.00	—	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US LE VEIN MAPPING RIGHT	$664.80	$831.00	—	—	20%
Wrist X-ray, 2 views both sides CPT 73100 XR WRIST 2 VIEWS BILATERAL	$289.60	$362.00	—	—	20%
Wrist X-ray, 2 views both sides CPT 73100 XR WRIST 1 VIEW BILATERAL	$289.60	$362.00	—	—	20%
Wrist X-ray, 2 views one side CPT 73100 XR WRIST 2 VIEWS RIGHT	$186.40	$233.00	—	19% above	20%
Wrist X-ray, 2 views one side CPT 73100 XR WRIST 1 VIEW LEFT	$186.40	$233.00	—	19% above	20%
Wrist X-ray, 2 views one side CPT 73100 XR WRIST 1 VIEW RIGHT	$186.40	$233.00	—	19% above	20%
Wrist X-ray, 2 views one side CPT 73100 XR WRIST 2 VIEWS LEFT	$186.40	$233.00	—	19% above	20%
Wrist X-ray, 2 views inpatient both sides CPT 73100 XR WRIST 2 VIEWS BILATERAL	$289.60	$362.00	—	—	20%
Wrist X-ray, 2 views inpatient both sides CPT 73100 XR WRIST 1 VIEW BILATERAL	$289.60	$362.00	—	—	20%
Wrist X-ray, 2 views inpatient one side CPT 73100 XR WRIST 2 VIEWS LEFT	$186.40	$233.00	—	—	20%
Wrist X-ray, 2 views inpatient one side CPT 73100 XR WRIST 1 VIEW LEFT	$186.40	$233.00	—	—	20%
Wrist X-ray, 2 views inpatient one side CPT 73100 XR WRIST 2 VIEWS RIGHT	$186.40	$233.00	—	—	20%
Wrist X-ray, 2 views inpatient one side CPT 73100 XR WRIST 1 VIEW RIGHT	$186.40	$233.00	—	—	20%
Wrist X-ray, complete, 3 or more views both sides CPT 73110 XR WRIST COMPLETE BILATERAL	$289.60	$362.00	—	—	20%
Wrist X-ray, complete, 3 or more views CPT 73110 XR WRIST W/NAVICULAR VIEWS BILATE	$289.60	$362.00	—	66% above	20%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR WRIST W/NAVICULAR VIEWS RIGHT	$186.40	$233.00	—	7% above	20%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR WRIST W/NAVICULAR VIEWS LEFT	$186.40	$233.00	—	7% above	20%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR WRIST COMPLETE LEFT	$186.40	$233.00	—	7% above	20%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR WRIST COMPLETE RIGHT	$186.40	$233.00	—	7% above	20%
Wrist X-ray, complete, 3 or more views inpatient both sides CPT 73110 XR WRIST COMPLETE BILATERAL	$289.60	$362.00	—	—	20%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 XR WRIST W/NAVICULAR VIEWS BILATE	$289.60	$362.00	—	—	20%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR WRIST COMPLETE RIGHT	$186.40	$233.00	—	—	20%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR WRIST W/NAVICULAR VIEWS LEFT	$186.40	$233.00	—	—	20%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR WRIST W/NAVICULAR VIEWS RIGHT	$186.40	$233.00	—	—	20%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR WRIST COMPLETE LEFT	$186.40	$233.00	—	—	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR HIP 2 VIEWS RIGHT W/PELVIS	$204.80	$256.00	—	at median	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR HIP 2 VIEWS LEFT W/PELVIS	$204.80	$256.00	—	at median	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR HIP COMPLETE LEFT 2-3 VWS- EXA	$204.80	$256.00	—	at median	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR HIP COMPLETE RIGHT 2-3 VWS	$204.80	$256.00	—	at median	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR HIP OPERATIVE LEFT	$204.80	$256.00	—	at median	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR HIP OPERATIVE RIGHT	$204.80	$256.00	—	at median	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR HIP COMPLETE RIGHT 2-3 VWS	$204.80	$256.00	—	—	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR HIP OPERATIVE RIGHT	$204.80	$256.00	—	—	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR HIP OPERATIVE LEFT	$204.80	$256.00	—	—	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR HIP COMPLETE LEFT 2-3 VWS- EXA	$204.80	$256.00	—	—	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR HIP 2 VIEWS RIGHT W/PELVIS	$204.80	$256.00	—	—	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR HIP 2 VIEWS LEFT W/PELVIS	$204.80	$256.00	—	—	20%
X-ray of the abdomen, 1 view CPT 74018 XR ABDOMEN AP	$155.20	$194.00	—	11% above	20%
X-ray of the abdomen, 1 view inpatient CPT 74018 XR ABDOMEN AP	$155.20	$194.00	—	—	20%
X-ray of the ankle, 2 views both sides CPT 73600 XR ANKLE 2 VIEWS BILATERAL	$372.80	$466.00	—	—	20%
X-ray of the ankle, 2 views both sides CPT 73600 XR ANKLE 1 VIEW BILATERAL	$372.80	$466.00	—	—	20%
X-ray of the ankle, 2 views one side CPT 73600 XR ANKLE 2 VIEWS LEFT	$186.40	$233.00	—	27% above	20%
X-ray of the ankle, 2 views one side CPT 73600 XR ANKLE 1 VIEW RIGHT	$186.40	$233.00	—	27% above	20%
X-ray of the ankle, 2 views one side CPT 73600 XR ANKLE 2 VIEWS RIGHT	$186.40	$233.00	—	27% above	20%
X-ray of the ankle, 2 views one side CPT 73600 XR ANKLE 1 VIEW LEFT	$186.40	$233.00	—	27% above	20%
X-ray of the ankle, 2 views inpatient both sides CPT 73600 XR ANKLE 1 VIEW BILATERAL	$372.80	$466.00	—	—	20%
X-ray of the ankle, 2 views inpatient both sides CPT 73600 XR ANKLE 2 VIEWS BILATERAL	$372.80	$466.00	—	—	20%
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR ANKLE 2 VIEWS LEFT	$186.40	$233.00	—	—	20%
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR ANKLE 1 VIEW RIGHT	$186.40	$233.00	—	—	20%
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR ANKLE 1 VIEW LEFT	$186.40	$233.00	—	—	20%
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR ANKLE 2 VIEWS RIGHT	$186.40	$233.00	—	—	20%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER 3RD DIGIT LEFT	$163.20	$204.00	—	5% above	20%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER 4TH DIGIT RIGHT	$163.20	$204.00	—	5% above	20%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER 2ND DIGIT LEFT	$163.20	$204.00	—	5% above	20%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER 2ND DIGIT RIGHT	$163.20	$204.00	—	5% above	20%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER 3RD DIGIT RIGHT	$163.20	$204.00	—	5% above	20%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER 4TH DIGIT LEFT	$163.20	$204.00	—	5% above	20%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER THUMB RIGHT	$163.20	$204.00	—	5% above	20%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER THUMB LEFT	$163.20	$204.00	—	5% above	20%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER 5TH DIGIT RIGHT	$163.20	$204.00	—	5% above	20%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER 5TH DIGIT LEFT	$163.20	$204.00	—	5% above	20%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGER 4TH DIGIT RIGHT	$163.20	$204.00	—	—	20%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGER THUMB RIGHT	$163.20	$204.00	—	—	20%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGER 5TH DIGIT RIGHT	$163.20	$204.00	—	—	20%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGER 4TH DIGIT LEFT	$163.20	$204.00	—	—	20%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGER 3RD DIGIT RIGHT	$163.20	$204.00	—	—	20%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGER 5TH DIGIT LEFT	$163.20	$204.00	—	—	20%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGER 3RD DIGIT LEFT	$163.20	$204.00	—	—	20%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGER 2ND DIGIT RIGHT	$163.20	$204.00	—	—	20%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGER THUMB LEFT	$163.20	$204.00	—	—	20%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGER 2ND DIGIT LEFT	$163.20	$204.00	—	—	20%
X-ray of the foot, 2 views both sides CPT 73620 XR FOOT 2 VIEWS BILATERAL	$289.60	$362.00	—	—	20%
X-ray of the foot, 2 views both sides CPT 73620 XR FOOT 1 VIEW BILATERAL	$289.60	$362.00	—	—	20%
X-ray of the foot, 2 views one side CPT 73620 XR FOOT 2 VIEWS LEFT	$186.40	$233.00	—	33% above	20%
X-ray of the foot, 2 views one side CPT 73620 XR FOOT 2 VIEWS RIGHT	$186.40	$233.00	—	33% above	20%
X-ray of the foot, 2 views one side CPT 73620 XR FOOT 1 VIEW LEFT	$186.40	$233.00	—	33% above	20%
X-ray of the foot, 2 views one side CPT 73620 XR FOOT 1 VIEW RIGHT	$186.40	$233.00	—	33% above	20%
X-ray of the foot, 2 views inpatient both sides CPT 73620 XR FOOT 2 VIEWS BILATERAL	$289.60	$362.00	—	—	20%
X-ray of the foot, 2 views inpatient both sides CPT 73620 XR FOOT 1 VIEW BILATERAL	$289.60	$362.00	—	—	20%
X-ray of the foot, 2 views inpatient one side CPT 73620 XR FOOT 2 VIEWS LEFT	$186.40	$233.00	—	—	20%
X-ray of the foot, 2 views inpatient one side CPT 73620 XR FOOT 1 VIEW RIGHT	$186.40	$233.00	—	—	20%
X-ray of the foot, 2 views inpatient one side CPT 73620 XR FOOT 1 VIEW LEFT	$186.40	$233.00	—	—	20%
X-ray of the foot, 2 views inpatient one side CPT 73620 XR FOOT 2 VIEWS RIGHT	$186.40	$233.00	—	—	20%
X-ray of the foot, complete, 3 or more views both sides CPT 73630 XR FOOT COMPLETE BILATERAL	$289.60	$362.00	—	—	20%
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR FOOT COMPLETE LEFT	$192.00	$240.00	—	31% above	20%
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR FOOT COMPLETE RIGHT	$192.00	$240.00	—	31% above	20%
X-ray of the foot, complete, 3 or more views inpatient both sides CPT 73630 XR FOOT COMPLETE BILATERAL	$289.60	$362.00	—	—	20%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR FOOT COMPLETE LEFT	$192.00	$240.00	—	—	20%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR FOOT COMPLETE RIGHT	$192.00	$240.00	—	—	20%
X-ray of the hand, 3 or more views both sides CPT 73130 XR HAND COMPLETE BILATERAL	$428.80	$536.00	—	—	20%
X-ray of the hand, 3 or more views one side CPT 73130 XR HAND COMPLETE LEFT	$214.40	$268.00	—	30% above	20%
X-ray of the hand, 3 or more views one side CPT 73130 XR HAND COMPLETE RIGHT	$214.40	$268.00	—	30% above	20%
X-ray of the hand, 3 or more views inpatient both sides CPT 73130 XR HAND COMPLETE BILATERAL	$428.80	$536.00	—	—	20%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 XR HAND COMPLETE RIGHT	$214.40	$268.00	—	—	20%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 XR HAND COMPLETE LEFT	$214.40	$268.00	—	—	20%
X-ray of the knee, 1 or 2 views both sides CPT 73560 XR KNEE 1 OR 2 VIEWS BILATERAL	$289.60	$362.00	—	—	20%
X-ray of the knee, 1 or 2 views one side CPT 73560 XR KNEE 1 OR 2 VIEWS LEFT	$186.40	$233.00	—	16% above	20%
X-ray of the knee, 1 or 2 views one side CPT 73560 XR KNEE 1 OR 2 VIEWS RIGHT	$186.40	$233.00	—	16% above	20%
X-ray of the knee, 1 or 2 views inpatient both sides CPT 73560 XR KNEE 1 OR 2 VIEWS BILATERAL	$289.60	$362.00	—	—	20%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR KNEE 1 OR 2 VIEWS RIGHT	$186.40	$233.00	—	—	20%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR KNEE 1 OR 2 VIEWS LEFT	$186.40	$233.00	—	—	20%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XR SPINE LUMBOSACRAL 2 OR 3 VIEWS	$264.80	$331.00	—	37% above	20%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 XR SPINE LUMBOSACRAL 2 OR 3 VIEWS	$264.80	$331.00	—	—	20%
X-ray of the lower back, 4 or more views CPT 72110 XR SPINE LUMBOSACRAL MINIMUM 4 VI	$264.80	$331.00	—	11% above	20%
X-ray of the lower back, 4 or more views inpatient CPT 72110 XR SPINE LUMBOSACRAL MINIMUM 4 VI	$264.80	$331.00	—	—	20%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 XR SPINE THORACIC 2 VIEWS	$264.80	$331.00	—	74% above	20%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 XR SPINE THORACIC 2 VIEWS	$264.80	$331.00	—	—	20%
X-ray of the nasal bones, 3 or more views CPT 70160 XR NASAL BONES MINIMUM 3 VIEWS	$186.40	$233.00	—	23% above	20%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 XR NASAL BONES MINIMUM 3 VIEWS	$186.40	$233.00	—	—	20%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XR SPINE CERVICAL 2-3 VW FLEXION/	$163.20	$204.00	—	at median	20%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XR SPINE CERVICAL 2 OR 3 VIEWS	$163.20	$204.00	—	at median	20%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 XR SPINE CERVICAL 2-3 VW FLEXION/	$163.20	$204.00	—	—	20%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 XR SPINE CERVICAL 2 OR 3 VIEWS	$163.20	$204.00	—	—	20%
X-ray of the pelvis, 1 or 2 views CPT 72170 XR PELVIS INLET/OUTLET W/O AP PEL	$264.80	$331.00	—	71% above	20%
X-ray of the pelvis, 1 or 2 views CPT 72170 XR PELVIS JUDET VWS W/O AP PELVIS	$264.80	$331.00	—	71% above	20%
X-ray of the pelvis, 1 or 2 views CPT 72170 XR PELVIS 1 OR 2 VIEWS	$264.80	$331.00	—	71% above	20%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 XR PELVIS 1 OR 2 VIEWS	$264.80	$331.00	—	—	20%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 XR PELVIS JUDET VWS W/O AP PELVIS	$264.80	$331.00	—	—	20%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 XR PELVIS INLET/OUTLET W/O AP PEL	$264.80	$331.00	—	—	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XR COCCYX 3 VIEW W/SITTING LATERA	$186.40	$233.00	—	21% above	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XR SACRUM/COCCYX MINIMUM 2 VIEWS	$186.40	$233.00	—	21% above	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 XR COCCYX 3 VIEW W/SITTING LATERA	$186.40	$233.00	—	—	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 XR SACRUM/COCCYX MINIMUM 2 VIEWS	$186.40	$233.00	—	—	20%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs North Dakota	Off list
ACTH blood test CPT 82024 ADRENOCORTICOTROPIC HORMONE	$158.40	$198.00	—	9% above	20%
ACTH blood test inpatient CPT 82024 ADRENOCORTICOTROPIC HORMONE	$158.40	$198.00	—	—	20%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 74683 HCVF ALANINE AMINO (ALT)	$26.40	$33.00	—	35% below	20%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALT (SGPT)	$65.60	$82.00	—	62% above	20%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 74683 HCVF ALANINE AMINO (ALT)	$26.40	$33.00	—	—	20%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALT (SGPT)	$65.60	$82.00	—	—	20%
AST (aspartate aminotransferase) enzyme test CPT 84450 AST (SGOT)	$55.20	$69.00	—	33% above	20%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 AST (SGOT)	$55.20	$69.00	—	—	20%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE HEPATITIS PROFILE	$326.40	$408.00	—	44% above	20%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 ACUTE HEPATITIS PROFILE	$326.40	$408.00	—	—	20%
Albumin blood test CPT 82040 IGGI,ALBUMIN, TOTAL	$46.40	$58.00	—	33% above	20%
Albumin blood test CPT 82040 ASSAY OF SERUM ALBUMIN	$53.60	$67.00	—	53% above	20%
Albumin blood test CPT 82040 ALBUMIN, TOTAL	$56.00	$70.00	—	60% above	20%
Albumin blood test inpatient CPT 82040 IGGI,ALBUMIN, TOTAL	$46.40	$58.00	—	—	20%
Albumin blood test inpatient CPT 82040 ASSAY OF SERUM ALBUMIN	$53.60	$67.00	—	—	20%
Albumin blood test inpatient CPT 82040 ALBUMIN, TOTAL	$56.00	$70.00	—	—	20%
Aldosterone blood test CPT 82088 ALDOSTERONE	$123.20	$154.00	—	at median	20%
Aldosterone blood test CPT 82088 ALDOSTERONE,URINE	$140.80	$176.00	—	14% above	20%
Aldosterone blood test CPT 82088 ALDOSTERONE,SERUM	$204.80	$256.00	—	66% above	20%
Aldosterone blood test inpatient CPT 82088 ALDOSTERONE	$123.20	$154.00	—	—	20%
Aldosterone blood test inpatient CPT 82088 ALDOSTERONE,URINE	$140.80	$176.00	—	—	20%
Aldosterone blood test inpatient CPT 82088 ALDOSTERONE,SERUM	$204.80	$256.00	—	—	20%
Alkaline phosphatase (ALP) blood test CPT 84075 API,ALKALINE PHOSPHATASE	$41.60	$52.00	—	24% above	20%
Alkaline phosphatase (ALP) blood test CPT 84075 ALKALINE PHOSPHATASE	$67.20	$84.00	—	101% above	20%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 API,ALKALINE PHOSPHATASE	$41.60	$52.00	—	—	20%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 ALKALINE PHOSPHATASE	$67.20	$84.00	—	—	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLG SPEC IGE CRUDE XTRC EA.	$28.00	$35.00	—	5% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLG SPEC IGE CRUDE XTRC EACH	$28.00	$35.00	—	5% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLG SPEC IGE CRUDE XTRC EA..	$28.00	$35.00	—	5% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN (IGE), CAROB	$30.40	$38.00	—	14% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 SCS,ALLERGEN SPECIFIC IGE	$36.80	$46.00	—	37% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 SESAME SEED IGE W/REFLEX TO SESAM	$38.40	$48.00	—	43% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 HAZELNUT-FOOD IGE W/REFLEX TO HAZ	$38.40	$48.00	—	43% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN (IGE), ZUCCHINI-MAYO	$46.40	$58.00	—	73% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 74893 FAGPL,ALLERGEN SPECIFIC IGE	$56.80	$71.00	—	112% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN (IGE), ORCHARD GRASS	$63.20	$79.00	—	136% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN (IGE), EASTERN SYCAMORE,	$63.20	$79.00	—	136% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 STACHYBOTRYS CHARTARUM/ATRA, IGE	$63.20	$79.00	—	136% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN(IGE) D MICROCERAS	$63.20	$79.00	—	136% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN (IGE), CARMINE DYE/RED D	$68.00	$85.00	—	154% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 BRAZIL NUT IGE W/REFLEX TO BRAZIL	$69.60	$87.00	—	160% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 CASHEW IGE W/REFLEX TO CASHEW	$69.60	$87.00	—	160% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERG SP IGE, QUAN OR SEMIQUAN	$69.60	$87.00	—	160% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 PENICILLIN G ALLERGEN,IGE AB	$70.40	$88.00	—	163% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 IGE ANTIBODY,SINGLE ALLERGEN	$70.40	$88.00	—	163% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 AP5, ALLERGEN EACH	$70.40	$88.00	—	163% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 74637 ALLERGEN IGE	$70.40	$88.00	—	163% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN (IGE),BAHIA GRASS-MAYO	$70.40	$88.00	—	163% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 PED.ALLERGY SCRN	$70.40	$88.00	—	163% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 AP10, ALLERGEN EACH	$70.40	$88.00	—	163% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 LATEX ALLERGEN TITER	$70.40	$88.00	—	163% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 PENICILLIN V ALLERGEN,IGE AB	$70.40	$88.00	—	163% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLG SPEC IGE CRUDE XTRC EA	$76.80	$96.00	—	187% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN (IGE), QUINOA	$81.60	$102.00	—	205% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN (IGE) PERCH OCEAN-MAYO	$84.00	$105.00	—	214% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE IBT	$85.60	$107.00	—	220% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 MULTI-ALLERGEN IGE PANEL	$114.40	$143.00	—	327% above	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLG SPEC IGE CRUDE XTRC EACH	$28.00	$35.00	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLG SPEC IGE CRUDE XTRC EA..	$28.00	$35.00	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLG SPEC IGE CRUDE XTRC EA.	$28.00	$35.00	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN (IGE), CAROB	$30.40	$38.00	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 SCS,ALLERGEN SPECIFIC IGE	$36.80	$46.00	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 SESAME SEED IGE W/REFLEX TO SESAM	$38.40	$48.00	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HAZELNUT-FOOD IGE W/REFLEX TO HAZ	$38.40	$48.00	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN (IGE), ZUCCHINI-MAYO	$46.40	$58.00	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 74893 FAGPL,ALLERGEN SPECIFIC IGE	$56.80	$71.00	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN (IGE), ORCHARD GRASS	$63.20	$79.00	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN (IGE), EASTERN SYCAMORE,	$63.20	$79.00	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN(IGE) D MICROCERAS	$63.20	$79.00	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 STACHYBOTRYS CHARTARUM/ATRA, IGE	$63.20	$79.00	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN (IGE), CARMINE DYE/RED D	$68.00	$85.00	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 BRAZIL NUT IGE W/REFLEX TO BRAZIL	$69.60	$87.00	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERG SP IGE, QUAN OR SEMIQUAN	$69.60	$87.00	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CASHEW IGE W/REFLEX TO CASHEW	$69.60	$87.00	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN (IGE),BAHIA GRASS-MAYO	$70.40	$88.00	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 AP10, ALLERGEN EACH	$70.40	$88.00	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 AP5, ALLERGEN EACH	$70.40	$88.00	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 74637 ALLERGEN IGE	$70.40	$88.00	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 PED.ALLERGY SCRN	$70.40	$88.00	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 PENICILLIN G ALLERGEN,IGE AB	$70.40	$88.00	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 PENICILLIN V ALLERGEN,IGE AB	$70.40	$88.00	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 LATEX ALLERGEN TITER	$70.40	$88.00	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 IGE ANTIBODY,SINGLE ALLERGEN	$70.40	$88.00	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLG SPEC IGE CRUDE XTRC EA	$76.80	$96.00	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN (IGE), QUINOA	$81.60	$102.00	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN (IGE) PERCH OCEAN-MAYO	$84.00	$105.00	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE IBT	$85.60	$107.00	—	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MULTI-ALLERGEN IGE PANEL	$114.40	$143.00	—	—	20%
Alpha-fetoprotein (AFP) blood test CPT 82105 74508 FM,AFP	$96.00	$120.00	—	at median	20%
Alpha-fetoprotein (AFP) blood test CPT 82105 ALPHA-FETOPROTEIN,SERUM	$165.60	$207.00	—	72% above	20%
Alpha-fetoprotein (AFP) blood test CPT 82105 ALPHA-FETOPROTEIN,MATERNAL	$165.60	$207.00	—	72% above	20%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 74508 FM,AFP	$96.00	$120.00	—	—	20%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 ALPHA-FETOPROTEIN,MATERNAL	$165.60	$207.00	—	—	20%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 ALPHA-FETOPROTEIN,SERUM	$165.60	$207.00	—	—	20%
Ammonia blood test CPT 82140 AMMONIA	$49.60	$62.00	—	at median	20%
Ammonia blood test CPT 82140 AMMONIA, BLOOD	$118.40	$148.00	—	139% above	20%
Ammonia blood test inpatient CPT 82140 AMMONIA	$49.60	$62.00	—	—	20%
Ammonia blood test inpatient CPT 82140 AMMONIA, BLOOD	$118.40	$148.00	—	—	20%
Amylase blood test CPT 82150 ASSAY OF AMYLASE1	$18.40	$23.00	—	60% below	20%
Amylase blood test CPT 82150 ASSAY OF AMYLASE2	$18.40	$23.00	—	60% below	20%
Amylase blood test CPT 82150 AMYLASE.	$79.20	$99.00	—	74% above	20%
Amylase blood test CPT 82150 CHEM MISC SURVEY - TH LAB	$79.20	$99.00	—	74% above	20%
Amylase blood test CPT 82150 AMYLASE LEVEL	$79.20	$99.00	—	74% above	20%
Amylase blood test CPT 82150 AMYLASE, BODY FLUID	$79.20	$99.00	—	74% above	20%
Amylase blood test CPT 82150 AMYLASE RANDOM URINE	$79.20	$99.00	—	74% above	20%
Amylase blood test CPT 82150 MACROAMYLASE.	$148.00	$185.00	—	225% above	20%
Amylase blood test inpatient CPT 82150 ASSAY OF AMYLASE2	$18.40	$23.00	—	—	20%
