Kenmare Community Hospital
Kenmare Community Hospital in Kenmare, ND publishes cash prices for 330 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 173 of 321 procedures and below it for 85. By typical cash price it ranks #13 of 22 North Dakota hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.
Po Box 697, Kenmare, ND 58746 Collected Sep 27, 2026 Source price file (701) 385-4296
Critical access hospital (rural, 25 beds or fewer) Emergency department CCN 351305 · CMS hospital register
Scans and imaging
| Procedure | Cash price | List price | Insurers pay | vs North Dakota | Off list |
|---|---|---|---|---|---|
| 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 LEFT | $214.40 | $268.00 | — | 28% above | 20% |
| Ankle X-ray, complete, 3 or more views one side CPT 73610 XR ANKLE COMPLETE RIGHT | $214.40 | $268.00 | — | 28% 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 LEFT | $214.40 | $268.00 | — | — | 20% |
| Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR ANKLE COMPLETE RIGHT | $214.40 | $268.00 | — | — | 20% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 US LE ANKLE/RADIAL BRACH INDICES | $194.40 | $243.00 | — | 30% 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% |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 XR ESOPHAGUS SINGLE CONTRAST | $557.60 | $697.00 | — | 48% 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 | — | 34% below | 20% |
| Bone scan, whole body (nuclear medicine) CPT 78306 NM BONE SPECT WHOLE BODY | $672.00 | $840.00 | — | 34% 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 BREAST BILATERAL COMPLETE | $904.00 | $1,130.00 | — | — | 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 one side CPT 76641 US MA BREAST LEFT COMPLETE | $453.60 | $567.00 | — | 32% above | 20% |
| Breast ultrasound, complete, one breast one side CPT 76641 US BREAST RIGHT COMPLETE | $453.60 | $567.00 | — | 32% above | 20% |
| Breast ultrasound, complete, one breast one side CPT 76641 US MA BREAST RIGHT COMPLETE | $453.60 | $567.00 | — | 32% above | 20% |
| Breast ultrasound, complete, one breast one side CPT 76641 US BREAST LEFT COMPLETE | $453.60 | $567.00 | — | 32% 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 MA BREAST RIGHT 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, 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) both sides CPT 76642 US MA 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 | — | 28% above | 20% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 US MA BREAST LEFT LIMITED | $333.60 | $417.00 | — | 28% above | 20% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST RIGHT LIMITED | $333.60 | $417.00 | — | 28% above | 20% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 US MA BREAST RIGHT LIMITED | $333.60 | $417.00 | — | 28% above | 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 both sides CPT 76642 US 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 MA BREAST LEFT 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% |
| 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 | — | 8% 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 | — | 8% 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 | — | 8% 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 - PE PROTOCO | $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 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 | — | 28% above | 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 | — | 28% 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 | — | 28% 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 | — | 28% 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 CT ANGIO CORONARY W+WO CONTRAST | $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 CTA PRE-TAVR CORONARY/CHEST/ABD/P | $2,693.60 | $3,367.00 | — | — | 20% |
| CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT SCREEN CLINIC CALCIUM | $36.00 | $45.00 | — | 29% below | 20% |
| CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT HEART WO CONTRAST QUAL CALC | $781.60 | $977.00 | — | 1449% above | 20% |
| CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT PRE-TAVR CALCIUM SCORE | $781.60 | $977.00 | — | 1449% above | 20% |
| CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT SCREEN CLINIC CALCIUM | $36.00 | $45.00 | — | — | 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 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 scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABDOMEN/PELVIS W/O CONTRAST | $2,314.40 | $2,893.00 | — | 75% 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 | — | 9% 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 | — | 7% 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 | — | 32% 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 | — | 62% 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 MEDTRONIC | $1,256.80 | $1,571.00 | — | 18% above | 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 inpatient CPT 70486 CT SINUS MEDTRONIC | $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 W/O CONTRAST | $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 | — | 18% 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 | — | 18% above | 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 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 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 | — | 2% above | 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 | — | 1% above | 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 | — | 4% 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 | — | 2% 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 X-ray, 2 views CPT 71046 XR CHEST 2 VIEWS | $232.80 | $291.00 | — | 47% above | 20% |
| Chest X-ray, 2 views CPT 71046 XR CHEST 2 VIEWS PRE-OP | $232.80 | $291.00 | — | 47% above | 20% |
| Chest X-ray, 2 views inpatient CPT 71046 XR CHEST 2 VIEWS PRE-OP | $232.80 | $291.00 | — | — | 20% |
| Chest X-ray, 2 views inpatient CPT 71046 XR CHEST 2 VIEWS | $232.80 | $291.00 | — | — | 20% |
| Chest X-ray, single view CPT 71045 XR CHEST SPECIAL VIEWS | $232.80 | $291.00 | — | 76% above | 20% |
| Chest X-ray, single view CPT 71045 XR CHEST 1 VIEW ACUTE STROKE PRO | $232.80 | $291.00 | — | 76% above | 20% |
| Chest X-ray, single view CPT 71045 XR CHEST B-READ | $232.80 | $291.00 | — | 76% above | 20% |
| Chest X-ray, single view CPT 71045 XR CHEST 1 VIEW PRE-OP | $232.80 | $291.00 | — | 76% above | 20% |
| Chest X-ray, single view CPT 71045 XR CHEST EXPIRATION ONLY 1 VIEW | $232.80 | $291.00 | — | 76% above | 20% |
| Chest X-ray, single view CPT 71045 XR CHEST 1 VIEW AP FRONTAL | $232.80 | $291.00 | — | 76% above | 20% |
| Chest X-ray, single view one side CPT 71045 XR CHEST DECUBITUS LEFT | $232.80 | $291.00 | — | 76% above | 20% |
| Chest X-ray, single view one side CPT 71045 XR CHEST DECUBITUS RIGHT | $232.80 | $291.00 | — | 76% 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 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 CPT 71045 XR CHEST 1 VIEW AP FRONTAL | $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 ACUTE STROKE PRO | $232.80 | $291.00 | — | — | 20% |
| Chest X-ray, single view inpatient one side CPT 71045 XR CHEST DECUBITUS LEFT | $232.80 | $291.00 | — | — | 20% |
| Chest X-ray, single view inpatient one side CPT 71045 XR CHEST DECUBITUS RIGHT | $232.80 | $291.00 | — | — | 20% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US KIDNEY | $485.60 | $607.00 | — | 21% above | 20% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RETROPERITONEAL COMPLETE | $485.60 | $607.00 | — | 21% above | 20% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US ABDOMINAL AORTA | $485.60 | $607.00 | — | 21% 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 ABDOMINAL AORTA | $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% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 BD BONE DENSITY DEXA AXIAL SKELET | $264.80 | $331.00 | — | 1% below | 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 | — | 80% below | 20% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 BD BONE DENSITY PERIPHERAL | $163.20 | $204.00 | — | 60% 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 | — | 38% 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 HI RES W/O CONTRAST | $1,256.80 | $1,571.00 | — | 7% 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 | — | 7% 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 | — | 7% 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 | — | 7% above | 20% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST W/O CONTRAST | $1,256.80 | $1,571.00 | — | 7% 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 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 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 CHEST HI RES 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, with contrast dye CPT 71260 CT CHEST W/ CONTRAST | $1,444.80 | $1,806.00 | — | 2% 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 ADD VW 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 DIAG-BILAT | $416.00 | $520.00 | — | — | 20% |
| Diagnostic mammogram, both breasts CPT 77066 MA MAMMO ADDL VW BIL DIGITAL-MOBI | $416.00 | $520.00 | — | — | 20% |
| Diagnostic mammogram, both breasts CPT 77066 MA MAMMO BIL DIAG DIGITAL-MOBILE | $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 DIGITAL ADD VW 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 BIL DIAG DIGITAL-MOBILE | $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, one breast CPT 77065 MA MAMMO DIGITAL ADD VW DIAG-SD | $378.40 | $473.00 | — | 1% below | 20% |
| Diagnostic mammogram, one breast one side CPT 77065 MA MAMMO POST LOC ADD VW LEFT | $378.40 | $473.00 | — | 1% below | 20% |
| Diagnostic mammogram, one breast one side CPT 77065 MA MAMMO POST LOC ADD VW RIGHT | $378.40 | $473.00 | — | 1% below | 20% |
| Diagnostic mammogram, one breast one side CPT 77065 MA MAMMO DIGITAL DIAG-RT | $378.40 | $473.00 | — | 1% below | 20% |
| Diagnostic mammogram, one breast one side CPT 77065 MA MAMMO DIGITAL ADD VW LT | $378.40 | $473.00 | — | 1% below | 20% |
| Diagnostic mammogram, one breast one side CPT 77065 MA MAMMO DIGITAL ADD VW RT | $378.40 | $473.00 | — | 1% below | 20% |
| Diagnostic mammogram, one breast one side CPT 77065 MA MAMMO DIGITAL DIAG-LT | $378.40 | $473.00 | — | 1% below | 20% |
| Diagnostic mammogram, one breast one side CPT 77065 MA MAMMO LT DIAG DIGITAL-MOBILE | $378.40 | $473.00 | — | 1% below | 20% |
| Diagnostic mammogram, one breast one side CPT 77065 MA MAMMO RT DIAG DIGITAL-MOBILE | $378.40 | $473.00 | — | 1% below | 20% |
| Diagnostic mammogram, one breast one side CPT 77065 MA MAMMO ADDL VW RT DIGITAL-MOBIL | $378.40 | $473.00 | — | 1% below | 20% |
| Diagnostic mammogram, one breast one side CPT 77065 MA MAMMO ADDL VW LT DIGITAL-MOBIL | $378.40 | $473.00 | — | 1% 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 DIGITAL ADD VW LT | $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 RT DIAG DIGITAL-MOBILE | $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 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 LT DIAG DIGITAL-MOBILE | $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 POST LOC ADD VW LEFT | $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 | — | 59% 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 LE VEIN MAPPING BILATERAL | $982.40 | $1,228.00 | — | — | 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 CPT 93970 US LE VENOUS INSUFFICIENCY/REFLUX | $982.40 | $1,228.00 | — | 67% above | 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 both sides CPT 93970 US LE VEIN MAPPING 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 ECHOCARD/2D/M-MODE | $924.80 | $1,156.00 | — | 13% above | 20% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 US ECHOCARDIOGRAM PEDIATRIC | $924.80 | $1,156.00 | — | 13% above | 20% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 US ECHOCARDIOGRAM COMPLETE. | $924.80 | $1,156.00 | — | 13% above | 20% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 US ECHOCARDIOGRAM COMPLETE | $924.80 | $1,156.00 | — | 13% 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% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM HEPATOBILIARY DUCT IMAGING | $566.40 | $708.00 | — | 47% 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% |
| Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 SLEEP STUDY UNATT&RESP EFFT | $316.80 | $396.00 | — | 26% 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-SPLIT NIGHT STUD | $2,240.00 | $2,800.00 | — | 3% below | 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 | — | 3% 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 | — | 3% 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-CPAP STUDY (52) | $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% |
| 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 VIEWS RIGHT | $204.80 | $256.00 | — | 3% above | 20% |
| Knee X-ray, 3 views one side CPT 73562 XR KNEE 3 VWS W/AP STANDING RIGHT | $204.80 | $256.00 | — | 3% above | 20% |
| Knee X-ray, 3 views one side CPT 73562 XR KNEE 3 VIEWS LEFT | $204.80 | $256.00 | — | 3% above | 20% |
| Knee X-ray, 3 views one side CPT 73562 XR KNEE 3 VWS W/AP STANDING LEFT | $204.80 | $256.00 | — | 3% 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 VWS W/AP STANDING 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 VIEWS 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% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMEN RUQ | $453.60 | $567.00 | — | 20% above | 20% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US LIVER | $453.60 | $567.00 | — | 20% above | 20% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US GALLBLADDER | $453.60 | $567.00 | — | 20% above | 20% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMEN LIMITED | $453.60 | $567.00 | — | 20% above | 20% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ETC ABDOMEN LIMITED | $453.60 | $567.00 | — | 20% above | 20% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US PANCREAS | $453.60 | $567.00 | — | 20% above | 20% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US SPLEEN | $453.60 | $567.00 | — | 20% above | 20% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US PYLORIC VALVE | $453.60 | $567.00 | — | 20% 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 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 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% |
| 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 | — | 55% above | 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 | — | 55% above | 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% |
| 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% |
| 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 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 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 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 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 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 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 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 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 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 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 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 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 HIP 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 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 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 CPT 73723 MRI LE JOINT W/ + W/O CONTRAST RI | $2,680.80 | $3,351.00 | — | 7% 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 | — | 7% below | 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 | — | 87% above | 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 | — | 87% above | 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 | — | 7% 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 | — | 7% 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 | — | 7% 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 | — | 7% 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 | — | 7% 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 RIGHT | $2,680.80 | $3,351.00 | — | 7% 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 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 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 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 the abdomen without contrast CPT 74181 MRI ABDOMEN W/O CONTRAST | $1,932.80 | $2,416.00 | — | 1% above | 20% |
| MRI of the abdomen without contrast CPT 74181 MRI CHOLANGIOPANCREATOGRAM (MRCP) | $1,932.80 | $2,416.00 | — | 1% above | 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 contrast inpatient CPT 74181 MRI ABDOMEN W/O CONTRAST | $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 - DIFFUSION IMAGING | $1,064.80 | $1,331.00 | — | 35% below | 20% |
| MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O CONTRAST | $1,064.80 | $1,331.00 | — | 35% below | 20% |
| MRI of the brain, no contrast dye CPT 70551 MRI BRAIN DIFFUSION IMAGING LTD W | $1,064.80 | $1,331.00 | — | 35% below | 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 DIFFUSION IMAGING LTD W | $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 | — | 13% 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 | — | 33% 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 | — | 9% 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 | — | 24% 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 | — | 31% 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 | — | 20% above | 20% |
| MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS DYNAMIC W/O CONTRAST | $2,440.00 | $3,050.00 | — | 20% 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 WRIST 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 ELBOW 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 ELBOW W/O CONTRAST LEFT | $1,932.80 | $2,416.00 | — | — | 20% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM MYOCARDIAL SPECT MULTI REST/ST | $1,950.40 | $2,438.00 | — | at median | 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 | — | — | 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 | — | 37% 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 | — | 37% 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 ultrasound (not pregnancy), limited or follow-up CPT 76857 US BLADDER W/MEASUREMENT | $453.60 | $567.00 | — | 43% above | 20% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 ETC PELVIS LIMITED | $453.60 | $567.00 | — | 43% above | 20% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIS NON-OB LIMITED W OR W/O | $453.60 | $567.00 | — | 43% 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 | — | 23% above | 20% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIS CRITICAL(TORSION) | $479.20 | $599.00 | — | 23% above | 20% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIS NON-OB COMPLETE | $479.20 | $599.00 | — | — | 20% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIS CRITICAL(TORSION) | $479.20 | $599.00 | — | — | 20% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US PG >1ST TRIM SNGL | $580.00 | $725.00 | — | 26% above | 20% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US FETAL DEATH | $580.00 | $725.00 | — | 26% above | 20% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US FETAL DEATH | $580.00 | $725.00 | — | — | 20% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US PG >1ST TRIM SNGL | $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 | — | 27% 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 HELLO BABY 2D GENDER | $52.00 | $65.00 | — | 81% below | 20% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US HELLO BABY 3D KEEPSAKE | $80.00 | $100.00 | — | 71% below | 20% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US PREGNANCY LIMITED SGL W OR W/O | $453.60 | $567.00 | — | 64% above | 20% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US PREGNANCY LIMITED TWIN W OR W/ | $1,104.00 | $1,380.00 | — | 298% 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 | — | 298% above | 20% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US HELLO BABY 2D GENDER | $52.00 | $65.00 | — | — | 20% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US HELLO BABY 3D KEEPSAKE | $80.00 | $100.00 | — | — | 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% |
| 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 BIL SCREEN DIGITAL-MOBIL | $344.00 | $430.00 | — | at median | 20% |
| Screening mammogram, both breasts CPT 77067 MA MAMMO UNI SCREEN DIGITAL-MOBIL | $344.00 | $430.00 | — | at median | 20% |
| Screening mammogram, both breasts one side CPT 77067 MA MAMMO DIGITAL SCREEN-UNILAT | $344.00 | $430.00 | — | at median | 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 RIGHT | $186.40 | $233.00 | — | 8% above | 20% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR SHOULDER COMPLETE LEFT | $186.40 | $233.00 | — | 8% 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 RIGHT | $186.40 | $233.00 | — | — | 20% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR SHOULDER COMPLETE LEFT | $186.40 | $233.00 | — | — | 20% |
| Sleep study in a lab (polysomnography) CPT 95810 POLYSOMNOGRAPHY-DIAGNOSTIC | $2,240.00 | $2,800.00 | — | at median | 20% |
| Sleep study in a lab (polysomnography) CPT 95810 POLYSOMNOGRAPHY-DIAGNOSTIC (52) | $2,240.00 | $2,800.00 | — | at median | 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 ECHO COMPLETE | $924.80 | $1,156.00 | — | at median | 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 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 | — | 1% below | 20% |
| Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 XR SWALLOWING FUNCTION W/ VIDEO | $494.40 | $618.00 | — | — | 20% |
| Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL | $552.80 | $691.00 | — | 22% above | 20% |
| Transvaginal pelvic ultrasound CPT 76830 US OVARIAN FOLLICLES | $552.80 | $691.00 | — | 22% above | 20% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL | $552.80 | $691.00 | — | — | 20% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US OVARIAN FOLLICLES | $552.80 | $691.00 | — | — | 20% |
| Transvaginal ultrasound during pregnancy CPT 76817 US PREGNANCY TRANSVAGINAL | $453.60 | $567.00 | — | 53% 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 | — | 17% 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 | — | 52% above | 20% |
| Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM (CONTENTS) | $585.60 | $732.00 | — | 52% above | 20% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM CRITICAL(TORSION) W/DO | $585.60 | $732.00 | — | — | 20% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM (CONTENTS) | $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 | — | 24% above | 20% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US THYROID | $560.00 | $700.00 | — | 24% above | 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% |
| 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% |
| 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 | — | 37% 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 | — | 37% above | 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 | — | 37% 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% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 US LE VENOUS INSUFFICIENCY/REFL R | $664.80 | $831.00 | — | 18% 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 | — | 18% 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 | — | 18% 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 | — | 18% 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 | — | 18% 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 | — | 18% 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 | — | 18% 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 | — | 18% above | 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 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 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 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 VEIN MAPPING 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 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 RIGHT | $664.80 | $831.00 | — | — | 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 | — | 55% above | 20% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 XR WRIST COMPLETE LEFT | $186.40 | $233.00 | — | at median | 20% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 XR WRIST W/NAVICULAR VIEWS RIGHT | $186.40 | $233.00 | — | at median | 20% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 XR WRIST COMPLETE RIGHT | $186.40 | $233.00 | — | at median | 20% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 XR WRIST W/NAVICULAR VIEWS LEFT | $186.40 | $233.00 | — | at median | 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 W/NAVICULAR VIEWS 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 COMPLETE 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 LEFT W/PELVIS | $204.80 | $256.00 | — | 6% above | 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 | — | 6% above | 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 | — | 6% above | 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 | — | 6% above | 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 | — | 6% above | 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 | — | 6% above | 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 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 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 2 VIEWS LEFT 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 RIGHT W/PELVIS | $204.80 | $256.00 | — | — | 20% |
| X-ray of the abdomen, 1 view CPT 74018 XR ABDOMEN AP | $155.20 | $194.00 | — | 35% 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 RIGHT | $186.40 | $233.00 | — | 24% above | 20% |
| X-ray of the ankle, 2 views one side CPT 73600 XR ANKLE 2 VIEWS LEFT | $186.40 | $233.00 | — | 24% above | 20% |
| X-ray of the ankle, 2 views one side CPT 73600 XR ANKLE 1 VIEW LEFT | $186.40 | $233.00 | — | 24% above | 20% |