Amylase blood test inpatient CPT 82150 ASSAY OF AMYLASE1	$18.40	$23.00	—	—	20%
Amylase blood test inpatient CPT 82150 AMYLASE, BODY FLUID	$79.20	$99.00	—	—	20%
Amylase blood test inpatient CPT 82150 AMYLASE LEVEL	$79.20	$99.00	—	—	20%
Amylase blood test inpatient CPT 82150 CHEM MISC SURVEY - TH LAB	$79.20	$99.00	—	—	20%
Amylase blood test inpatient CPT 82150 AMYLASE RANDOM URINE	$79.20	$99.00	—	—	20%
Amylase blood test inpatient CPT 82150 AMYLASE.	$79.20	$99.00	—	—	20%
Amylase blood test inpatient CPT 82150 MACROAMYLASE.	$148.00	$185.00	—	—	20%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP ANTIBODY	$132.00	$165.00	—	60% above	20%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP ANTIBODIES,SERUM	$180.80	$226.00	—	119% above	20%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CCP ANTIBODY	$132.00	$165.00	—	—	20%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CCP ANTIBODIES,SERUM	$180.80	$226.00	—	—	20%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR AB	$72.80	$91.00	—	14% above	20%
Antinuclear antibody (ANA) blood test, screen CPT 86038 72145 ALDP,ANTINUCLEAR AB (ANA)	$72.80	$91.00	—	14% above	20%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR AB (ANA),	$118.40	$148.00	—	86% above	20%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODY SCREEN W/REF	$135.20	$169.00	—	112% above	20%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 72145 ALDP,ANTINUCLEAR AB (ANA)	$72.80	$91.00	—	—	20%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR AB	$72.80	$91.00	—	—	20%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR AB (ANA),	$118.40	$148.00	—	—	20%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR ANTIBODY SCREEN W/REF	$135.20	$169.00	—	—	20%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NATRIURETIC PEPTIDE	$118.40	$148.00	—	49% below	20%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 BNP,B-TYPE NATRIURETIC PEPTIDE	$194.40	$243.00	—	16% below	20%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NATRIURETIC PEPTIDE	$118.40	$148.00	—	—	20%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 BNP,B-TYPE NATRIURETIC PEPTIDE	$194.40	$243.00	—	—	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, GYN, AEROBIC	$64.80	$81.00	—	at median	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, BODY FLUID, AEROBIC	$64.80	$81.00	—	at median	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 EAR CULTURE AEROBIC	$64.80	$81.00	—	at median	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 NASOPHARYNX CULTURE AEROBIC	$64.80	$81.00	—	at median	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, THROAT, AEROBIC	$64.80	$81.00	—	at median	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 WOUND CULTURE AEROBIC	$64.80	$81.00	—	at median	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 EYE CULTURE AEROBIC	$64.80	$81.00	—	at median	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 LOWER RESPIRATORY CULTURE	$64.80	$81.00	—	at median	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 POSTTXN RXN CULTURE	$64.80	$81.00	—	at median	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, BACTERIA, OTHER,AEROBIC	$64.80	$81.00	—	at median	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, INTRAVAS.CATHTIP,AEROB	$64.80	$81.00	—	at median	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 NASAL CULTURE AEROBIC	$64.80	$81.00	—	at median	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 EYE CULTURE AEROBIC	$64.80	$81.00	—	—	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, BODY FLUID, AEROBIC	$64.80	$81.00	—	—	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 NASOPHARYNX CULTURE AEROBIC	$64.80	$81.00	—	—	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, THROAT, AEROBIC	$64.80	$81.00	—	—	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, GYN, AEROBIC	$64.80	$81.00	—	—	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 WOUND CULTURE AEROBIC	$64.80	$81.00	—	—	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, INTRAVAS.CATHTIP,AEROB	$64.80	$81.00	—	—	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 NASAL CULTURE AEROBIC	$64.80	$81.00	—	—	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, BACTERIA, OTHER,AEROBIC	$64.80	$81.00	—	—	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 EAR CULTURE AEROBIC	$64.80	$81.00	—	—	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 POSTTXN RXN CULTURE	$64.80	$81.00	—	—	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 LOWER RESPIRATORY CULTURE	$64.80	$81.00	—	—	20%
Basic metabolic panel (blood test) CPT 80048 BMP (BASIC METABOLIC PANEL)	$98.40	$123.00	—	32% above	20%
Basic metabolic panel (blood test) inpatient CPT 80048 BMP (BASIC METABOLIC PANEL)	$98.40	$123.00	—	—	20%
Bilirubin blood test, total CPT 82247 BILIRUBIN, TOTAL	$56.00	$70.00	—	59% above	20%
Bilirubin blood test, total CPT 82247 BILIRUBIN BODY FLUID-MAYO	$144.00	$180.00	—	310% above	20%
Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN, TOTAL	$56.00	$70.00	—	—	20%
Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN BODY FLUID-MAYO	$144.00	$180.00	—	—	20%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 SURG PATH, LEVEL IV	$141.60	$177.00	—	15% above	20%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 DERMATOPATHOLOGY EXAM OF TISSUE-M	$141.60	$177.00	—	15% above	20%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 89005 RPC,SURG PATH TISSUE EXAM	$146.40	$183.00	—	19% above	20%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 SLIDE PREP-H&E	$160.80	$201.00	—	30% above	20%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 SURGICAL PATHOLOGY LEVEL IV	$160.80	$201.00	—	30% above	20%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 73036 MPCT,TISSUE EXAM BY PATHOLO	$233.60	$292.00	—	90% above	20%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 BM,SURG PATH, LEVEL IV	$332.00	$415.00	—	169% above	20%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 DERMATOPATHOLOGY EXAM OF TISSUE-M	$141.60	$177.00	—	—	20%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 SURG PATH, LEVEL IV	$141.60	$177.00	—	—	20%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 89005 RPC,SURG PATH TISSUE EXAM	$146.40	$183.00	—	—	20%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 SURGICAL PATHOLOGY LEVEL IV	$160.80	$201.00	—	—	20%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 SLIDE PREP-H&E	$160.80	$201.00	—	—	20%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 73036 MPCT,TISSUE EXAM BY PATHOLO	$233.60	$292.00	—	—	20%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 BM,SURG PATH, LEVEL IV	$332.00	$415.00	—	—	20%
Blood culture for bacteria CPT 87040 CULTURE, BLOOD,AEROBIC ANAEROBIC	$188.80	$236.00	—	122% above	20%
Blood culture for bacteria inpatient CPT 87040 CULTURE, BLOOD,AEROBIC ANAEROBIC	$188.80	$236.00	—	—	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 ROUTINE VENIPUNCTURE1	$16.00	$20.00	—	6% below	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 ROUTINE VENIPUNCT	$16.00	$20.00	—	6% below	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 PROMETHEUS KIT DRAW	$20.00	$25.00	—	17% above	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLLECTION OF VENOUS BLOOD BY VEN	$20.00	$25.00	—	17% above	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 BILLION TO ONE KIT DRAW	$20.00	$25.00	—	17% above	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE	$20.00	$25.00	—	17% above	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 ROUTINE VENIPUNCTURE-ETC	$20.00	$25.00	—	17% above	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 ROUTINE VENI	$20.00	$25.00	—	17% above	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 ROUTINE VENIPUNCTURE.	$20.00	$25.00	—	17% above	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 ROUTINE VENIPUNCTU	$20.00	$25.00	—	17% above	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLLECTION- VENOUS DRAW CHG ONLY	$21.60	$27.00	—	26% above	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 FOUNDATION MED KIT DRAW BLD T252	$24.00	$30.00	—	40% above	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 KIT DRAW W/PACKAGE CONTRACT ACCOU	$36.00	$45.00	—	111% above	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 ROUTINE VENIPUNCTURE1	$16.00	$20.00	—	—	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 ROUTINE VENIPUNCT	$16.00	$20.00	—	—	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 ROUTINE VENIPUNCTURE-ETC	$20.00	$25.00	—	—	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 COLLECTION OF VENOUS BLOOD BY VEN	$20.00	$25.00	—	—	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE	$20.00	$25.00	—	—	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 ROUTINE VENIPUNCTU	$20.00	$25.00	—	—	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 ROUTINE VENI	$20.00	$25.00	—	—	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 ROUTINE VENIPUNCTURE.	$20.00	$25.00	—	—	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 PROMETHEUS KIT DRAW	$20.00	$25.00	—	—	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 BILLION TO ONE KIT DRAW	$20.00	$25.00	—	—	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 COLLECTION- VENOUS DRAW CHG ONLY	$21.60	$27.00	—	—	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 FOUNDATION MED KIT DRAW BLD T252	$24.00	$30.00	—	—	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 KIT DRAW W/PACKAGE CONTRACT ACCOU	$36.00	$45.00	—	—	20%
Blood glucose (sugar) test CPT 82947 12282 WP, GLUCOSE	$4.00	$5.00	—	86% below	20%
Blood glucose (sugar) test CPT 82947 TCC-ACCUCHECK GLUCOSE	$20.80	$26.00	—	29% below	20%
Blood glucose (sugar) test CPT 82947 GLUCOSE	$30.40	$38.00	—	3% above	20%
Blood glucose (sugar) test CPT 82947 82947 GLU (GLUCOSE)	$30.40	$38.00	—	3% above	20%
Blood glucose (sugar) test inpatient CPT 82947 12282 WP, GLUCOSE	$4.00	$5.00	—	—	20%
Blood glucose (sugar) test inpatient CPT 82947 TCC-ACCUCHECK GLUCOSE	$20.80	$26.00	—	—	20%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE	$30.40	$38.00	—	—	20%
Blood glucose (sugar) test inpatient CPT 82947 82947 GLU (GLUCOSE)	$30.40	$38.00	—	—	20%
Blood lead test CPT 83655 LEAD, CAPILLARY BLOOD-MAYO	$44.00	$55.00	—	4% below	20%
Blood lead test CPT 83655 LEAD, VENOUS BLOOD-MAYO	$49.60	$62.00	—	8% above	20%
Blood lead test CPT 83655 HMU,LEAD	$57.60	$72.00	—	25% above	20%
Blood lead test CPT 83655 LEAD	$76.80	$96.00	—	67% above	20%
Blood lead test CPT 83655 83655 LEAD	$107.20	$134.00	—	133% above	20%
Blood lead test CPT 83655 LEAD, 24 HR URINE	$108.80	$136.00	—	137% above	20%
Blood lead test inpatient CPT 83655 LEAD, CAPILLARY BLOOD-MAYO	$44.00	$55.00	—	—	20%
Blood lead test inpatient CPT 83655 LEAD, VENOUS BLOOD-MAYO	$49.60	$62.00	—	—	20%
Blood lead test inpatient CPT 83655 HMU,LEAD	$57.60	$72.00	—	—	20%
Blood lead test inpatient CPT 83655 LEAD	$76.80	$96.00	—	—	20%
Blood lead test inpatient CPT 83655 83655 LEAD	$107.20	$134.00	—	—	20%
Blood lead test inpatient CPT 83655 LEAD, 24 HR URINE	$108.80	$136.00	—	—	20%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HCG, QUAL., BLOOD	$79.20	$99.00	—	23% above	20%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HCG, QUAL	$79.20	$99.00	—	23% above	20%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HCG, QUAL., BLOOD	$79.20	$99.00	—	—	20%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HCG, QUAL	$79.20	$99.00	—	—	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPE, ABO	$195.20	$244.00	—	398% above	20%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BLOOD TYPE, ABO	$195.20	$244.00	—	—	20%
Blood urea nitrogen (BUN) test CPT 84520 BUN	$48.00	$60.00	—	30% above	20%
Blood urea nitrogen (BUN) test CPT 84520 UREA NITROGEN, DIALYSATE	$48.00	$60.00	—	30% above	20%
Blood urea nitrogen (BUN) test inpatient CPT 84520 BUN	$48.00	$60.00	—	—	20%
Blood urea nitrogen (BUN) test inpatient CPT 84520 UREA NITROGEN, DIALYSATE	$48.00	$60.00	—	—	20%
C-peptide blood test CPT 84681 C-PEPTIDE	$176.00	$220.00	—	61% above	20%
C-peptide blood test inpatient CPT 84681 C-PEPTIDE	$176.00	$220.00	—	—	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN	$24.80	$31.00	—	31% below	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C REACTIVE PROTEIN	$86.40	$108.00	—	140% above	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN	$24.80	$31.00	—	—	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C REACTIVE PROTEIN	$86.40	$108.00	—	—	20%
C. difficile toxin gene test (stool PCR) CPT 87493 C.DIFFICILE TOXIN B 027/NAP1/B1,P	$207.20	$259.00	—	8% above	20%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C.DIFFICILE TOXIN B 027/NAP1/B1,P	$207.20	$259.00	—	—	20%
CA 19-9 blood test (tumor marker) CPT 86301 CA 19-9	$237.60	$297.00	—	117% above	20%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA 19-9	$237.60	$297.00	—	—	20%
CA-125 blood test (ovarian cancer marker) CPT 86304 CA-125	$170.40	$213.00	—	34% above	20%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA-125	$170.40	$213.00	—	—	20%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-COV-2. PCR (CEPHEID)-NDDOH	$120.00	$150.00	—	4% below	20%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 CORONAVIRUS,COVID-19	$120.00	$150.00	—	4% below	20%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COV-19 AMP PRB HGH THRUPUT.	$295.20	$369.00	—	137% above	20%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS COV-2 RNA DDPCR, QUAL, FFPE	$790.40	$988.00	—	533% above	20%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-COV-2. PCR (CEPHEID)-NDDOH	$120.00	$150.00	—	—	20%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 CORONAVIRUS,COVID-19	$120.00	$150.00	—	—	20%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COV-19 AMP PRB HGH THRUPUT.	$295.20	$369.00	—	—	20%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS COV-2 RNA DDPCR, QUAL, FFPE	$790.40	$988.00	—	—	20%
Calcium blood test, total CPT 82310 ASSAY OF CALCIUM	$16.00	$20.00	—	50% below	20%
Calcium blood test, total CPT 82310 CALCIUM URINE	$36.80	$46.00	—	15% above	20%
Calcium blood test, total CPT 82310 CALCIUM, RANDOM URINE	$36.80	$46.00	—	15% above	20%
Calcium blood test, total CPT 82310 CALCIUM, TOTAL	$56.00	$70.00	—	75% above	20%
Calcium blood test, total inpatient CPT 82310 ASSAY OF CALCIUM	$16.00	$20.00	—	—	20%
Calcium blood test, total inpatient CPT 82310 CALCIUM URINE	$36.80	$46.00	—	—	20%
Calcium blood test, total inpatient CPT 82310 CALCIUM, RANDOM URINE	$36.80	$46.00	—	—	20%
Calcium blood test, total inpatient CPT 82310 CALCIUM, TOTAL	$56.00	$70.00	—	—	20%
Carcinoembryonic antigen (CEA) test CPT 82378 CEA (CARCINOEMBRYONIC ANTIGEN)	$140.80	$176.00	—	14% above	20%
Carcinoembryonic antigen (CEA) test CPT 82378 CRCINOEMBRYONIC AG (CEA), S	$140.80	$176.00	—	14% above	20%
Carcinoembryonic antigen (CEA) test CPT 82378 CEA,PERITONEAL FLUID	$264.80	$331.00	—	114% above	20%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CRCINOEMBRYONIC AG (CEA), S	$140.80	$176.00	—	—	20%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CEA (CARCINOEMBRYONIC ANTIGEN)	$140.80	$176.00	—	—	20%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CEA,PERITONEAL FLUID	$264.80	$331.00	—	—	20%
Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA-ZOSTER AB,IFF-NDDOH	$59.20	$74.00	—	at median	20%
Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA-ZOSTER AB,IGM-NDDOH	$59.20	$74.00	—	at median	20%
Chickenpox (varicella) immunity blood test CPT 86787 78147 EAP,VARICELLA-ZOSTER	$80.00	$100.00	—	35% above	20%
Chickenpox (varicella) immunity blood test CPT 86787 AB, VARICELLA-ZOSTER	$80.00	$100.00	—	35% above	20%
Chickenpox (varicella) immunity blood test CPT 86787 AB,VARICELLA-ZOSTER	$80.00	$100.00	—	35% above	20%
Chickenpox (varicella) immunity blood test CPT 86787 74548 MMRV, VARICELL-ZOSTER AB	$85.60	$107.00	—	45% above	20%
Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA-ZOSTER ANTIBODY IGG, CS	$85.60	$107.00	—	45% above	20%
Chickenpox (varicella) immunity blood test CPT 86787 VZA, VZV ANTIBODY IGG AND IGM	$156.80	$196.00	—	165% above	20%
Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA ZOSTER AB,IGG,SERUM	$163.20	$204.00	—	176% above	20%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA-ZOSTER AB,IFF-NDDOH	$59.20	$74.00	—	—	20%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA-ZOSTER AB,IGM-NDDOH	$59.20	$74.00	—	—	20%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 78147 EAP,VARICELLA-ZOSTER	$80.00	$100.00	—	—	20%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 AB,VARICELLA-ZOSTER	$80.00	$100.00	—	—	20%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 AB, VARICELLA-ZOSTER	$80.00	$100.00	—	—	20%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 74548 MMRV, VARICELL-ZOSTER AB	$85.60	$107.00	—	—	20%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA-ZOSTER ANTIBODY IGG, CS	$85.60	$107.00	—	—	20%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 VZA, VZV ANTIBODY IGG AND IGM	$156.80	$196.00	—	—	20%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA ZOSTER AB,IGG,SERUM	$163.20	$204.00	—	—	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA T AMPLIF NA PROBE	$237.60	$297.00	—	55% above	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 78171 CHLAMYDIA T AMPLIF NA PROBE	$237.60	$297.00	—	55% above	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 C TRACHOMATIS AMP RNA, MISC SITES	$237.60	$297.00	—	55% above	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA BY NUCLEIC ACID AMPLIF	$237.60	$297.00	—	55% above	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 89018 CHLAMYDIA T AMPLIF NA PROBE	$237.60	$297.00	—	55% above	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 59014 CHLAMYDIA AMPLIFIED PROBE	$237.60	$297.00	—	55% above	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 C TRACHOMATIS AMP RNA, MISC SITES	$237.60	$297.00	—	—	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 78171 CHLAMYDIA T AMPLIF NA PROBE	$237.60	$297.00	—	—	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 89018 CHLAMYDIA T AMPLIF NA PROBE	$237.60	$297.00	—	—	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 59014 CHLAMYDIA AMPLIFIED PROBE	$237.60	$297.00	—	—	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA BY NUCLEIC ACID AMPLIF	$237.60	$297.00	—	—	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA T AMPLIF NA PROBE	$237.60	$297.00	—	—	20%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 71185 LMP, LIPID PANEL	$68.00	$85.00	—	8% below	20%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PROFILE	$114.40	$143.00	—	55% above	20%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 71185 LMP, LIPID PANEL	$68.00	$85.00	—	—	20%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PROFILE	$114.40	$143.00	—	—	20%
Complete blood count (CBC) with differential CPT 85025 COMPLETE BLOOD COUNT WITH DIFFERE	$80.80	$101.00	—	39% above	20%
Complete blood count (CBC) with differential inpatient CPT 85025 COMPLETE BLOOD COUNT WITH DIFFERE	$80.80	$101.00	—	—	20%
Complete blood count (CBC), no differential CPT 85027 COMPLETE BLOOD COUNT.	$64.00	$80.00	—	39% above	20%
Complete blood count (CBC), no differential CPT 85027 20096 COMPLETE BLOOD COUNT	$64.00	$80.00	—	39% above	20%
Complete blood count (CBC), no differential inpatient CPT 85027 COMPLETE BLOOD COUNT.	$64.00	$80.00	—	—	20%
Complete blood count (CBC), no differential inpatient CPT 85027 20096 COMPLETE BLOOD COUNT	$64.00	$80.00	—	—	20%
Comprehensive metabolic panel (blood test) CPT 80053 KDU CMP*	$121.60	$152.00	—	29% above	20%
Comprehensive metabolic panel (blood test) CPT 80053 CMP-COMPREHENSIVE METABOLIC PANE	$121.60	$152.00	—	29% above	20%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 CMP-COMPREHENSIVE METABOLIC PANE	$121.60	$152.00	—	—	20%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 KDU CMP*	$121.60	$152.00	—	—	20%
Cortisol blood test, total CPT 82533 TOTAL CORTISOL	$54.40	$68.00	—	at median	20%
Cortisol blood test, total CPT 82533 CORTISOL,SALIVA TOTAL	$81.60	$102.00	—	50% above	20%
Cortisol blood test, total CPT 82533 CTF,CORTISOL,TOTAL	$95.20	$119.00	—	75% above	20%
Cortisol blood test, total CPT 82533 CORTISOL, TOTAL	$119.20	$149.00	—	119% above	20%
Cortisol blood test, total inpatient CPT 82533 TOTAL CORTISOL	$54.40	$68.00	—	—	20%
Cortisol blood test, total inpatient CPT 82533 CORTISOL,SALIVA TOTAL	$81.60	$102.00	—	—	20%
Cortisol blood test, total inpatient CPT 82533 CTF,CORTISOL,TOTAL	$95.20	$119.00	—	—	20%
Cortisol blood test, total inpatient CPT 82533 CORTISOL, TOTAL	$119.20	$149.00	—	—	20%
Creatine kinase (CK) blood test, total CPT 82550 CK	$108.80	$136.00	—	131% above	20%
Creatine kinase (CK) blood test, total inpatient CPT 82550 CK	$108.80	$136.00	—	—	20%
Creatinine blood test CPT 82565 CREATININE (ISTAT)	$40.00	$50.00	—	1% above	20%
Creatinine blood test CPT 82565 CREATININE	$40.00	$50.00	—	1% above	20%
Creatinine blood test inpatient CPT 82565 CREATININE (ISTAT)	$40.00	$50.00	—	—	20%
Creatinine blood test inpatient CPT 82565 CREATININE	$40.00	$50.00	—	—	20%
Cytomegalovirus (CMV) antibody test CPT 86644 CMV ANTIBODY, IGG	$32.00	$40.00	—	39% below	20%
Cytomegalovirus (CMV) antibody test CPT 86644 CYTOMEGALOVIRUS AB, IGG	$33.60	$42.00	—	36% below	20%
Cytomegalovirus (CMV) antibody test CPT 86644 CMV ANTIBODY	$86.40	$108.00	—	65% above	20%
Cytomegalovirus (CMV) antibody test CPT 86644 CMV NEG, ROUTINE UNIT ANTIBODY	$115.20	$144.00	—	120% above	20%
Cytomegalovirus (CMV) antibody test CPT 86644 AB,CMV	$183.20	$229.00	—	251% above	20%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CMV ANTIBODY, IGG	$32.00	$40.00	—	—	20%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CYTOMEGALOVIRUS AB, IGG	$33.60	$42.00	—	—	20%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CMV ANTIBODY	$86.40	$108.00	—	—	20%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CMV NEG, ROUTINE UNIT ANTIBODY	$115.20	$144.00	—	—	20%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 AB,CMV	$183.20	$229.00	—	—	20%
D-dimer blood test (blood clot marker) CPT 85379 74039, D-DIMER	$45.60	$57.00	—	38% below	20%
D-dimer blood test (blood clot marker) CPT 85379 D-DIMER	$76.00	$95.00	—	3% above	20%
D-dimer blood test (blood clot marker) CPT 85379 74059, D-DIMER	$124.00	$155.00	—	69% above	20%
D-dimer blood test (blood clot marker) CPT 85379 PCC D-DIMER	$144.80	$181.00	—	97% above	20%
D-dimer blood test (blood clot marker) CPT 85379 D-DIMER, P	$163.20	$204.00	—	122% above	20%
D-dimer blood test (blood clot marker) inpatient CPT 85379 74039, D-DIMER	$45.60	$57.00	—	—	20%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-DIMER	$76.00	$95.00	—	—	20%
D-dimer blood test (blood clot marker) inpatient CPT 85379 74059, D-DIMER	$124.00	$155.00	—	—	20%
D-dimer blood test (blood clot marker) inpatient CPT 85379 PCC D-DIMER	$144.80	$181.00	—	—	20%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-DIMER, P	$163.20	$204.00	—	—	20%
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA-S	$98.40	$123.00	—	9% below	20%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA-S	$98.40	$123.00	—	—	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 ALCOHOL, MEDICAL	$184.80	$231.00	—	28% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 GABAPENTIN, URINE	$216.80	$271.00	—	50% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 AMPHETAMINE ANALYSIS, SERUM	$219.20	$274.00	—	52% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRG TEST PRSMV CHEM ANLYZR	$223.20	$279.00	—	55% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZR...	$234.40	$293.00	—	63% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 GAMMA-HYDROXYBUTYRIC ACID,SERUM	$238.40	$298.00	—	65% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 GHB, URINE	$238.40	$298.00	—	65% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUGS OF ABUSE SCREEN	$238.40	$298.00	—	65% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZR	$238.40	$298.00	—	65% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 MECONIUM DRUG SCREEN 5 *	$238.40	$298.00	—	65% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 CONTROLLED SUBSTANCE PNL, U	$238.40	$298.00	—	65% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZR..	$238.40	$298.00	—	65% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZR....	$238.40	$298.00	—	65% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DIURETIC SCREEN, UR-MAYO	$238.40	$298.00	—	65% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZR 75541	$238.40	$298.00	—	65% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 CONTROLLED SUBSTANCE PNL	$238.40	$298.00	—	65% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG SCREEN,PRESCRIPTION/OTC UR	$278.40	$348.00	—	93% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 74156 DRUG SCREEN	$278.40	$348.00	—	93% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZER	$278.40	$348.00	—	93% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG SCREEN, PRESCRIPTION/OTC-MAY	$278.40	$348.00	—	93% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZ	$278.40	$348.00	—	93% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 THC, QUANTITATIVE	$298.40	$373.00	—	107% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 FLUNITRAZEPAM,URINE	$312.00	$390.00	—	116% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 SEDATIVE HYPNOTIC PANEL, UR	$313.60	$392.00	—	117% above	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 ALCOHOL, MEDICAL	$184.80	$231.00	—	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 GABAPENTIN, URINE	$216.80	$271.00	—	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 AMPHETAMINE ANALYSIS, SERUM	$219.20	$274.00	—	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRG TEST PRSMV CHEM ANLYZR	$223.20	$279.00	—	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZR...	$234.40	$293.00	—	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 GHB, URINE	$238.40	$298.00	—	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 MECONIUM DRUG SCREEN 5 *	$238.40	$298.00	—	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 CONTROLLED SUBSTANCE PNL, U	$238.40	$298.00	—	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 GAMMA-HYDROXYBUTYRIC ACID,SERUM	$238.40	$298.00	—	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZR 75541	$238.40	$298.00	—	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZR..	$238.40	$298.00	—	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZR....	$238.40	$298.00	—	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DIURETIC SCREEN, UR-MAYO	$238.40	$298.00	—	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 CONTROLLED SUBSTANCE PNL	$238.40	$298.00	—	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZR	$238.40	$298.00	—	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUGS OF ABUSE SCREEN	$238.40	$298.00	—	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG SCREEN,PRESCRIPTION/OTC UR	$278.40	$348.00	—	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 74156 DRUG SCREEN	$278.40	$348.00	—	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG SCREEN, PRESCRIPTION/OTC-MAY	$278.40	$348.00	—	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZER	$278.40	$348.00	—	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZ	$278.40	$348.00	—	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 THC, QUANTITATIVE	$298.40	$373.00	—	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 FLUNITRAZEPAM,URINE	$312.00	$390.00	—	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 SEDATIVE HYPNOTIC PANEL, UR	$313.60	$392.00	—	—	20%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 LYTES (ELECTROLYTES)	$80.00	$100.00	—	44% above	20%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 LYTES (ELECTROLYTES)	$80.00	$100.00	—	—	20%
Epstein-Barr virus (EBV) antibody test CPT 86665 AB,EB VC	$132.00	$165.00	—	57% above	20%
Epstein-Barr virus (EBV) antibody test CPT 86665 AB, EB VCA.	$132.00	$165.00	—	57% above	20%
Epstein-Barr virus (EBV) antibody test CPT 86665 VCA IGM	$165.60	$207.00	—	96% above	20%
Epstein-Barr virus (EBV) antibody test CPT 86665 VCA IGG	$165.60	$207.00	—	96% above	20%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 AB,EB VC	$132.00	$165.00	—	—	20%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 AB, EB VCA.	$132.00	$165.00	—	—	20%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 VCA IGM	$165.60	$207.00	—	—	20%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 VCA IGG	$165.60	$207.00	—	—	20%
Estradiol blood test CPT 82670 ASSAY OF TOTAL ESTRADIOL	$80.00	$100.00	—	38% below	20%
Estradiol blood test CPT 82670 ESTRADIOL	$169.60	$212.00	—	31% above	20%
Estradiol blood test CPT 82670 ESTRADIOL,SERUM	$227.20	$284.00	—	76% above	20%
Estradiol blood test inpatient CPT 82670 ASSAY OF TOTAL ESTRADIOL	$80.00	$100.00	—	—	20%
Estradiol blood test inpatient CPT 82670 ESTRADIOL	$169.60	$212.00	—	—	20%
Estradiol blood test inpatient CPT 82670 ESTRADIOL,SERUM	$227.20	$284.00	—	—	20%
FSH (follicle-stimulating hormone) test CPT 83001 FOLLICLE STIMUL HORMONE (FSH)	$139.20	$174.00	—	31% above	20%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FOLLICLE STIMUL HORMONE (FSH)	$139.20	$174.00	—	—	20%
Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN, F	$221.60	$277.00	—	41% above	20%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CALPROTECTIN, F	$221.60	$277.00	—	—	20%
Ferritin blood test (iron stores) CPT 82728 FERRITIN	$106.40	$133.00	—	14% above	20%
Ferritin blood test (iron stores) CPT 82728 THE,FERRITIN	$202.40	$253.00	—	116% above	20%
Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN	$106.40	$133.00	—	—	20%
Ferritin blood test (iron stores) inpatient CPT 82728 THE,FERRITIN	$202.40	$253.00	—	—	20%
Fibrinogen blood test CPT 85384 74039, FIBRINOGEN	$46.40	$58.00	—	16% below	20%
Fibrinogen blood test CPT 85384 FIBRINOGEN, ACTIVITY	$80.80	$101.00	—	47% above	20%
Fibrinogen blood test CPT 85384 FIBRINOGEN	$92.00	$115.00	—	67% above	20%
Fibrinogen blood test CPT 85384 FIBRINOGEN,PLASMA	$102.40	$128.00	—	86% above	20%
Fibrinogen blood test CPT 85384 74059, FIBRINOGEN	$131.20	$164.00	—	139% above	20%
Fibrinogen blood test CPT 85384 PCC FIBRINOGEN	$152.00	$190.00	—	176% above	20%
Fibrinogen blood test inpatient CPT 85384 74039, FIBRINOGEN	$46.40	$58.00	—	—	20%
Fibrinogen blood test inpatient CPT 85384 FIBRINOGEN, ACTIVITY	$80.80	$101.00	—	—	20%
Fibrinogen blood test inpatient CPT 85384 FIBRINOGEN	$92.00	$115.00	—	—	20%
Fibrinogen blood test inpatient CPT 85384 FIBRINOGEN,PLASMA	$102.40	$128.00	—	—	20%
Fibrinogen blood test inpatient CPT 85384 74059, FIBRINOGEN	$131.20	$164.00	—	—	20%
Fibrinogen blood test inpatient CPT 85384 PCC FIBRINOGEN	$152.00	$190.00	—	—	20%
Folate (folic acid) blood test CPT 82746 FOLATE, SERUM	$104.00	$130.00	—	11% above	20%
Folate (folic acid) blood test inpatient CPT 82746 FOLATE, SERUM	$104.00	$130.00	—	—	20%
Free T3 thyroid hormone test CPT 84481 74845 T3, FREE	$100.80	$126.00	—	at median	20%
Free T3 thyroid hormone test CPT 84481 T3, FREE (FT3)	$108.80	$136.00	—	8% above	20%
Free T3 thyroid hormone test inpatient CPT 84481 74845 T3, FREE	$100.80	$126.00	—	—	20%
Free T3 thyroid hormone test inpatient CPT 84481 T3, FREE (FT3)	$108.80	$136.00	—	—	20%
Free T4 (free thyroxine) thyroid blood test CPT 84439 T4 (THYROXINE), FREE	$24.00	$30.00	—	62% below	20%
Free T4 (free thyroxine) thyroid blood test CPT 84439 T4, FREE BY DIALYSIS	$43.20	$54.00	—	31% below	20%
Free T4 (free thyroxine) thyroid blood test CPT 84439 T4, FREE (FT4)	$62.40	$78.00	—	at median	20%
Free T4 (free thyroxine) thyroid blood test CPT 84439 T4, FREE-MAYO	$126.40	$158.00	—	102% above	20%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4 (THYROXINE), FREE	$24.00	$30.00	—	—	20%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4, FREE BY DIALYSIS	$43.20	$54.00	—	—	20%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4, FREE (FT4)	$62.40	$78.00	—	—	20%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4, FREE-MAYO	$126.40	$158.00	—	—	20%
Free testosterone test CPT 84402 ASSAY OF FREE TESTOSTERONE	$72.00	$90.00	—	6% below	20%
Free testosterone test CPT 84402 TESTOSTERONE,FREE	$104.00	$130.00	—	36% above	20%
Free testosterone test inpatient CPT 84402 ASSAY OF FREE TESTOSTERONE	$72.00	$90.00	—	—	20%
Free testosterone test inpatient CPT 84402 TESTOSTERONE,FREE	$104.00	$130.00	—	—	20%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 GGT	$60.80	$76.00	—	37% above	20%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 GGT	$60.80	$76.00	—	—	20%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 GENERAL HEALTH PANEL	$306.40	$383.00	—	30% above	20%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 GENERAL HEALTH PANEL	$306.40	$383.00	—	—	20%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE TOLERANCE 1 HR	$55.20	$69.00	—	56% above	20%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE TOLERANCE 1 HR	$55.20	$69.00	—	—	20%
Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE 3 SPECIMENS	$132.80	$166.00	—	46% above	20%
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOLERANCE 3 SPECIMENS	$132.80	$166.00	—	—	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 59014 GONORRHEA AMPLIFIED PROBE	$237.60	$297.00	—	55% above	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 N.GONORRHOEAE BY NUCLEIC ACID AM	$237.60	$297.00	—	55% above	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 89018 NEISSERIA AMPLIF NA PROBE	$237.60	$297.00	—	55% above	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 N GONORRHOEA AMP RNA, MISC SITES-	$237.60	$297.00	—	55% above	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 78171 NEISSERIA AMPLIF NA PROBE	$237.60	$297.00	—	55% above	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 NEISSERIA AMPLIF NA PROBE	$237.60	$297.00	—	55% above	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 89018 NEISSERIA AMPLIF NA PROBE	$237.60	$297.00	—	—	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 N.GONORRHOEAE BY NUCLEIC ACID AM	$237.60	$297.00	—	—	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 59014 GONORRHEA AMPLIFIED PROBE	$237.60	$297.00	—	—	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 NEISSERIA AMPLIF NA PROBE	$237.60	$297.00	—	—	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 N GONORRHOEA AMP RNA, MISC SITES-	$237.60	$297.00	—	—	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 78171 NEISSERIA AMPLIF NA PROBE	$237.60	$297.00	—	—	20%
H. pylori antibody blood test CPT 86677 74124,H PYLORI IGG,IGM, IGA	$115.20	$144.00	—	36% above	20%
H. pylori antibody blood test inpatient CPT 86677 74124,H PYLORI IGG,IGM, IGA	$115.20	$144.00	—	—	20%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV TYPE 1 RNA QUANTIFICATION	$261.60	$327.00	—	9% above	20%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 QUANT&REVRSE TRNSCRPJ	$316.00	$395.00	—	32% above	20%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV TYPE 1 RNA QUANTIFICATION	$261.60	$327.00	—	—	20%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV-1 QUANT&REVRSE TRNSCRPJ	$316.00	$395.00	—	—	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 GLYCOSYLATED HEMOGLOBIN (A1C)	$72.80	$91.00	—	4% above	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 GLYCOSYLATED HEMOGLOBIN (A1C)	$72.80	$91.00	—	—	20%
Hemoglobin blood test CPT 85018 85018 HEMOGLOBIN	$23.20	$29.00	—	at median	20%
Hemoglobin blood test CPT 85018 TCC-HEMOCUE HEMOGLOBIN	$30.40	$38.00	—	31% above	20%
Hemoglobin blood test CPT 85018 BODY FLUID, HEMOGLOBIN	$31.20	$39.00	—	34% above	20%
Hemoglobin blood test CPT 85018 HEMOGLOBIN (HGB)	$31.20	$39.00	—	34% above	20%
Hemoglobin blood test inpatient CPT 85018 85018 HEMOGLOBIN	$23.20	$29.00	—	—	20%
Hemoglobin blood test inpatient CPT 85018 TCC-HEMOCUE HEMOGLOBIN	$30.40	$38.00	—	—	20%
Hemoglobin blood test inpatient CPT 85018 HEMOGLOBIN (HGB)	$31.20	$39.00	—	—	20%
Hemoglobin blood test inpatient CPT 85018 BODY FLUID, HEMOGLOBIN	$31.20	$39.00	—	—	20%
Hepatitis B core antibody test (total) CPT 86704 ANTI-HBC (IGG & IGM)	$72.80	$91.00	—	10% above	20%
Hepatitis B core antibody test (total) CPT 86704 HEPATITIS B CORE TOTAL ANTIBODIES	$97.60	$122.00	—	47% above	20%
Hepatitis B core antibody test (total) CPT 86704 HEPATITIS B CORE ANTIBODIES, TOTA	$144.00	$180.00	—	117% above	20%
Hepatitis B core antibody test (total) inpatient CPT 86704 ANTI-HBC (IGG & IGM)	$72.80	$91.00	—	—	20%
Hepatitis B core antibody test (total) inpatient CPT 86704 HEPATITIS B CORE TOTAL ANTIBODIES	$97.60	$122.00	—	—	20%
Hepatitis B core antibody test (total) inpatient CPT 86704 HEPATITIS B CORE ANTIBODIES, TOTA	$144.00	$180.00	—	—	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HPPE,HBSAB QUAL QUANT	$66.40	$83.00	—	18% above	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS BS ANTIBODY-MAYO	$70.40	$88.00	—	25% above	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURFACE AB QUAL/QUANT	$96.80	$121.00	—	72% above	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HPPE,HBSAB QUAL QUANT	$66.40	$83.00	—	—	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS BS ANTIBODY-MAYO	$70.40	$88.00	—	—	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B SURFACE AB QUAL/QUANT	$96.80	$121.00	—	—	20%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEP B SURF ANTI HBSAG CMIA-NDDOH	$50.40	$63.00	—	7% below	20%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HBSAG	$57.60	$72.00	—	7% above	20%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURFACE ANTIGEN	$64.00	$80.00	—	19% above	20%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HBSAG PRENATAL	$64.00	$80.00	—	19% above	20%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEP. B SURFACE AG, NDLSTICK, EMP	$64.00	$80.00	—	19% above	20%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEP B SURF ANTI HBSAG CMIA-NDDOH	$50.40	$63.00	—	—	20%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HBSAG	$57.60	$72.00	—	—	20%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS B SURFACE ANTIGEN	$64.00	$80.00	—	—	20%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HBSAG PRENATAL	$64.00	$80.00	—	—	20%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEP. B SURFACE AG, NDLSTICK, EMP	$64.00	$80.00	—	—	20%
Hepatitis C antibody blood test (screening) CPT 86803 HCV AB SCRN W/REFLEX TO HCV PCR	$44.80	$56.00	—	40% below	20%
Hepatitis C antibody blood test (screening) CPT 86803 ANTI-HCV	$86.40	$108.00	—	16% above	20%
Hepatitis C antibody blood test (screening) CPT 86803 HEP. C ANTIBODY, NDLSTICK, EMP.	$114.40	$143.00	—	54% above	20%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ANTIBODY	$114.40	$143.00	—	54% above	20%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ANTIBODY IGG IGM SCRE	$114.40	$143.00	—	54% above	20%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C VIRUS ANTIBODY, TOTAL	$114.40	$143.00	—	54% above	20%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HCV AB SCRN W/REFLEX TO HCV PCR	$44.80	$56.00	—	—	20%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 ANTI-HCV	$86.40	$108.00	—	—	20%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C ANTIBODY	$114.40	$143.00	—	—	20%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C ANTIBODY IGG IGM SCRE	$114.40	$143.00	—	—	20%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C VIRUS ANTIBODY, TOTAL	$114.40	$143.00	—	—	20%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEP. C ANTIBODY, NDLSTICK, EMP.	$114.40	$143.00	—	—	20%
Hepatitis C viral load (HCV RNA) test CPT 87522 HEPATITIS C REVRS TRNSCRPJ	$131.20	$164.00	—	at median	20%
Hepatitis C viral load (HCV RNA) test one side CPT 87522 HCV QUANT.BY RT-PCR	$243.20	$304.00	—	85% above	20%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEPATITIS C REVRS TRNSCRPJ	$131.20	$164.00	—	—	20%
Hepatitis C viral load (HCV RNA) test inpatient one side CPT 87522 HCV QUANT.BY RT-PCR	$243.20	$304.00	—	—	20%
Herpes blood test, HSV-1 antibody CPT 86695 AB, HSV 1	$56.80	$71.00	—	at median	20%
Herpes blood test, HSV-1 antibody CPT 86695 AB, HSV 1..	$59.20	$74.00	—	4% above	20%
Herpes blood test, HSV-1 antibody CPT 86695 78147 EAP,HERPES SIMPLEX TYPE 1	$81.60	$102.00	—	44% above	20%
Herpes blood test, HSV-1 antibody CPT 86695 HSV 1 IGG	$96.00	$120.00	—	69% above	20%
Herpes blood test, HSV-1 antibody CPT 86695 74472 HSV,AB, HSV TYPE 1	$117.60	$147.00	—	107% above	20%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 AB, HSV 1	$56.80	$71.00	—	—	20%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 AB, HSV 1..	$59.20	$74.00	—	—	20%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 78147 EAP,HERPES SIMPLEX TYPE 1	$81.60	$102.00	—	—	20%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HSV 1 IGG	$96.00	$120.00	—	—	20%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 74472 HSV,AB, HSV TYPE 1	$117.60	$147.00	—	—	20%
Herpes blood test, HSV-2 antibody CPT 86696 AB, HSV TYPE 2	$84.00	$105.00	—	25% above	20%
Herpes blood test, HSV-2 antibody CPT 86696 AB, HSV TYPE 2..	$88.00	$110.00	—	31% above	20%
Herpes blood test, HSV-2 antibody CPT 86696 74472 HSV,AB, HSV TYPE 2	$108.00	$135.00	—	60% above	20%
Herpes blood test, HSV-2 antibody CPT 86696 78147 EAP,HERPES SIMPLEX TYPE 2	$120.80	$151.00	—	79% above	20%
Herpes blood test, HSV-2 antibody CPT 86696 HSV 2 IGG	$140.00	$175.00	—	108% above	20%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 AB, HSV TYPE 2	$84.00	$105.00	—	—	20%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 AB, HSV TYPE 2..	$88.00	$110.00	—	—	20%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 74472 HSV,AB, HSV TYPE 2	$108.00	$135.00	—	—	20%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 78147 EAP,HERPES SIMPLEX TYPE 2	$120.80	$151.00	—	—	20%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HSV 2 IGG	$140.00	$175.00	—	—	20%
High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROTEIN, HIGH SENS, S	$144.00	$180.00	—	86% above	20%
High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROTEIN, HIGH SENSITI	$144.00	$180.00	—	86% above	20%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-REACTIVE PROTEIN, HIGH SENSITI	$144.00	$180.00	—	—	20%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-REACTIVE PROTEIN, HIGH SENS, S	$144.00	$180.00	—	—	20%
Homocysteine blood test CPT 83090 ASSAY OF HOMOCYSTINE	$59.20	$74.00	—	39% below	20%
Homocysteine blood test CPT 83090 HOMOCYSTEINE, TOTAL, PLASMA	$60.00	$75.00	—	38% below	20%
Homocysteine blood test CPT 83090 ASSAY OF HOMOCYSTIENE	$244.00	$305.00	—	152% above	20%
Homocysteine blood test inpatient CPT 83090 ASSAY OF HOMOCYSTINE	$59.20	$74.00	—	—	20%
Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINE, TOTAL, PLASMA	$60.00	$75.00	—	—	20%
Homocysteine blood test inpatient CPT 83090 ASSAY OF HOMOCYSTIENE	$244.00	$305.00	—	—	20%
Insulin blood test CPT 83525 74872 INSFT,INSULIN,TOTAL	$57.60	$72.00	—	1% below	20%
Insulin blood test CPT 83525 INSULIN LEVEL-MAYO	$57.60	$72.00	—	1% below	20%
Insulin blood test inpatient CPT 83525 74872 INSFT,INSULIN,TOTAL	$57.60	$72.00	—	—	20%
Insulin blood test inpatient CPT 83525 INSULIN LEVEL-MAYO	$57.60	$72.00	—	—	20%
Iron blood test (serum iron) CPT 83540 IRON, SERUM	$46.40	$58.00	—	21% above	20%
Iron blood test (serum iron) CPT 83540 IRON, LIVER TISSUE-MAYO	$120.00	$150.00	—	212% above	20%
Iron blood test (serum iron) inpatient CPT 83540 IRON, SERUM	$46.40	$58.00	—	—	20%
Iron blood test (serum iron) inpatient CPT 83540 IRON, LIVER TISSUE-MAYO	$120.00	$150.00	—	—	20%
Iron-binding capacity (TIBC) test CPT 83550 TOTAL IRON BINDING	$63.20	$79.00	—	18% above	20%
Iron-binding capacity (TIBC) test inpatient CPT 83550 TOTAL IRON BINDING	$63.20	$79.00	—	—	20%
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL	$80.00	$100.00	—	19% above	20%
Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL	$80.00	$100.00	—	—	20%
LH (luteinizing hormone) test CPT 83002 LUTEINIZING HORMONE (LH)	$139.20	$174.00	—	29% above	20%
LH (luteinizing hormone) test CPT 83002 LH, PEDIATRICS, S-MAYO	$201.60	$252.00	—	87% above	20%
LH (luteinizing hormone) test inpatient CPT 83002 LUTEINIZING HORMONE (LH)	$139.20	$174.00	—	—	20%
LH (luteinizing hormone) test inpatient CPT 83002 LH, PEDIATRICS, S-MAYO	$201.60	$252.00	—	—	20%
Lactate (lactic acid) blood test CPT 83605 LACTATE	$40.00	$50.00	—	48% below	20%
Lactate (lactic acid) blood test CPT 83605 83605 LACTIC ACID	$44.80	$56.00	—	42% below	20%
Lactate (lactic acid) blood test CPT 83605 LACTIC ACID	$56.00	$70.00	—	28% below	20%
Lactate (lactic acid) blood test CPT 83605 ASSAY OF LACTIC ACID	$76.80	$96.00	—	1% below	20%
Lactate (lactic acid) blood test CPT 83605 LACTATE,CSF	$124.00	$155.00	—	61% above	20%
Lactate (lactic acid) blood test CPT 83605 D-LACTATE,URINE	$296.80	$371.00	—	284% above	20%
Lactate (lactic acid) blood test inpatient CPT 83605 LACTATE	$40.00	$50.00	—	—	20%
Lactate (lactic acid) blood test inpatient CPT 83605 83605 LACTIC ACID	$44.80	$56.00	—	—	20%
Lactate (lactic acid) blood test inpatient CPT 83605 LACTIC ACID	$56.00	$70.00	—	—	20%
Lactate (lactic acid) blood test inpatient CPT 83605 ASSAY OF LACTIC ACID	$76.80	$96.00	—	—	20%
Lactate (lactic acid) blood test inpatient CPT 83605 LACTATE,CSF	$124.00	$155.00	—	—	20%
Lactate (lactic acid) blood test inpatient CPT 83605 D-LACTATE,URINE	$296.80	$371.00	—	—	20%
Lactate dehydrogenase (LDH) blood test CPT 83615 LDH, BODY FLUID	$60.80	$76.00	—	40% above	20%
Lactate dehydrogenase (LDH) blood test CPT 83615 LDH	$60.80	$76.00	—	40% above	20%
Lactate dehydrogenase (LDH) blood test CPT 83615 LDI,LACTATE DEHYDROGENASE	$64.00	$80.00	—	47% above	20%