| X-ray of the ankle, 2 views one side CPT 73600 XR ANKLE 1 VIEW RIGHT | $186.40 | $233.00 | — | 24% above | 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 both sides CPT 73600 XR ANKLE 1 VIEW BILATERAL | $372.80 | $466.00 | — | — | 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 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 LEFT | $186.40 | $233.00 | — | — | 20% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER 5TH DIGIT LEFT | $163.20 | $204.00 | — | 3% above | 20% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER THUMB LEFT | $163.20 | $204.00 | — | 3% 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 | — | 3% above | 20% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER THUMB RIGHT | $163.20 | $204.00 | — | 3% 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 | — | 3% 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 | — | 3% above | 20% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER 3RD DIGIT LEFT | $163.20 | $204.00 | — | 3% 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 | — | 3% 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 | — | 3% 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 | — | 3% above | 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 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 THUMB 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 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 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 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 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 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 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 RIGHT | $186.40 | $233.00 | — | 17% above | 20% |
| X-ray of the foot, 2 views one side CPT 73620 XR FOOT 2 VIEWS LEFT | $186.40 | $233.00 | — | 17% above | 20% |
| X-ray of the foot, 2 views one side CPT 73620 XR FOOT 1 VIEW RIGHT | $186.40 | $233.00 | — | 17% above | 20% |
| X-ray of the foot, 2 views one side CPT 73620 XR FOOT 1 VIEW LEFT | $186.40 | $233.00 | — | 17% 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 1 VIEW LEFT | $186.40 | $233.00 | — | — | 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 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 RIGHT | $192.00 | $240.00 | — | 17% above | 20% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 XR FOOT COMPLETE LEFT | $192.00 | $240.00 | — | 17% 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 RIGHT | $214.40 | $268.00 | — | 11% above | 20% |
| X-ray of the hand, 3 or more views one side CPT 73130 XR HAND COMPLETE LEFT | $214.40 | $268.00 | — | 11% 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 RIGHT | $186.40 | $233.00 | — | at median | 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 | — | at median | 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 LEFT | $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 RIGHT | $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 | — | 55% 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 | — | 14% 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 | — | 85% 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 | — | 26% 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 | — | 4% above | 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 | — | 4% above | 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 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 pelvis, 1 or 2 views CPT 72170 XR PELVIS 1 OR 2 VIEWS | $264.80 | $331.00 | — | 78% 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 | — | 78% above | 20% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 XR PELVIS INLET/OUTLET W/O AP PEL | $264.80 | $331.00 | — | 78% above | 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 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 tailbone (sacrum and coccyx), 2 or more views CPT 72220 XR SACRUM/COCCYX MINIMUM 2 VIEWS | $186.40 | $233.00 | — | 28% above | 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 | — | 28% above | 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% |
| 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% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs North Dakota | Off list |
|---|---|---|---|---|---|
| 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 | — | 24% 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 | — | 50% above | 20% |
| Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 ACUTE HEPATITIS PROFILE | $326.40 | $408.00 | — | — | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLG SPEC IGE CRUDE XTRC EA.. | $28.00 | $35.00 | — | 94% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLG SPEC IGE CRUDE XTRC EACH | $28.00 | $35.00 | — | 94% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLG SPEC IGE CRUDE XTRC EA. | $28.00 | $35.00 | — | 94% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN (IGE), CAROB | $30.40 | $38.00 | — | 111% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 SCS,ALLERGEN SPECIFIC IGE | $36.80 | $46.00 | — | 156% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 HAZELNUT-FOOD IGE W/REFLEX TO HAZ | $38.40 | $48.00 | — | 167% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 SESAME SEED IGE W/REFLEX TO SESAM | $38.40 | $48.00 | — | 167% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN (IGE), ZUCCHINI-MAYO | $46.40 | $58.00 | — | 222% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 74893 FAGPL,ALLERGEN SPECIFIC IGE | $56.80 | $71.00 | — | 294% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 STACHYBOTRYS CHARTARUM/ATRA, IGE | $63.20 | $79.00 | — | 339% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN(IGE) D MICROCERAS | $63.20 | $79.00 | — | 339% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN (IGE), ORCHARD GRASS | $63.20 | $79.00 | — | 339% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN (IGE), EASTERN SYCAMORE, | $63.20 | $79.00 | — | 339% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN (IGE), CARMINE DYE/RED D | $68.00 | $85.00 | — | 372% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 CASHEW IGE W/REFLEX TO CASHEW | $69.60 | $87.00 | — | 383% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 BRAZIL NUT IGE W/REFLEX TO BRAZIL | $69.60 | $87.00 | — | 383% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERG SP IGE, QUAN OR SEMIQUAN | $69.60 | $87.00 | — | 383% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 AP10, ALLERGEN EACH | $70.40 | $88.00 | — | 389% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 AP5, ALLERGEN EACH | $70.40 | $88.00 | — | 389% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN (IGE),BAHIA GRASS-MAYO | $70.40 | $88.00 | — | 389% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 PENICILLIN V ALLERGEN,IGE AB | $70.40 | $88.00 | — | 389% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 PENICILLIN G ALLERGEN,IGE AB | $70.40 | $88.00 | — | 389% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 PED.ALLERGY SCRN | $70.40 | $88.00 | — | 389% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 74637 ALLERGEN IGE | $70.40 | $88.00 | — | 389% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 IGE ANTIBODY,SINGLE ALLERGEN | $70.40 | $88.00 | — | 389% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 LATEX ALLERGEN TITER | $70.40 | $88.00 | — | 389% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLG SPEC IGE CRUDE XTRC EA | $76.80 | $96.00 | — | 433% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN (IGE), QUINOA | $81.60 | $102.00 | — | 467% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN (IGE) PERCH OCEAN-MAYO | $84.00 | $105.00 | — | 483% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE IBT | $85.60 | $107.00 | — | 494% above | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MULTI-ALLERGEN IGE PANEL | $114.40 | $143.00 | — | 694% 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) D MICROCERAS | $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), ORCHARD GRASS | $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 ALLERG SP IGE, QUAN OR SEMIQUAN | $69.60 | $87.00 | — | — | 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 CASHEW IGE W/REFLEX TO CASHEW | $69.60 | $87.00 | — | — | 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 PED.ALLERGY SCRN | $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 AP10, ALLERGEN EACH | $70.40 | $88.00 | — | — | 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 LATEX ALLERGEN TITER | $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 PENICILLIN V ALLERGEN,IGE AB | $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% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP ANTIBODY | $132.00 | $165.00 | — | 132% above | 20% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP ANTIBODIES,SERUM | $180.80 | $226.00 | — | 218% 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 | — | 28% above | 20% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 72145 ALDP,ANTINUCLEAR AB (ANA) | $72.80 | $91.00 | — | 28% above | 20% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR AB (ANA), | $118.40 | $148.00 | — | 108% above | 20% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODY SCREEN W/REF | $135.20 | $169.00 | — | 138% 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 | — | 44% below | 20% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 BNP,B-TYPE NATRIURETIC PEPTIDE | $194.40 | $243.00 | — | 9% 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% |
| Basic metabolic panel (blood test) CPT 80048 BMP (BASIC METABOLIC PANEL) | $98.40 | $123.00 | — | 33% above | 20% |
| Basic metabolic panel (blood test) inpatient CPT 80048 BMP (BASIC METABOLIC PANEL) | $98.40 | $123.00 | — | — | 20% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 SURG PATH, LEVEL IV | $141.60 | $177.00 | — | 25% above | 20% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 DERMATOPATHOLOGY EXAM OF TISSUE-M | $141.60 | $177.00 | — | 25% above | 20% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 89005 RPC,SURG PATH TISSUE EXAM | $146.40 | $183.00 | — | 30% above | 20% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 SURGICAL PATHOLOGY LEVEL IV | $160.80 | $201.00 | — | 42% above | 20% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 SLIDE PREP-H&E | $160.80 | $201.00 | — | 42% above | 20% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 73036 MPCT,TISSUE EXAM BY PATHOLO | $233.60 | $292.00 | — | 107% above | 20% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 BM,SURG PATH, LEVEL IV | $332.00 | $415.00 | — | 194% 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 SLIDE PREP-H&E | $160.80 | $201.00 | — | — | 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 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 | — | 150% 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 VENIPUNCT | $16.00 | $20.00 | — | 7% below | 20% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 ROUTINE VENIPUNCTURE1 | $16.00 | $20.00 | — | 7% below | 20% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 ROUTINE VENIPUNCTURE-ETC | $20.00 | $25.00 | — | 16% above | 20% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE | $20.00 | $25.00 | — | 16% above | 20% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 ROUTINE VENIPUNCTU | $20.00 | $25.00 | — | 16% above | 20% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 ROUTINE VENI | $20.00 | $25.00 | — | 16% above | 20% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 ROUTINE VENIPUNCTURE. | $20.00 | $25.00 | — | 16% above | 20% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 PROMETHEUS KIT DRAW | $20.00 | $25.00 | — | 16% above | 20% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 BILLION TO ONE KIT DRAW | $20.00 | $25.00 | — | 16% above | 20% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLLECTION OF VENOUS BLOOD BY VEN | $20.00 | $25.00 | — | 16% 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 | — | 110% above | 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 VENIPUNCTURE1 | $16.00 | $20.00 | — | — | 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 COLLECTION OF VENOUS BLOOD BY VEN | $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 PROMETHEUS KIT DRAW | $20.00 | $25.00 | — | — | 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 ROUTINE VENIPUNCTURE. | $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 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 | — | 85% below | 20% |
| Blood glucose (sugar) test CPT 82947 TCC-ACCUCHECK GLUCOSE | $20.80 | $26.00 | — | 19% below | 20% |
| Blood glucose (sugar) test CPT 82947 82947 GLU (GLUCOSE) | $30.40 | $38.00 | — | 18% above | 20% |
| Blood glucose (sugar) test CPT 82947 GLUCOSE | $30.40 | $38.00 | — | 18% 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 | — | 49% above | 20% |
| Blood lead test CPT 83655 LEAD, VENOUS BLOOD-MAYO | $49.60 | $62.00 | — | 68% above | 20% |
| Blood lead test CPT 83655 HMU,LEAD | $57.60 | $72.00 | — | 95% above | 20% |
| Blood lead test CPT 83655 LEAD | $76.80 | $96.00 | — | 159% above | 20% |
| Blood lead test CPT 83655 83655 LEAD | $107.20 | $134.00 | — | 262% above | 20% |
| Blood lead test CPT 83655 LEAD, 24 HR URINE | $108.80 | $136.00 | — | 268% 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 | — | 17% above | 20% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HCG, QUAL | $79.20 | $99.00 | — | 17% above | 20% |
| Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HCG, QUAL | $79.20 | $99.00 | — | — | 20% |
| Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HCG, QUAL., BLOOD | $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% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN | $24.80 | $31.00 | — | at median | 20% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C REACTIVE PROTEIN | $86.40 | $108.00 | — | 248% 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 | — | 12% 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 | — | 134% 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 | — | 61% 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 | — | at median | 20% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 CORONAVIRUS,COVID-19 | $120.00 | $150.00 | — | at median | 20% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COV-19 AMP PRB HGH THRUPUT. | $295.20 | $369.00 | — | 146% above | 20% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS COV-2 RNA DDPCR, QUAL, FFPE | $790.40 | $988.00 | — | 559% 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% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 59014 CHLAMYDIA AMPLIFIED PROBE | $237.60 | $297.00 | — | 108% above | 20% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 78171 CHLAMYDIA T AMPLIF NA PROBE | $237.60 | $297.00 | — | 108% above | 20% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 C TRACHOMATIS AMP RNA, MISC SITES | $237.60 | $297.00 | — | 108% above | 20% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA BY NUCLEIC ACID AMPLIF | $237.60 | $297.00 | — | 108% above | 20% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA T AMPLIF NA PROBE | $237.60 | $297.00 | — | 108% above | 20% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 89018 CHLAMYDIA T AMPLIF NA PROBE | $237.60 | $297.00 | — | 108% above | 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 89018 CHLAMYDIA T AMPLIF NA 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 78171 CHLAMYDIA T AMPLIF NA PROBE | $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% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 C TRACHOMATIS AMP RNA, MISC SITES | $237.60 | $297.00 | — | — | 20% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 71185 LMP, LIPID PANEL | $68.00 | $85.00 | — | at median | 20% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PROFILE | $114.40 | $143.00 | — | 68% 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 20096 COMPLETE BLOOD COUNT | $64.00 | $80.00 | — | 41% above | 20% |
| Complete blood count (CBC), no differential CPT 85027 COMPLETE BLOOD COUNT. | $64.00 | $80.00 | — | 41% 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 | — | 28% above | 20% |
| Comprehensive metabolic panel (blood test) CPT 80053 CMP-COMPREHENSIVE METABOLIC PANE | $121.60 | $152.00 | — | 28% 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% |
| D-dimer blood test (blood clot marker) CPT 85379 74039, D-DIMER | $45.60 | $57.00 | — | 39% below | 20% |
| D-dimer blood test (blood clot marker) CPT 85379 D-DIMER | $76.00 | $95.00 | — | 1% above | 20% |
| D-dimer blood test (blood clot marker) CPT 85379 74059, D-DIMER | $124.00 | $155.00 | — | 65% above | 20% |
| D-dimer blood test (blood clot marker) CPT 85379 PCC D-DIMER | $144.80 | $181.00 | — | 93% above | 20% |
| D-dimer blood test (blood clot marker) CPT 85379 D-DIMER, P | $163.20 | $204.00 | — | 118% 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 | — | 4% above | 20% |
| DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA-S | $98.40 | $123.00 | — | — | 20% |
| Estradiol blood test CPT 82670 ASSAY OF TOTAL ESTRADIOL | $80.00 | $100.00 | — | at median | 20% |
| Estradiol blood test CPT 82670 ESTRADIOL | $169.60 | $212.00 | — | 112% above | 20% |
| Estradiol blood test CPT 82670 ESTRADIOL,SERUM | $227.20 | $284.00 | — | 184% 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 | — | 43% 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 | — | 88% 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 | — | 49% above | 20% |
| Ferritin blood test (iron stores) CPT 82728 THE,FERRITIN | $202.40 | $253.00 | — | 184% 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% |
| Folate (folic acid) blood test CPT 82746 FOLATE, SERUM | $104.00 | $130.00 | — | 26% 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 | — | 18% above | 20% |
| Free T3 thyroid hormone test CPT 84481 T3, FREE (FT3) | $108.80 | $136.00 | — | 27% 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 | — | 31% below | 20% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 T4, FREE BY DIALYSIS | $43.20 | $54.00 | — | 24% above | 20% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 T4, FREE (FT4) | $62.40 | $78.00 | — | 79% above | 20% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 T4, FREE-MAYO | $126.40 | $158.00 | — | 262% 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 | — | 20% above | 20% |
| Free testosterone test CPT 84402 TESTOSTERONE,FREE | $104.00 | $130.00 | — | 73% 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% |
| General health panel: metabolic panel, blood count and TSH in one order CPT 80050 GENERAL HEALTH PANEL | $306.40 | $383.00 | — | 33% 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 | — | 41% 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 | — | 40% 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 78171 NEISSERIA AMPLIF NA PROBE | $237.60 | $297.00 | — | 175% above | 20% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 59014 GONORRHEA AMPLIFIED PROBE | $237.60 | $297.00 | — | 175% above | 20% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 89018 NEISSERIA AMPLIF NA PROBE | $237.60 | $297.00 | — | 175% above | 20% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 NEISSERIA AMPLIF NA PROBE | $237.60 | $297.00 | — | 175% above | 20% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 N.GONORRHOEAE BY NUCLEIC ACID AM | $237.60 | $297.00 | — | 175% above | 20% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 N GONORRHOEA AMP RNA, MISC SITES- | $237.60 | $297.00 | — | 175% 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 78171 NEISSERIA AMPLIF NA 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 59014 GONORRHEA AMPLIFIED 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% |
| 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 | — | 24% above | 20% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 QUANT&REVRSE TRNSCRPJ | $316.00 | $395.00 | — | 50% 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% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HPPE,HBSAB QUAL QUANT | $66.40 | $83.00 | — | 94% above | 20% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS BS ANTIBODY-MAYO | $70.40 | $88.00 | — | 106% above | 20% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURFACE AB QUAL/QUANT | $96.80 | $121.00 | — | 183% 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 | — | at median | 20% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 HBSAG | $57.60 | $72.00 | — | 14% above | 20% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURFACE ANTIGEN | $64.00 | $80.00 | — | 27% above | 20% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 HBSAG PRENATAL | $64.00 | $80.00 | — | 27% above | 20% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 HEP. B SURFACE AG, NDLSTICK, EMP | $64.00 | $80.00 | — | 27% 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 | — | at median | 20% |
| Hepatitis C antibody blood test (screening) CPT 86803 ANTI-HCV | $86.40 | $108.00 | — | 93% above | 20% |
| Hepatitis C antibody blood test (screening) CPT 86803 HEP. C ANTIBODY, NDLSTICK, EMP. | $114.40 | $143.00 | — | 155% above | 20% |
| Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C VIRUS ANTIBODY, TOTAL | $114.40 | $143.00 | — | 155% above | 20% |
| Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ANTIBODY IGG IGM SCRE | $114.40 | $143.00 | — | 155% above | 20% |
| Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ANTIBODY | $114.40 | $143.00 | — | 155% 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 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 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 ANTIBODY | $114.40 | $143.00 | — | — | 20% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 HEPATITIS C REVRS TRNSCRPJ | $131.20 | $164.00 | — | 1% above | 20% |
| Hepatitis C viral load (HCV RNA) test one side CPT 87522 HCV QUANT.BY RT-PCR | $243.20 | $304.00 | — | 88% 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 | — | 71% above | 20% |
| Herpes blood test, HSV-1 antibody CPT 86695 AB, HSV 1.. | $59.20 | $74.00 | — | 78% above | 20% |
| Herpes blood test, HSV-1 antibody CPT 86695 78147 EAP,HERPES SIMPLEX TYPE 1 | $81.60 | $102.00 | — | 145% above | 20% |
| Herpes blood test, HSV-1 antibody CPT 86695 HSV 1 IGG | $96.00 | $120.00 | — | 189% above | 20% |
| Herpes blood test, HSV-1 antibody CPT 86695 74472 HSV,AB, HSV TYPE 1 | $117.60 | $147.00 | — | 253% 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 | — | 75% above | 20% |
| Herpes blood test, HSV-2 antibody CPT 86696 AB, HSV TYPE 2.. | $88.00 | $110.00 | — | 83% above | 20% |
| Herpes blood test, HSV-2 antibody CPT 86696 74472 HSV,AB, HSV TYPE 2 | $108.00 | $135.00 | — | 125% above | 20% |
| Herpes blood test, HSV-2 antibody CPT 86696 78147 EAP,HERPES SIMPLEX TYPE 2 | $120.80 | $151.00 | — | 151% above | 20% |
| Herpes blood test, HSV-2 antibody CPT 86696 HSV 2 IGG | $140.00 | $175.00 | — | 191% 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 | — | 110% above | 20% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROTEIN, HIGH SENSITI | $144.00 | $180.00 | — | 110% above | 20% |
| High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-REACTIVE PROTEIN, HIGH SENS, S | $144.00 | $180.00 | — | — | 20% |
| High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-REACTIVE PROTEIN, HIGH SENSITI | $144.00 | $180.00 | — | — | 20% |
| Homocysteine blood test CPT 83090 ASSAY OF HOMOCYSTINE | $59.20 | $74.00 | — | at median | 20% |
| Homocysteine blood test CPT 83090 HOMOCYSTEINE, TOTAL, PLASMA | $60.00 | $75.00 | — | 1% above | 20% |
| Homocysteine blood test CPT 83090 ASSAY OF HOMOCYSTIENE | $244.00 | $305.00 | — | 312% 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 | — | at median | 20% |
| Insulin blood test CPT 83525 INSULIN LEVEL-MAYO | $57.60 | $72.00 | — | at median | 20% |
| Insulin blood test inpatient CPT 83525 INSULIN LEVEL-MAYO | $57.60 | $72.00 | — | — | 20% |
| Insulin blood test inpatient CPT 83525 74872 INSFT,INSULIN,TOTAL | $57.60 | $72.00 | — | — | 20% |
| Iron blood test (serum iron) CPT 83540 IRON, SERUM | $46.40 | $58.00 | — | 45% above | 20% |
| Iron blood test (serum iron) CPT 83540 IRON, LIVER TISSUE-MAYO | $120.00 | $150.00 | — | 275% 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 | — | 36% 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 | — | 41% above | 20% |
| LH (luteinizing hormone) test CPT 83002 LH, PEDIATRICS, S-MAYO | $201.60 | $252.00 | — | 104% 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% |
| Lipase blood test (pancreas enzyme) CPT 83690 LIPASE | $100.00 | $125.00 | — | 97% 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 | — | 62% 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 | — | at median | 20% |
| Lyme disease antibody test CPT 86618 AB, LYME'S DISEASE. | $71.20 | $89.00 | — | 78% above | 20% |
| Lyme disease antibody test CPT 86618 LNBAB-MAYO | $76.00 | $95.00 | — | 90% above | 20% |
| Lyme disease antibody test CPT 86618 LYME DISEASE SEROLOGY | $79.20 | $99.00 | — | 98% above | 20% |
| Lyme disease antibody test CPT 86618 AB, LYME'S DISEASE | $240.00 | $300.00 | — | 500% 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 | — | 18% above | 20% |
| Magnesium blood test CPT 83735 EQF,MAGNESIUM,FECES | $31.20 | $39.00 | — | 53% above | 20% |
| Magnesium blood test CPT 83735 MU, MAGNESIUM, URINE | $40.00 | $50.00 | — | 96% above | 20% |
| Magnesium blood test CPT 83735 MAGNESIUM, RANDOM URINE | $40.00 | $50.00 | — | 96% above | 20% |
| Magnesium blood test CPT 83735 MAGNESIUM | $40.00 | $50.00 | — | 96% 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 MU, MAGNESIUM, URINE | $40.00 | $50.00 | — | — | 20% |
| Magnesium blood test inpatient CPT 83735 MAGNESIUM, RANDOM URINE | $40.00 | $50.00 | — | — | 20% |
| Magnesium blood test inpatient CPT 83735 MAGNESIUM | $40.00 | $50.00 | — | — | 20% |
| Measles (rubeola) antibody test CPT 86765 RA,RUBEOLA AB IGG AND IGM | $56.80 | $71.00 | — | 3% above | 20% |
| Measles (rubeola) antibody test CPT 86765 AB, RUBEOLA | $68.80 | $86.00 | — | 25% above | 20% |
| Measles (rubeola) antibody test CPT 86765 74548 MMRV, RUBEOLA AB | $78.40 | $98.00 | — | 42% above | 20% |
| Measles (rubeola) antibody test CPT 86765 MEASLES VIRUS ANTIBODY, IGG IFA-N | $78.40 | $98.00 | — | 42% above | 20% |
| Measles (rubeola) antibody test CPT 86765 78147 EAP,RUBEOLA | $80.00 | $100.00 | — | 45% above | 20% |
| Measles (rubeola) antibody test CPT 86765 AB, RUBEOLA. | $80.00 | $100.00 | — | 45% above | 20% |
| Measles (rubeola) antibody test CPT 86765 AB, RUBEOLA.. | $80.00 | $100.00 | — | 45% above | 20% |
| Measles (rubeola) antibody test CPT 86765 RUBEOLA (MEASLES) AB ,SERUM | $187.20 | $234.00 | — | 240% 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 MEASLES VIRUS ANTIBODY, IGG IFA-N | $78.40 | $98.00 | — | — | 20% |
| Measles (rubeola) antibody test inpatient CPT 86765 74548 MMRV, RUBEOLA AB | $78.40 | $98.00 | — | — | 20% |
| Measles (rubeola) antibody test inpatient CPT 86765 AB, RUBEOLA. | $80.00 | $100.00 | — | — | 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 RUBEOLA (MEASLES) AB ,SERUM | $187.20 | $234.00 | — | — | 20% |