Lactate dehydrogenase (LDH) blood test CPT 83615 LACTATE (LD) (LDH) ENZYME	$81.60	$102.00	—	88% above	20%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH, BODY FLUID	$60.80	$76.00	—	—	20%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH	$60.80	$76.00	—	—	20%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDI,LACTATE DEHYDROGENASE	$64.00	$80.00	—	—	20%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LACTATE (LD) (LDH) ENZYME	$81.60	$102.00	—	—	20%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE	$100.00	$125.00	—	87% above	20%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE	$100.00	$125.00	—	—	20%
Liver function blood test panel CPT 80076 LIVER PANEL	$116.80	$146.00	—	65% above	20%
Liver function blood test panel inpatient CPT 80076 LIVER PANEL	$116.80	$146.00	—	—	20%
Lyme disease antibody test CPT 86618 LYME AB MODIFIED 2-TIER W/REFLEX,	$40.00	$50.00	—	39% below	20%
Lyme disease antibody test CPT 86618 AB, LYME'S DISEASE.	$71.20	$89.00	—	9% above	20%
Lyme disease antibody test CPT 86618 LNBAB-MAYO	$76.00	$95.00	—	16% above	20%
Lyme disease antibody test CPT 86618 LYME DISEASE SEROLOGY	$79.20	$99.00	—	21% above	20%
Lyme disease antibody test CPT 86618 AB, LYME'S DISEASE	$240.00	$300.00	—	266% above	20%
Lyme disease antibody test inpatient CPT 86618 LYME AB MODIFIED 2-TIER W/REFLEX,	$40.00	$50.00	—	—	20%
Lyme disease antibody test inpatient CPT 86618 AB, LYME'S DISEASE.	$71.20	$89.00	—	—	20%
Lyme disease antibody test inpatient CPT 86618 LNBAB-MAYO	$76.00	$95.00	—	—	20%
Lyme disease antibody test inpatient CPT 86618 LYME DISEASE SEROLOGY	$79.20	$99.00	—	—	20%
Lyme disease antibody test inpatient CPT 86618 AB, LYME'S DISEASE	$240.00	$300.00	—	—	20%
Magnesium blood test CPT 83735 MAGNESIUM 75225	$24.00	$30.00	—	24% below	20%
Magnesium blood test CPT 83735 EQF,MAGNESIUM,FECES	$31.20	$39.00	—	2% below	20%
Magnesium blood test CPT 83735 MAGNESIUM	$40.00	$50.00	—	26% above	20%
Magnesium blood test CPT 83735 MAGNESIUM, RANDOM URINE	$40.00	$50.00	—	26% above	20%
Magnesium blood test CPT 83735 MU, MAGNESIUM, URINE	$40.00	$50.00	—	26% above	20%
Magnesium blood test inpatient CPT 83735 MAGNESIUM 75225	$24.00	$30.00	—	—	20%
Magnesium blood test inpatient CPT 83735 EQF,MAGNESIUM,FECES	$31.20	$39.00	—	—	20%
Magnesium blood test inpatient CPT 83735 MAGNESIUM	$40.00	$50.00	—	—	20%
Magnesium blood test inpatient CPT 83735 MU, MAGNESIUM, URINE	$40.00	$50.00	—	—	20%
Magnesium blood test inpatient CPT 83735 MAGNESIUM, RANDOM URINE	$40.00	$50.00	—	—	20%
Measles (rubeola) antibody test CPT 86765 RA,RUBEOLA AB IGG AND IGM	$56.80	$71.00	—	at median	20%
Measles (rubeola) antibody test CPT 86765 AB, RUBEOLA	$68.80	$86.00	—	21% above	20%
Measles (rubeola) antibody test CPT 86765 MEASLES VIRUS ANTIBODY, IGG IFA-N	$78.40	$98.00	—	38% above	20%
Measles (rubeola) antibody test CPT 86765 74548 MMRV, RUBEOLA AB	$78.40	$98.00	—	38% above	20%
Measles (rubeola) antibody test CPT 86765 AB, RUBEOLA.	$80.00	$100.00	—	41% above	20%
Measles (rubeola) antibody test CPT 86765 AB, RUBEOLA..	$80.00	$100.00	—	41% above	20%
Measles (rubeola) antibody test CPT 86765 78147 EAP,RUBEOLA	$80.00	$100.00	—	41% above	20%
Measles (rubeola) antibody test CPT 86765 RUBEOLA (MEASLES) AB ,SERUM	$187.20	$234.00	—	230% above	20%
Measles (rubeola) antibody test inpatient CPT 86765 RA,RUBEOLA AB IGG AND IGM	$56.80	$71.00	—	—	20%
Measles (rubeola) antibody test inpatient CPT 86765 AB, RUBEOLA	$68.80	$86.00	—	—	20%
Measles (rubeola) antibody test inpatient CPT 86765 74548 MMRV, RUBEOLA AB	$78.40	$98.00	—	—	20%
Measles (rubeola) antibody test inpatient CPT 86765 MEASLES VIRUS ANTIBODY, IGG IFA-N	$78.40	$98.00	—	—	20%
Measles (rubeola) antibody test inpatient CPT 86765 78147 EAP,RUBEOLA	$80.00	$100.00	—	—	20%
Measles (rubeola) antibody test inpatient CPT 86765 AB, RUBEOLA.	$80.00	$100.00	—	—	20%
Measles (rubeola) antibody test inpatient CPT 86765 AB, RUBEOLA..	$80.00	$100.00	—	—	20%
Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA (MEASLES) AB ,SERUM	$187.20	$234.00	—	—	20%
Mono test (heterophile antibody, Monospot) CPT 86308 MONOTEST	$64.00	$80.00	—	45% above	20%
Mono test (heterophile antibody, Monospot) CPT 86308 QUAL HETEROPHILE AB	$64.00	$80.00	—	45% above	20%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONOTEST	$64.00	$80.00	—	—	20%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 QUAL HETEROPHILE AB	$64.00	$80.00	—	—	20%
Mumps immunity blood test CPT 86735 MUMPS AB,IGG AND IGM	$40.80	$51.00	—	at median	20%
Mumps immunity blood test CPT 86735 AB, MUMPS	$68.80	$86.00	—	69% above	20%
Mumps immunity blood test CPT 86735 MUMPS VIRUS ANTIBODY, IGG IFA-NDD	$79.20	$99.00	—	94% above	20%
Mumps immunity blood test CPT 86735 74548 MMRV, MUMPS AB	$79.20	$99.00	—	94% above	20%
Mumps immunity blood test CPT 86735 AB, MUMPS.	$80.00	$100.00	—	96% above	20%
Mumps immunity blood test CPT 86735 IMMUNOASSAY NONANTIBODY...	$80.00	$100.00	—	96% above	20%
Mumps immunity blood test CPT 86735 78147 EAP,MUMPS	$81.60	$102.00	—	100% above	20%
Mumps immunity blood test CPT 86735 MUMPS VIRUS AB, IGM	$148.00	$185.00	—	263% above	20%
Mumps immunity blood test CPT 86735 MUMPS VIRUS AB, IGG	$148.00	$185.00	—	263% above	20%
Mumps immunity blood test CPT 86735 MUMPS, IGG SCREEN,SERUM	$198.40	$248.00	—	386% above	20%
Mumps immunity blood test inpatient CPT 86735 MUMPS AB,IGG AND IGM	$40.80	$51.00	—	—	20%
Mumps immunity blood test inpatient CPT 86735 AB, MUMPS	$68.80	$86.00	—	—	20%
Mumps immunity blood test inpatient CPT 86735 MUMPS VIRUS ANTIBODY, IGG IFA-NDD	$79.20	$99.00	—	—	20%
Mumps immunity blood test inpatient CPT 86735 74548 MMRV, MUMPS AB	$79.20	$99.00	—	—	20%
Mumps immunity blood test inpatient CPT 86735 IMMUNOASSAY NONANTIBODY...	$80.00	$100.00	—	—	20%
Mumps immunity blood test inpatient CPT 86735 AB, MUMPS.	$80.00	$100.00	—	—	20%
Mumps immunity blood test inpatient CPT 86735 78147 EAP,MUMPS	$81.60	$102.00	—	—	20%
Mumps immunity blood test inpatient CPT 86735 MUMPS VIRUS AB, IGG	$148.00	$185.00	—	—	20%
Mumps immunity blood test inpatient CPT 86735 MUMPS VIRUS AB, IGM	$148.00	$185.00	—	—	20%
Mumps immunity blood test inpatient CPT 86735 MUMPS, IGG SCREEN,SERUM	$198.40	$248.00	—	—	20%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA, FREE	$64.80	$81.00	—	at median	20%
PSA (prostate-specific antigen) blood test, free CPT 84154 FREE PSA	$127.20	$159.00	—	96% above	20%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA, FREE	$64.80	$81.00	—	—	20%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 FREE PSA	$127.20	$159.00	—	—	20%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA,TOTAL	$64.80	$81.00	—	33% below	20%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA, DIAGNOSTIC TOTAL	$117.60	$147.00	—	22% above	20%
PSA (prostate-specific antigen) blood test, total CPT 84153 TOTAL PSA	$127.20	$159.00	—	32% above	20%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA,TOTAL	$64.80	$81.00	—	—	20%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA, DIAGNOSTIC TOTAL	$117.60	$147.00	—	—	20%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 TOTAL PSA	$127.20	$159.00	—	—	20%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 CYTOPATHOLOGY LIQUID DIAGNOST.	$116.80	$146.00	—	14% above	20%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 CYTOPATHOLOGY LIQUID DIAGNOST.	$116.80	$146.00	—	—	20%
Parathyroid hormone (PTH) blood test CPT 83970 PTH,FNAB,NEEDLE WASH	$208.00	$260.00	—	at median	20%
Parathyroid hormone (PTH) blood test CPT 83970 PTH	$278.40	$348.00	—	33% above	20%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH,FNAB,NEEDLE WASH	$208.00	$260.00	—	—	20%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH	$278.40	$348.00	—	—	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 74039, PTT	$32.00	$40.00	—	3% below	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 85730 THROMBOPLASTIN TIME	$52.00	$65.00	—	58% above	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT, PARTIAL THROMBOPLASTIN	$81.60	$102.00	—	147% above	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 74059, PTT	$92.00	$115.00	—	179% above	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 74035, PTT	$92.80	$116.00	—	181% above	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 PCC APTT	$106.40	$133.00	—	222% above	20%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 74039, PTT	$32.00	$40.00	—	—	20%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 85730 THROMBOPLASTIN TIME	$52.00	$65.00	—	—	20%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT, PARTIAL THROMBOPLASTIN	$81.60	$102.00	—	—	20%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 74059, PTT	$92.00	$115.00	—	—	20%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 74035, PTT	$92.80	$116.00	—	—	20%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PCC APTT	$106.40	$133.00	—	—	20%
Phosphorus (phosphate) blood test CPT 84100 73870 EFPO,PHOSPHORUS,FECES	$22.40	$28.00	—	33% below	20%
Phosphorus (phosphate) blood test CPT 84100 PHOSPHORUS LEVEL	$60.80	$76.00	—	81% above	20%
Phosphorus (phosphate) blood test inpatient CPT 84100 73870 EFPO,PHOSPHORUS,FECES	$22.40	$28.00	—	—	20%
Phosphorus (phosphate) blood test inpatient CPT 84100 PHOSPHORUS LEVEL	$60.80	$76.00	—	—	20%
Potassium blood test CPT 84132 84132 POTASSIUM,SERUM,PLASMA,OR W	$25.60	$32.00	—	37% below	20%
Potassium blood test CPT 84132 POTASSIUM, SERUM,PLASMA,OR WHL BL	$32.00	$40.00	—	21% below	20%
Potassium blood test inpatient CPT 84132 84132 POTASSIUM,SERUM,PLASMA,OR W	$25.60	$32.00	—	—	20%
Potassium blood test inpatient CPT 84132 POTASSIUM, SERUM,PLASMA,OR WHL BL	$32.00	$40.00	—	—	20%
Progesterone blood test CPT 84144 PROGESTERONE	$176.00	$220.00	—	47% above	20%
Progesterone blood test inpatient CPT 84144 PROGESTERONE	$176.00	$220.00	—	—	20%
Prolactin blood test CPT 84146 PROLACTIN,PITUITARY MACROADENOMA	$96.00	$120.00	—	5% below	20%
Prolactin blood test CPT 84146 PROLACTIN, SERUM-MAYO	$104.00	$130.00	—	3% above	20%
Prolactin blood test CPT 84146 74246 MACROPROLACTIN	$116.80	$146.00	—	16% above	20%
Prolactin blood test CPT 84146 PROLACTIN	$149.60	$187.00	—	48% above	20%
Prolactin blood test inpatient CPT 84146 PROLACTIN,PITUITARY MACROADENOMA	$96.00	$120.00	—	—	20%
Prolactin blood test inpatient CPT 84146 PROLACTIN, SERUM-MAYO	$104.00	$130.00	—	—	20%
Prolactin blood test inpatient CPT 84146 74246 MACROPROLACTIN	$116.80	$146.00	—	—	20%
Prolactin blood test inpatient CPT 84146 PROLACTIN	$149.60	$187.00	—	—	20%
Prothrombin time (PT/INR) clotting test CPT 85610 74039, PROTHROMBIN TIME	$20.00	$25.00	—	23% below	20%
Prothrombin time (PT/INR) clotting test CPT 85610 PT, PROTHROMBIN TIME	$44.80	$56.00	—	73% above	20%
Prothrombin time (PT/INR) clotting test CPT 85610 74035, PROTHROMBIN TIME	$59.20	$74.00	—	129% above	20%
Prothrombin time (PT/INR) clotting test CPT 85610 74059, PROTHROMBIN TIME	$59.20	$74.00	—	129% above	20%
Prothrombin time (PT/INR) clotting test CPT 85610 PCC PROTHROMBIN TIME	$70.40	$88.00	—	172% above	20%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 74039, PROTHROMBIN TIME	$20.00	$25.00	—	—	20%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT, PROTHROMBIN TIME	$44.80	$56.00	—	—	20%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 74035, PROTHROMBIN TIME	$59.20	$74.00	—	—	20%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 74059, PROTHROMBIN TIME	$59.20	$74.00	—	—	20%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PCC PROTHROMBIN TIME	$70.40	$88.00	—	—	20%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 DRUG TEST PRSMV DIR OPT OBS	$58.40	$73.00	—	32% below	20%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 DRUG TEST PRSMV DIR OPT OBS	$58.40	$73.00	—	—	20%
Rapid flu test (influenza antigen) CPT 87804 MC INFLUENZA RAPID POC, ER	$84.00	$105.00	—	at median	20%
Rapid flu test (influenza antigen) CPT 87804 MC POC RAPID INFLUENZA TEST.	$84.00	$105.00	—	at median	20%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA IA W DO.	$87.20	$109.00	—	4% above	20%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA IA W DO...	$87.20	$109.00	—	4% above	20%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA IA W DO	$87.20	$109.00	—	4% above	20%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA IA W DO..	$87.20	$109.00	—	4% above	20%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA ASSAY W/OPTIC	$87.20	$109.00	—	4% above	20%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA A AND B AG	$87.20	$109.00	—	4% above	20%
Rapid flu test (influenza antigen) inpatient CPT 87804 MC POC RAPID INFLUENZA TEST.	$84.00	$105.00	—	—	20%
Rapid flu test (influenza antigen) inpatient CPT 87804 MC INFLUENZA RAPID POC, ER	$84.00	$105.00	—	—	20%
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA A AND B AG	$87.20	$109.00	—	—	20%
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA ASSAY W/OPTIC	$87.20	$109.00	—	—	20%
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA IA W DO..	$87.20	$109.00	—	—	20%
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA IA W DO.	$87.20	$109.00	—	—	20%
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA IA W DO	$87.20	$109.00	—	—	20%
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA IA W DO...	$87.20	$109.00	—	—	20%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREP GROUP A SCREEN, THROAT	$64.00	$80.00	—	19% below	20%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 MC 10 MINUTE STREP TEST, RAPID	$68.80	$86.00	—	13% below	20%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 MC 10 MIN STREP RAPID POC, ER	$84.00	$105.00	—	7% above	20%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREP SCREEN	$84.00	$105.00	—	7% above	20%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 STREP GROUP A SCREEN, THROAT	$64.00	$80.00	—	—	20%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 MC 10 MINUTE STREP TEST, RAPID	$68.80	$86.00	—	—	20%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 MC 10 MIN STREP RAPID POC, ER	$84.00	$105.00	—	—	20%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 STREP SCREEN	$84.00	$105.00	—	—	20%
Renin blood test CPT 84244 RENIN ACTIVITY, PLASMA	$75.20	$94.00	—	at median	20%
Renin blood test inpatient CPT 84244 RENIN ACTIVITY, PLASMA	$75.20	$94.00	—	—	20%
Rh blood typing CPT 86901 BLOOD TYPE, RH	$61.60	$77.00	—	61% above	20%
Rh blood typing inpatient CPT 86901 BLOOD TYPE, RH	$61.60	$77.00	—	—	20%
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR-MAYO	$79.20	$99.00	—	116% above	20%
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR, QUANT.	$87.20	$109.00	—	138% above	20%
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR, BODY FLUID	$99.20	$124.00	—	171% above	20%
Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR-MAYO	$79.20	$99.00	—	—	20%
Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR, QUANT.	$87.20	$109.00	—	—	20%
Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR, BODY FLUID	$99.20	$124.00	—	—	20%
Rubella antibody test (immunity check) CPT 86762 RUBELLA ANTIBODY, IGG	$80.00	$100.00	—	20% above	20%
Rubella antibody test (immunity check) CPT 86762 AB, RUBELLA	$80.00	$100.00	—	20% above	20%
Rubella antibody test (immunity check) CPT 86762 74548 MMRV, RUBELLA AB	$87.20	$109.00	—	31% above	20%
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA ANTIBODY, IGG	$80.00	$100.00	—	—	20%
Rubella antibody test (immunity check) inpatient CPT 86762 AB, RUBELLA	$80.00	$100.00	—	—	20%
Rubella antibody test (immunity check) inpatient CPT 86762 74548 MMRV, RUBELLA AB	$87.20	$109.00	—	—	20%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 ESR CHARGE ONLY	$38.40	$48.00	—	24% above	20%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 SEDIMENTATION RATE	$38.40	$48.00	—	24% above	20%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 ESR CHARGE ONLY	$38.40	$48.00	—	—	20%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 SEDIMENTATION RATE	$38.40	$48.00	—	—	20%
Sodium blood test CPT 84295 84295 SODIUM,SERUM,PLASMA OR WHL	$20.80	$26.00	—	47% below	20%
Sodium blood test CPT 84295 SODIUM, SERUM,PLASMA,OR WHOLE BLO	$26.40	$33.00	—	32% below	20%
Sodium blood test inpatient CPT 84295 84295 SODIUM,SERUM,PLASMA OR WHL	$20.80	$26.00	—	—	20%
Sodium blood test inpatient CPT 84295 SODIUM, SERUM,PLASMA,OR WHOLE BLO	$26.40	$33.00	—	—	20%
Stool ova and parasites exam CPT 87177 78079 PA,CONCENTRATION FOR INFECT	$48.80	$61.00	—	at median	20%
Stool ova and parasites exam CPT 87177 78216 PS, OVA PARASITES CONC W ID	$48.80	$61.00	—	at median	20%
Stool ova and parasites exam CPT 87177 74978 CS,OVA & PARASITES DIR SMR	$51.20	$64.00	—	5% above	20%
Stool ova and parasites exam CPT 87177 SCHISTOSOMA EXAM, URINE-MAYO	$179.20	$224.00	—	267% above	20%
Stool ova and parasites exam inpatient CPT 87177 78216 PS, OVA PARASITES CONC W ID	$48.80	$61.00	—	—	20%
Stool ova and parasites exam inpatient CPT 87177 78079 PA,CONCENTRATION FOR INFECT	$48.80	$61.00	—	—	20%
Stool ova and parasites exam inpatient CPT 87177 74978 CS,OVA & PARASITES DIR SMR	$51.20	$64.00	—	—	20%
Stool ova and parasites exam inpatient CPT 87177 SCHISTOSOMA EXAM, URINE-MAYO	$179.20	$224.00	—	—	20%
Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLOOD, FECES 3 CARD 82270	$30.40	$38.00	—	7% above	20%
Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLOOD III,FECES	$30.40	$38.00	—	7% above	20%
Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLOOD I,FECES	$30.40	$38.00	—	7% above	20%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 OCCULT BLOOD I,FECES	$30.40	$38.00	—	—	20%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 OCCULT BLOOD, FECES 3 CARD 82270	$30.40	$38.00	—	—	20%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 OCCULT BLOOD III,FECES	$30.40	$38.00	—	—	20%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 OCCULT BLD IMMUNO.	$89.60	$112.00	—	7% above	20%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 OCCULT BLD IMMUNO.	$89.60	$112.00	—	—	20%
Syphilis antibody test (Treponema pallidum) CPT 86780 NEUROSYPHILIS IGG AB INDEX W/VDRL	$40.00	$50.00	—	6% below	20%
Syphilis antibody test (Treponema pallidum) CPT 86780 SYPHILIS TESTING PANEL-NDDOH	$64.80	$81.00	—	52% above	20%
Syphilis antibody test (Treponema pallidum) CPT 86780 SYPHILIS SEROLOGY (RPR)	$64.80	$81.00	—	52% above	20%
Syphilis antibody test (Treponema pallidum) CPT 86780 TREPONEMA PALLIDUM.	$64.80	$81.00	—	52% above	20%
Syphilis antibody test (Treponema pallidum) CPT 86780 TREPONEMA PALLIDUM..	$96.00	$120.00	—	125% above	20%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 NEUROSYPHILIS IGG AB INDEX W/VDRL	$40.00	$50.00	—	—	20%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 SYPHILIS SEROLOGY (RPR)	$64.80	$81.00	—	—	20%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 TREPONEMA PALLIDUM.	$64.80	$81.00	—	—	20%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 SYPHILIS TESTING PANEL-NDDOH	$64.80	$81.00	—	—	20%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 TREPONEMA PALLIDUM..	$96.00	$120.00	—	—	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 SYPHILIS TEST NON-TREP QUAL	$26.40	$33.00	—	10% below	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 VDRL, CSF	$114.40	$143.00	—	291% above	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 SYPHILIS TEST NON-TREP QUAL	$26.40	$33.00	—	—	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 VDRL, CSF	$114.40	$143.00	—	—	20%
Testosterone blood test, total (not free testosterone) CPT 84403 ASSAY OF TOTAL TESTOSTERONE	$72.80	$91.00	—	4% below	20%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE,TOTAL ONLY-MAYO	$80.00	$100.00	—	6% above	20%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE, TOTAL	$80.00	$100.00	—	6% above	20%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE,TOTAL	$105.60	$132.00	—	40% above	20%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 ASSAY OF TOTAL TESTOSTERONE	$72.80	$91.00	—	—	20%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE,TOTAL ONLY-MAYO	$80.00	$100.00	—	—	20%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE, TOTAL	$80.00	$100.00	—	—	20%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE,TOTAL	$105.60	$132.00	—	—	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 LIVER/KIDNEY MICROSOME AB	$60.80	$76.00	—	5% below	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 THYROPEROXIDASE (TPO) ANTIBODIES	$119.20	$149.00	—	86% above	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 THYROPEROXIDASE ANTIBODIES	$174.40	$218.00	—	172% above	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 LIVER CYTOSOL AUTOANTIBODIES	$211.20	$264.00	—	230% above	20%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 LIVER/KIDNEY MICROSOME AB	$60.80	$76.00	—	—	20%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 THYROPEROXIDASE (TPO) ANTIBODIES	$119.20	$149.00	—	—	20%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 THYROPEROXIDASE ANTIBODIES	$174.40	$218.00	—	—	20%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 LIVER CYTOSOL AUTOANTIBODIES	$211.20	$264.00	—	—	20%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH-THYROID STIMULATING HORMON	$104.00	$130.00	—	1% above	20%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID STIMULATING HORMONE	$107.20	$134.00	—	4% above	20%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH-THYROID STIMULATING HORMON	$104.00	$130.00	—	—	20%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 THYROID STIMULATING HORMONE	$107.20	$134.00	—	—	20%
Total IgE blood test CPT 82785 74637 ASSAY OF IGE	$84.80	$106.00	—	at median	20%
Total IgE blood test CPT 82785 IGE,IMMUNOGLOBULIN E,SERUM	$116.00	$145.00	—	37% above	20%
Total IgE blood test inpatient CPT 82785 74637 ASSAY OF IGE	$84.80	$106.00	—	—	20%
Total IgE blood test inpatient CPT 82785 IGE,IMMUNOGLOBULIN E,SERUM	$116.00	$145.00	—	—	20%
Total cholesterol blood test CPT 82465 12282 WP, CHOLESTEROL	$4.00	$5.00	—	88% below	20%
Total cholesterol blood test CPT 82465 LCAD,CHOLESTEROL,TOTAL	$40.80	$51.00	—	21% above	20%
Total cholesterol blood test CPT 82465 CHOLESTEROL	$41.60	$52.00	—	23% above	20%
Total cholesterol blood test inpatient CPT 82465 12282 WP, CHOLESTEROL	$4.00	$5.00	—	—	20%
Total cholesterol blood test inpatient CPT 82465 LCAD,CHOLESTEROL,TOTAL	$40.80	$51.00	—	—	20%
Total cholesterol blood test inpatient CPT 82465 CHOLESTEROL	$41.60	$52.00	—	—	20%
Total thyroxine (T4) blood test CPT 84436 FTI, THYROXINE, TOTAL	$44.80	$56.00	—	at median	20%
Total thyroxine (T4) blood test CPT 84436 T-4, TOTAL	$60.80	$76.00	—	36% above	20%
Total thyroxine (T4) blood test inpatient CPT 84436 FTI, THYROXINE, TOTAL	$44.80	$56.00	—	—	20%
Total thyroxine (T4) blood test inpatient CPT 84436 T-4, TOTAL	$60.80	$76.00	—	—	20%
Total triiodothyronine (T3) blood test CPT 84480 74845 T3, TOTAL	$100.80	$126.00	—	11% above	20%
Total triiodothyronine (T3) blood test CPT 84480 T3, TOTAL ONLY, SERUM	$132.80	$166.00	—	46% above	20%
Total triiodothyronine (T3) blood test inpatient CPT 84480 74845 T3, TOTAL	$100.80	$126.00	—	—	20%
Total triiodothyronine (T3) blood test inpatient CPT 84480 T3, TOTAL ONLY, SERUM	$132.80	$166.00	—	—	20%
Transferrin blood test CPT 84466 TRANSFERRIN, SERUM	$135.20	$169.00	—	80% above	20%