| Mono test (heterophile antibody, Monospot) CPT 86308 MONOTEST | $64.00 | $80.00 | — | 68% above | 20% |
| Mono test (heterophile antibody, Monospot) CPT 86308 QUAL HETEROPHILE AB | $64.00 | $80.00 | — | 68% 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% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PSA, FREE | $64.80 | $81.00 | — | 6% above | 20% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 FREE PSA | $127.20 | $159.00 | — | 108% 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 | — | at median | 20% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA, DIAGNOSTIC TOTAL | $117.60 | $147.00 | — | 81% above | 20% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 TOTAL PSA | $127.20 | $159.00 | — | 96% 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 | — | 29% 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 | — | 34% 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 | — | 2% above | 20% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 85730 THROMBOPLASTIN TIME | $52.00 | $65.00 | — | 65% above | 20% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PTT, PARTIAL THROMBOPLASTIN | $81.60 | $102.00 | — | 159% above | 20% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 74059, PTT | $92.00 | $115.00 | — | 192% above | 20% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 74035, PTT | $92.80 | $116.00 | — | 195% above | 20% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PCC APTT | $106.40 | $133.00 | — | 238% 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% |
| Progesterone blood test CPT 84144 PROGESTERONE | $176.00 | $220.00 | — | 61% 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 | — | 97% above | 20% |
| Prolactin blood test CPT 84146 PROLACTIN, SERUM-MAYO | $104.00 | $130.00 | — | 113% above | 20% |
| Prolactin blood test CPT 84146 74246 MACROPROLACTIN | $116.80 | $146.00 | — | 139% above | 20% |
| Prolactin blood test CPT 84146 PROLACTIN | $149.60 | $187.00 | — | 207% 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 | — | at median | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PT, PROTHROMBIN TIME | $44.80 | $56.00 | — | 124% above | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 74035, PROTHROMBIN TIME | $59.20 | $74.00 | — | 196% above | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 74059, PROTHROMBIN TIME | $59.20 | $74.00 | — | 196% above | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PCC PROTHROMBIN TIME | $70.40 | $88.00 | — | 252% 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 | — | 22% 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 POC RAPID INFLUENZA TEST. | $84.00 | $105.00 | — | at median | 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 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) CPT 87804 INFLUENZA IA W DO. | $87.20 | $109.00 | — | 4% above | 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 MC POC RAPID INFLUENZA TEST. | $84.00 | $105.00 | — | — | 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 A AND B AG | $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 | — | 22% 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 | — | 16% below | 20% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREP SCREEN | $84.00 | $105.00 | — | 3% above | 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 | — | 3% 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% |
| Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR-MAYO | $79.20 | $99.00 | — | 120% above | 20% |
| Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR, QUANT. | $87.20 | $109.00 | — | 142% above | 20% |
| Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR, BODY FLUID | $99.20 | $124.00 | — | 176% 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 AB, RUBELLA | $80.00 | $100.00 | — | 79% above | 20% |
| Rubella antibody test (immunity check) CPT 86762 RUBELLA ANTIBODY, IGG | $80.00 | $100.00 | — | 79% above | 20% |
| Rubella antibody test (immunity check) CPT 86762 74548 MMRV, RUBELLA AB | $87.20 | $109.00 | — | 95% 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 | — | 40% above | 20% |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 SEDIMENTATION RATE | $38.40 | $48.00 | — | 40% above | 20% |
| Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 SEDIMENTATION RATE | $38.40 | $48.00 | — | — | 20% |
| Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 ESR CHARGE ONLY | $38.40 | $48.00 | — | — | 20% |
| Stool ova and parasites exam CPT 87177 78216 PS, OVA PARASITES CONC W ID | $48.80 | $61.00 | — | 1% above | 20% |
| Stool ova and parasites exam CPT 87177 78079 PA,CONCENTRATION FOR INFECT | $48.80 | $61.00 | — | 1% above | 20% |
| Stool ova and parasites exam CPT 87177 74978 CS,OVA & PARASITES DIR SMR | $51.20 | $64.00 | — | 6% above | 20% |
| Stool ova and parasites exam CPT 87177 SCHISTOSOMA EXAM, URINE-MAYO | $179.20 | $224.00 | — | 270% above | 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 78216 PS, OVA PARASITES CONC W ID | $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 | — | 11% above | 20% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLOOD I,FECES | $30.40 | $38.00 | — | 11% above | 20% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLOOD III,FECES | $30.40 | $38.00 | — | 11% above | 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 I,FECES | $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 | — | 56% above | 20% |
| Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 OCCULT BLD IMMUNO. | $89.60 | $112.00 | — | — | 20% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 SYPHILIS TEST NON-TREP QUAL | $26.40 | $33.00 | — | 14% above | 20% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 VDRL, CSF | $114.40 | $143.00 | — | 392% 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 | — | 20% above | 20% |
| Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE, TOTAL | $80.00 | $100.00 | — | 32% above | 20% |
| Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE,TOTAL ONLY-MAYO | $80.00 | $100.00 | — | 32% above | 20% |
| Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE,TOTAL | $105.60 | $132.00 | — | 74% 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 | — | 10% above | 20% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 THYROPEROXIDASE (TPO) ANTIBODIES | $119.20 | $149.00 | — | 116% above | 20% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 THYROPEROXIDASE ANTIBODIES | $174.40 | $218.00 | — | 216% above | 20% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 LIVER CYTOSOL AUTOANTIBODIES | $211.20 | $264.00 | — | 283% 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 | — | 19% above | 20% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID STIMULATING HORMONE | $107.20 | $134.00 | — | 22% 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% |
| Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS AMPLIF | $132.80 | $166.00 | — | 100% above | 20% |
| Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS,MISC SITES | $180.80 | $226.00 | — | 173% 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% |
| Uric acid blood test CPT 84550 URIC ACID - POST RASBURICASE | $45.60 | $57.00 | — | 24% above | 20% |
| Uric acid blood test CPT 84550 URIC ACID, BLOOD | $45.60 | $57.00 | — | 24% above | 20% |
| Uric acid blood test inpatient CPT 84550 URIC ACID, BLOOD | $45.60 | $57.00 | — | — | 20% |
| Uric acid blood test inpatient CPT 84550 URIC ACID - POST RASBURICASE | $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 CLINICAL STUDIES URINALYSIS WITH | $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 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 | — | 57% above | 20% |
| Urinalysis without microscope exam, automated CPT 81003 URINALYSIS W REFLEX TO MICROSCOPY | $27.20 | $34.00 | — | 57% above | 20% |
| Urinalysis without microscope exam, automated CPT 81003 URINALYSIS, ROUTINE | $27.20 | $34.00 | — | 57% above | 20% |
| Urinalysis without microscope exam, automated CPT 81003 URINALYSIS W/O MICROSCOPY 81003 | $32.00 | $40.00 | — | 85% 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 W REFLEX TO MICROSCOPY | $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/O MICROSCOPY 81003 | $32.00 | $40.00 | — | — | 20% |
| Urinalysis without microscope exam, manual CPT 81002 OCC MED URINALYSIS W/O MICROSCOPY | $32.00 | $40.00 | — | 78% above | 20% |
| Urinalysis without microscope exam, manual CPT 81002 URINALYSIS W/O MICRO | $32.00 | $40.00 | — | 78% above | 20% |
| Urinalysis without microscope exam, manual CPT 81002 URINE, KETONES | $40.80 | $51.00 | — | 127% above | 20% |
| Urinalysis without microscope exam, manual CPT 81002 URINE DIPSTICK, OFFICE | $40.80 | $51.00 | — | 127% above | 20% |
| Urinalysis without microscope exam, manual CPT 81002 HEMASTIX | $40.80 | $51.00 | — | 127% above | 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 OCC MED URINALYSIS W/O MICROSCOPY | $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 URINE, KETONES | $40.80 | $51.00 | — | — | 20% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 HEMASTIX | $40.80 | $51.00 | — | — | 20% |
| Urine culture for bacteria, with colony count CPT 87086 CULTURE, URINE | $113.60 | $142.00 | — | 76% above | 20% |
| Urine culture for bacteria, with colony count inpatient CPT 87086 CULTURE, URINE | $113.60 | $142.00 | — | — | 20% |
| Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY TEST POC | $61.60 | $77.00 | — | 10% above | 20% |
| Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY VISUAL COLOR | $61.60 | $77.00 | — | 10% above | 20% |
| Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY, VISUAL COLOR | $61.60 | $77.00 | — | 10% above | 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% |
| Urine pregnancy test, read by color change inpatient CPT 81025 URINE PREGNANCY TEST POC | $61.60 | $77.00 | — | — | 20% |
| Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B12 | $96.80 | $121.00 | — | 21% above | 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 | — | 72% above | 20% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 25-HYDROXYVITAMIN D2,D3 BLOOD | $236.80 | $296.00 | — | 145% 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% |
| Zinc blood test CPT 84630 ASSAY OF ZINC | $32.00 | $40.00 | — | 21% above | 20% |
| Zinc blood test CPT 84630 ZINC SERUM | $135.20 | $169.00 | — | 412% above | 20% |
| Zinc blood test CPT 84630 ZINC, URINE | $137.60 | $172.00 | — | 421% 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 | — | 20% above | 20% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 CHORIONIC GONADOTROPIN,TUM.MKR | $137.60 | $172.00 | — | 89% above | 20% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG, QUANT., BLOOD | $149.60 | $187.00 | — | 105% above | 20% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 CHORIONIC GONADOTROPIN, BETA-SUBU | $192.00 | $240.00 | — | 164% 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 | — | 6% above | 20% |
| Botox injections for chronic migraine CPT 64615 CHEMODENERV MUSC MIGRAINE 64615 | $436.00 | $545.00 | — | 53% 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 | — | at median | 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 | — | at median | 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% |
| 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% |
| Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 TREATMENT ANKLE FRACTURE 27786 | $246.40 | $308.00 | — | 36% 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 | — | 330% 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 | — | at median | 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 | — | 17% 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 CL CARDIOVERSION | $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 ANS CARDIOVERSION ELECTIVE | $1,019.20 | $1,274.00 | — | at median | 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 CL CARDIOVERSION EXTERNAL | $1,019.20 | $1,274.00 | — | at median | 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% |
| 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 | $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% |
| Cataract surgery with lens implant CPT 66984 SJS-CATARACT SURG W/IOL, 66984 | $1,500.80 | $1,876.00 | — | 47% 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 | — | 14% above | 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 | — | at median | 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 | — | 136% 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 | — | 44% 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 | — | 5% above | 20% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 NRS 25600 TREAT FRACTURE RADIUS/U | $458.40 | $573.00 | — | 5% 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 | — | 17% 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 | — | 188% 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 | — | 42% above | 20% |
| Colonoscopy, diagnostic CPT 45378 45378 GI COLONOSCOPY | $1,814.40 | $2,268.00 | — | 175% 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 | — | at median | 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 | — | 8% above | 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 | — | 47% 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 | — | 1% below | 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 ETC CYSTOURETHROSCOPY | $1,394.40 | $1,743.00 | — | 61% above | 20% |
| Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOURETHROSCOPY | $1,394.40 | $1,743.00 | — | 61% 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 CYSTOURETHROSCOPY | $1,394.40 | $1,743.00 | — | — | 20% |
| Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 ETC 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 | — | at median | 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 | — | 39% above | 20% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTR BENIGN/PM LES, 1ST | $314.40 | $393.00 | — | 114% 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 | — | at median | 20% |
| Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 SJS-TYMPANOSTOMY, GEN ANESTHESIA | $1,712.80 | $2,141.00 | — | 13% above | 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 | — | 30% below | 20% |
| Ear tube placement (tympanostomy) with local anesthesia, one ear one side CPT 69433 TYMPANOSTOMY LOCAL, UNILATERAL | $853.60 | $1,067.00 | — | 15% above | 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 | — | 13% below | 20% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 ETC REMOVE IMPACTED EAR WAX UNI | $114.40 | $143.00 | — | 63% above | 20% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 NRS REMOVE IMPACTED EAR WAX UNI | $114.40 | $143.00 | — | 63% 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 | — | 33% below | 20% |
| Earwax removal with instruments, one ear CPT 69210 ETC REMOVE IMPACTED EAR WAX | $97.60 | $122.00 | — | 7% above | 20% |
| Earwax removal with instruments, one ear CPT 69210 NRS REMOVE IMPACTED EAR WAX,UNILA | $97.60 | $122.00 | — | 7% above | 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 | — | at median | 20% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 ETC BIOPSY OF UTERUS LINING | $486.40 | $608.00 | — | 135% above | 20% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 NRS ENDOMETRIAL BX, WO CERVICAL D | $486.40 | $608.00 | — | 135% 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 | — | 38% below | 20% |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 IR INJ TRANSLAMINAR ESI CERVICAL/ | $1,081.60 | $1,352.00 | — | 6% 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 | — | 6% below | 20% |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 CT GUIDE INTERLAMINAR EPIDURAL ST | $1,081.60 | $1,352.00 | — | 6% below | 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 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 TRANSLAMINAR ESI CERVICAL/ | $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 | — | 4% below | 20% |
| Eye injection into the vitreous (intravitreal injection) CPT 67028 ETC INTRAVITREAL INJECTION OF DRU | $641.60 | $802.00 | — | 81% 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 | — | 30% 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 | — | 3% above | 20% |
| Facet joint injection, lower back, one level, with imaging guidance CPT 64493 XR LUMB PARAVERTEBRAL FACET JOINT | $1,336.80 | $1,671.00 | — | 3% above | 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 | — | 3% above | 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 | — | 3% above | 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 | — | 106% 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 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 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 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 BIL | $2,673.60 | $3,342.00 | — | — | 20% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 DIAGNOSTIC SIGMOIDOSCOPY 45330 | $937.60 | $1,172.00 | — | at median | 20% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 45330 GI SIGMOIDOSCOPY | $1,742.40 | $2,178.00 | — | 86% 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 | — | at median | 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 | — | 20% below | 20% |
| Hemorrhoid banding (rubber band ligation) CPT 46221 46221 LIGATION OF HEMORRHOID(S) | $2,972.80 | $3,716.00 | — | 155% 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 | — | 5% below | 20% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 US HYSTEROSONOGRAM INJECTION | $307.20 | $384.00 | — | 5% 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 | — | at median | 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 | — | at median | 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 | — | 19% below | 20% |
| Incision and drainage of a simple or single skin abscess CPT 10060 PRM I&D ABSC, SMPL OR SGL 10060 | $258.40 | $323.00 | — | 2% above | 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 | — | 85% above | 20% |
| Incision and drainage of a simple or single skin abscess CPT 10060 ETC DRAINAGE OF SKIN ABSCESS 60 | $468.00 | $585.00 | — | 85% above | 20% |
| Incision and drainage of a simple or single skin abscess CPT 10060 IR DRAIN ABSCESS SUBCUTANEOUS-S | $468.00 | $585.00 | — | 85% 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 PRM I&D ABSC, SMPL OR SGL 10060 | $258.40 | $323.00 | — | — | 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% |
| 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 NRS 10060 I&D ABSC, SMPL OR SGL | $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 | — | 63% above | 20% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 ETC INJECT TENDON/LIGAMENT/CYST | $486.40 | $608.00 | — | 161% 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 | — | 161% above | 20% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 CT INJECTION TENDON SHEATH-S | $486.40 | $608.00 | — | 161% 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 ETC INJECT TENDON/LIGAMENT/CYST | $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 US INJECT SGL TENDON SHEATH/LIGAM | $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 | — | 21% 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 | — | 204% 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 | — | 204% above | 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 | — | 204% 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 | — | 204% 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 | — | 204% 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 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% |
| 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% |
| Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 INSERTION DRUG DELIVERY IMPLANT | $132.80 | $166.00 | — | 31% 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 | — | at median | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 XR JOINT INJ INTERMED FLUORO | $662.40 | $828.00 | — | 118% 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 | — | 118% above | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 NRS DRN/INJ JOINT/BURSA W/O US | $662.40 | $828.00 | — | 118% 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 | — | 13% above | 20% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 XR JOINT INJ SMALL FLUORO | $576.00 | $720.00 | — | 115% above | 20% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 ETC DRN/INJ JOINT/BURSA W/O US | $576.00 | $720.00 | — | 115% 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 ETC DRN/INJ JOINT/BURSA W/O US | $576.00 | $720.00 | — | — | 20% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 XR JOINT INJ SMALL FLUORO | $576.00 | $720.00 | — | — | 20% |
| Laser treatment of clouding after cataract surgery (YAG) CPT 66821 YAG LASER - SECONDARY CATARACT | $564.00 | $705.00 | — | 15% below | 20% |
| Laser treatment of clouding after cataract surgery (YAG) CPT 66821 SJS-AFTER CATARACT LASER SURGERY | $798.40 | $998.00 | — | 20% 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 INTMD WND REPAIR S/A/T/EXT | $399.20 | $499.00 | — | 5% below | 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 | — | 3% 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 | — | 224% above | 20% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 INTMD WND REPAIR S/A/T/EXT | $399.20 | $499.00 | — | — | 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 | — | at median | 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 | — | 23% below | 20% |
| Lower-back epidural injection, with imaging guidance CPT 62323 IR INJ TRANSLAMINAR ESI LUMBAR/SA | $1,081.60 | $1,352.00 | — | 16% above | 20% |
| Lower-back epidural injection, with imaging guidance CPT 62323 CT GUIDE INTERLAMINAR EPIDURAL S | $1,081.60 | $1,352.00 | — | 16% above | 20% |
| Lower-back epidural injection, with imaging guidance CPT 62323 IR INJ EPIDURAL/SUBARACH SGL LUMB | $1,081.60 | $1,352.00 | — | 16% above | 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 CT GUIDE INTERLAMINAR EPIDURAL S | $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 IR INJ EPIDURAL/SUBARACH SGL LUMB | $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 | — | at median | 20% |
| Lower-back epidural injection, without imaging guidance CPT 62322 NJX INTERLAMINAR LMBR/SAC-NRS | $1,643.20 | $2,054.00 | — | 80% above | 20% |
| Lower-back epidural injection, without imaging guidance CPT 62322 NJX INTERLAMINAR LMBR/SAC-ETC | $1,643.20 | $2,054.00 | — | 80% 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-ETC | $1,643.20 | $2,054.00 | — | — | 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 nerve root steroid injection, with imaging guidance CPT 64483 INJ, A/S, TRANSF EPID, LUMB/SAC, | $915.20 | $1,144.00 | — | at median | 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 | — | 46% 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 | — | 46% above | 20% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 IR LUMBOSAC TRANSFORAMINAL EPID I | $1,336.80 | $1,671.00 | — | 46% above | 20% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 CT INJ FORAMEN EPIDUR LUMBAR | $1,336.80 | $1,671.00 | — | 46% above | 20% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 CT GUIDE TRANSFORAMINAL EPIDURA | $1,336.80 | $1,671.00 | — | 46% above | 20% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 XR LUMB TRANSFORAMINAL EPIDURAL I | $2,673.60 | $3,342.00 | — | 192% 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 | — | 192% 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 | — | 192% 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 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 LUMBOSAC TRANSFORAMINAL EPID I | $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 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 | — | — | 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 | — | 37% 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 | — | 158% 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 | — | 158% 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 NRS 11400 EXC TR-EXT B9+MARG<=0.5 | $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 EXC TR-EXT 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 CPT 11440 REMOVAL OF SKIN LESION 11440 | $723.20 | $904.00 | — | 77% 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 | — | 234% 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 | — | 234% 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 SJS-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 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 | — | 16% below | 20% |
| Nail removal (partial or complete), one nail CPT 11730 ETC REMOVAL OF NAIL PLATE | $314.40 | $393.00 | — | 30% 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 | — | at median | 20% |
| Occipital nerve block (injection for headaches) CPT 64405 INJ ANESTH , GREATER OCCIPITAL NE | $800.00 | $1,000.00 | — | 164% above | 20% |
| Occipital nerve block (injection for headaches) CPT 64405 ETC INJECTION FOR NERVE BLOCK.. | $800.00 | $1,000.00 | — | 164% above | 20% |
| Occipital nerve block (injection for headaches) CPT 64405 CT INJECTION GREATER OCCIPITAL NE | $800.00 | $1,000.00 | — | 164% 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 | — | 52% below | 20% |
| Pacemaker implant (dual chamber) CPT 33208 CL BIVENTRICULAR PACEMAKER PLCMNT | $8,042.40 | $10,053.00 | — | 47% 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 | — | 9% above | 20% |
| Paracentesis with imaging guidance CPT 49083 US ABD PARACENTESIS-SUBSEQ | $1,564.80 | $1,956.00 | — | 78% above | 20% |
| Paracentesis with imaging guidance CPT 49083 US ABD PARACENTESIS INIT-S | $1,564.80 | $1,956.00 | — | 78% above | 20% |
| Paracentesis with imaging guidance CPT 49083 CT GUIDED PARACENTESIS-S | $1,564.80 | $1,956.00 | — | 78% above | 20% |
| Paracentesis with imaging guidance CPT 49083 ETC ABD PARACENTESIS W/ IMG | $1,564.80 | $1,956.00 | — | 78% above | 20% |
| Paracentesis with imaging guidance CPT 49083 US PARACENTESIS W/ALBUMIN REPLACE | $1,564.80 | $1,956.00 | — | 78% 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 INIT-S | $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 US ABD PARACENTESIS-SUBSEQ | $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 ETC ABD PARACENTESIS W/ IMG | $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 | — | at median | 20% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 ETC REMOVAL OF NAIL BED | $813.60 | $1,017.00 | — | 98% 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 CT MEDIAL BRANCH RHIZOTOMY LUMBAR | $1,888.00 | $2,360.00 | — | at median | 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 | — | at median | 20% |
| Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 IR MEDIAL BRANCH RHIZOTOMY LUMBAR | $1,888.80 | $2,361.00 | — | at median | 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 | — | 6% above | 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 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 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 | — | 240% 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 | — | at median | 20% |
| Removal of a foreign object under the skin, simple CPT 10120 ETC REMOVE FOREIGN BODY 20 | $608.00 | $760.00 | — | 48% 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 | — | 2% above | 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 | — | 6% above | 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 | — | 1% above | 20% |
| Short arm cast (elbow to hand) CPT 29075 APPLY SHORT ARM CAST | $456.80 | $571.00 | — | 69% 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 | $107.20 | $134.00 | — | 35% below | 20% |
| Short arm splint (forearm and hand) CPT 29125 SPLINT APPL,SHORT ARM,STATIC | $132.80 | $166.00 | — | 20% below | 20% |
| Short arm splint (forearm and hand) CPT 29125 NRS APPLY SHORT ARM SPLINT,STATIC | $283.20 | $354.00 | — | 70% above | 20% |
| Short arm splint (forearm and hand) CPT 29125 APPLY SHORT ARM SPLINT, STATIC | $283.20 | $354.00 | — | 70% above | 20% |
| Short arm splint (forearm and hand) inpatient CPT 29125 SPLINT APPL, SHORT ARM, STATIC | $107.20 | $134.00 | — | — | 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 NRS APPLY SHORT ARM SPLINT,STATIC | $283.20 | $354.00 | — | — | 20% |
| Short arm splint (forearm and hand) inpatient CPT 29125 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 | — | at median | 20% |
| Short leg cast (below the knee) CPT 29405 APPLY SH LEG CAST | $456.80 | $571.00 | — | 67% 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 | — | 11% below | 20% |
| Short leg splint (calf to foot) CPT 29515 NRS APPLY SHORT LEG SPLINT | $275.20 | $344.00 | — | 51% above | 20% |
| Short leg splint (calf to foot) CPT 29515 APPLY SHORT LEG SPLINT | $275.20 | $344.00 | — | 51% 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 APPLY SHORT LEG SPLINT | $275.20 | $344.00 | — | — | 20% |
| Short leg splint (calf to foot) inpatient CPT 29515 NRS 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 | — | 4% below | 20% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 PRM SREP S/N/A/G/TR/E, 2.5CM/< | $316.80 | $396.00 | — | 49% 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 | — | 65% above | 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 | — | 65% 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 PRM SREP S/N/A/G/TR/E, 2.5CM/< | $316.80 | $396.00 | — | — | 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 | — | 37% above | 20% |
| Skin biopsy, punch, one lesion CPT 11104 ETC PUNCH BX SKIN SINGLE LESION | $608.00 | $760.00 | — | 103% above | 20% |
| Skin biopsy, punch, one lesion CPT 11104 NRS PUNCH BX SKIN SINGLE LESION | $608.00 | $760.00 | — | 103% 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 ETC PUNCH BX SKIN SINGLE LESION | $608.00 | $760.00 | — | — | 20% |
| Skin biopsy, punch, one lesion inpatient CPT 11104 NRS 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 | — | 22% 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 | — | at median | 20% |
| Skin tag removal, up to 15 tags CPT 11200 ETC REMOVAL OF SKIN TAGS | $350.40 | $438.00 | — | 72% above | 20% |
| Skin tag removal, up to 15 tags CPT 11200 SJS-REMOVAL OF SKIN TAGS | $350.40 | $438.00 | — | 72% above | 20% |
| Skin tag removal, up to 15 tags CPT 11200 NRS REMOVAL OF SKIN TAGS | $350.40 | $438.00 | — | 72% 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 | — | 18% below | 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 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 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 NM SPINAL INJECTION-S | $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% |
| 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 | — | 4% 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 PRM SREPS/N/A/G/TR/E, 2.6-7.5CM 1 | $359.20 | $449.00 | — | 70% 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 | — | 91% 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 SREPS/N/A/G/TR/E, 2.6-7.5CM | $403.20 | $504.00 | — | 91% 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 PRM SREPS/N/A/G/TR/E, 2.6-7.5CM 1 | $359.20 | $449.00 | — | — | 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 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 on the face up to 2.5 cm (1 inch), simple repair CPT 12011 REPAIR SUPERFICIAL WOUNDS 12011 | $204.00 | $255.00 | — | 19% 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 | — | 38% 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 | — | 47% 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 | — | 84% above | 20% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 ETC TANGNTL BX SKIN SINGLE LES | $404.00 | $505.00 | — | 103% above | 20% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 NRS TANGNTL BX SKIN SINGLE LES | $404.00 | $505.00 | — | 103% 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 | — | at median | 20% |
| Thoracentesis with imaging guidance CPT 32555 CT THORACENTESIS W/O TUBE-S | $1,425.60 | $1,782.00 | — | 124% above | 20% |
| Thoracentesis with imaging guidance CPT 32555 ETC ASPIRATE PLEURA W/IMG | $1,425.60 | $1,782.00 | — | 124% above | 20% |
| Thoracentesis with imaging guidance CPT 32555 CT THORACENTESIS | $1,425.60 | $1,782.00 | — | 124% above | 20% |
| Thoracentesis with imaging guidance CPT 32555 US THORACENTESIS-S | $1,425.60 | $1,782.00 | — | 124% above | 20% |
| Thoracentesis with imaging guidance one side CPT 32555 US THORACENTESIS LEFT | $1,425.60 | $1,782.00 | — | 124% above | 20% |
| Thoracentesis with imaging guidance one side CPT 32555 US THORACENTESIS RIGHT | $1,425.60 | $1,782.00 | — | 124% 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 US THORACENTESIS-S | $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 ETC ASPIRATE PLEURA W/IMG | $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% |
| Thoracentesis with imaging guidance inpatient one side CPT 32555 US THORACENTESIS RIGHT | $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 | — | at median | 20% |
| Trigger point injections, 1 or 2 muscles CPT 20552 CT INJECT TRIGGER PT 1-2 MUSCL | $576.00 | $720.00 | — | 90% above | 20% |
| Trigger point injections, 1 or 2 muscles CPT 20552 IR PIRIFORMIS INJECTION-S | $576.00 | $720.00 | — | 90% above | 20% |
| Trigger point injections, 1 or 2 muscles CPT 20552 NRS INJ TRIGGER POINT 1/2 MUSCL 2 | $576.00 | $720.00 | — | 90% above | 20% |
| Trigger point injections, 1 or 2 muscles CPT 20552 ETC INJECT TRIGGER POINT 1 OR 2 | $576.00 | $720.00 | — | 90% above | 20% |
| Trigger point injections, 1 or 2 muscles CPT 20552 US INJECT SGL/MUL TRIGGER PT 1-2 | $576.00 | $720.00 | — | 90% 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 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 IR PIRIFORMIS INJECTION-S | $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 US INJECT SGL/MUL TRIGGER PT 1-2 | $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 | — | 28% above | 20% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 US BIOPSY BREAST-S | $2,836.80 | $3,546.00 | — | 28% 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 | — | 28% 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 | — | 28% 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 BIOPSY BREAST-S | $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 one side CPT 19083 US BIOPSY BREAST LEFT | $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% |
| Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 43249 GI GASTRO W/BALLOON DIL | $3,199.20 | $3,999.00 | — | 33% 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 | — | 41% 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 | — | 9% 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 | — | 33% 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 | — | at median | 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 | — | 6% 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 | — | at median | 20% |
| Vein ablation, radiofrequency, first vein CPT 36475 IR ENDOVEN ABLATION RF PERC INIT- | $5,248.00 | $6,560.00 | — | 62% above | 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 | — | at median | 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 | — | at median | 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 | — | 70% above | 20% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEB SUBQ TISSUE 20 SQ CM/< | $699.20 | $874.00 | — | 70% above | 20% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDE SKIN/TISSUE | $699.20 | $874.00 | — | 70% 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 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 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 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 | — | 40% below | 20% |
| Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSFUSION SERVICE 36430 | $708.00 | $885.00 | — | 5% below | 20% |
| Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION BLOOD OR COMPONENT | $708.00 | $885.00 | — | 5% below | 20% |
| Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION BLOOD OR BLOOD COMPON | $708.00 | $885.00 | — | 5% below | 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 TRANSFUSION BLOOD OR COMPONENT | $708.00 | $885.00 | — | — | 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% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NRS HAND HELD NEBULIZER-INITIAL | $245.60 | $307.00 | — | 92% above | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HHN SUBSEQUENT ETC-NURSE | $245.60 | $307.00 | — | 92% above | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HHN INITIAL ETC | $245.60 | $307.00 | — | 92% above | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 INHALATION TRMT FOR OBSTRUCT | $245.60 | $307.00 | — | 92% above | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 IPPB TREATMENT-SUBSEQUENT | $245.60 | $307.00 | — | 92% above | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 IPPB TREATMENT-INITIAL | $245.60 | $307.00 | — | 92% above | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 VOLARA SUBSEQUENT | $245.60 | $307.00 | — | 92% above | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 METANEB INITIAL | $245.60 | $307.00 | — | 92% above | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HHN SUBSEQUENT | $245.60 | $307.00 | — | 92% above | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HHN INITIAL | $245.60 | $307.00 | — | 92% above | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 SPUTUM INDUCTION | $245.60 | $307.00 | — | 92% above | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AIRWAY INHALATION TX | $245.60 | $307.00 | — | 92% above | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 PREP-RECOVERY/PACU AIRWAY HHN | $245.60 | $307.00 | — | 92% above | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NRS HAND HELD NEBULIZER-SUBSEQUEN | $245.60 | $307.00 | — | 92% above | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AIRWAY INHALATION TX | $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 NRS HAND HELD NEBULIZER-SUBSEQUEN | $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 HHN INITIAL | $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 IPPB TREATMENT-SUBSEQUENT | $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 NRS HAND HELD NEBULIZER-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 METANEB INITIAL | $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 SPUTUM INDUCTION | $245.60 | $307.00 | — | — | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 VOLARA SUBSEQUENT | $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 | — | 32% below | 20% |
| Chemotherapy IV infusion, first hour CPT 96413 NRS 96413 CHEMO INFUSION INITIAL | $480.00 | $600.00 | — | 32% 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 | — | — | 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 | — | — | 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 | — | at median | 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 CRITICAL CARE SERVICES FOR 1ST 30 | $760.80 | $951.00 | — | 13% below | 20% |
| Critical care, first 30 to 74 minutes CPT 99291 ETC TREATMENT-CRITICAL CARE | $2,800.00 | $3,500.00 | — | 220% 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 | — | 312% 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 | — | 678% 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 | — | 953% above | 20% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 CRITICAL CARE SERVICES FOR 1ST 30 | $760.80 | $951.00 | — | — | 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 ETC EEG AWAKE AND DROWSY | $638.40 | $798.00 | — | 8% below | 20% |
| EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG AWAKE AND DROWSY | $638.40 | $798.00 | — | 8% below | 20% |
| EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG AWAKE AND DROWSY.. | $638.40 | $798.00 | — | 8% below | 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 | — | 80% below | 20% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG W/OUT INTERP | $60.80 | $76.00 | — | 50% below | 20% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 PRE ADMISSION TESTING EKG | $84.00 | $105.00 | — | 30% below | 20% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG | $84.00 | $105.00 | — | 30% below | 20% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ETC EKG | $84.00 | $105.00 | — | 30% below | 20% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG THSSDSJ | $84.00 | $105.00 | — | 30% 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 PRE ADMISSION TESTING EKG | $84.00 | $105.00 | — | — | 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% |
| Electroconvulsive therapy (ECT), one session CPT 90870 ELECTROCONVULSIVE THERAPY | $957.60 | $1,197.00 | — | 14% below | 20% |
| Electroconvulsive therapy (ECT), one session CPT 90870 NRS ELECTROCONVULSIVE THERAPY | $957.60 | $1,197.00 | — | 14% below | 20% |
| Electroconvulsive therapy (ECT), one session CPT 90870 SJS-ELECTROCONVULSIVE THERAPY | $957.60 | $1,197.00 | — | 14% below | 20% |
| Electroconvulsive therapy (ECT), one session inpatient CPT 90870 ELECTROCONVULSIVE THERAPY | $957.60 | $1,197.00 | — | — | 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% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 EMERGENCY ROOM-LIMITED | $79.20 | $99.00 | — | 9% below | 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 | — | 314% 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 | — | 1233% 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 | — | 4911% 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 | — | 7670% above | 20% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 EMERGENCY ROOM-LIMITED | $79.20 | $99.00 | — | — | 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 EMERGENCY ROOM-L | $111.20 | $139.00 | — | 16% below | 20% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ETC TREATMENT LEVEL 2 | $540.00 | $675.00 | — | 309% 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 | — | 915% 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 | — | 3339% 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 | — | 5158% above | 20% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 EMERGENCY ROOM-L | $111.20 | $139.00 | — | — | 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 EMERGENCY ROOM-M | $175.20 | $219.00 | — | 9% below | 20% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ETC TREATMENT LEVEL 3 | $880.00 | $1,100.00 | — | 360% 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 | — | 777% 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 | — | 2448% 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 | — | 3702% above | 20% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 EMERGENCY ROOM-M | $175.20 | $219.00 | — | — | 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 EMERGENCY ROOM-H | $272.80 | $341.00 | — | 17% below | 20% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ETC TREATMENT LEVEL 4 | $1,440.00 | $1,800.00 | — | 340% 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 | — | 585% 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 | — | 1564% 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 | — | 2298% above | 20% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 EMERGENCY ROOM-H | $272.80 | $341.00 | — | — | 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 EMERGENCY ROOM-S.T. | $416.00 | $520.00 | — | 12% below | 20% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ETC TREATMENT LEVEL 5 | $1,920.00 | $2,400.00 | — | 305% 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 | — | 474% 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 | — | 1149% 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 | — | 1655% above | 20% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 EMERGENCY ROOM-S.T. | $416.00 | $520.00 | — | — | 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 | — | 18% below | 20% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 TREADMILL STRESS TEST | $431.20 | $539.00 | — | 10% above | 20% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 STRESS STUDY W/NUC MED | $492.80 | $616.00 | — | 26% 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 | — | — | 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 | — | 69% 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 | — | 66% 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 | — | 33% below | 20% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 ONC HYDRATION 31-60 MIN | $432.00 | $540.00 | — | 34% above | 20% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 NRS 96360 HYDRATION INITIAL | $432.00 | $540.00 | — | 34% above | 20% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 ETC HYDRATION IV INFUSION, INIT | $432.00 | $540.00 | — | 34% above | 20% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRATE IV INF, INITIAL | $432.00 | $540.00 | — | 34% 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 ONC HYDRATION 31-60 MIN | $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 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 ETC HYDRATION IV INFUSION, INIT | $432.00 | $540.00 | — | — | 20% |
| IV infusion of a medicine, first hour CPT 96365 THER/PROPH/DIAG IV INF, INIT | $456.00 | $570.00 | — | 16% above | 20% |
| IV infusion of a medicine, first hour CPT 96365 ETC THER/PROPH/DIAG IV INF, INIT | $456.00 | $570.00 | — | 16% above | 20% |
| IV infusion of a medicine, first hour CPT 96365 INFUSION THERAPY | $456.00 | $570.00 | — | 16% above | 20% |
| IV infusion of a medicine, first hour CPT 96365 NON-CHEMO INITIAL HOUR | $456.00 | $570.00 | — | 16% above | 20% |
| IV infusion of a medicine, first hour CPT 96365 SDS- THER/PROPH/DIAG IV INF, INIT | $456.00 | $570.00 | — | 16% above | 20% |
| IV infusion of a medicine, first hour CPT 96365 NRS 96365 NON CHEMO INITIAL | $456.00 | $570.00 | — | 16% above | 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 INFUSION THERAPY | $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 NRS 96365 NON CHEMO INITIAL | $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% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 ADMIN STATE SUBQ IM 96372 | $16.79 | $20.99 | — | 52% below | 20% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 ADMIN SUBQ IM 96372 | $72.80 | $91.00 | — | 107% 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 | — | 274% 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 | — | 274% 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 | — | 274% above | 20% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 IR INJECTION THERAPEUTIC SUBCUTAN | $131.20 | $164.00 | — | 274% above | 20% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 NON-CHEMO-SUBQ/IM | $131.20 | $164.00 | — | 274% 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 IR INJECTION THERAPEUTIC SUBCUTAN | $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% |
| 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 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 NON-CHEMO-SUBQ/IM | $131.20 | $164.00 | — | — | 20% |
| Mental health diagnostic evaluation (intake), without medical services CPT 90791 PSYCH DIAGNOSTIC EVALUATION 90791 | $164.80 | $206.00 | — | 22% 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 | — | 19% above | 20% |
| Nerve conduction study, 7 or 8 nerve studies CPT 95910 NERVE CONDUCTION TEST 7-8 STUDIES | $1,072.00 | $1,340.00 | — | 299% 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 | — | 1% above | 20% |
| Neuromuscular re-education, 15 minutes CPT 97112 OT-NEUROMUSC RE-EDUCATION-15MIN | $112.80 | $141.00 | — | 1% above | 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 | — | 21% 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 | — | 18% 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 | — | 10% 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 | — | 3% 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 | — | 2% 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 OT-MANUAL THERAPY /EACH 15 MIN | $120.00 | $150.00 | — | 17% above | 20% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PT MANUAL THERAPY EA 15 MIN | $120.00 | $150.00 | — | 17% 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 | — | 9% above | 20% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT THERAPEUTIC EXERCISE EA 15 MIN | $116.00 | $145.00 | — | 9% 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 | — | 15% below | 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 | — | 6% 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 | — | 4% 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 | — | 16% 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 | — | 13% 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 | — | at median | 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 | — | 47% below | 20% |
| Psychotherapy session, 30 minutes CPT 90832 PSYTX W/PATIENT 30 MIN | $219.20 | $274.00 | — | 29% below | 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 | — | 57% below | 20% |
| Psychotherapy session, 45 minutes CPT 90834 PSYTX W/PATIENT 45 MIN | $227.20 | $284.00 | — | 41% 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 | — | 58% below | 20% |
| Psychotherapy session, 60 minutes CPT 90837 PSYTX W/PATIENT 60 MIN | $233.60 | $292.00 | — | 40% 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 | — | 18% above | 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 | — | at median | 20% |
| Speech therapy session, individual CPT 92507 TRMT AUDITORY PROCESS HEARING LOS | $313.60 | $392.00 | — | 32% 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 BREATHING CAPACITY | $160.80 | $201.00 | — | at median | 20% |
| Spirometry (breathing test) CPT 94010 SPIROMETRY PFT (NIOSH) WO INTERP | $160.80 | $201.00 | — | at median | 20% |
| Spirometry (breathing test) CPT 94010 PFT SPIROMETRY | $214.40 | $268.00 | — | 33% above | 20% |
| Spirometry (breathing test) CPT 94010 OPFT-SPIROMETRY (PRE) | $214.40 | $268.00 | — | 33% above | 20% |
| Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY PFT (NIOSH) WO INTERP | $160.80 | $201.00 | — | — | 20% |
| Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY BREATHING CAPACITY | $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 | — | at median | 20% |
| Spirometry before and after a bronchodilator CPT 94060 PFT-PRE/POST SPIROMETRY | $431.20 | $539.00 | — | 35% 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 | — | at median | 20% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 PT THERAPEUTIC ACTIVITIES | $115.20 | $144.00 | — | at median | 20% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 OT-THERAP. ACTIVITY/15 MIN. | $115.20 | $144.00 | — | — | 20% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 PT THERAPEUTIC ACTIVITIES | $115.20 | $144.00 | — | — | 20% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 THERAPEUTIC PHLEBOTOMY | $200.80 | $251.00 | — | 24% below | 20% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 ONC THERAPEUTIC PHLEBOTOMY | $252.00 | $315.00 | — | 5% below | 20% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 NRS 99195 THERAPEUTIC PHLEBOTOMY | $252.00 | $315.00 | — | 5% below | 20% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY THERAPEUTIC | $252.00 | $315.00 | — | 5% below | 20% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 MC THERAPEUTIC PHLEBOTOMY | $253.60 | $317.00 | — | 4% below | 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 PHLEBOTOMY THERAPEUTIC | $252.00 | $315.00 | — | — | 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 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 | — | — | 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 NRS ADMIN STATE SUPPLIED VACCINE | $16.79 | $20.99 | — | 25% below | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN 1ST STATE VACCINE | $16.79 | $20.99 | — | 25% below | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMINISTRATION | $72.80 | $91.00 | — | 224% above | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ETC IMMUNIZATION ADMINISTRATION | $120.00 | $150.00 | — | 433% above | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ONC-IMMUNIZATION ADMIN | $120.00 | $150.00 | — | 433% above | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 NRS 90471 ADMIN IMMUNIZE 2 | $120.00 | $150.00 | — | 433% 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 NRS ADMIN STATE VACCINE EA ADD'L | $16.79 | $20.99 | — | 43% below | 20% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 ADMIN EA ADDL STATE VACCINE | $16.79 | $20.99 | — | 43% below | 20% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMIN (IM/SQ) EA AD | $40.80 | $51.00 | — | 39% above | 20% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 ONC-IMMUNIZATION ADM, EA ADDTL | $40.80 | $51.00 | — | 39% above | 20% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 NRS 90472 ADMIN ADDL IMMUNIZE 2 | $40.80 | $51.00 | — | 39% above | 20% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMINISTRATION 2+ | $40.80 | $51.00 | — | 39% 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 ONC-IMMUNIZATION ADM, EA ADDTL | $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 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% |
Source file: https://hospitalpricedisclosure.com/download.aspx?pi=oJubMF8*_*EJI5yGO8tB02EA*-*