Transferrin blood test inpatient CPT 84466 TRANSFERRIN, SERUM	$135.20	$169.00	—	—	20%
Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS AMPLIF	$132.80	$166.00	—	32% above	20%
Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS,MISC SITES	$180.80	$226.00	—	80% above	20%
Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS VAGINALIS AMPLIF	$132.80	$166.00	—	—	20%
Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS VAGINALIS,MISC SITES	$180.80	$226.00	—	—	20%
Triglycerides blood test CPT 84478 12282 WP,TRIGLYCERIDES	$4.00	$5.00	—	91% below	20%
Triglycerides blood test CPT 84478 74579 LA, TRIGLYCERIDES	$27.20	$34.00	—	37% below	20%
Triglycerides blood test CPT 84478 TRIGLYCERIDES	$55.20	$69.00	—	29% above	20%
Triglycerides blood test inpatient CPT 84478 12282 WP,TRIGLYCERIDES	$4.00	$5.00	—	—	20%
Triglycerides blood test inpatient CPT 84478 74579 LA, TRIGLYCERIDES	$27.20	$34.00	—	—	20%
Triglycerides blood test inpatient CPT 84478 TRIGLYCERIDES	$55.20	$69.00	—	—	20%
Troponin test, quantitative CPT 84484 TROPONIN, T, 5TH GEN, P	$80.00	$100.00	—	at median	20%
Troponin test, quantitative CPT 84484 TROPONIN-I	$108.80	$136.00	—	36% above	20%
Troponin test, quantitative inpatient CPT 84484 TROPONIN, T, 5TH GEN, P	$80.00	$100.00	—	—	20%
Troponin test, quantitative inpatient CPT 84484 TROPONIN-I	$108.80	$136.00	—	—	20%
Uric acid blood test CPT 84550 URIC ACID - POST RASBURICASE	$45.60	$57.00	—	13% above	20%
Uric acid blood test CPT 84550 URIC ACID, BLOOD	$45.60	$57.00	—	13% above	20%
Uric acid blood test inpatient CPT 84550 URIC ACID - POST RASBURICASE	$45.60	$57.00	—	—	20%
Uric acid blood test inpatient CPT 84550 URIC ACID, BLOOD	$45.60	$57.00	—	—	20%
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS AUTOMATED,WITH MICROSC	$46.40	$58.00	—	29% above	20%
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS W MICROSCOPY	$46.40	$58.00	—	29% above	20%
Urinalysis with microscope exam, automated CPT 81001 CLINICAL STUDIES URINALYSIS WITH	$46.40	$58.00	—	29% above	20%
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS W MICROSCOPY	$46.40	$58.00	—	—	20%
Urinalysis with microscope exam, automated inpatient CPT 81001 CLINICAL STUDIES URINALYSIS WITH	$46.40	$58.00	—	—	20%
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS AUTOMATED,WITH MICROSC	$46.40	$58.00	—	—	20%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS WITH REFLEX MICROSCOPY	$27.20	$34.00	—	53% above	20%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS W REFLEX TO MICROSCOPY	$27.20	$34.00	—	53% above	20%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS, ROUTINE	$27.20	$34.00	—	53% above	20%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS W/O MICROSCOPY 81003	$32.00	$40.00	—	80% above	20%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS, ROUTINE	$27.20	$34.00	—	—	20%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS WITH REFLEX MICROSCOPY	$27.20	$34.00	—	—	20%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS W REFLEX TO MICROSCOPY	$27.20	$34.00	—	—	20%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS W/O MICROSCOPY 81003	$32.00	$40.00	—	—	20%
Urinalysis without microscope exam, manual CPT 81002 URINALYSIS W/O MICRO	$32.00	$40.00	—	52% above	20%
Urinalysis without microscope exam, manual CPT 81002 OCC MED URINALYSIS W/O MICROSCOPY	$32.00	$40.00	—	52% above	20%
Urinalysis without microscope exam, manual CPT 81002 URINE, KETONES	$40.80	$51.00	—	94% above	20%
Urinalysis without microscope exam, manual CPT 81002 HEMASTIX	$40.80	$51.00	—	94% above	20%
Urinalysis without microscope exam, manual CPT 81002 URINE DIPSTICK, OFFICE	$40.80	$51.00	—	94% above	20%
Urinalysis without microscope exam, manual inpatient CPT 81002 OCC MED URINALYSIS W/O MICROSCOPY	$32.00	$40.00	—	—	20%
Urinalysis without microscope exam, manual inpatient CPT 81002 URINALYSIS W/O MICRO	$32.00	$40.00	—	—	20%
Urinalysis without microscope exam, manual inpatient CPT 81002 URINE DIPSTICK, OFFICE	$40.80	$51.00	—	—	20%
Urinalysis without microscope exam, manual inpatient CPT 81002 HEMASTIX	$40.80	$51.00	—	—	20%
Urinalysis without microscope exam, manual inpatient CPT 81002 URINE, KETONES	$40.80	$51.00	—	—	20%
Urine culture for bacteria, with colony count CPT 87086 CULTURE, URINE	$113.60	$142.00	—	88% above	20%
Urine culture for bacteria, with colony count inpatient CPT 87086 CULTURE, URINE	$113.60	$142.00	—	—	20%
Urine microalbumin (albumin) test CPT 82043 URINE ALBUMIN QUANTITATIVE	$40.00	$50.00	—	1% below	20%
Urine microalbumin (albumin) test CPT 82043 MICROALBUMIN, URINE, 24 HOUR	$57.60	$72.00	—	42% above	20%
Urine microalbumin (albumin) test CPT 82043 ALBUMIN URINE,MICROALBUM QUANT	$57.60	$72.00	—	42% above	20%
Urine microalbumin (albumin) test inpatient CPT 82043 URINE ALBUMIN QUANTITATIVE	$40.00	$50.00	—	—	20%
Urine microalbumin (albumin) test inpatient CPT 82043 MICROALBUMIN, URINE, 24 HOUR	$57.60	$72.00	—	—	20%
Urine microalbumin (albumin) test inpatient CPT 82043 ALBUMIN URINE,MICROALBUM QUANT	$57.60	$72.00	—	—	20%
Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY VISUAL COLOR	$61.60	$77.00	—	11% above	20%
Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY, VISUAL COLOR	$61.60	$77.00	—	11% above	20%
Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY TEST POC	$61.60	$77.00	—	11% above	20%
Urine pregnancy test, read by color change inpatient CPT 81025 URINE PREGNANCY TEST POC	$61.60	$77.00	—	—	20%
Urine pregnancy test, read by color change inpatient CPT 81025 URINE PREGNANCY, VISUAL COLOR	$61.60	$77.00	—	—	20%
Urine pregnancy test, read by color change inpatient CPT 81025 URINE PREGNANCY VISUAL COLOR	$61.60	$77.00	—	—	20%
Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B12	$96.80	$121.00	—	at median	20%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B12	$96.80	$121.00	—	—	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 25(OH) VITAMIN D TOTAL	$166.40	$208.00	—	at median	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 25-HYDROXYVITAMIN D2,D3 BLOOD	$236.80	$296.00	—	42% above	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 25(OH) VITAMIN D TOTAL	$166.40	$208.00	—	—	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 25-HYDROXYVITAMIN D2,D3 BLOOD	$236.80	$296.00	—	—	20%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 CALCITRIOL 1,25 DIOH VITD-MAYO	$129.60	$162.00	—	at median	20%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 VITAMIN D,1,25-DIHYDROXY, SERUM	$283.20	$354.00	—	119% above	20%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 CALCITRIOL 1,25 DIOH VITD-MAYO	$129.60	$162.00	—	—	20%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 VITAMIN D,1,25-DIHYDROXY, SERUM	$283.20	$354.00	—	—	20%
Zinc blood test CPT 84630 ASSAY OF ZINC	$32.00	$40.00	—	32% below	20%
Zinc blood test CPT 84630 ZINC SERUM	$135.20	$169.00	—	188% above	20%
Zinc blood test CPT 84630 ZINC, URINE	$137.60	$172.00	—	193% above	20%
Zinc blood test inpatient CPT 84630 ASSAY OF ZINC	$32.00	$40.00	—	—	20%
Zinc blood test inpatient CPT 84630 ZINC SERUM	$135.20	$169.00	—	—	20%
Zinc blood test inpatient CPT 84630 ZINC, URINE	$137.60	$172.00	—	—	20%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 74508 FM, TOTAL HCG	$87.20	$109.00	—	10% above	20%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 CHORIONIC GONADOTROPIN,TUM.MKR	$137.60	$172.00	—	73% above	20%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG, QUANT., BLOOD	$149.60	$187.00	—	88% above	20%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 CHORIONIC GONADOTROPIN, BETA-SUBU	$192.00	$240.00	—	142% above	20%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 74508 FM, TOTAL HCG	$87.20	$109.00	—	—	20%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 CHORIONIC GONADOTROPIN,TUM.MKR	$137.60	$172.00	—	—	20%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCG, QUANT., BLOOD	$149.60	$187.00	—	—	20%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 CHORIONIC GONADOTROPIN, BETA-SUBU	$192.00	$240.00	—	—	20%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs North Dakota	Off list
Balloon dilation of the maxillary sinus opening, one side CPT 31295 SINUS ENDO W/BALLOON DIL MAX SINU	$7,120.00	$8,900.00	—	at median	20%
Balloon dilation of the maxillary sinus opening, one side inpatient CPT 31295 SINUS ENDO W/BALLOON DIL MAX SINU	$7,120.00	$8,900.00	—	—	20%
Botox injections for chronic migraine CPT 64615 CHEMODENERV MUSC MIGRAINE	$303.20	$379.00	—	21% below	20%
Botox injections for chronic migraine CPT 64615 CHEMODENERV MUSC MIGRAINE 64615	$436.00	$545.00	—	14% above	20%
Botox injections for chronic migraine inpatient CPT 64615 CHEMODENERV MUSC MIGRAINE	$303.20	$379.00	—	—	20%
Botox injections for chronic migraine inpatient CPT 64615 CHEMODENERV MUSC MIGRAINE 64615	$436.00	$545.00	—	—	20%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 MA LARGE CORE BREAST BIOPSY-S	$2,836.80	$3,546.00	—	18% above	20%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 MA BREAST BIOPSY VACUUM-S	$2,836.80	$3,546.00	—	18% above	20%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 MA BREAST BIOPSY VACUUM-S	$2,836.80	$3,546.00	—	—	20%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 MA LARGE CORE BREAST BIOPSY-S	$2,836.80	$3,546.00	—	—	20%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 TREATMENT ANKLE FRACTURE 27786	$246.40	$308.00	—	38% below	20%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 CL TX DSTL FIB FX WO MANIP	$1,656.00	$2,070.00	—	316% above	20%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 TREATMENT ANKLE FRACTURE 27786	$246.40	$308.00	—	—	20%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 CL TX DSTL FIB FX WO MANIP	$1,656.00	$2,070.00	—	—	20%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 TREAT METATARSAL FRACTURE 28470	$246.40	$308.00	—	38% below	20%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 CL TX METATARSAL FX, WO MANIP	$458.40	$573.00	—	15% above	20%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 TREAT METATARSAL FRACTURE 28470	$246.40	$308.00	—	—	20%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 CL TX METATARSAL FX, WO MANIP	$458.40	$573.00	—	—	20%
Bunion correction with removal of part of the big toe joint CPT 28292 CORRECTION HALLUX VALGUS	$3,336.00	$4,170.00	—	42% below	20%
Bunion correction with removal of part of the big toe joint inpatient CPT 28292 CORRECTION HALLUX VALGUS	$3,336.00	$4,170.00	—	—	20%
Cardiac catheterization with coronary angiogram one side CPT 93458 CL LEFT HEART CATH-LV & CORONARYS	$7,576.00	$9,470.00	—	22% below	20%
Cardiac catheterization with coronary angiogram inpatient one side CPT 93458 CL LEFT HEART CATH-LV & CORONARYS	$7,576.00	$9,470.00	—	—	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 ETC CARDIOVERSION ELECTRIC EXT	$1,019.20	$1,274.00	—	at median	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 ANS CARDIOVERSION ELECTIVE	$1,019.20	$1,274.00	—	at median	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 NRS CARDIOVERSION	$1,019.20	$1,274.00	—	at median	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CL CARDIOVERSION EXTERNAL	$1,019.20	$1,274.00	—	at median	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CL CARDIOVERSION	$1,019.20	$1,274.00	—	at median	20%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 ANS CARDIOVERSION ELECTIVE	$1,019.20	$1,274.00	—	—	20%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CL CARDIOVERSION EXTERNAL	$1,019.20	$1,274.00	—	—	20%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CL CARDIOVERSION	$1,019.20	$1,274.00	—	—	20%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 NRS CARDIOVERSION	$1,019.20	$1,274.00	—	—	20%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 ETC CARDIOVERSION ELECTRIC EXT	$1,019.20	$1,274.00	—	—	20%
Cataract surgery with lens implant CPT 66984 SJS-CATARACT SURG W/IOL, 66984	$1,500.80	$1,876.00	—	57% below	20%
Cataract surgery with lens implant inpatient CPT 66984 SJS-CATARACT SURG W/IOL, 66984	$1,500.80	$1,876.00	—	—	20%
Cervical biopsy CPT 57500 BIOPSY OF CERVIX 57500	$895.20	$1,119.00	—	at median	20%
Cervical biopsy inpatient CPT 57500 BIOPSY OF CERVIX 57500	$895.20	$1,119.00	—	—	20%
Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 CIRCUMCISION, SURGICAL EXCISION O	$2,104.00	$2,630.00	—	26% below	20%
Circumcision by surgical excision, older than 28 days (children and adults) inpatient CPT 54161 CIRCUMCISION, SURGICAL EXCISION O	$2,104.00	$2,630.00	—	—	20%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION 54150	$2,104.00	$2,630.00	—	53% above	20%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 CIRCUMCISION 54150	$2,104.00	$2,630.00	—	—	20%
Circumcision, surgical, older than a newborn CPT 54160 CIRCUMCISION NEONATE	$686.40	$858.00	—	at median	20%
Circumcision, surgical, older than a newborn CPT 54160 CIRCUMCISION	$824.80	$1,031.00	—	20% above	20%
Circumcision, surgical, older than a newborn inpatient CPT 54160 CIRCUMCISION NEONATE	$686.40	$858.00	—	—	20%
Circumcision, surgical, older than a newborn inpatient CPT 54160 CIRCUMCISION	$824.80	$1,031.00	—	—	20%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 TREAT FRACTURE RADIUS/ULNA 25600	$246.40	$308.00	—	45% below	20%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 CL TX DIST RAD FX ES, WO MANIP	$458.40	$573.00	—	3% above	20%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 NRS 25600 TREAT FRACTURE RADIUS/U	$458.40	$573.00	—	3% above	20%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 TREAT FRACTURE RADIUS/ULNA 25600	$246.40	$308.00	—	—	20%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 NRS 25600 TREAT FRACTURE RADIUS/U	$458.40	$573.00	—	—	20%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 CL TX DIST RAD FX ES, WO MANIP	$458.40	$573.00	—	—	20%
Colonoscopy with polyp removal CPT 45385 45385 GI COLON W POLYP/SNARE	$2,291.20	$2,864.00	—	14% above	20%
Colonoscopy with polyp removal inpatient CPT 45385 45385 GI COLON W POLYP/SNARE	$2,291.20	$2,864.00	—	—	20%
Colonoscopy with tissue sample CPT 45380 45380 GI COLONOSCOPY W BX	$2,291.20	$2,864.00	—	25% above	20%
Colonoscopy with tissue sample inpatient CPT 45380 45380 GI COLONOSCOPY W BX	$2,291.20	$2,864.00	—	—	20%
Colonoscopy, diagnostic CPT 45378 COLONOSCOPY, FLEXIBLE, DIAGNOSTIC	$937.60	$1,172.00	—	48% below	20%
Colonoscopy, diagnostic CPT 45378 45378 GI COLONOSCOPY	$1,814.40	$2,268.00	—	1% above	20%
Colonoscopy, diagnostic inpatient CPT 45378 COLONOSCOPY, FLEXIBLE, DIAGNOSTIC	$937.60	$1,172.00	—	—	20%
Colonoscopy, diagnostic inpatient CPT 45378 45378 GI COLONOSCOPY	$1,814.40	$2,268.00	—	—	20%
Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 CERVIX EXCISION 57460	$3,272.00	$4,090.00	—	17% below	20%
Colposcopy with LEEP (loop electrosurgical excision) inpatient CPT 57460 CERVIX EXCISION 57460	$3,272.00	$4,090.00	—	—	20%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 COLPOSCOPY W/BX & EXAM 57454	$312.80	$391.00	—	at median	20%
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 COLPOSCOPY W/BX & EXAM 57454	$312.80	$391.00	—	—	20%
Complex cataract surgery with lens implant CPT 66982 SJS-CATARACT SURGERY, COMPLEX	$1,500.80	$1,876.00	—	57% below	20%
Complex cataract surgery with lens implant inpatient CPT 66982 SJS-CATARACT SURGERY, COMPLEX	$1,500.80	$1,876.00	—	—	20%
Coronary stent placement, one artery CPT 92928 CL STENT/BM/PTCA	$13,219.20	$16,524.00	—	at median	20%
Coronary stent placement, one artery inpatient CPT 92928 CL STENT/BM/PTCA	$13,219.20	$16,524.00	—	—	20%
Cystoscopy with ureteral stent placement CPT 52332 CYSTOSCOPY AND TREATMENT	$3,544.00	$4,430.00	—	at median	20%
Cystoscopy with ureteral stent placement inpatient CPT 52332 CYSTOSCOPY AND TREATMENT	$3,544.00	$4,430.00	—	—	20%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOSCOPY 52000	$686.40	$858.00	—	21% below	20%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOURETHROSCOPY	$1,394.40	$1,743.00	—	60% above	20%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 ETC CYSTOURETHROSCOPY	$1,394.40	$1,743.00	—	60% above	20%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 CYSTOSCOPY 52000	$686.40	$858.00	—	—	20%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 ETC CYSTOURETHROSCOPY	$1,394.40	$1,743.00	—	—	20%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 CYSTOURETHROSCOPY	$1,394.40	$1,743.00	—	—	20%
D&C (dilation and curettage), not related to pregnancy CPT 58120 DILATION AND CURETTAGE 58120	$3,272.00	$4,090.00	—	25% below	20%
D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 DILATION AND CURETTAGE 58120	$3,272.00	$4,090.00	—	—	20%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DETROY BENIGN/PREMAL LESION 17000	$204.00	$255.00	—	3% above	20%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTR BENIGN/PM LES, 1ST	$314.40	$393.00	—	58% above	20%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 DETROY BENIGN/PREMAL LESION 17000	$204.00	$255.00	—	—	20%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 DESTR BENIGN/PM LES, 1ST	$314.40	$393.00	—	—	20%
Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 TYMPANOSTOMY W/ANESTHESIA	$1,520.00	$1,900.00	—	39% below	20%
Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 SJS-TYMPANOSTOMY, GEN ANESTHESIA	$1,712.80	$2,141.00	—	32% below	20%
Ear tube placement (tympanostomy) under general anesthesia, one ear inpatient CPT 69436 TYMPANOSTOMY W/ANESTHESIA	$1,520.00	$1,900.00	—	—	20%
Ear tube placement (tympanostomy) under general anesthesia, one ear inpatient CPT 69436 SJS-TYMPANOSTOMY, GEN ANESTHESIA	$1,712.80	$2,141.00	—	—	20%
Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 CREATE EARDRUM OPENING 69433	$523.20	$654.00	—	48% below	20%
Ear tube placement (tympanostomy) with local anesthesia, one ear one side CPT 69433 TYMPANOSTOMY LOCAL, UNILATERAL	$853.60	$1,067.00	—	14% below	20%
Ear tube placement (tympanostomy) with local anesthesia, one ear inpatient CPT 69433 CREATE EARDRUM OPENING 69433	$523.20	$654.00	—	—	20%
Ear tube placement (tympanostomy) with local anesthesia, one ear inpatient one side CPT 69433 TYMPANOSTOMY LOCAL, UNILATERAL	$853.60	$1,067.00	—	—	20%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVE IMPACTED EAR WAX UNI	$60.80	$76.00	—	at median	20%
Earwax removal by irrigation (rinsing), one ear CPT 69209 ETC REMOVE IMPACTED EAR WAX UNI	$114.40	$143.00	—	88% above	20%
Earwax removal by irrigation (rinsing), one ear CPT 69209 NRS REMOVE IMPACTED EAR WAX UNI	$114.40	$143.00	—	88% above	20%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 REMOVE IMPACTED EAR WAX UNI	$60.80	$76.00	—	—	20%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 NRS REMOVE IMPACTED EAR WAX UNI	$114.40	$143.00	—	—	20%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 ETC REMOVE IMPACTED EAR WAX UNI	$114.40	$143.00	—	—	20%
Earwax removal with instruments, one ear CPT 69210 REMOVE IMPACTED EAR WAX 69210	$60.80	$76.00	—	47% below	20%
Earwax removal with instruments, one ear CPT 69210 ETC REMOVE IMPACTED EAR WAX	$97.60	$122.00	—	15% below	20%
Earwax removal with instruments, one ear CPT 69210 NRS REMOVE IMPACTED EAR WAX,UNILA	$97.60	$122.00	—	15% below	20%
Earwax removal with instruments, one ear inpatient CPT 69210 REMOVE IMPACTED EAR WAX 69210	$60.80	$76.00	—	—	20%
Earwax removal with instruments, one ear inpatient CPT 69210 ETC REMOVE IMPACTED EAR WAX	$97.60	$122.00	—	—	20%
Earwax removal with instruments, one ear inpatient CPT 69210 NRS REMOVE IMPACTED EAR WAX,UNILA	$97.60	$122.00	—	—	20%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 BIOPSY OF UTERUS LINING 58100	$207.20	$259.00	—	28% below	20%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 NRS ENDOMETRIAL BX, WO CERVICAL D	$486.40	$608.00	—	69% above	20%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 ETC BIOPSY OF UTERUS LINING	$486.40	$608.00	—	69% above	20%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 BIOPSY OF UTERUS LINING 58100	$207.20	$259.00	—	—	20%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 ETC BIOPSY OF UTERUS LINING	$486.40	$608.00	—	—	20%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 NRS ENDOMETRIAL BX, WO CERVICAL D	$486.40	$608.00	—	—	20%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 NJX INTERLAMINAR CRV/THRC 62321	$712.00	$890.00	—	34% below	20%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 IR INJ EPIDURAL/SUBARACH SGL CERV	$1,081.60	$1,352.00	—	at median	20%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 CT GUIDE INTERLAMINAR EPIDURAL ST	$1,081.60	$1,352.00	—	at median	20%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 IR INJ TRANSLAMINAR ESI CERVICAL/	$1,081.60	$1,352.00	—	at median	20%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 NJX INTERLAMINAR CRV/THRC 62321	$712.00	$890.00	—	—	20%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 IR INJ TRANSLAMINAR ESI CERVICAL/	$1,081.60	$1,352.00	—	—	20%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 CT GUIDE INTERLAMINAR EPIDURAL ST	$1,081.60	$1,352.00	—	—	20%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 IR INJ EPIDURAL/SUBARACH SGL CERV	$1,081.60	$1,352.00	—	—	20%
Eye injection into the vitreous (intravitreal injection) CPT 67028 INJECTION PHARMACOLOGIC AGENT	$340.80	$426.00	—	21% below	20%
Eye injection into the vitreous (intravitreal injection) CPT 67028 ETC INTRAVITREAL INJECTION OF DRU	$641.60	$802.00	—	49% above	20%
Eye injection into the vitreous (intravitreal injection) inpatient CPT 67028 INJECTION PHARMACOLOGIC AGENT	$340.80	$426.00	—	—	20%
Eye injection into the vitreous (intravitreal injection) inpatient CPT 67028 ETC INTRAVITREAL INJECTION OF DRU	$641.60	$802.00	—	—	20%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 INJ PARAVERT F JNT L/S 1 LEV	$915.20	$1,144.00	—	32% below	20%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 IR LUMBOSAC PARAVERT FACET JT INJ	$1,336.80	$1,671.00	—	1% below	20%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 IR LUMB PARAVER FACET JT INJ SGL-	$1,336.80	$1,671.00	—	1% below	20%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 XR LUMB PARAVERTEBRAL FACET JOINT	$1,336.80	$1,671.00	—	1% below	20%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 CT GUIDE PARAVERT FACET JT/NRV I	$1,336.80	$1,671.00	—	1% below	20%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 IR LUMB PARAVER FACET JT INJ BIL	$2,673.60	$3,342.00	—	99% above	20%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 INJ PARAVERT F JNT L/S 1 LEV	$915.20	$1,144.00	—	—	20%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 CT GUIDE PARAVERT FACET JT/NRV I	$1,336.80	$1,671.00	—	—	20%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 IR LUMB PARAVER FACET JT INJ SGL-	$1,336.80	$1,671.00	—	—	20%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 XR LUMB PARAVERTEBRAL FACET JOINT	$1,336.80	$1,671.00	—	—	20%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 IR LUMBOSAC PARAVERT FACET JT INJ	$1,336.80	$1,671.00	—	—	20%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 IR LUMB PARAVER FACET JT INJ BIL	$2,673.60	$3,342.00	—	—	20%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 DIAGNOSTIC SIGMOIDOSCOPY 45330	$937.60	$1,172.00	—	15% below	20%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 45330 GI SIGMOIDOSCOPY	$1,742.40	$2,178.00	—	58% above	20%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 DIAGNOSTIC SIGMOIDOSCOPY 45330	$937.60	$1,172.00	—	—	20%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 45330 GI SIGMOIDOSCOPY	$1,742.40	$2,178.00	—	—	20%
Hammertoe correction surgery CPT 28285 REPAIR OF HAMMERTOE 28285	$3,336.00	$4,170.00	—	16% below	20%
Hammertoe correction surgery inpatient CPT 28285 REPAIR OF HAMMERTOE 28285	$3,336.00	$4,170.00	—	—	20%
Hemorrhoid banding (rubber band ligation) CPT 46221 HEMORRHOIDECTOMY SIMPL LIG 46221	$937.60	$1,172.00	—	34% below	20%
Hemorrhoid banding (rubber band ligation) CPT 46221 46221 LIGATION OF HEMORRHOID(S)	$2,972.80	$3,716.00	—	109% above	20%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 HEMORRHOIDECTOMY SIMPL LIG 46221	$937.60	$1,172.00	—	—	20%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 46221 LIGATION OF HEMORRHOID(S)	$2,972.80	$3,716.00	—	—	20%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 XR HYSTEROSALPINGOGRAM-S	$307.20	$384.00	—	2% below	20%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 US HYSTEROSONOGRAM INJECTION	$307.20	$384.00	—	2% below	20%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 XR HYSTEROSALPINGOGRAM-S	$307.20	$384.00	—	—	20%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 US HYSTEROSONOGRAM INJECTION	$307.20	$384.00	—	—	20%
Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 HYSTEROSCOPY W/BIOPSY W OR WO D&C	$3,272.00	$4,090.00	—	28% below	20%
Hysteroscopy with uterine lining sampling and/or polyp removal inpatient CPT 58558 HYSTEROSCOPY W/BIOPSY W OR WO D&C	$3,272.00	$4,090.00	—	—	20%
IUD insertion (the device itself billed separately) CPT 58300 INSERTION INTRAUTERINE DEVICE, IU	$163.20	$204.00	—	29% above	20%
IUD insertion (the device itself billed separately) inpatient CPT 58300 INSERTION INTRAUTERINE DEVICE, IU	$163.20	$204.00	—	—	20%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D OF ABSCESS,SIMPLE/SINGLE	$204.00	$255.00	—	33% below	20%
Incision and drainage of a simple or single skin abscess CPT 10060 NRS 10060 I&D ABSC, SMPL OR SGL	$468.00	$585.00	—	54% above	20%
Incision and drainage of a simple or single skin abscess CPT 10060 IR DRAIN ABSCESS SUBCUTANEOUS-S	$468.00	$585.00	—	54% above	20%
Incision and drainage of a simple or single skin abscess CPT 10060 ETC DRAINAGE OF SKIN ABSCESS 60	$468.00	$585.00	—	54% above	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D OF ABSCESS,SIMPLE/SINGLE	$204.00	$255.00	—	—	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 NRS 10060 I&D ABSC, SMPL OR SGL	$468.00	$585.00	—	—	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 IR DRAIN ABSCESS SUBCUTANEOUS-S	$468.00	$585.00	—	—	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 ETC DRAINAGE OF SKIN ABSCESS 60	$468.00	$585.00	—	—	20%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJECT TENDON/LIGAMENT/CYST 20550	$303.20	$379.00	—	3% below	20%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 CT INJECTION TENDON SHEATH-S	$486.40	$608.00	—	56% above	20%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 US INJECT SGL TENDON SHEATH/LIGAM	$486.40	$608.00	—	56% above	20%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 ETC INJECT TENDON/LIGAMENT/CYST	$486.40	$608.00	—	56% above	20%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJECT TENDON/LIGAMENT/CYST 20550	$303.20	$379.00	—	—	20%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 US INJECT SGL TENDON SHEATH/LIGAM	$486.40	$608.00	—	—	20%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 CT INJECTION TENDON SHEATH-S	$486.40	$608.00	—	—	20%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 ETC INJECT TENDON/LIGAMENT/CYST	$486.40	$608.00	—	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJ JT/BURSA W/O US 20610	$303.20	$379.00	—	at median	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ETC-DRAIN/INJ JOINT/BURSA W/O US	$762.40	$953.00	—	151% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 CT JOINT ASPIRATION/INJECTION-S	$762.40	$953.00	—	151% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 XR JOINT INJ MAJOR FLUORO	$762.40	$953.00	—	151% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 IR INJ TROCHANTERIC BURSA	$762.40	$953.00	—	151% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 NRS DRN/INJ JNT/BURSA W/O US	$762.40	$953.00	—	151% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRAIN/INJ JT/BURSA W/O US 20610	$303.20	$379.00	—	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 NRS DRN/INJ JNT/BURSA W/O US	$762.40	$953.00	—	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 XR JOINT INJ MAJOR FLUORO	$762.40	$953.00	—	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 CT JOINT ASPIRATION/INJECTION-S	$762.40	$953.00	—	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 IR INJ TROCHANTERIC BURSA	$762.40	$953.00	—	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ETC-DRAIN/INJ JOINT/BURSA W/O US	$762.40	$953.00	—	—	20%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 INSERTION DRUG DELIVERY IMPLANT	$132.80	$166.00	—	46% below	20%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 INSERTION DRUG DELIVERY IMPLANT	$132.80	$166.00	—	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/INJ JT/BURSA W/O US 20605	$303.20	$379.00	—	1% below	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 NRS DRN/INJ JOINT/BURSA W/O US	$662.40	$828.00	—	115% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ETC DRAIN/INJ JNT/BURSA W/O US	$662.40	$828.00	—	115% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 XR JOINT INJ INTERMED FLUORO	$662.40	$828.00	—	115% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 DRAIN/INJ JT/BURSA W/O US 20605	$303.20	$379.00	—	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 XR JOINT INJ INTERMED FLUORO	$662.40	$828.00	—	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 NRS DRN/INJ JOINT/BURSA W/O US	$662.40	$828.00	—	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ETC DRAIN/INJ JNT/BURSA W/O US	$662.40	$828.00	—	—	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAIN/INJ JOINT/BURSA W/O US	$303.20	$379.00	—	6% above	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ETC DRN/INJ JOINT/BURSA W/O US	$576.00	$720.00	—	102% above	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 XR JOINT INJ SMALL FLUORO	$576.00	$720.00	—	102% above	20%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 DRAIN/INJ JOINT/BURSA W/O US	$303.20	$379.00	—	—	20%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 XR JOINT INJ SMALL FLUORO	$576.00	$720.00	—	—	20%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ETC DRN/INJ JOINT/BURSA W/O US	$576.00	$720.00	—	—	20%
Laser treatment of clouding after cataract surgery (YAG) CPT 66821 YAG LASER - SECONDARY CATARACT	$564.00	$705.00	—	25% below	20%
Laser treatment of clouding after cataract surgery (YAG) CPT 66821 SJS-AFTER CATARACT LASER SURGERY	$798.40	$998.00	—	6% above	20%
Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 YAG LASER - SECONDARY CATARACT	$564.00	$705.00	—	—	20%
Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 SJS-AFTER CATARACT LASER SURGERY	$798.40	$998.00	—	—	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 LAYER CLOSURE OF WOUND(S) 12031	$410.40	$513.00	—	21% below	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 INT REP S/A/T/EX, 2.5CM/<	$1,368.00	$1,710.00	—	164% above	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 LAYER CLOSURE OF WOUND(S) 12031	$410.40	$513.00	—	—	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 INT REP S/A/T/EX, 2.5CM/<	$1,368.00	$1,710.00	—	—	20%
Left heart catheterization, diagnostic one side CPT 93452 CL LEFT HEART CATH-LV ONLY	$7,576.00	$9,470.00	—	15% below	20%
Left heart catheterization, diagnostic inpatient one side CPT 93452 CL LEFT HEART CATH-LV ONLY	$7,576.00	$9,470.00	—	—	20%
Lower-back epidural injection, with imaging guidance CPT 62323 NJX INTERLAMINAR LMBR/SAC 62323	$712.00	$890.00	—	36% below	20%
Lower-back epidural injection, with imaging guidance CPT 62323 IR INJ EPIDURAL/SUBARACH SGL LUMB	$1,081.60	$1,352.00	—	3% below	20%
Lower-back epidural injection, with imaging guidance CPT 62323 IR INJ TRANSLAMINAR ESI LUMBAR/SA	$1,081.60	$1,352.00	—	3% below	20%
Lower-back epidural injection, with imaging guidance CPT 62323 CT GUIDE INTERLAMINAR EPIDURAL S	$1,081.60	$1,352.00	—	3% below	20%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 NJX INTERLAMINAR LMBR/SAC 62323	$712.00	$890.00	—	—	20%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 IR INJ EPIDURAL/SUBARACH SGL LUMB	$1,081.60	$1,352.00	—	—	20%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 IR INJ TRANSLAMINAR ESI LUMBAR/SA	$1,081.60	$1,352.00	—	—	20%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 CT GUIDE INTERLAMINAR EPIDURAL S	$1,081.60	$1,352.00	—	—	20%
Lower-back epidural injection, without imaging guidance CPT 62322 NJX INTERLAMINAR LMBR/SAC-MAP	$915.20	$1,144.00	—	13% below	20%
Lower-back epidural injection, without imaging guidance CPT 62322 NJX INTERLAMINAR LMBR/SAC-ETC	$1,643.20	$2,054.00	—	57% above	20%
Lower-back epidural injection, without imaging guidance CPT 62322 NJX INTERLAMINAR LMBR/SAC-NRS	$1,643.20	$2,054.00	—	57% above	20%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 NJX INTERLAMINAR LMBR/SAC-MAP	$915.20	$1,144.00	—	—	20%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 NJX INTERLAMINAR LMBR/SAC-NRS	$1,643.20	$2,054.00	—	—	20%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 NJX INTERLAMINAR LMBR/SAC-ETC	$1,643.20	$2,054.00	—	—	20%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJ, A/S, TRANSF EPID, LUMB/SAC,	$915.20	$1,144.00	—	28% below	20%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 CT GUIDE TRANSFORAMINAL EPIDURA	$1,336.80	$1,671.00	—	6% above	20%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 IR LUMBOSAC TRANSFORAMINAL EPID I	$1,336.80	$1,671.00	—	6% above	20%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 IR LUMB TRANSFOR EPID INJ UNIL	$1,336.80	$1,671.00	—	6% above	20%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 NRS 64483 INJ,A/S,TRANSF EPID,LUM	$1,336.80	$1,671.00	—	6% above	20%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 CT INJ FORAMEN EPIDUR LUMBAR	$1,336.80	$1,671.00	—	6% above	20%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 CT INJ TRANS EPID LUMB/SAC BIL	$2,673.60	$3,342.00	—	111% above	20%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 IR LUMB TRANSFOR EPID INJ SGL BIL	$2,673.60	$3,342.00	—	111% above	20%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 XR LUMB TRANSFORAMINAL EPIDURAL I	$2,673.60	$3,342.00	—	111% above	20%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 INJ, A/S, TRANSF EPID, LUMB/SAC,	$915.20	$1,144.00	—	—	20%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 CT GUIDE TRANSFORAMINAL EPIDURA	$1,336.80	$1,671.00	—	—	20%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 CT INJ FORAMEN EPIDUR LUMBAR	$1,336.80	$1,671.00	—	—	20%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 NRS 64483 INJ,A/S,TRANSF EPID,LUM	$1,336.80	$1,671.00	—	—	20%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 IR LUMBOSAC TRANSFORAMINAL EPID I	$1,336.80	$1,671.00	—	—	20%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 IR LUMB TRANSFOR EPID INJ UNIL	$1,336.80	$1,671.00	—	—	20%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 IR LUMB TRANSFOR EPID INJ SGL BIL	$2,673.60	$3,342.00	—	—	20%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 XR LUMB TRANSFORAMINAL EPIDURAL I	$2,673.60	$3,342.00	—	—	20%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 CT INJ TRANS EPID LUMB/SAC BIL	$2,673.60	$3,342.00	—	—	20%
Mohs surgery for skin cancer, first stage, head, neck, hands, feet or genitals CPT 17311 MOHS, 1 STAGE, HEAD/NECK/HF/G	$629.60	$787.00	—	17% below	20%
Mohs surgery for skin cancer, first stage, head, neck, hands, feet or genitals inpatient CPT 17311 MOHS, 1 STAGE, HEAD/NECK/HF/G	$629.60	$787.00	—	—	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 REMOVAL OF SKIN LESION 11400	$723.20	$904.00	—	24% above	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 NRS 11400 EXC TR-EXT B9+MARG<=0.5	$1,368.00	$1,710.00	—	135% above	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC TR-EXT B9+MARG 0.5 < CM	$1,368.00	$1,710.00	—	135% above	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 REMOVAL OF SKIN LESION 11400	$723.20	$904.00	—	—	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXC TR-EXT B9+MARG 0.5 < CM	$1,368.00	$1,710.00	—	—	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 NRS 11400 EXC TR-EXT B9+MARG<=0.5	$1,368.00	$1,710.00	—	—	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 REMOVAL OF SKIN LESION 11440	$723.20	$904.00	—	28% above	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 SJS-EXC FACE-MM B9+MARG 0.5 < CM	$1,368.00	$1,710.00	—	143% above	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXC FACE-MM B9+MARG 0.5 < CM	$1,368.00	$1,710.00	—	143% above	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 REMOVAL OF SKIN LESION 11440	$723.20	$904.00	—	—	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 EXC FACE-MM B9+MARG 0.5 < CM	$1,368.00	$1,710.00	—	—	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 SJS-EXC FACE-MM B9+MARG 0.5 < CM	$1,368.00	$1,710.00	—	—	20%
Nail removal (partial or complete), one nail CPT 11730 REMOVAL OF NAIL PLATE 11730	$204.00	$255.00	—	27% below	20%
Nail removal (partial or complete), one nail CPT 11730 ETC REMOVAL OF NAIL PLATE	$314.40	$393.00	—	12% above	20%
Nail removal (partial or complete), one nail inpatient CPT 11730 REMOVAL OF NAIL PLATE 11730	$204.00	$255.00	—	—	20%
Nail removal (partial or complete), one nail inpatient CPT 11730 ETC REMOVAL OF NAIL PLATE	$314.40	$393.00	—	—	20%
Occipital nerve block (injection for headaches) CPT 64405 NJX AA&/STRD GR OCPL NRV	$303.20	$379.00	—	16% below	20%
Occipital nerve block (injection for headaches) CPT 64405 INJ ANESTH , GREATER OCCIPITAL NE	$800.00	$1,000.00	—	122% above	20%
Occipital nerve block (injection for headaches) CPT 64405 CT INJECTION GREATER OCCIPITAL NE	$800.00	$1,000.00	—	122% above	20%
Occipital nerve block (injection for headaches) CPT 64405 ETC INJECTION FOR NERVE BLOCK..	$800.00	$1,000.00	—	122% above	20%
Occipital nerve block (injection for headaches) inpatient CPT 64405 NJX AA&/STRD GR OCPL NRV	$303.20	$379.00	—	—	20%
Occipital nerve block (injection for headaches) inpatient CPT 64405 INJ ANESTH , GREATER OCCIPITAL NE	$800.00	$1,000.00	—	—	20%
Occipital nerve block (injection for headaches) inpatient CPT 64405 ETC INJECTION FOR NERVE BLOCK..	$800.00	$1,000.00	—	—	20%
Occipital nerve block (injection for headaches) inpatient CPT 64405 CT INJECTION GREATER OCCIPITAL NE	$800.00	$1,000.00	—	—	20%
Pacemaker implant (dual chamber) CPT 33208 CL PACEMAKER INSERT ATRIAL&VENT	$7,366.40	$9,208.00	—	59% below	20%
Pacemaker implant (dual chamber) CPT 33208 CL BIVENTRICULAR PACEMAKER PLCMNT	$8,042.40	$10,053.00	—	55% below	20%
Pacemaker implant (dual chamber) inpatient CPT 33208 CL PACEMAKER INSERT ATRIAL&VENT	$7,366.40	$9,208.00	—	—	20%
Pacemaker implant (dual chamber) inpatient CPT 33208 CL BIVENTRICULAR PACEMAKER PLCMNT	$8,042.40	$10,053.00	—	—	20%
Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS W/IMAGING 49083	$960.00	$1,200.00	—	at median	20%
Paracentesis with imaging guidance CPT 49083 US PARACENTESIS W/ALBUMIN REPLACE	$1,564.80	$1,956.00	—	63% above	20%
Paracentesis with imaging guidance CPT 49083 ETC ABD PARACENTESIS W/ IMG	$1,564.80	$1,956.00	—	63% above	20%
Paracentesis with imaging guidance CPT 49083 US ABD PARACENTESIS INIT-S	$1,564.80	$1,956.00	—	63% above	20%
Paracentesis with imaging guidance CPT 49083 CT GUIDED PARACENTESIS-S	$1,564.80	$1,956.00	—	63% above	20%
Paracentesis with imaging guidance CPT 49083 US ABD PARACENTESIS-SUBSEQ	$1,564.80	$1,956.00	—	63% above	20%
Paracentesis with imaging guidance inpatient CPT 49083 ABD PARACENTESIS W/IMAGING 49083	$960.00	$1,200.00	—	—	20%
Paracentesis with imaging guidance inpatient CPT 49083 US ABD PARACENTESIS-SUBSEQ	$1,564.80	$1,956.00	—	—	20%
Paracentesis with imaging guidance inpatient CPT 49083 ETC ABD PARACENTESIS W/ IMG	$1,564.80	$1,956.00	—	—	20%
Paracentesis with imaging guidance inpatient CPT 49083 US PARACENTESIS W/ALBUMIN REPLACE	$1,564.80	$1,956.00	—	—	20%
Paracentesis with imaging guidance inpatient CPT 49083 CT GUIDED PARACENTESIS-S	$1,564.80	$1,956.00	—	—	20%
Paracentesis with imaging guidance inpatient CPT 49083 US ABD PARACENTESIS INIT-S	$1,564.80	$1,956.00	—	—	20%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 REMOVAL OF NAIL BED 11750	$410.40	$513.00	—	27% below	20%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 ETC REMOVAL OF NAIL BED	$813.60	$1,017.00	—	45% above	20%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 REMOVAL OF NAIL BED 11750	$410.40	$513.00	—	—	20%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 ETC REMOVAL OF NAIL BED	$813.60	$1,017.00	—	—	20%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 XR LUMBAR PARAVERT FACET JNT AB S	$1,888.00	$2,360.00	—	28% below	20%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 CT MEDIAL BRANCH RHIZOTOMY LUMBAR	$1,888.00	$2,360.00	—	28% below	20%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 IR MEDIAL BRANCH RHIZOTOMY LUMBAR	$1,888.80	$2,361.00	—	28% below	20%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 DESTROY LUMB/SAC FACET JNT 64635	$2,008.00	$2,510.00	—	24% below	20%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 XR LUMBAR PARAVERT FACET JNT AB S	$1,888.00	$2,360.00	—	—	20%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 CT MEDIAL BRANCH RHIZOTOMY LUMBAR	$1,888.00	$2,360.00	—	—	20%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 IR MEDIAL BRANCH RHIZOTOMY LUMBAR	$1,888.80	$2,361.00	—	—	20%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 DESTROY LUMB/SAC FACET JNT 64635	$2,008.00	$2,510.00	—	—	20%
Removal of a breast lump, open surgery CPT 19120 REMOVAL OF BREAST LESION 19120	$3,936.00	$4,920.00	—	121% above	20%
Removal of a breast lump, open surgery inpatient CPT 19120 REMOVAL OF BREAST LESION 19120	$3,936.00	$4,920.00	—	—	20%
Removal of a foreign object under the skin, simple CPT 10120 REMOVE FOREIGN BODY 10120	$410.40	$513.00	—	4% below	20%
Removal of a foreign object under the skin, simple CPT 10120 ETC REMOVE FOREIGN BODY 20	$608.00	$760.00	—	42% above	20%
Removal of a foreign object under the skin, simple inpatient CPT 10120 REMOVE FOREIGN BODY 10120	$410.40	$513.00	—	—	20%
Removal of a foreign object under the skin, simple inpatient CPT 10120 ETC REMOVE FOREIGN BODY 20	$608.00	$760.00	—	—	20%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 G0121 GI COLON SCRN PT NOT HI RSK	$1,742.40	$2,178.00	—	at median	20%
Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 G0121 GI COLON SCRN PT NOT HI RSK	$1,742.40	$2,178.00	—	—	20%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 G0105 GI COLON SCRN ON HI RISK PT	$1,742.40	$2,178.00	—	at median	20%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 G0105 GI COLON SCRN ON HI RISK PT	$1,742.40	$2,178.00	—	—	20%
Shock-wave lithotripsy to break up kidney stones (from outside the body) both sides CPT 50590 LITHOTRIPSY-BILATERAL	$11,188.80	$13,986.00	—	—	20%
Shock-wave lithotripsy to break up kidney stones (from outside the body) one side CPT 50590 LITHOTRIPSY-UNILATERAL	$6,689.60	$8,362.00	—	at median	20%
Shock-wave lithotripsy to break up kidney stones (from outside the body) inpatient both sides CPT 50590 LITHOTRIPSY-BILATERAL	$11,188.80	$13,986.00	—	—	20%
Shock-wave lithotripsy to break up kidney stones (from outside the body) inpatient one side CPT 50590 LITHOTRIPSY-UNILATERAL	$6,689.60	$8,362.00	—	—	20%
Short arm cast (elbow to hand) CPT 29075 CAST APPL,ELBOW TO FINGER FOREARM	$272.80	$341.00	—	12% below	20%
Short arm cast (elbow to hand) CPT 29075 APPLY SHORT ARM CAST	$456.80	$571.00	—	48% above	20%
Short arm cast (elbow to hand) inpatient CPT 29075 CAST APPL,ELBOW TO FINGER FOREARM	$272.80	$341.00	—	—	20%
Short arm cast (elbow to hand) inpatient CPT 29075 APPLY SHORT ARM CAST	$456.80	$571.00	—	—	20%
Short arm splint (forearm and hand) CPT 29125 SPLINT APPL,SHORT ARM,STATIC	$132.80	$166.00	—	31% below	20%
Short arm splint (forearm and hand) CPT 29125 APPLY SHORT ARM SPLINT, STATIC	$283.20	$354.00	—	47% above	20%
Short arm splint (forearm and hand) CPT 29125 NRS APPLY SHORT ARM SPLINT,STATIC	$283.20	$354.00	—	47% above	20%
Short arm splint (forearm and hand) inpatient CPT 29125 SPLINT APPL,SHORT ARM,STATIC	$132.80	$166.00	—	—	20%
Short arm splint (forearm and hand) inpatient CPT 29125 APPLY SHORT ARM SPLINT, STATIC	$283.20	$354.00	—	—	20%
Short arm splint (forearm and hand) inpatient CPT 29125 NRS APPLY SHORT ARM SPLINT,STATIC	$283.20	$354.00	—	—	20%
Short leg cast (below the knee) CPT 29405 APPLY SHORT LEG CAST 29405	$272.80	$341.00	—	23% below	20%
Short leg cast (below the knee) CPT 29405 APPLY SH LEG CAST	$456.80	$571.00	—	29% above	20%
Short leg cast (below the knee) inpatient CPT 29405 APPLY SHORT LEG CAST 29405	$272.80	$341.00	—	—	20%
Short leg cast (below the knee) inpatient CPT 29405 APPLY SH LEG CAST	$456.80	$571.00	—	—	20%
Short leg splint (calf to foot) CPT 29515 SPLINT APPL,SHORT LEG 29515	$162.40	$203.00	—	27% below	20%
Short leg splint (calf to foot) CPT 29515 APPLY SHORT LEG SPLINT	$275.20	$344.00	—	24% above	20%
Short leg splint (calf to foot) CPT 29515 NRS APPLY SHORT LEG SPLINT	$275.20	$344.00	—	24% above	20%
Short leg splint (calf to foot) inpatient CPT 29515 SPLINT APPL,SHORT LEG 29515	$162.40	$203.00	—	—	20%
Short leg splint (calf to foot) inpatient CPT 29515 NRS APPLY SHORT LEG SPLINT	$275.20	$344.00	—	—	20%
Short leg splint (calf to foot) inpatient CPT 29515 APPLY SHORT LEG SPLINT	$275.20	$344.00	—	—	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 REPAIR SUPERFICIAL WOUNDS 12001	$204.00	$255.00	—	34% below	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 SREP S/N/A/G/TR/E, 2.5CM/<	$350.40	$438.00	—	14% above	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 NRS 12001 SREP S/N/A/G/TR/E,2.5CM	$350.40	$438.00	—	14% above	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 REPAIR SUPERFICIAL WOUNDS 12001	$204.00	$255.00	—	—	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 NRS 12001 SREP S/N/A/G/TR/E,2.5CM	$350.40	$438.00	—	—	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 SREP S/N/A/G/TR/E, 2.5CM/<	$350.40	$438.00	—	—	20%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BX SKIN SINGLE LESION	$410.40	$513.00	—	21% above	20%
Skin biopsy, punch, one lesion CPT 11104 NRS PUNCH BX SKIN SINGLE LESION	$608.00	$760.00	—	79% above	20%
Skin biopsy, punch, one lesion CPT 11104 ETC PUNCH BX SKIN SINGLE LESION	$608.00	$760.00	—	79% above	20%
Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BX SKIN SINGLE LESION	$410.40	$513.00	—	—	20%
Skin biopsy, punch, one lesion inpatient CPT 11104 NRS PUNCH BX SKIN SINGLE LESION	$608.00	$760.00	—	—	20%
Skin biopsy, punch, one lesion inpatient CPT 11104 ETC PUNCH BX SKIN SINGLE LESION	$608.00	$760.00	—	—	20%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 REMOVAL OF SKIN LESION 11600	$723.20	$904.00	—	37% above	20%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 REMOVAL OF SKIN LESION 11600	$723.20	$904.00	—	—	20%
Skin tag removal, up to 15 tags CPT 11200 REMOVAL OF SKIN TAGS 11200	$204.00	$255.00	—	11% below	20%
Skin tag removal, up to 15 tags CPT 11200 ETC REMOVAL OF SKIN TAGS	$350.40	$438.00	—	52% above	20%
Skin tag removal, up to 15 tags CPT 11200 SJS-REMOVAL OF SKIN TAGS	$350.40	$438.00	—	52% above	20%
Skin tag removal, up to 15 tags CPT 11200 NRS REMOVAL OF SKIN TAGS	$350.40	$438.00	—	52% above	20%
Skin tag removal, up to 15 tags inpatient CPT 11200 REMOVAL OF SKIN TAGS 11200	$204.00	$255.00	—	—	20%
Skin tag removal, up to 15 tags inpatient CPT 11200 ETC REMOVAL OF SKIN TAGS	$350.40	$438.00	—	—	20%
Skin tag removal, up to 15 tags inpatient CPT 11200 SJS-REMOVAL OF SKIN TAGS	$350.40	$438.00	—	—	20%
Skin tag removal, up to 15 tags inpatient CPT 11200 NRS REMOVAL OF SKIN TAGS	$350.40	$438.00	—	—	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL FLUID TAP DIAG 62270	$712.00	$890.00	—	17% below	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 XR SPINAL TAP-DIAGNOSTIC	$1,081.60	$1,352.00	—	25% above	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 NM SPINAL INJECTION-S	$1,081.60	$1,352.00	—	25% above	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 ETC SPINAL FLUID TAP, DIAGNOSTIC	$1,081.60	$1,352.00	—	25% above	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 ANS LUMBAR/SPINAL PUNCTURE	$1,081.60	$1,352.00	—	25% above	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 62270 LUMBAR PUNCTURE	$1,081.60	$1,352.00	—	25% above	20%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL FLUID TAP DIAG 62270	$712.00	$890.00	—	—	20%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 ANS LUMBAR/SPINAL PUNCTURE	$1,081.60	$1,352.00	—	—	20%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 ETC SPINAL FLUID TAP, DIAGNOSTIC	$1,081.60	$1,352.00	—	—	20%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 62270 LUMBAR PUNCTURE	$1,081.60	$1,352.00	—	—	20%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 XR SPINAL TAP-DIAGNOSTIC	$1,081.60	$1,352.00	—	—	20%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 NM SPINAL INJECTION-S	$1,081.60	$1,352.00	—	—	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 REPAIR SUPERFICIAL WOUNDS 12002	$204.00	$255.00	—	32% below	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 SREPS/N/A/G/TR/E, 2.6-7.5CM	$403.20	$504.00	—	35% above	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 SREP S/N/A/G/TR/E, 2.6-7.5CM	$403.20	$504.00	—	35% above	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 REPAIR SUPERFICIAL WOUNDS 12002	$204.00	$255.00	—	—	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 SREP S/N/A/G/TR/E, 2.6-7.5CM	$403.20	$504.00	—	—	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 SREPS/N/A/G/TR/E, 2.6-7.5CM	$403.20	$504.00	—	—	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 REPAIR SUPERFICIAL WOUNDS 12011	$204.00	$255.00	—	30% below	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 SREP F/E/N/L/MM, 2.5CM/<	$350.40	$438.00	—	20% above	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 SJS SREP F/E/N/L/MM, 2.5CM/< 1201	$371.20	$464.00	—	27% above	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 REPAIR SUPERFICIAL WOUNDS 12011	$204.00	$255.00	—	—	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 SREP F/E/N/L/MM, 2.5CM/<	$350.40	$438.00	—	—	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 SJS SREP F/E/N/L/MM, 2.5CM/< 1201	$371.20	$464.00	—	—	20%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGNTL BX SKIN SINGLE LES	$368.00	$460.00	—	36% above	20%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 NRS TANGNTL BX SKIN SINGLE LES	$404.00	$505.00	—	50% above	20%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 ETC TANGNTL BX SKIN SINGLE LES	$404.00	$505.00	—	50% above	20%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 TANGNTL BX SKIN SINGLE LES	$368.00	$460.00	—	—	20%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 ETC TANGNTL BX SKIN SINGLE LES	$404.00	$505.00	—	—	20%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 NRS TANGNTL BX SKIN SINGLE LES	$404.00	$505.00	—	—	20%
Thoracentesis with imaging guidance CPT 32555 THORACENTESIS ASP/PLEURA SPACE	$636.00	$795.00	—	20% below	20%
Thoracentesis with imaging guidance CPT 32555 CT THORACENTESIS	$1,425.60	$1,782.00	—	80% above	20%
Thoracentesis with imaging guidance CPT 32555 ETC ASPIRATE PLEURA W/IMG	$1,425.60	$1,782.00	—	80% above	20%
Thoracentesis with imaging guidance CPT 32555 US THORACENTESIS-S	$1,425.60	$1,782.00	—	80% above	20%
Thoracentesis with imaging guidance CPT 32555 CT THORACENTESIS W/O TUBE-S	$1,425.60	$1,782.00	—	80% above	20%
Thoracentesis with imaging guidance one side CPT 32555 US THORACENTESIS LEFT	$1,425.60	$1,782.00	—	80% above	20%
Thoracentesis with imaging guidance one side CPT 32555 US THORACENTESIS RIGHT	$1,425.60	$1,782.00	—	80% above	20%
Thoracentesis with imaging guidance inpatient CPT 32555 THORACENTESIS ASP/PLEURA SPACE	$636.00	$795.00	—	—	20%
Thoracentesis with imaging guidance inpatient CPT 32555 CT THORACENTESIS W/O TUBE-S	$1,425.60	$1,782.00	—	—	20%
Thoracentesis with imaging guidance inpatient CPT 32555 ETC ASPIRATE PLEURA W/IMG	$1,425.60	$1,782.00	—	—	20%
Thoracentesis with imaging guidance inpatient CPT 32555 CT THORACENTESIS	$1,425.60	$1,782.00	—	—	20%
Thoracentesis with imaging guidance inpatient CPT 32555 US THORACENTESIS-S	$1,425.60	$1,782.00	—	—	20%
Thoracentesis with imaging guidance inpatient one side CPT 32555 US THORACENTESIS RIGHT	$1,425.60	$1,782.00	—	—	20%
Thoracentesis with imaging guidance inpatient one side CPT 32555 US THORACENTESIS LEFT	$1,425.60	$1,782.00	—	—	20%
Trigger point injections, 1 or 2 muscles CPT 20552 INJECTION(S) SGLE OR MULT TRIGGER	$303.20	$379.00	—	17% below	20%
Trigger point injections, 1 or 2 muscles CPT 20552 IR PIRIFORMIS INJECTION-S	$576.00	$720.00	—	58% above	20%
Trigger point injections, 1 or 2 muscles CPT 20552 ETC INJECT TRIGGER POINT 1 OR 2	$576.00	$720.00	—	58% above	20%
Trigger point injections, 1 or 2 muscles CPT 20552 NRS INJ TRIGGER POINT 1/2 MUSCL 2	$576.00	$720.00	—	58% above	20%
Trigger point injections, 1 or 2 muscles CPT 20552 US INJECT SGL/MUL TRIGGER PT 1-2	$576.00	$720.00	—	58% above	20%
Trigger point injections, 1 or 2 muscles CPT 20552 CT INJECT TRIGGER PT 1-2 MUSCL	$576.00	$720.00	—	58% above	20%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJECTION(S) SGLE OR MULT TRIGGER	$303.20	$379.00	—	—	20%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 US INJECT SGL/MUL TRIGGER PT 1-2	$576.00	$720.00	—	—	20%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 NRS INJ TRIGGER POINT 1/2 MUSCL 2	$576.00	$720.00	—	—	20%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 ETC INJECT TRIGGER POINT 1 OR 2	$576.00	$720.00	—	—	20%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 CT INJECT TRIGGER PT 1-2 MUSCL	$576.00	$720.00	—	—	20%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 IR PIRIFORMIS INJECTION-S	$576.00	$720.00	—	—	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion both sides CPT 19083 US BIOPSY BREAST BILATERAL	$2,836.80	$3,546.00	—	—	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 US BREAST BIOPSY VACUUM-S	$2,836.80	$3,546.00	—	34% above	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 US BIOPSY BREAST-S	$2,836.80	$3,546.00	—	34% above	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US BIOPSY BREAST LEFT	$2,836.80	$3,546.00	—	34% above	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US BIOPSY BREAST RIGHT	$2,836.80	$3,546.00	—	34% above	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient both sides CPT 19083 US BIOPSY BREAST BILATERAL	$2,836.80	$3,546.00	—	—	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 US BREAST BIOPSY VACUUM-S	$2,836.80	$3,546.00	—	—	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 US BIOPSY BREAST-S	$2,836.80	$3,546.00	—	—	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 US BIOPSY BREAST RIGHT	$2,836.80	$3,546.00	—	—	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 US BIOPSY BREAST LEFT	$2,836.80	$3,546.00	—	—	20%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 43249 GI GASTRO W/BALLOON DIL	$3,199.20	$3,999.00	—	10% above	20%
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 43249 GI GASTRO W/BALLOON DIL	$3,199.20	$3,999.00	—	—	20%
Upper endoscopy (EGD) with biopsy CPT 43239 43239 GI GASTRO W/ BIOPSY	$1,604.00	$2,005.00	—	11% above	20%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 43239 GI GASTRO W/ BIOPSY	$1,604.00	$2,005.00	—	—	20%
Upper endoscopy (EGD) with injection into the lining CPT 43236 43236 GI GASTRO W/SUBMUCOSAL INJ	$2,172.00	$2,715.00	—	30% above	20%
Upper endoscopy (EGD) with injection into the lining inpatient CPT 43236 43236 GI GASTRO W/SUBMUCOSAL INJ	$2,172.00	$2,715.00	—	—	20%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 43251 GI GASTRO W/POLYPECTOMY	$3,199.20	$3,999.00	—	7% above	20%
Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 43251 GI GASTRO W/POLYPECTOMY	$3,199.20	$3,999.00	—	—	20%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 43248 GI GASTRO W/SAVARY DIL	$1,672.80	$2,091.00	—	at median	20%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire inpatient CPT 43248 43248 GI GASTRO W/SAVARY DIL	$1,672.80	$2,091.00	—	—	20%
Upper endoscopy (EGD), diagnostic CPT 43235 43235 GI GASTROSCOPY	$1,464.80	$1,831.00	—	5% below	20%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 43235 GI GASTROSCOPY	$1,464.80	$1,831.00	—	—	20%
Vasectomy, one or both sides, including follow-up semen testing CPT 55250 REMOVAL OF SPERM DUCT(S) 55250	$2,104.00	$2,630.00	—	4% above	20%
Vasectomy, one or both sides, including follow-up semen testing inpatient CPT 55250 REMOVAL OF SPERM DUCT(S) 55250	$2,104.00	$2,630.00	—	—	20%
Vein ablation, radiofrequency, first vein CPT 36475 ENDOVENOUS RF, 1ST VEIN	$3,240.00	$4,050.00	—	38% below	20%
Vein ablation, radiofrequency, first vein CPT 36475 IR ENDOVEN ABLATION RF PERC INIT-	$5,248.00	$6,560.00	—	at median	20%
Vein ablation, radiofrequency, first vein inpatient CPT 36475 ENDOVENOUS RF, 1ST VEIN	$3,240.00	$4,050.00	—	—	20%
Vein ablation, radiofrequency, first vein inpatient CPT 36475 IR ENDOVEN ABLATION RF PERC INIT-	$5,248.00	$6,560.00	—	—	20%
Wart removal, up to 14 warts CPT 17110 DESTRUCT LESION, 1-14 17110	$204.00	$255.00	—	19% below	20%
Wart removal, up to 14 warts inpatient CPT 17110 DESTRUCT LESION, 1-14 17110	$204.00	$255.00	—	—	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDE SKIN/TISSUE 11042	$410.40	$513.00	—	3% below	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEB SUBQ TISSUE 20 SQ CM/<	$699.20	$874.00	—	65% above	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDE SKIN/TISSUE	$699.20	$874.00	—	65% above	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 WND DEB SUBQ TISSUE 20 SQ CM/<	$699.20	$874.00	—	65% above	20%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDE SKIN/TISSUE 11042	$410.40	$513.00	—	—	20%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 WND DEB SUBQ TISSUE 20 SQ CM/<	$699.20	$874.00	—	—	20%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEB SUBQ TISSUE 20 SQ CM/<	$699.20	$874.00	—	—	20%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDE SKIN/TISSUE	$699.20	$874.00	—	—	20%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs North Dakota	Off list
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION,BLOOD/BLD COMPON	$449.60	$562.00	—	37% below	20%
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION BLOOD OR COMPONENT	$708.00	$885.00	—	at median	20%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSFUSION SERVICE 36430	$708.00	$885.00	—	at median	20%
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION BLOOD OR BLOOD COMPON	$708.00	$885.00	—	at median	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSION,BLOOD/BLD COMPON	$449.60	$562.00	—	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD TRANSFUSION SERVICE 36430	$708.00	$885.00	—	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSION BLOOD OR BLOOD COMPON	$708.00	$885.00	—	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSION BLOOD OR COMPONENT	$708.00	$885.00	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 VOLARA SUBSEQUENT	$245.60	$307.00	—	135% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 IPPB TREATMENT-SUBSEQUENT	$245.60	$307.00	—	135% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 IPPB TREATMENT-INITIAL	$245.60	$307.00	—	135% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HHN INITIAL	$245.60	$307.00	—	135% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 SPUTUM INDUCTION	$245.60	$307.00	—	135% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AIRWAY INHALATION TX	$245.60	$307.00	—	135% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 PREP-RECOVERY/PACU AIRWAY HHN	$245.60	$307.00	—	135% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NRS HAND HELD NEBULIZER-SUBSEQUEN	$245.60	$307.00	—	135% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NRS HAND HELD NEBULIZER-INITIAL	$245.60	$307.00	—	135% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 INHALATION TRMT FOR OBSTRUCT	$245.60	$307.00	—	135% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HHN INITIAL ETC	$245.60	$307.00	—	135% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HHN SUBSEQUENT ETC-NURSE	$245.60	$307.00	—	135% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HHN SUBSEQUENT	$245.60	$307.00	—	135% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 METANEB INITIAL	$245.60	$307.00	—	135% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 SPUTUM INDUCTION	$245.60	$307.00	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 IPPB TREATMENT-SUBSEQUENT	$245.60	$307.00	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 IPPB TREATMENT-INITIAL	$245.60	$307.00	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 VOLARA SUBSEQUENT	$245.60	$307.00	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 METANEB INITIAL	$245.60	$307.00	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HHN SUBSEQUENT	$245.60	$307.00	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HHN INITIAL	$245.60	$307.00	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HHN SUBSEQUENT ETC-NURSE	$245.60	$307.00	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HHN INITIAL ETC	$245.60	$307.00	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 INHALATION TRMT FOR OBSTRUCT	$245.60	$307.00	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 NRS HAND HELD NEBULIZER-INITIAL	$245.60	$307.00	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 NRS HAND HELD NEBULIZER-SUBSEQUEN	$245.60	$307.00	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 PREP-RECOVERY/PACU AIRWAY HHN	$245.60	$307.00	—	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AIRWAY INHALATION TX	$245.60	$307.00	—	—	20%
Chemotherapy IV infusion, first hour CPT 96413 CHEMO, IV INFUSION, 1 HR	$340.80	$426.00	—	51% below	20%
Chemotherapy IV infusion, first hour CPT 96413 CHEMO INFUSION INITIAL HR	$480.00	$600.00	—	30% below	20%
Chemotherapy IV infusion, first hour CPT 96413 NRS 96413 CHEMO INFUSION INITIAL	$480.00	$600.00	—	30% below	20%
Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO, IV INFUSION, 1 HR	$340.80	$426.00	—	—	20%
Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO INFUSION INITIAL HR	$480.00	$600.00	—	—	20%
Chemotherapy IV infusion, first hour inpatient CPT 96413 NRS 96413 CHEMO INFUSION INITIAL	$480.00	$600.00	—	—	20%
Comprehensive eye exam by an eye doctor, new patient CPT 92004 COMPREH EYE EXAM - NEW PT	$132.80	$166.00	—	9% above	20%
Comprehensive eye exam by an eye doctor, new patient inpatient CPT 92004 COMPREH EYE EXAM - NEW PT	$132.80	$166.00	—	—	20%
Comprehensive eye exam, returning patient CPT 92014 EST PATIENT EYE EXAM,COMPREH	$132.80	$166.00	—	9% above	20%
Comprehensive eye exam, returning patient inpatient CPT 92014 EST PATIENT EYE EXAM,COMPREH	$132.80	$166.00	—	—	20%
Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 AUD-SPEECH AUD,THRHHLD,W/RECOG	$209.60	$262.00	—	12% above	20%
Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 AUD-SPEECH AUD,THRHHLD,W/RECOG	$209.60	$262.00	—	—	20%
Critical care, first 30 to 74 minutes CPT 99291 ETC TREATMENT-CRITICAL CARE	$2,800.00	$3,500.00	—	48% above	20%
Critical care, first 30 to 74 minutes CPT 99291 ETC CC W/TRAUMA V CAH W/O NOTIFY	$3,600.00	$4,500.00	—	90% above	20%
Critical care, first 30 to 74 minutes CPT 99291 ETC CC W/PART TRAUMA W/O NOTIFY	$6,800.00	$8,500.00	—	259% above	20%
Critical care, first 30 to 74 minutes CPT 99291 ETC CC W/FULL TRAUMA W/O NOTIFY	$9,200.00	$11,500.00	—	385% above	20%
Critical care, first 30 to 74 minutes inpatient CPT 99291 ETC TREATMENT-CRITICAL CARE	$2,800.00	$3,500.00	—	—	20%
Critical care, first 30 to 74 minutes inpatient CPT 99291 ETC CC W/TRAUMA V CAH W/O NOTIFY	$3,600.00	$4,500.00	—	—	20%
Critical care, first 30 to 74 minutes inpatient CPT 99291 ETC CC W/PART TRAUMA W/O NOTIFY	$6,800.00	$8,500.00	—	—	20%
Critical care, first 30 to 74 minutes inpatient CPT 99291 ETC CC W/FULL TRAUMA W/O NOTIFY	$9,200.00	$11,500.00	—	—	20%
EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG AWAKE AND DROWSY..	$638.40	$798.00	—	at median	20%
EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG AWAKE AND DROWSY	$638.40	$798.00	—	at median	20%
EEG (brain wave test), awake and drowsy, routine CPT 95816 ETC EEG AWAKE AND DROWSY	$638.40	$798.00	—	at median	20%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 ETC EEG AWAKE AND DROWSY	$638.40	$798.00	—	—	20%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 EEG AWAKE AND DROWSY..	$638.40	$798.00	—	—	20%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 EEG AWAKE AND DROWSY	$638.40	$798.00	—	—	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 XR TRINITY SCREENING CLINIC EKG	$24.00	$30.00	—	79% below	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG W/OUT INTERP	$60.80	$76.00	—	46% below	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG	$84.00	$105.00	—	25% below	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG THSSDSJ	$84.00	$105.00	—	25% below	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 PRE ADMISSION TESTING EKG	$84.00	$105.00	—	25% below	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ETC EKG	$84.00	$105.00	—	25% below	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 XR TRINITY SCREENING CLINIC EKG	$24.00	$30.00	—	—	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG W/OUT INTERP	$60.80	$76.00	—	—	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG THSSDSJ	$84.00	$105.00	—	—	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ETC EKG	$84.00	$105.00	—	—	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG	$84.00	$105.00	—	—	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 PRE ADMISSION TESTING EKG	$84.00	$105.00	—	—	20%
Electroconvulsive therapy (ECT), one session CPT 90870 NRS ELECTROCONVULSIVE THERAPY	$957.60	$1,197.00	—	at median	20%
Electroconvulsive therapy (ECT), one session CPT 90870 ELECTROCONVULSIVE THERAPY	$957.60	$1,197.00	—	at median	20%
Electroconvulsive therapy (ECT), one session CPT 90870 SJS-ELECTROCONVULSIVE THERAPY	$957.60	$1,197.00	—	at median	20%
Electroconvulsive therapy (ECT), one session inpatient CPT 90870 SJS-ELECTROCONVULSIVE THERAPY	$957.60	$1,197.00	—	—	20%
Electroconvulsive therapy (ECT), one session inpatient CPT 90870 NRS ELECTROCONVULSIVE THERAPY	$957.60	$1,197.00	—	—	20%
Electroconvulsive therapy (ECT), one session inpatient CPT 90870 ELECTROCONVULSIVE THERAPY	$957.60	$1,197.00	—	—	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ETC TREATMENT LEVEL 1	$360.00	$450.00	—	103% above	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ETC LEVEL1 W/TRAUMA V CAH W/O NOT	$1,160.00	$1,450.00	—	555% above	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ETC LEVEL 1 W/PART TRAUMA W/O NOT	$4,360.00	$5,450.00	—	2363% above	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ETC LEVEL 1 W/FULL TRAUMA W/O NOT	$6,760.00	$8,450.00	—	3719% above	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ETC TREATMENT LEVEL 1	$360.00	$450.00	—	—	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ETC LEVEL1 W/TRAUMA V CAH W/O NOT	$1,160.00	$1,450.00	—	—	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ETC LEVEL 1 W/PART TRAUMA W/O NOT	$4,360.00	$5,450.00	—	—	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ETC LEVEL 1 W/FULL TRAUMA W/O NOT	$6,760.00	$8,450.00	—	—	20%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ETC TREATMENT LEVEL 2	$540.00	$675.00	—	81% above	20%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ETC LEVEL2 W/TRAUMA V CAH W/O NOT	$1,340.00	$1,675.00	—	350% above	20%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ETC LEVEL 2 W/PART TRAUMA W/O NOT	$4,540.00	$5,675.00	—	1425% above	20%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ETC LEVEL 2 W/FULL TRAUMA W/O NOT	$6,940.00	$8,675.00	—	2231% above	20%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ETC TREATMENT LEVEL 2	$540.00	$675.00	—	—	20%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ETC LEVEL2 W/TRAUMA V CAH W/O NOT	$1,340.00	$1,675.00	—	—	20%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ETC LEVEL 2 W/PART TRAUMA W/O NOT	$4,540.00	$5,675.00	—	—	20%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ETC LEVEL 2 W/FULL TRAUMA W/O NOT	$6,940.00	$8,675.00	—	—	20%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ETC TREATMENT LEVEL 3	$880.00	$1,100.00	—	89% above	20%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ETC LEVEL3 W/TRAUMA V CAH W/O NOT	$1,680.00	$2,100.00	—	260% above	20%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ETC LEVEL 3 W/PART TRAUMA W/O NOT	$4,880.00	$6,100.00	—	947% above	20%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ETC LEVEL 3 W/FULL TRAUMA W/O NOT	$7,280.00	$9,100.00	—	1462% above	20%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ETC TREATMENT LEVEL 3	$880.00	$1,100.00	—	—	20%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ETC LEVEL3 W/TRAUMA V CAH W/O NOT	$1,680.00	$2,100.00	—	—	20%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ETC LEVEL 3 W/PART TRAUMA W/O NOT	$4,880.00	$6,100.00	—	—	20%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ETC LEVEL 3 W/FULL TRAUMA W/O NOT	$7,280.00	$9,100.00	—	—	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ETC TREATMENT LEVEL 4	$1,440.00	$1,800.00	—	78% above	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ETC LEVEL4 W/TRAUMA V CAH W/O NOT	$2,240.00	$2,800.00	—	177% above	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ETC LEVEL 4 W/PART TRAUMA W/O NOT	$5,440.00	$6,800.00	—	572% above	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ETC LEVEL 4 W/FULL TRAUMA W/O NOT	$7,840.00	$9,800.00	—	868% above	20%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ETC TREATMENT LEVEL 4	$1,440.00	$1,800.00	—	—	20%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ETC LEVEL4 W/TRAUMA V CAH W/O NOT	$2,240.00	$2,800.00	—	—	20%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ETC LEVEL 4 W/PART TRAUMA W/O NOT	$5,440.00	$6,800.00	—	—	20%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ETC LEVEL 4 W/FULL TRAUMA W/O NOT	$7,840.00	$9,800.00	—	—	20%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ETC TREATMENT LEVEL 5	$1,920.00	$2,400.00	—	56% above	20%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ETC LEVEL5 W/TRAUMA V CAH W/O NOT	$2,720.00	$3,400.00	—	121% above	20%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ETC LEVEL 5 W/PART TRAUMA W/O NOT	$5,920.00	$7,400.00	—	381% above	20%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ETC LEVEL 5 W/FULL TRAUMA W/O NOT	$8,320.00	$10,400.00	—	576% above	20%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ETC TREATMENT LEVEL 5	$1,920.00	$2,400.00	—	—	20%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ETC LEVEL5 W/TRAUMA V CAH W/O NOT	$2,720.00	$3,400.00	—	—	20%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ETC LEVEL 5 W/PART TRAUMA W/O NOT	$5,920.00	$7,400.00	—	—	20%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ETC LEVEL 5 W/FULL TRAUMA W/O NOT	$8,320.00	$10,400.00	—	—	20%
Exercise stress test, tracing only, the hospital charge CPT 93017 STRESS TEST	$320.00	$400.00	—	at median	20%
Exercise stress test, tracing only, the hospital charge CPT 93017 TREADMILL STRESS TEST	$431.20	$539.00	—	35% above	20%
Exercise stress test, tracing only, the hospital charge CPT 93017 STRESS STUDY W/NUC MED	$492.80	$616.00	—	54% above	20%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 STRESS TEST	$320.00	$400.00	—	—	20%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 TREADMILL STRESS TEST	$431.20	$539.00	—	—	20%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 STRESS STUDY W/NUC MED	$492.80	$616.00	—	—	20%
Eye exam, returning patient, intermediate CPT 92012 INTERM EYE EXAM EST PT	$132.80	$166.00	—	57% above	20%
Eye exam, returning patient, intermediate inpatient CPT 92012 INTERM EYE EXAM EST PT	$132.80	$166.00	—	—	20%
Family therapy with the patient, 50 minutes CPT 90847 PSYCHOTHX FAMILY W/PT PRESENT	$164.80	$206.00	—	65% below	20%
Family therapy with the patient, 50 minutes inpatient CPT 90847 PSYCHOTHX FAMILY W/PT PRESENT	$164.80	$206.00	—	—	20%
Family therapy without the patient, 50 minutes CPT 90846 FAMILY PSYTX W/O PATIENT	$164.80	$206.00	—	63% below	20%
Family therapy without the patient, 50 minutes inpatient CPT 90846 FAMILY PSYTX W/O PATIENT	$164.80	$206.00	—	—	20%
Group psychotherapy session CPT 90853 GROUP PSYCHOTHERAPY	$95.20	$119.00	—	79% below	20%
Group psychotherapy session inpatient CPT 90853 GROUP PSYCHOTHERAPY	$95.20	$119.00	—	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRATION IV INFUSION, INIT	$216.80	$271.00	—	35% below	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 NRS 96360 HYDRATION INITIAL	$432.00	$540.00	—	29% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRATE IV INF, INITIAL	$432.00	$540.00	—	29% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 ETC HYDRATION IV INFUSION, INIT	$432.00	$540.00	—	29% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 ONC HYDRATION 31-60 MIN	$432.00	$540.00	—	29% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HYDRATION IV INFUSION, INIT	$216.80	$271.00	—	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 ETC HYDRATION IV INFUSION, INIT	$432.00	$540.00	—	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 ONC HYDRATION 31-60 MIN	$432.00	$540.00	—	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 NRS 96360 HYDRATION INITIAL	$432.00	$540.00	—	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HYDRATE IV INF, INITIAL	$432.00	$540.00	—	—	20%
IV infusion of a medicine, first hour CPT 96365 THER/PROPH/DIAG IV INF, INIT	$456.00	$570.00	—	18% above	20%
IV infusion of a medicine, first hour CPT 96365 NRS 96365 NON CHEMO INITIAL	$456.00	$570.00	—	18% above	20%
IV infusion of a medicine, first hour CPT 96365 SDS- THER/PROPH/DIAG IV INF, INIT	$456.00	$570.00	—	18% above	20%
IV infusion of a medicine, first hour CPT 96365 INFUSION THERAPY	$456.00	$570.00	—	18% above	20%
IV infusion of a medicine, first hour CPT 96365 ETC THER/PROPH/DIAG IV INF, INIT	$456.00	$570.00	—	18% above	20%
IV infusion of a medicine, first hour CPT 96365 NON-CHEMO INITIAL HOUR	$456.00	$570.00	—	18% above	20%
IV infusion of a medicine, first hour inpatient CPT 96365 NRS 96365 NON CHEMO INITIAL	$456.00	$570.00	—	—	20%
IV infusion of a medicine, first hour inpatient CPT 96365 ETC THER/PROPH/DIAG IV INF, INIT	$456.00	$570.00	—	—	20%
IV infusion of a medicine, first hour inpatient CPT 96365 THER/PROPH/DIAG IV INF, INIT	$456.00	$570.00	—	—	20%
IV infusion of a medicine, first hour inpatient CPT 96365 SDS- THER/PROPH/DIAG IV INF, INIT	$456.00	$570.00	—	—	20%
IV infusion of a medicine, first hour inpatient CPT 96365 NON-CHEMO INITIAL HOUR	$456.00	$570.00	—	—	20%
IV infusion of a medicine, first hour inpatient CPT 96365 INFUSION THERAPY	$456.00	$570.00	—	—	20%
IV push of a medicine, first drug CPT 96374 ETC THER/PROPH/DIAG INJ, IV PUSH	$256.00	$320.00	—	14% below	20%
IV push of a medicine, first drug CPT 96374 NON-CHEMO IV PUSH	$256.00	$320.00	—	14% below	20%
IV push of a medicine, first drug CPT 96374 NRS 96374 NON CHEMO IV PUSH	$256.00	$320.00	—	14% below	20%
IV push of a medicine, first drug CPT 96374 THER/PROPH/DIAG INJ, IV PUSH	$256.00	$320.00	—	14% below	20%
IV push of a medicine, first drug inpatient CPT 96374 NON-CHEMO IV PUSH	$256.00	$320.00	—	—	20%
IV push of a medicine, first drug inpatient CPT 96374 ETC THER/PROPH/DIAG INJ, IV PUSH	$256.00	$320.00	—	—	20%
IV push of a medicine, first drug inpatient CPT 96374 THER/PROPH/DIAG INJ, IV PUSH	$256.00	$320.00	—	—	20%
IV push of a medicine, first drug inpatient CPT 96374 NRS 96374 NON CHEMO IV PUSH	$256.00	$320.00	—	—	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 ADMIN STATE SUBQ IM 96372	$16.79	$20.99	—	80% below	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 ADMIN SUBQ IM 96372	$72.80	$91.00	—	14% below	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 IR INJECTION THERAPEUTIC SUBCUTAN	$131.20	$164.00	—	55% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 ETC THER/PROPH/DIAG INJ, SC/IM	$131.20	$164.00	—	55% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 NRS 96372 NON CHEMO SQ/IM 2	$131.20	$164.00	—	55% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DIAG INJ, SC/IM	$131.20	$164.00	—	55% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 NON-CHEMO-SUBQ/IM	$131.20	$164.00	—	55% above	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 ADMIN STATE SUBQ IM 96372	$16.79	$20.99	—	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 ADMIN SUBQ IM 96372	$72.80	$91.00	—	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 NRS 96372 NON CHEMO SQ/IM 2	$131.20	$164.00	—	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 IR INJECTION THERAPEUTIC SUBCUTAN	$131.20	$164.00	—	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 ETC THER/PROPH/DIAG INJ, SC/IM	$131.20	$164.00	—	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 NON-CHEMO-SUBQ/IM	$131.20	$164.00	—	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THER/PROPH/DIAG INJ, SC/IM	$131.20	$164.00	—	—	20%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 PSYCH DIAGNOSTIC EVALUATION 90791	$164.80	$206.00	—	40% below	20%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 PSYCH DIAGNOSTIC EVALUATION 90791	$164.80	$206.00	—	—	20%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 NRV CNDJ TEST 7-8 STUDIES 95910	$320.00	$400.00	—	68% above	20%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 NERVE CONDUCTION TEST 7-8 STUDIES	$1,072.00	$1,340.00	—	461% above	20%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 NRV CNDJ TEST 7-8 STUDIES 95910	$320.00	$400.00	—	—	20%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 NERVE CONDUCTION TEST 7-8 STUDIES	$1,072.00	$1,340.00	—	—	20%
Neuromuscular re-education, 15 minutes CPT 97112 PT NEUROMUSCULAR REED EA 15 MIN	$112.80	$141.00	—	at median	20%
Neuromuscular re-education, 15 minutes CPT 97112 OT-NEUROMUSC RE-EDUCATION-15MIN	$112.80	$141.00	—	at median	20%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 PT NEUROMUSCULAR REED EA 15 MIN	$112.80	$141.00	—	—	20%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 OT-NEUROMUSC RE-EDUCATION-15MIN	$112.80	$141.00	—	—	20%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 DM INIT NUTRITION THERAPY, EACH 1	$112.00	$140.00	—	12% above	20%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 DM INIT NUTRITION THERAPY, EACH 1	$112.00	$140.00	—	—	20%
Occupational therapy evaluation, low complexity CPT 97165 OT EVAL LOW COMPLEX 30 MIN	$306.40	$383.00	—	17% above	20%
Occupational therapy evaluation, low complexity inpatient CPT 97165 OT EVAL LOW COMPLEX 30 MIN	$306.40	$383.00	—	—	20%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT EVAL HIGH COMPLEX	$269.60	$337.00	—	14% below	20%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT EVAL HIGH COMPLEX	$269.60	$337.00	—	—	20%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT EVAL LOW COMPLEX	$269.60	$337.00	—	1% above	20%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT EVAL LOW COMPLEX	$269.60	$337.00	—	—	20%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT EVAL MOD COMPLEX	$269.60	$337.00	—	6% below	20%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT EVAL MOD COMPLEX	$269.60	$337.00	—	—	20%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PT MANUAL THERAPY EA 15 MIN	$120.00	$150.00	—	12% above	20%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 OT-MANUAL THERAPY /EACH 15 MIN	$120.00	$150.00	—	12% above	20%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 PT MANUAL THERAPY EA 15 MIN	$120.00	$150.00	—	—	20%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 OT-MANUAL THERAPY /EACH 15 MIN	$120.00	$150.00	—	—	20%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT-EXERCISE/15 MIN	$116.00	$145.00	—	6% above	20%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT THERAPEUTIC EXERCISE EA 15 MIN	$116.00	$145.00	—	6% above	20%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT THERAPEUTIC EXERCISE EA 15 MIN	$116.00	$145.00	—	—	20%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT-EXERCISE/15 MIN	$116.00	$145.00	—	—	20%
Preventive checkup, new patient aged 18–39 CPT 99385 INIT PM VISIT NEW AGE 18-39 99385	$108.80	$136.00	—	at median	20%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 INIT PM VISIT NEW AGE 18-39 99385	$108.80	$136.00	—	—	20%
Preventive checkup, new patient aged 40–64 CPT 99386 INIT PM VISIT NEW AGE 40-64	$132.00	$165.00	—	10% below	20%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 INIT PM VISIT NEW AGE 40-64	$132.00	$165.00	—	—	20%
Preventive checkup, new patient aged 65 or older CPT 99387 INIT PM E/M NEW PAT 65+ YRS	$141.60	$177.00	—	15% below	20%
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 INIT PM E/M NEW PAT 65+ YRS	$141.60	$177.00	—	—	20%
Preventive checkup, returning patient aged 18–39 CPT 99395 PER PM VISIT NEW AGE 18-39	$99.20	$124.00	—	20% below	20%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 PER PM VISIT NEW AGE 18-39	$99.20	$124.00	—	—	20%
Preventive checkup, returning patient aged 40–64 CPT 99396 PER PM VISIT NEW AGE 40-64	$108.00	$135.00	—	44% below	20%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 PER PM VISIT NEW AGE 40-64	$108.00	$135.00	—	—	20%
Preventive checkup, returning patient aged 65 or older CPT 99397 PER PM E/M NEW PAT 65+ YRS	$113.60	$142.00	—	44% below	20%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 PER PM E/M NEW PAT 65+ YRS	$113.60	$142.00	—	—	20%
Psychiatric evaluation with medical services CPT 90792 PSYCH DIAG EVAL W/MED SRVCS 90792	$164.80	$206.00	—	40% below	20%
Psychiatric evaluation with medical services inpatient CPT 90792 PSYCH DIAG EVAL W/MED SRVCS 90792	$164.80	$206.00	—	—	20%
Psychological testing evaluation by a psychologist or physician, first hour CPT 96130 MAP PSYCL TST EVAL PHYS/QHP 1ST	$320.00	$400.00	—	5% above	20%
Psychological testing evaluation by a psychologist or physician, first hour CPT 96130 MHS PSYCL TST EVAL PHYS/QHP 1ST	$558.40	$698.00	—	82% above	20%
Psychological testing evaluation by a psychologist or physician, first hour CPT 96130 CAP PSYCL TST EVAL PHYS/QHP 1ST	$558.40	$698.00	—	82% above	20%
Psychological testing evaluation by a psychologist or physician, first hour inpatient CPT 96130 MAP PSYCL TST EVAL PHYS/QHP 1ST	$320.00	$400.00	—	—	20%
Psychological testing evaluation by a psychologist or physician, first hour inpatient CPT 96130 CAP PSYCL TST EVAL PHYS/QHP 1ST	$558.40	$698.00	—	—	20%
Psychological testing evaluation by a psychologist or physician, first hour inpatient CPT 96130 MHS PSYCL TST EVAL PHYS/QHP 1ST	$558.40	$698.00	—	—	20%
Psychotherapy for crisis, first 60 minutes CPT 90839 PSYTX CRISIS INITIAL 60MIN 90839	$164.80	$206.00	—	at median	20%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 PSYTX CRISIS INITIAL 60MIN 90839	$164.80	$206.00	—	—	20%
Psychotherapy session, 30 minutes CPT 90832 PSYTX PT&FAMILY 30 MINUTES 90832	$164.80	$206.00	—	12% below	20%
Psychotherapy session, 30 minutes CPT 90832 PSYTX W/PATIENT 30 MIN	$219.20	$274.00	—	17% above	20%
Psychotherapy session, 30 minutes inpatient CPT 90832 PSYTX PT&FAMILY 30 MINUTES 90832	$164.80	$206.00	—	—	20%
Psychotherapy session, 30 minutes inpatient CPT 90832 PSYTX W/PATIENT 30 MIN	$219.20	$274.00	—	—	20%
Psychotherapy session, 45 minutes CPT 90834 PSYTX PT&FAM 45MIN 90834	$164.80	$206.00	—	36% below	20%
Psychotherapy session, 45 minutes CPT 90834 PSYTX W/PATIENT 45 MIN	$227.20	$284.00	—	12% below	20%
Psychotherapy session, 45 minutes inpatient CPT 90834 PSYTX PT&FAM 45MIN 90834	$164.80	$206.00	—	—	20%
Psychotherapy session, 45 minutes inpatient CPT 90834 PSYTX W/PATIENT 45 MIN	$227.20	$284.00	—	—	20%
Psychotherapy session, 60 minutes CPT 90837 PSYTX PT&/FAMILY 60 MINUTES	$164.80	$206.00	—	32% below	20%
Psychotherapy session, 60 minutes CPT 90837 PSYTX W/PATIENT 60 MIN	$233.60	$292.00	—	3% below	20%
Psychotherapy session, 60 minutes inpatient CPT 90837 PSYTX PT&/FAMILY 60 MINUTES	$164.80	$206.00	—	—	20%
Psychotherapy session, 60 minutes inpatient CPT 90837 PSYTX W/PATIENT 60 MIN	$233.60	$292.00	—	—	20%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 BEHAV CHNG SMOKING 3-10MIN 99406	$36.00	$45.00	—	at median	20%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 BEHAV CHNG SMOKING 3-10 MIN	$56.80	$71.00	—	58% above	20%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 BEHAV CHNG SMOKING 3-10MIN 99406	$36.00	$45.00	—	—	20%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 BEHAV CHNG SMOKING 3-10 MIN	$56.80	$71.00	—	—	20%
Speech and language evaluation CPT 92523 SPEECH SOUND LANG COMPREHENSION &	$572.00	$715.00	—	at median	20%
Speech and language evaluation inpatient CPT 92523 SPEECH SOUND LANG COMPREHENSION &	$572.00	$715.00	—	—	20%
Speech therapy session, individual CPT 92507 ST-SPEECH THERAPY	$236.80	$296.00	—	13% below	20%
Speech therapy session, individual CPT 92507 TRMT AUDITORY PROCESS HEARING LOS	$313.60	$392.00	—	15% above	20%
Speech therapy session, individual inpatient CPT 92507 ST-SPEECH THERAPY	$236.80	$296.00	—	—	20%
Speech therapy session, individual inpatient CPT 92507 TRMT AUDITORY PROCESS HEARING LOS	$313.60	$392.00	—	—	20%
Spirometry (breathing test) CPT 94010 SPIROMETRY PFT (NIOSH) WO INTERP	$160.80	$201.00	—	16% above	20%
Spirometry (breathing test) CPT 94010 SPIROMETRY BREATHING CAPACITY	$160.80	$201.00	—	16% above	20%
Spirometry (breathing test) CPT 94010 OPFT-SPIROMETRY (PRE)	$214.40	$268.00	—	55% above	20%
Spirometry (breathing test) CPT 94010 PFT SPIROMETRY	$214.40	$268.00	—	55% above	20%
Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY BREATHING CAPACITY	$160.80	$201.00	—	—	20%
Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY PFT (NIOSH) WO INTERP	$160.80	$201.00	—	—	20%
Spirometry (breathing test) inpatient CPT 94010 PFT SPIROMETRY	$214.40	$268.00	—	—	20%
Spirometry (breathing test) inpatient CPT 94010 OPFT-SPIROMETRY (PRE)	$214.40	$268.00	—	—	20%
Spirometry before and after a bronchodilator CPT 94060 BRONCHOSPASM EVALUATION	$320.00	$400.00	—	25% above	20%
Spirometry before and after a bronchodilator CPT 94060 PFT-PRE/POST SPIROMETRY	$431.20	$539.00	—	68% above	20%
Spirometry before and after a bronchodilator inpatient CPT 94060 BRONCHOSPASM EVALUATION	$320.00	$400.00	—	—	20%
Spirometry before and after a bronchodilator inpatient CPT 94060 PFT-PRE/POST SPIROMETRY	$431.20	$539.00	—	—	20%
TMS (transcranial magnetic stimulation), first session with mapping CPT 90867 TMS INITIAL	$320.00	$400.00	—	—	20%
TMS (transcranial magnetic stimulation), first session with mapping inpatient CPT 90867 TMS INITIAL	$320.00	$400.00	—	—	20%
Therapeutic activities (functional training), 15 minutes CPT 97530 OT-THERAP. ACTIVITY/15 MIN.	$115.20	$144.00	—	2% below	20%
Therapeutic activities (functional training), 15 minutes CPT 97530 PT THERAPEUTIC ACTIVITIES	$115.20	$144.00	—	2% below	20%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 PT THERAPEUTIC ACTIVITIES	$115.20	$144.00	—	—	20%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 OT-THERAP. ACTIVITY/15 MIN.	$115.20	$144.00	—	—	20%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 THERAPEUTIC PHLEBOTOMY	$200.80	$251.00	—	21% below	20%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY THERAPEUTIC	$252.00	$315.00	—	at median	20%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 NRS 99195 THERAPEUTIC PHLEBOTOMY	$252.00	$315.00	—	at median	20%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 ONC THERAPEUTIC PHLEBOTOMY	$252.00	$315.00	—	at median	20%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 MC THERAPEUTIC PHLEBOTOMY	$253.60	$317.00	—	at median	20%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 THERAPEUTIC PHLEBOTOMY	$200.80	$251.00	—	—	20%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 NRS 99195 THERAPEUTIC PHLEBOTOMY	$252.00	$315.00	—	—	20%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY THERAPEUTIC	$252.00	$315.00	—	—	20%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 ONC THERAPEUTIC PHLEBOTOMY	$252.00	$315.00	—	—	20%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 MC THERAPEUTIC PHLEBOTOMY	$253.60	$317.00	—	—	20%
Visual field test, extended CPT 92083 VISUAL FIELD-EXTENDED TECH FEE	$131.20	$164.00	—	8% above	20%
Visual field test, extended inpatient CPT 92083 VISUAL FIELD-EXTENDED TECH FEE	$131.20	$164.00	—	—	20%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs North Dakota	Off list
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN 1ST STATE VACCINE	$16.79	$20.99	—	65% below	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 NRS ADMIN STATE SUPPLIED VACCINE	$16.79	$20.99	—	65% below	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMINISTRATION	$72.80	$91.00	—	52% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ETC IMMUNIZATION ADMINISTRATION	$120.00	$150.00	—	150% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 NRS 90471 ADMIN IMMUNIZE 2	$120.00	$150.00	—	150% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ONC-IMMUNIZATION ADMIN	$120.00	$150.00	—	150% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 NRS ADMIN STATE SUPPLIED VACCINE	$16.79	$20.99	—	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMIN 1ST STATE VACCINE	$16.79	$20.99	—	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMINISTRATION	$72.80	$91.00	—	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 NRS 90471 ADMIN IMMUNIZE 2	$120.00	$150.00	—	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ETC IMMUNIZATION ADMINISTRATION	$120.00	$150.00	—	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ONC-IMMUNIZATION ADMIN	$120.00	$150.00	—	—	20%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 ADMIN EA ADDL STATE VACCINE	$16.79	$20.99	—	42% below	20%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 NRS ADMIN STATE VACCINE EA ADD'L	$16.79	$20.99	—	42% below	20%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 ONC-IMMUNIZATION ADM, EA ADDTL	$40.80	$51.00	—	40% above	20%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMIN (IM/SQ) EA AD	$40.80	$51.00	—	40% above	20%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMINISTRATION 2+	$40.80	$51.00	—	40% above	20%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 NRS 90472 ADMIN ADDL IMMUNIZE 2	$40.80	$51.00	—	40% above	20%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 ADMIN EA ADDL STATE VACCINE	$16.79	$20.99	—	—	20%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 NRS ADMIN STATE VACCINE EA ADD'L	$16.79	$20.99	—	—	20%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 NRS 90472 ADMIN ADDL IMMUNIZE 2	$40.80	$51.00	—	—	20%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUNIZATION ADMIN (IM/SQ) EA AD	$40.80	$51.00	—	—	20%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUNIZATION ADMINISTRATION 2+	$40.80	$51.00	—	—	20%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 ONC-IMMUNIZATION ADM, EA ADDTL	$40.80	$51.00	—	—	20%

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

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

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

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

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

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

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

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

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

Source file: https://hospitalpricedisclosure.com/download.aspx?pi=oJubMF8*_*EJI5yGO8tB02EA*-*